It’s the start of National Breastfeeding week, and that means the start of the Keep Britain Breastfeeding Scavenger Hunt! You can find out more about the hunt in general and where to find more posts from participating bloggers on the main hunt website. The idea is that you read blog posts to find out more about breastfeeding, and there you will also find ways to enter individual competitions as well as the main prize draw in which you can win lots of breastfeeding-related and general baby goodies.
For my first post I’m writing on the theme of the ‘benefits’ of breastfeeding, or, as I prefer to think of it, simply what I love about breastfeeding. Breast milk from mum is the normal food that human babies are biologically designed to eat for the first months of their life, so it makes sense to think of this as the norm and instead what might be the ‘disadvantages’ of formula milk which comes from a cow (or soya bean).
For those of you who haven’t followed my breastfeeding journey until now (there are plenty of older posts on the blog in the ‘bump and breastfeeding bits’ if you’d like to read about it), I have actually had to supplement my own milk with formula milk for both my boys as babies, more for my first (Andrew, 28 months) than my second (Joel, 7 months). This is because I have hypoplasia or insufficient glandular tissue (IGT) in my breasts to make enough milk for a baby before they eat solid food. This was diagnosed my a Lactation Consultant, and is not just to do with size but rather shape of breast too. I have still managed to breastfeed though, mainly with the help of an at-breast supplementer (the SNS) – Joel, although he has had a fair amount of formula over the past 7 months, refuses to take a bottle (like many exclusively breastfed babies) and has had all his intake of milk directly at the breast. I’ve written about this before in various posts (if you search ‘SNS’ on the blog they will come up).
There are many things I love about breastfeeding, all of which have encouraged me to carry on in the face of struggles with IGT and the faff of having to supplement. Before I had Andrew, I only thought of breastfeeding as a way to feed a baby, to get calories into them so that they grow. Of course this is a part of it, but for me the things I love about breastfeeding are the non-nutritive bits!
As I sit here and type, I have a baby snuggled up to me, half asleep, half sucking, all cosy and content. This is a lovely feeling, and I feel as though I have a very close bond with my two boys which has been formed over time whilst feeding them. Even when I was struggling, I couldn’t imagine not having a baby sucking fro me for much of the day (it’s a great excuse to rest on the sofa when you’re shattered!) My toddler still doesn’t think he is too old for Mummy milk, and I love the time that he takes to snuggle up to me before bedtime because we can reconnect after a busy day during which he is very independent. Even though I spent a lot of time feeding his newborn brother in the early months, the fact that he could still have some Mummy milk meant that neither he nor I missed out on some quality time together when there was a new person in the mix. And I’m sure that tandem feeding (not often at exactly the same time) has helped build a bond between the two brothers so far.
One thing I didn’t expect to get through having kids was better quality sleep. For most of my adult life before children, I wasn’t the best sleeper – it only took a small (or big) amount of stress such as worrying about my studies, exams or work and I would have sleepless nights, lying in bed awake for ages and not finding it at all easy to drop off. Of course my boys have had me up in the night many times, but the difference is that when my head does hit the pillow I’m out for the count until I’m next woken up. We know that the hormones released when a mum breastfeeds help her to get off to sleep, and I am convinced that this has been responsible for such a big shift in my sleep.
It is noticeable how little my boys have been ill. They’ve had minor colds like we all do, but they’ve rarely had temperatures – I think we’re only on our second bottle of paracetamol and ibuprofen suspensions in nearly 2 and a half years of having children. We’ve hardly ever needed to go to the doctor with them, and when we did it was more to be cautious with little ones and they didn’t feel there was much they could do. We do mix with lots of other children as we go to lots of groups, and Andrew went to a childminder for 11 months when I went back to work part-time before having Joel. Breast milk has antibodies which I as mum produce that then get passed on to them as they feed. These help their own developing immune systems to fight infections quickly and effectively. No matter what claims formula milks make about what they contain, they cannot contain this living stuff! The way I look at our situation is that I’m providing the immunological help and the formula is providing the extra calories that I cannot physically produce enough of.
There are also some longer term reasons why breastfeeding is good for both me and my boys, which are nice to think of even if they aren’t tangible on a daily basis. The more I breastfeed, the lower my risk of developing breast and cervical cancers. Breastfed babies tend to have higher IQs than formula fed babies, are less likely to develop allergies, and are less likely to become obese. Of course this is a generalisation over a whole population – my husband Tom was bottle fed and has always been a tall beanpole despite having a large appetite, probably because he is very active and as a family we are very active too, which will no doubt influence our boys’ weights.
These are the main reasons why I love breastfeeding. There are others that I can think of, but the fact that I’ve had to supplement with formula means that I haven’t been able to enjoy all of them. For example, breastfeeding is convenient as there is no faff of sterilising and making up milk and getting it to the right temperature – you just latch baby on and away you go, which means it’s easy to go out without having to think about how much milk to take.
I’ll be back with another post on Tuesday, but for now I’ll leave you to read some posts by others and have a go at entering the main competition below. Don’t forget you can also still be in with a chance of winning a Breastvest here.
It occurred to me the other day whilst feeding Joel that I haven’t blogged much about our breastfeeding experience in the first 5 months of his life. Before know it, and before I can cover the kitchen floor in some kind of food-repelling forcefield, he’ll be sampling some big boys’ food, and slowly the amount of milk he will require will decrease. Not that this necessarily means the end of breastfeeding him – I’m happy to carry on until he wants to stop, and his big brother is still going at 26 months. But this has made me look back on these past few months and reflect on what it’s been like breastfeeding my second baby and how it has differed from our experience the first time round.
I think the main reason I haven’t blogged loads about it has been that it has gone much more smoothly. It’s just fallen into place and fitted into our lives in a much more normal way than when Andrew was a baby, so it hasn’t crossed my mind often to blog about it. The two main reasons why it has gone so smoothly this time are: (1) I was much more practically and emotionally prepared for what was to come – I’d done it before and knew what to expect, including knowledge of my hypoplasia and low supply and being prepared with an SNS (or 2!) in the flat; (2) I had a support network already in place for if things got difficult and I needed useful and accurate help – this came in handy when Joel was readmitted to hospital with jaundice, and when I’ve come into contact with health professionals worried about his weight.
I only started blogging when Andrew was nearly a year old, but if I had have had a blog back in his first 6-ish months, I imagine I would have been doing weekly (or more frequent) updates about how breastfeeding was going and how we were finding our way along a very bumpy path. Some days I was very positive and felt like things were going well, and then I’d have bad days when I’d question why on earth I was doing this when it was so hard and I couldn’t see the bigger picture. Of course there have been difficult days when feeding Joel, but overall they are been much fewer and much more manageable than last time.
One of the biggest helps this time is that I am an expert on our SNS! (Read all about what it is here). It took me a while last time to figure out various things about it, such as the fact that powdered formula made up with boiled and cooled water flows more easily through the tubes than the instant formula. Also I wasn’t confident enough to use it when we were out (other than at breastfeeding drop-ins or support groups), so Andrew was used to taking both breast and bottle for usually only one feed a day, and we didn’t go out to that many groups until he was about 5 months anyway – for the first child you can fit in around them much more easily than for the second. But this time, right from the start I’ve been more confident, and as we’ve needed to get out to groups to amuse Andrew, the SNS has come with us (though Joel rarely feeds when we’re out these days, but he did when younger).
This has meant that Joel has never had a bottle. In fact I tried to give him one a few times at around 3 months when I was worried that he was having to work too hard at the SNS and I wanted to compare flow with a bottle, but he refused to take one, no matter how many different things I tried (me/Tom, day/evening, warm/cold, 2 different brands of teat etc.) I think it’s pretty amazing that a baby who has quite a lot of supplement on top of breast milk is behaving like many exclusively breastfed babies do in this respect. And when I eventually did trick him into taking an ounce before he realised and spit out the teat, the flow was about the same rate for bottle and SNS, so my concern was quietened.
On the matter of supplements, how much is he having compared to what Andrew had at this age? The answer is I actually don’t know for sure. I didn’t write down what either of them have had as it’s just one more thing to think about. But it feels like Joel has needed less supplement over the first 5 months than Andrew did, which suggests that I have been able to provide more milk myself this time. The fact that we had to finish off some of Andrew’s feeds with a bottle as he was on a lot of top-up by this age, whereas Joel manages it all in the SNS very comfortably, also suggests that he’s needing less top-up as the second baby.
I should also say here, as an update to my previous post on weight watching, that at his last weigh-in a few weeks ago, Joel had put on a lot of weight and had gone up on the infamous centiles, so the health visitor at the clinic didn’t even say when I had to bring him back next to be weighed – this meant a lot to me, and took a lot of stress away, as we’d always been told to go back either fortnightly or monthly; the ball’s in my court now and I can decide when to next have him weighed.
When I reflect on breastfeeding Joel, I think about how much I learned from doing it before with baby Andrew. The first time around I just had to find my way as we went along, whereas the second time around I feel that Joel is benefitting from things I already know. In other aspects of being a baby, I sometimes feel like Joel is getting a rougher deal being the second child – he’s put down more often than Andrew was and has to share my attention; but then I think about the deal he’s got with breastfeeding, and I realise that he’s experiencing a mummy who is much more on top of things. First and second (and third etc.) children are all going to have different experiences, and that’s not to say that any are worse off than others, they are just different.
So all in all, as we approach the 6-month mark, when our society says that the end of breastfeeding a baby is in sight, I’m feeling very happy with where we are and how well we are doing. Plus I’m looking forward to the next stage when breastfeeding really isn’t all about calorific intake and the non-nutritional aspects like closeness, calming him down, getting him to sleep, immunological protection etc. become even clearer. Stay tuned for more updates as (/if) I remember to write them – I’m aware that I haven’t talked here about Andrew’s nursing at the moment.
I thought it was about time that I wrote a pregnancy post with an update about how breastfeeding Andrew is going and my thoughts on how it might go once baby is here. In early pregnancy, I wrote about my thoughts on nursling (self-)weaning. I then wrote a sort of update at 21 weeks, but I hadn’t come to any firm conclusion about how or when I would initiate weaning if Andrew didn’t self-wean. I guess I was trying to leave it as long as possible, to see if Andrew would self-wean, even if right at the last minute. Well he’s still going strong (as strong as he has been for the past 6 months), and feeding for about 20 minutes first thing in the morning and about 20 minutes last thing before bed, plus the occasional feed in the day if he’s upset or grumpy for some reason (for example, teething).
I’ve been reading the book Adventures in Tandem Nursing on and off for a while, so I now have lots of info about breastfeeding a toddler in pregnancy and once the new baby is born. This has been very helpful, but since I know that we’re a special case, given my hypoplasia (insufficient glandular (milk-making) breast tissue), I wasn’t sure that all of the info was completely applicable to us, because it doesn’t specifically mention mums with hypoplasia. So I decided that the best thing would be to get some expert advice, more than is available in books.
I spoke to the leaders at my local La Leche League (LLL) group where we’ve been going since Andrew was just a few weeks old. They have been an amazing support to us, and I knew they would do everything they could to help us with this situation too. One leader in particular was very helpful. As we talked and she helped to unravel my thoughts by asking me specific questions about what I was thinking, I came to the conclusion that I wasn’t against tandem feeding in itself, but what was stopping me from thinking it was possible for us was my hypoplasia and the memory of awful supply issues that I had when Andrew was a baby. (If you’ve not read from the beginning of our breastfeeding journey, you can find it here.) I realised that IF supply wasn’t an issue (a big IF) then I’d have no hesitation in tandem feeding both Andrew and baby – I was up for that. But of course, like I said, it’s a big IF, because it’s likely that supply will be an issue again with baby. My concern would be that Andrew, although he’d help make more milk by feeding (the more he takes the more I make), would also take milk, and I wouldn’t want him to take what would be better drunk by the newborn.
My helpful LLL leader understood what I was telling her, and agreed that it’s an unusual situation to be in – there can’t be many mums out there who have hypolasia and are considering tandem feeding, or are actually tandem feeding. She recognised that our unusual situation went beyond what she had personally read as part of her LLL leader training and experienced with other mums through her role as an LLL leader. So she offered to post our question to the online national forum of LLL leaders, to see if anyone else had experienced a similar situation, either themselves as a breastfeeding mum, or from other mums they had met through their role as leader. What was our question though? Essentially it boiled down to: Is it possible to tandem feed with hypoplasia?
Within a couple of weeks, I had three very helpful leads as a result of my leader’s post to the national leader forum. One was from a mum who hadn’t had supply issues herself, but who had recently been to a conference for lactation consultants (people whose job it is to support breastfeeding mums), where there had been a paper on insufficient glandular tissue and possible ways of helping increase supply. The main focus of her emails to me was on herbs that act as galactologues (substances that help increase milk supply in breastfeeding mums). She gave me some links to resources on these, including those that are apparently safe to use in pregnancy, because relatively few of them are. I’m not entirely convinced about taking herbs in pregnancy, because Andrew is still feeding now and helping to keep my supply going, and the herbs are pretty expensive to keep taking every day over extended periods. As money will be even tighter once I leave work, I have to weigh up all the pros and cons of dealing with supply issues.
Another email correspondence I had was (indirectly via my LLL leader) with Diana West, author of The Breastfeeding Mother’s Guide to Making More Milk. She’s done some research herself into insufficient glandular tissue, and, as you can tell from the title of the book she wrote, is an expert on supply issues in general. Nothing like going straight to the top lady for advice! Her reply was very to the point: in her opinion it is possible for a mum with hypoplasia to tandem feed, though she would need to take some steps to make sure she is making as much milk as possible, such as taking herbs, expressing and using an at-breast supplementer if supplements are needed for the newborn – all the stuff you can read about in her book, which was relevant to me as a first-time mum breastfeeding just one child; the toddler would also help to boost supply. She said there was no reason that I couldn’t be treated like any other tandem-feeding mum and any other mum with low supply, in terms of the support that my LLL leaders could give me. That was encouraging!
But even more encouraging was to hear from an LLL leader who’s a mum who has personally experienced tandem feeding with hypoplasia. She gave it a go, and it worked out well for her and her children, who have a similar age gap to the one that Andrew and baby will have. She said that she definitely noticed that she had more milk with her second baby, though it’s hard to tell whether this is just the result of having a second child (generally mums have more milk with subsequent babies) or whether the breastfeeding toddler actually helped improve her supply even more than if she hadn’t have been feeding still. She also gave me some tips on herbs that she used, and told me that she always made sure that the newborn fed before the toddler did. Like us, she used a supplemental nursing system (SNS) in the early months for both babies, and she said that with her second baby she stopped using it a lot sooner than with her first, because her supply was better. She said that her toddler acted like her ‘breast pump’, by feeding after the newborn to remove even more milk from the breast so that more would be made for the next newborn feed. One thing that she highlighted, as I often do, is that breastfeeding is not just about food, and that the tandem feeding was a way for her children to bond with each other, and it helped her toddler through the transition of having a new baby in the family.
So my assumption that it’s not possible for us to give tandem feeding a go due to the hypoplasia and supply issue has turned out to be wrong. That’s not to say from what I’ve heard from these contacts that it would be easy, but I’m not one to avoid a challenge just because it sounds hard. I would never have continued to breastfeed Andrew if I wasn’t determined, despite how hard it was, to give him as much of my milk as possible, and in the end we’re still going now at 19 months. When I think about how much milk he’s had from me over those 19 months, I bet it’s not actually that far off what some babies get in 6 months of exclusive breastfeeding who are then weaned onto formula. Breastfeeding in early pregnancy was tough too, because I was so sick, but we’ve got through that and I’m feeling much better and glad that I was able to persevere in the hard times when I really didn’t feel like letting Andrew feed.
You can probably guess that my thoughts are now not so focussed on the necessity of weaning. My current thinking on breastfeeding is that I’m happy to let Andrew continue, if he wants to, and see where we end up. If he self-weans before baby arrives, that’s fine; there’s still plenty of time, given that weaning in pregnancy can be quite abrupt, and who knows what he’ll be like next week even if he’s going strong now. Or if he’s still feeding when baby arrives, that’s fine too. As he is pretty predictable in his feeding pattern (i.e. twice a day for main feeds and occasionally other small ones), it should be fairly easy to judge when to offer the newborn the breast before allowing Andrew to feed. If the newborn is anything like Andrew was, for which of course there is no guarantee, then he/she will feed most of the day on and off anyway, inter-dispersed with lots of activity and alertness; it would be harder if he/she is a sleepy baby, as I would then need to be more watchful as to when he/she needs to feed, especially in relation to Andrew. Or if Andrew decides to self-wean once the newborn is here – maybe because there’s less milk for him? – then that’s fine too. If breastfeeding helps him to accept the new baby and not feel jealous or like I’ve got less time for him, then I’m definitely up for tandem feeding as a means of meeting the needs of both my children.
It’s a nice feeling knowing that I have so much more info and support for breastfeeding already in place this time. At 31 weeks of pregnancy with Andrew, I had barely even thought about reading up on breastfeeding and was just getting round to booking my place at an antenatal breastfeeding workshop, which in the end was OK, but didn’t give me any info other than the textbook case, which of course we turned out not to be. I look back and wish I’d been more aware and able to get more info and support antenatally with Andrew, but it’s one of those things that is easy to say with hindsight, and Tom has reminded me that we did our best with the info and knowledge we had at the time, and that’s all we could do. At least this time we have been given another chance to learn from our first experience.
That’s all for now, except to say that this week saw Tom and I celebrate our 4th wedding anniversary. It’s amazing to think how much has happened in those four years, and I can’t believe that there are now nearly 4 of us instead of the 2 who started a journey together on our wedding day four years ago. Andrew is definitely a mixture of the 2 of us – I love looking at him and thinking of how he has bits from me and bits from Tom. I’m looking forward to discovering in what ways the new baby is another mixture of the two of us 🙂
In this post I’d like to share my experience of using a little-known ingenious device for supplementing breast milk with formula milk. I haven’t met many mums who have used such a thing, and as far as I can see there isn’t much info out there about it compared to other breastfeeding-related ‘equipment’, so I’m hoping this will be a really informative post for anyone who this might be useful to.
Before I go any further though, let me first talk a bit about low milk supply and the possible need for supplementing with formula. Much of the useful information that I have taken in about breastfeeding has been through La Leche League (LLL), and, more specifically, the book published by the organisation called The Womanly Art of Breastfeeding (which I’ll call WAB for short). The information in this book was written by mums with years of breastfeeding experience, and is backed up by medical professionals and scientific research into various aspects of breastfeeding; plus it is constantly being updated (currently in its 8th edition).
A common anxiety that many mums-to-be and new mums have about breastfeeding is ‘will I (or do I) have enough milk?’ WAB’s answer is that most mums are able to make plenty of milk; some do have difficulty making enough, but often the reasons are fixable if the mum gets the right support and information at the right time. So what might cause a deficient milk supply? WAB puts it like this…. The baby might not be taking enough from the breast (leading to a declining supply because breastfeeding works on the principle of the more milk taken the more is produced); this could be due to issues such as position at the breast, the frequency and length of feedings (not often enough, too short), prematurity, tongue-tie, muscle weakness etc. Or mum might have hormonal issues which lead to lower milk supply, such as thyroid problems, polycystic ovary syndrome and other fertility issues, or structural issues with her breasts, such as previous surgery or insufficient milk-making tissue. There are many possible factors involved, and the combination of factors is different for each breastfeeding pair (mum and baby).
In the case of Andrew and I, there was a mixture of both mum and baby issues which lead to our supply problem (you can read our full story here, but I’ll summarise for you now). I don’t have a huge amount of milk-making tissue, which is evident from the shape and size of my breasts (it is important to note that small breasts does not automatically mean insufficient milk-making tissue, nor indeed does big breasts automatically mean loads of milk-making tissue – there could be lots of fat tissue too which doesn’t make milk; shape is also key in this. For more info, I’d recommend reading p381-382 of WAB or the LLL book Breastfeeding Mother’s Guide to Making More Milk). Also, Andrew was born with a tongue-tie. This was a particularly tricky one to spot, and we didn’t get an official diagnosis until he was nearly 10 weeks old, at which point it was snipped and this did make a difference to his weight gain (the indicator that he was getting more milk).
And finally, before I actually get on to at-breast supplementing after this important deviation into low milk supply, let me mention a few points (from WAB) that might explain why a mum thinks she isn’t making enough milk (when in fact she is). She might not realise that babies need to feed as often and for as long as they do (though they all differ in exact requirements) – what seems like all day every day canbe completely normal. She might have someone else asking her ‘are you sure your baby is getting enough?’ – that’s enough to make any new (or not so new!) mum doubt herself and her instincts. She might not be letting the baby lead the way by letting him/her feed whenever and for however long he/she wants to, and instead following a schedule imposed by herself or a parenting book.
If you along with your health professionals and breastfeeding supporters have ruled out all the potential causes of low milk supply (actual and perceived), and tried to fix any that could be at play, but baby is still not thriving as he/she should (usually indicated by poor weight gain, at least that’s what medical professionals look for, though there are other things like lethargy, dry mouth/eyes/skin, not reaching milestones), then supplementing baby’s milk intake is a necessity for his/her well-being.
At this point I would like to point out that, despite the impression that some people including medical professionals give, baby feeding does not have to be black and white: either you breast feed (exclusively) or you bottle feed. I successfully combined breastfeeding with formula supplements until Andrew was on a balanced and varied solid food diet, at which point I dropped the formula and continued to breast feed. Don’t let anyone tell you this isn’t possible!!! WAB also makes the same point. Another thing to point out is that there are ways in which mum can try and increase her supply as much as possible, for example by expressing milk to give to baby as well as feeding directly at the breast and taking herbal supplements (I won’t go into this here, but again I’d recommend WAB or Breastfeeding Mother’s Guide to Making More Milk).
One thing that helped us a lot with our supplementing (and increasing my supply as much as possible) was the at-breast supplementer that we were given (and then later bought one of our own) by our local hospital’s infant feeding specialist midwife when Andrew was admitted with dehydration and major weight loss at 6 days old. It’s called a ‘Supplemental Nursing System’, or SNS for short, by Medela. This ingenious device is quite simple really – it’s a bottle, into which formula or expressed breast milk is poured, which hangs around mum’s neck with a thin tube coming out of the bottom that mum sticks to her breast with tape so that the end of the tube sits just on the nipple; when baby sucks on the breast, he/she not only gets all the breast milk available, but also the milk in the bottle via the tube.
The reason why I liked this was that Andrew was still breastfeeding all the time that he was also getting the top-up. He did have a bottle every now and then – basically when we were out somewhere that I couldn’t easily prepare and use the SNS – but I would always offer him both breasts first and then the bottle. He didn’t miss out on any of the milk that I was able to make, and I enjoyed the feeling of having him sucking from me and felt like I bonded very well with him in this way. I am convinced that without the SNS we would not still be breastfeeding today, at 16 months! So, ironically, it was a good thing that we went into hospital at 6 days old and were given very good advice by the feeding specialist.
Sure it was fiddly using the SNS to begin with, and it did take some time to get to know the best ways to use it. Here are some of the things I learnt about what worked for us:
If Andrew was very hungry by the time I got ready to feed him, it was sometimes easier to get him latched on first and then stick the tube in at the side of his mouth, rather than try and latch him on with the tube in place at the nipple, as this often ended up with him knocking it out the way during the latching process! Ideally I tried to feed him when he wasn’t already fussing, but this was sometimes impossible.
As he got older and I found I needed to support him less than in the early days, I found it easier to hold the bottle or put it down next to me instead of having it hanging round my neck which sometimes got in the way when he was bigger.
There are different thicknesses of tube, and working out which one was best at each stage was a process of trial and error: as he got older I thought it was logical to go for thicker tubing to get a faster flow which he could then cope with, but then I realised he got used to that and was more fussy about sucking from me without the SNS (i.e. without the artificial immediate let down of milk), and I reverted to the thinner tubes.
But these issues that we learnt to deal with were nothing compared to the help it gave us, and I would recommend it to anyone who is facing a situation of low supply and the need to top-up. Although we put formula in the SNS (because I was unable to express much with a pump or by hand), it is also possible to put expressed breast milk in it as a way of increasing supply – i.e. you express and baby feeds from you, to maximise the milk output from the breasts.
I’ve tried to remember all the information about low supply and supplementing that I think would be useful for others, but if you have any more specific question, please leave a comment and I’d be happy to tell you more about our experience. For a while I felt like a failure for not being able to produce enough milk and desperately wanted to be able to exclusively breastfeed, but I came (a) to realise that I’m not the only one who struggled with low supply, (b) to accept that this is just the way I and Andrew are (after lots of determined trying to increase supply and put everything right), and (c) to see myself as a breastfeeding mum who gave her baby a bit of calorific help from formula in the early months. Now that Andrew breastfeeds happily without top-ups, but of course a good diet, I’m so happy I persevered through feeling like a failure, because I know now that I most certainly am not! In fact the longer Andrew feeds, the more likely it is that I’ve developed more milk-making tissue to be able to feed the next newborn with less (or no) supplementing. Most of all, I hope that our story inspires others to not feel like a failure when breastfeeding is not going like it does in the textbooks – this is the real world.
Why not hop over to some other blogs and read other mums sharing their experiences? There are some links below, and more on the main website, where you can also find out more about the Keep Britain Breastfeeding Scavenger Hunt 2012. I’m sure there will be lots of other tips and stories to inspire and encourage. Don’t forget to enter the competition below to have a chance of winning the grand prize.
Starting this blog in December meant that the first month’s posts were predominantly Advent- and Christmas-related. So with the start of a new year, it’s time to introduce a few topics that are more on-going. A new year always makes me think back over the highs and lows of the previous year, and 2011 was for me an amazing year – the best so far I have to say, of course thanks to Andrew. I also think about what I’ve achieved in the year, and in 2011 came the hardest but best thing I’ve achieved in my life so far.
It must be the PhD, I hear you say? But wait, that was 2010, right? Up until 2011 I probably would have said it was my PhD. But then Andrew came along, and with him a very strong, instinctual desire to breastfeed no matter how many problems came our way when we tried to do it, a desire which wasn’t even present during pregnancy. 11 months later, and I believe that breastfeeding Andrew is my hardest but best achievement so far. I must acknowledge that I couldn’t have done it without the support of several people, in particular Tom (who made it clear every day that he would support me in whatever I decided to do about feeding), my parents (who gave us so much practical help around the flat so I could concentrate on feeding), and our friends who prayed for us all during the hard times.
Since I now feel very passionately about breastfeeding, I know this will feature quite a bit on this blog. I don’t want to give the impression that I’m one of those people who bang on about ‘breast is best’, full stop; you’ll see that from experience I know that breastfeeding is not black and white, but rather there are many, many shades of grey, with every mum and baby pair having their own breastfeeding relationship.
So to start with, I think it’s best if I share our breastfeeding story to date. This is in fact a bit of a cheat of a post, because I’m posting an article that I already wrote which is published in the latest issue of Breastfeeding Matters, the regular magazine of La Leche League (GB). I’ll say more about this organisation in future posts, but for now let me give you the background behind my passion for breastfeeding….
Making the most of what we have
It must have been around 30 weeks into my pregnancy, when I saw that the NHS-run antenatal classes we were about to attend had an optional breastfeeding workshop running one day quite soon. I’d thought that I’d like to breastfeed; my mum had breastfed my brother and me until around 8 months, and I’d read about the health benefits for baby. But I guess I always had it in the back of my mind that I had small breasts and so wouldn’t be surprised if I couldn’t. So I thought it was worth going to the workshop; after all, they would know if breast size would likely affect my ability to feed. Indeed it was helpful, and I came away with knowledge of latching baby on, feeding on demand, and various other important things. Most importantly in my mind, though, was the assurance that it is very rare that a woman cannot physically breastfeed, and small breasts certainly didn’t matter. Excellent, I thought.
Andrew arrived 4 days overdue (clearly he was waiting to share his birthday with his daddy!), in a much faster time than I’d expected for my first baby. At 7.30pm my waters suddenly broke, then my labour progressed very quickly, with Andrew arriving at 10.22pm. I had no pain relief, other than being in a pool for about an hour, but that seemed to slow me down, so the midwife suggested I get out, and he was delivered without complications soon after. She put him straight onto my tummy, and after just a few minutes, he lunged quite spectacularly across to my breast, latched on, and began sucking. Great, I thought, my baby knows what to do!
12 hours later we were home, and things went well for 3 days. I breastfed on demand, whilst my husband, Tom, and my parents did everything for me. On day 4, Andrew became very unsettled – he wanted to feed literally all the time, and when I desperately needed the toilet or a shower, Tom could do nothing to settle him for that short break from me. Although I’d heard that feeding constantly in the early days was normal, I wanted some reassurance that Andrew was OK. As my midwife was on annual leave until day 6, Tom, rang her team of colleagues, who advised us to go to a breastfeeding drop-in clinic (which was on day 5), where I explained Andrew’s unsettled situation, and that I didn’t feel any changes in my breasts, like my milk hadn’t come in. They assured me that it would, and advised us to have lots of skin-to-skin contact; they knew that my midwife would come tomorrow to assess Andrew. After another sleepless night, we were greeted at the door bright and early by the midwife. She looked him over and was happy with his appearance. But her expression turned more worried as she put him on the scales; she couldn’t quite believe it, and checked it again 3 times. He had lost nearly 20% of his birth weight. She sent us to A&E, as this was more than the normal post-birth weight loss.
I cried most of the rest of that day, sitting in hospital, watching them do all sorts of tests on my little baby, and thinking that I had failed as a mother already at less than a week. The doctor explained that he was dehydrated, so they would have to keep him in hospital and give him formula milk through a naso-gastric tube every 3 hours until he improved. We were lucky, though, that breastfeeding was not ruled out altogether by the doctor’s introduction of formula. First, he told me to continue breastfeeding as much as possible; second, the hospital’s infant feeding specialist came and looked at Andrew’s latch, which was good in her view, as well as my breasts, which she admitted were small, but she hand expressed something from them, albeit still colostrum at 6 days. As I was clearly physically and emotionally exhausted, she asked whether I wanted to carry on breastfeeding. Since Little Miss Determination should be my nickname, giving up on this was not an option for me, despite the exhaustion. Her suggestions were to use a supplementary nursing system (SNS) (see pictures below), and express with a pump between feeds, as these would make sure Andrew got as much breastmilk as possible and build up my supply. She’d even brought an SNS to the ward, and fitted it onto me for his next feed. Although this was a bit sneaky (because the doctors wanted him to be tube fed), it was the best thing that had happened for 3 days – Andrew fed amazingly well, latching on and draining the SNS of formula in no time, no problem. He had that lovely drunken full look, and I felt better already knowing that he was being nourished, but still getting whatever colostrum I had.
By the next day, his dehydration was back down to the higher end of normal. The question of discharge came up, and between discussions about his blood test results, Andrew yanked out his naso-gastric tube in a moment of arm flailing! It was as if he was telling the doctors: “I don’t need this tube, I can feed like a big boy, thank you very much! And now I’d like to go home, as would my mummy.” We were discharged that evening. Great, I thought, we were back on track with feeding.
Whilst my parents cooked us dinner, Tom and I set about sterilising the SNS in our microwave steriliser (which we’d been given before the birth along with an electric breast pump and bottles, as I thought I might need them when I returned to work). However, disaster struck, and the rubber band holding parts of the SNS together melted a hole through the plastic – it was no longer usable. It was Friday night, and despite my mum’s best efforts to google an SNS supplier, nowhere would deliver until at least Tuesday, plus we knew the infant feeding specialist was away for a few days. We had no alternative but to bottle-feed him some formula after he’d fed from me. That was it, I thought, he’d get nipple confusion and not stimulate my breasts enough to improve my milk supply.
After at least some hours sleep during the night, it occurred to me that we could contact La Leche League (LLL) Cambridge, as they might know where we could get an ‘emergency SNS’ at the weekend. I’d heard of LLL, as their website had come up whilst I’d googled breastfeeding in my antenatal research on the subject. Tom rang one of the contacts, Mary; not only did she know a lady who used to be a Medela rep and had an SNS for demonstration purposes, but she also offered to drop it round to us there and then. Within the hour we had an SNS, and Andrew and I were back in business as a breastfeeding pair, all thanks to Mary.
By day 14, Andrew had regained his birth weight. Also on that day I managed to squirt some milk into my eye whilst hand expressing, and the drops that followed were runnier and more opaque white than the creamy colostrum. What an amazing feeling, the almost 2 week wait had been worth it and finally my milk had come in, though not in great quantity.
Over the next month or so, Andrew started to settle into a daily rhythm of feeding, sleeping and being awake, whilst Tom and I tried to figure out how to manage the mixed breast/formula feeding. We wanted to make it as close to demand feeding as possible, though that seemed trickier with formula than if we could rely on breast milk alone. However, Andrew’s weight gain slowed down, and he gained only a few ounces maximum between each of his weekly weigh-ins, which our health visitor advised so we could keep an eye on him. We increased the formula supplement little by little each week as we didn’t want him to plateau on the baby-weight graph. Andrew and I also went along weekly to the breastfeeding drop-in clinic, as well as the fortnightly LLL meetings, to get support and remind myself why I was persevering when it was so easy to feel like there was no point giving him next to no breastmilk. During the clinic when Andrew was 8 weeks old, Mary (who volunteers there as well as LLL) was holding him; as he was showing off his wide smiles, Mary noticed that his tongue looked quite anchored towards the back, and it preferred to move to one side. She suggested that we could see a tongue-tie specialist, as she wasn’t an expert. I’d heard of tongue-tie, but nobody at the clinic or hospital had ever suspected it in Andrew, as I’d had no nipple damage and his latch seemed good from the outside.
We decided to get a private lactation consultant, Ann, who specialises in tongue-tie, after two GPs told me something along the lines of “oh well, you’ve breastfed for 8 weeks, that’s great; he’s on formula anyway, so there’s no point referring you to an NHS tongue-tie specialist if it’s a posterior tie and snipping it might not make a lot of difference”. Ann came to our flat when Andrew was 10 weeks old, and did a 3-hour assessment of his mouth and my breasts. Not only did she diagnose a 50% tongue-tie in Andrew (and incidentally an 80% tongue-tie in me, even though I was exclusively breast fed), but also breast hypoplasia in me. This is basically underdevelopment of the breasts, so there is insufficient glandular breast tissue. In LLL’s online article ‘Supporting Mothers with Mammary Hypoplasia’ (Cassar-Uhl, 2009), breasts are likened to a ‘milk factory’, and in the case of hypoplasia, the ‘“milk factory” is either missing key parts to its assembly line or is absent altogether’. In my case, there clearly was something happening in the assembly line, but perhaps there weren’t enough key parts to produce enough milk to satisfy Andrew’s growing appetite.
My breasts are small, I knew that, but this was the first time someone was totally up front with me – Ann said that their wide spacing and bulbous nipple and areola that merged into each other were signs that I had a medical condition which meant I was unlikely to produce enough milk, even if I tried really hard (which I felt I was!) She snipped Andrew’s tongue-tie, and showed me how to latch him on to make sure as much of my breast went into his mouth as possible. No wonder his latch had always been praised by others – my small nipple-cum-areola fitted into his small mouth no problem, so no darker skin was visible outside. After Ann left, I felt a sudden sense of built-up tension being released, and I slept for the rest of the evening after Tom got in (except when he woke me to feed Andrew before his bedtime).
For the next month or so, Andrew gained 7 or 8 ounces each week, and we went from weekly to monthly weigh-ins. I felt like I had more milk in terms of what I could express, though obviously I couldn’t see how much he could get out of me, but his sudden increase in weight gain suggested that it was more than previously. The snipped tongue-tie must have helped on a practical level, but I also think that the release of tension I’d experienced helped on an emotional level.
Now that Andrew is nearly 4 months old, I’d say that we’re making the most of what we have. I know my milk won’t be enough to drop the formula completely, and I’m coming to accept that there’s nothing I can do about my breasts, that’s just me. Don’t get me wrong, though, I still have days when I resent the faff of sterilisation and formula preparation, and wish I could just go out not worrying about how much milk to take. I see myself as a breastfeeding mum, who’s giving her baby all the goodies in breastmilk, with some extra calories in the formula milk (which at the end of the day isn’t awful – Tom was bottle fed and turned out alright, well, I married him!) Ann said I deserve a medal for persevering as long as I have given what was stacked against us; but I haven’t carried on for any prize other than seeing my son develop and grow after giving him the best possible start I can. Andrew has always been an alert, interested and bright little boy, even when he was admitted to hospital with dehydration – the doctor noted it on his discharge document. So even though he’s not exactly heavy for his age, we’re not worried about his development, and he’s reaching all the milestones as he should. And anyway, breastfeeding for us isn’t just about food for growth, it’s about the bonding and comfort we both get from being snuggled up close, which I wouldn’t change for anything right now, and (give or take the interesting distractions now that he’s getting older) I don’t think Andrew would either.
Since writing this piece when Andrew was nearly 4 months old, I’ve continued to breastfeed him, and he’s now over 11 months. If someone had have said to me at 11 weeks that I would still be breastfeeding at 11 months, I would not have believed them! My goal was to get to 6 months if possible, but when we got there, and he started eating solid food, I found I started to enjoy breastfeeding him even more. I think the reason is because I feel less pressure on myself now that I know milk isn’t his only source of energy. He loves his food, and will eat most things we offer him, shovelling it in messily with his hands and chewing away merrily. So I know that this food is complementing the goodies that he’s getting in my milk; more so than ever, breastfeeding is less about ‘feeding’ and more about snuggling up for quality time together, and me comforting him if he’s upset or calming him down if he’s agitated. He generally has one feed first thing in the morning, and one last thing before bedtime, though if he’s ill or upset, he sometimes wants more during the day or night.
There have been times over the past few months when I’ve worried that he was losing interest in me and my low milk supply, as he wanted fewer feeds. (One particular time turned out to be he start of a tummy bug, which Andrew and I only got mildly compared to Tom – probably due to the immunological help that we, the breastfeeding pair, give each other 😉 ). A LLL Cambridge leader, Justine, reassured me that this is quite normal at his age, even in babies whose mums haven’t had supply issues, as they start becoming independent, crawling off to explore the exciting world around them, and dropping feeds particularly during the day. This gave me confidence to carry on, and I’m happy to continue to meet his needs for as long as he would like me to, even if that means into toddlerhood.