I have to start by saying that I almost didn’t publish this post. I wrote it and it was therapeutic to put it all down but I second guessed it. My breastfeeding journey has been hard. I’ve felt so many emotions – joy, fear, shock, discomfort, pain, happiness, betrayal, sadness, disappointment and the worst, embarrassment and shame. I was scared to post this because I thought about the internet trolls and what they might think. But then, I decided I don’t care. I want to share my story because I know there are women out there with the same struggles and I want to offer them some comfort and possibly, hope.
A great start to breastfeeding in the hospital
Breastfeeding is hard. I actually had no idea how hard it would be. I had talked to friends, read a book (The Womanly Art of Breastfeeding) and learned about it in our Bradley Method birthing class, but nothing could prepare me for the real thing. We were fortunate and Siena latched on right away after her birth, despite it being a bit traumatic (after 45 hours of trying to get out, she had to be whisked over to the other side of the room immediately to have her lungs cleared because she had her first bowel movement in the womb). Thankfully the nurse helped us awkwardly find the right position for her to latch and eat and we had several more nurses and lactation consultants help us in the hospital during the next day and a half. Siena seemed happy to eat and our latch seemed to be good.
Despite our great start, we’ve had a very rocky road. Siena lost about 9% of her birth weight by three days after birth (which is actually in the normal range, although since I had no fluids during labor, you would actually expect her to have lost less) and we were asked to return to the pediatrician at 6 days old. We were happy to hear she had gained 6 ounces in 4 days but when we returned for our 2 week appointment a week later, I cried in the doctor’s office as we discovered she had gained only two more ounces in the last week and still had not reached her birthweight, despite the fact that I was literally nursing her around the clock, often for over an hour at a time (I tracked the time using an app and would spend about 8-9 hours nursing her a day). My nipples were raw and I would cringe every time she latched, but I was told that some pain was to be expected and it would get better with time. I figured the long nursing sessions were an indication of cluster feeding and personal preference, although I had a nagging feeling that something was not right (Siena was soiling the correct number of diapers, up to 10 a day, so that was convincing me there wasn’t a problem).
One of my biggest fears about motherhood was that I would unable to breastfeed. I was immediately told to pump after every feeding, to take fenugreek pills and also supplement (ideally with the pumped milk), which only made me cry more, since I was pretty dead set on exclusively breastfeeding for an entire year. I immediately pumped after the next feeding and no milk came out which freaked me out and made me think it was useless to pump. A friend gave us 5 ounces of breastmilk to use to supplement since I was very hesitant to try formula, and I cried the entire way to her house to get the milk. We gave Siena one ounce in bottle and she drank it so fast and ferociously that she immediately threw it all up. More tears. I felt like a failure as a mother (those crazy post-partum hormones probably did not help the situation).
I contacted a lactation consultant who told us to wait on the supplementing until she could see us given that Siena was actually still gaining some weight. Meanwhile, I started trying every natural milk booster known to man – I was downing Fenugreek like it was my job (still am and I smell like Maple syrup for it), made lactation cookies, bought lactation pills, drank a ton of water and ate plenty of protein and fat. There is a prescription drug that can boost supply, but I decided I would not try it since the side effects were pretty severe (including depression, no thanks!). We met with the lactation consultant a few days later and weighed her, with clothes on, and discovered she hadn’t gained any weight since our pediatrician appointment 3 days earlier. We also weighed her before and after a feeding to see how much she was getting from me, and it was about half of what she needed.
The lactation consultant said it was time to supplement, but she was confident it was temporary. She sold us a supplemental nursing system which would allow me to supplement without giving Siena a bottle (a small bottle of milk connected to a tiny tube which you position on your nipple and allows small amounts of milk to flow through when the baby sucks). She also told me to start pumping after every feeding and that it would take some time but I’d start to see more milk come out (which I did, but it was never more than a half ounce).
Supplemental Nursing System
The lactation consultant also diagnosed Siena with an obvious upper and deep lower (which isn’t as obvious) tongue tie and told me that it was causing the long nursing sessions, painful nipples, misshapen nipples after the baby unlatched (shape of a tube of lipstick) and the lack of weight gain. Breastfeeding is all about supply and demand, and since Siena wasn’t able to effectively suck, she wasn’t stimulating me to produce more. She gave us the contact information of a pediatric dentist who specialized in tongue and lip tie repair using an apparently mostly painless procedure using a laser and we got an appointment for the very next evening. The dentist confirmed both tongue and lip tie and we did the surgery right then and there (it took less than 10 minutes to perform). They promised an increase in my supply quickly, although it would take days (all changes in supply typically take a few days to kick in).
So began an incredibly labor intensive nursing routine. The entire process took roughly an hour and we did it 8-9 times a day, including in the middle of the night. Here is how it went:
- Mix and heat up formula or donated milk (we later found a friend who generously pumps extra milk for us so we don’t have to use formula regularly. Sometimes we used formula because it’s convenient on the go or we are out of the frozen milk). When Mike was home, he did this for me which saved a ton of time (he also woke up in the middle of the night to do it even after going back to work).
- Put milk into supplemental nursing system (we started with 2 oz per feeding but found she really only seemed to need one ounce at a feeding).
- Feed baby on breast without supplemental system for at least 15 minutes. Feed baby on other side for at least 10 minutes and then attach supplemental system and allow her to eat until it was gone. Total nursing time was usually 35-45 minutes.
- Pump for at least 10 minutes.
- Clean supplemental nursing system. (I store my pump parts in the fridge so that I don’t have to clean them more than once a day – major time saver).
At first, I always used the supplemental system and I always pumped, even in the middle of the night. As time went on, I got more and more milk from pumping (especially I found if I as able to wait about 10-15 minutes after nursing but it’s not always manageable to do so) and Siena started to get more milk. I started alternating the supplemental system with bottles and eventually switched just to bottles for supplementing. At first, we’d notice she’d spit up a lot more if we gave her a bottle (even with a newborn nipple), so the supplemental system was worth the extra time and effort. Eventually, her stomach got bigger and she was able to handle the bottles much easier.
I kept up with this process and continued to go to the weekly lactation support groups. The lactation consultant assured me that a baby Siena’s age only needed about 3-4 ounces of breastmilk per feeding (Fun fact: as your baby gets older, your breast milk changes to suit their needs. You actually won’t need to give your baby much more volume of breastmilk as they age because of this wonderful quality of your milk) and eventually I was getting her 2-2.5 oz every time we went (more in the middle of the night and early morning when my supply was higher). For a while I stopped being as religious about pumping, especially if I was in a rush to get somewhere or had guests over, but there hasn’t been a day that I haven’t pumped at least twice since she was 2 1/2 weeks old.
When Siena started only waking 2 times a night, I stopped supplementing on the 2nd feeding (usually around 5 a.m.) and she seemed fine. Then, as her first stretch got longer and eventually she only woke to eat only once over the course of 10-11 hours, I stopped supplementing in the night at all. By her 2 month birthday, I was only supplementing about 1-2 ounces at each feed (usually just 1), about 6 feeds of the day, for a total of about 8-10 ounces a day, about 2 of which were my own pumped milk and the remainder was donated breastmilk.
Sometimes she even holds her own bottle!
In mid-December, after a discussion I had with the friend who gives me her extra breast milk about the difference in her supply using a hospital grade pump (Medela Symphony) versus the normal double pump that insurance provides (Medela In Style), I went to the local hospital and rented a hospital grade pump. It’s TBD if my insurance will cover the cost (I have a prescription for it from my doctor) but it’s worth it (about $80 a month) we use our HSA account to pay for it. I became even more serious about pumping and saw a quick increase in my supply. At the next lactation support group I was over the moon when she ate 3 ounces in 20 minutes (which means in the middle of the night and morning when I’m very engorged I’m sure she’s getting more like 4-5) and the lactation consultant and I both agreed that I could try slowly backing off the supplementing.
The Beastly Pump that is the Medela Symphony
I’m happy to say that most days we’re only supplementing during the last two feedings of the day. I am now pumping more milk between feedings, 2-4 ounces for the day, which means that Siena is only taking about 2 ounces of donor milk on most days, sometimes more if she seems extra hungry or if we are out and about and bring a bottle and I pump (I still notice that my breasts aren’t completely emptied when I just pump – a baby is the best way to empty the breasts and will always be more efficient than a pump).
At 3 1/2 months old, Siena now only feeds for about 20 minutes per session, sometime longer for comfort. She is able to go about 3 hours between feeding in the morning and sleeps a 7-8 hour stretch every night (once 10 hours!) and then another 2-4 hours immediately afterward. In the afternoon and early evening I feed her more frequently to ensure she’s filling up when my supply is lower. I always feed her more if she seems unsatisfied or fussy after a feeding, but I’ve been happy that it rarely happens. She’s on track with her developmental milestones and gains weight every single week. I’m confident that although she’s a smaller baby on average, she’s happy and thriving.
We’re SO close to being supplement free. I’m not sure it’ll happen, especially given that I’m going to back to work in 2 months and know that’s another hurdle with my supply issues (as I said, the pump doesn’t drain the breast as efficiently and many women see a decrease in supply when returning to work) but I’ve come to the conclusion that I’m ok with that. Right now this works for us, and warming up a couple bottles in the evening isn’t an inconvenience. Not supplementing during the day has given me a lot more freedom to go out and know that I have what I need to feed my child without having to worry about warming bottles. This journey has been HARD, but it has been worth it. I cherish my time breastfeeding Siena (and it stopped hurting a long time ago) and I’m glad that I didn’t give up during those hard times. I really wanted to at times, but I didn’t.
This experience has also given me a lot of perspective on feeding babies and on motherhood in general. Before having a baby, I was so set on exclusively breastfeeding for a full year and I couldn’t imagine why people would formula feed. But, as I’ve shared my story with more moms, I’ve come to realize that more moms than not have some sort of breastfeeding issue – whether it be a strong letdown that causes baby to choke, mastitis, supply issues, baby refusing the breast after taking a bottle at daycare, latching issues, severe nipple pain from a tongue tie… the list goes on. Before I was a mother, I wasn’t aware of how hard it can be. I do not judge how any mom chooses to feed their child. A fed baby is a happy baby. And a mom who isn’t constantly stressed out about feeding her baby makes a happy baby and a happy mom. Sometimes exclusive breastfeeding just doesn’t work out. And sometimes moms just don’t want to breastfeed. And that’s ok. We’re all still great moms, no matter how we feed our children.
Moms, how did breastfeeding go for you?