Mum-to-Mum sharing: at-breast supplementation

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.

Well done, you've found another scavenger hunt logo! Keep reading for more tips, blog links and chances to win some cool breastfeeding-related prizes!

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.

SNS (supplemental nursing system) - a bottle that hangs round mummy's neck by a cord, and out of the lid (which is at the bottom when hung) comes a length of thin tubing, which is taped for each feed to the breast, so that the loose end of the tube sits on the nipple. As baby sucks on the nipple, he gets all the mummy milk available, plus the formula in the bottle. Quite ingenious if you ask me!

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.

Andrew (4 months) and mummy enjoying a feed, with the SNS around mummy's neck

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.

Bumps 2 Babies – The Beauty of Breastfeeding

Mama Geek – Getting Started with Breastfeeding – My Top Tips

Life, Love and Living with Boys – Breastfeeding Friendly Chester, An Update, A Guest Post AND a Competition! – A Babi-Mam Bib-Bob giveaway

Little Scribbles – Sharing

Breast 4 Babies – Ten Things your Midwife or Health Visitor Never Told Me about Breastfeeding and a BoobieMilk giveaway

Diary of The Milkshake Mummy – From One Breast Friend to Another

Blooming Lovely Jewellery has joined the Hunt with their beautiful Bola Pendants

a Rafflecopter giveaway

Pregnancy diary – week 15: thoughts on nursling (self-?)weaning

It’s that time of the week again, when I sit down and ramble about what’s going on in our pregnancy world this week. According to the various pregnancy week-by-week guides that I flick through (online or in print) every now and then, it’s normal by week 15 for most ladies to feel better from any sickness that they’ve experienced. As you may have guessed, I’m still feeling sick and haven’t stopped being sick, though thankfully not as often as in earlier weeks. But then I’ve never laid any claim to being ‘normal’, and some would advocate (probably Tom the most strongly) that I’m not ‘most ladies’.

What is ‘normal’ anyway?! The statistician in me (the one who was taught all she knew during the PhD) understands that every ‘normal distribution’ is a curve – some lucky ladies are in the thin end at the left and suffer no or hardly any nausea and sickness (lucky them, she says gritting her teeth), some not-so-lucky ladies are around the peak of the curve and suffer nausea and sickness for about 14-15 weeks, and some unlucky ladies find themselves in the thin end at the right and get the nausea and sickness thing real bad and/or for ages. So far I’m hanging around to the right of the peak, waiting to see whether I’ll slide any further down into the gloomy far-right of the curve, or whether I’ll be spared from the descent.Anyway, normal curves were not the intended topic of this week’s diary. At the end of last week, I borrowed a book from Cambridge La Leche League (LLL) group’s library called ‘Adventures in Tandem Nursing: Breastfeeding during pregnancy and beyond‘ by Hilary Flower. Of course I haven’t had time to read it all yet (if I ever will), but by flicking through the bits I was most interested in and was drawn to the most, it’s given me lots of information and things to think about. Let me try and trace my thoughts back to a while ago…

There was a point in the breastfeeding journey that Andrew and I undertook when getting to 15 weeks seemed like a big achievement, let alone 15 months! For the first 6 months of Andrew’s life, I never for one moment imagined that I would still be breastfeeding him when I would find myself pregnant again. As the months went by, Andrew was still keen to breastfeed, in fact even more so than he had been just before he was introduced to solids around 6 months, presumably because he wasn’t so hungry for the milk. So I continued to meet his need, and never thought about me being the one to wean him – I wanted him to carry on until he initiated the weaning himself. Then an embryo-sized spanner was thrown into the works of this plan. Don’t get me wrong, it’s a good spanner – obviously this was my own doing (with help from Tom), and we’re extremely happy that I’m pregnant again – we just weren’t sure how quickly this would happen. One of the first things that crossed my mind when the tests showed up positive was ‘now I’ll have to wean Andrew – how will I do that, and how will he take it?’

So far I’ve had mixed feelings about breastfeeding during pregnancy. Andrew still feeds for around 20 minutes first thing in the morning, around 20 minutes before bed, and wants a few other shorter feeds during the day if it’s just the two of us at home (he’s usually too distracted when we’re out, and has been since about 4 months old!) He hasn’t woken in the night to feed for a few months. The hardest thing about this feeding pattern has been any feeds in the afternoon and evening when I’m so sick. I’ve only been able to feed him lying down at any time of the day, but the nausea and sickness has made it incredibly hard to stay motivated. That said, I generally still enjoy the morning feed, as it slowly wakes us both up and I get to lie in bed for a bit longer, and in some ways giving in to the top-tugging, milk signing and whinging in the afternoons is actually by far the easiest option – it keeps him happy and in one place for 5 or 10 minutes, and again I’m lying down during that time.

Mummy resting and Andrew feeding before going to bed

At least I didn’t have the added complication about worrying whether breastfeeding was even compatible with a healthy pregnancy, as one might think, because I’d heard that it is perfectly possible, and I even know a couple of ladies who have done it, through going to lots of LLL meetings over the past 15 months. Indeed this is exactly what the book Adventures in Tandem Nursing confirmed when I started to read it. Although one might think that breastfeeding could lead to complications, particularly miscarriage in the early weeks, because of the hormones involved, research gives little indication of how this could happen from a molecular biology point of view, though more research could be done on this. Of course complications do happen in pregnancies with an older nursling involved, but it is not clear that this is due to the breastfeeding itself and it wouldn’t have happened anyway.

It is lovely to read a well-researched book that paints a picture of breastfeeding during pregnancy being ‘normal’ in the sense of ‘natural’ (even if not the ‘norm’ in our society) and not something to worry or feel weird about – it’s nice to know that I’m ‘normal’ in some respects even if not all 😉 In fact the picture painted is not only of breastfeeding during pregnancy being a natural thing to do, but also ‘tandem’ nursing – i.e. breastfeeding two children of different ages simultaneously (either literally with one on each breast, or one after the other within the same period of time). However, the book does point out that tandem nursing is a big commitment and not for the faint hearted! … and that choosing to wean your older nursling (I adore that term, it’s so cute!) before baby’s arrival does not make you a bad mum – every mum needs to make her own decision taking into account the needs of her newborn, her toddler and (believe it or not) herself.

I have known from the start of this pregnancy that weaning my current nursling  is the only option for us. My milk supply was low with newborn Andrew (you can read our story here), and it is unlikely that this will dramatically change to the extent that I would have a sufficient supply for two nurslings. In ‘normal’ supply cases, it is perfectly possible to produce enough milk for two, but given my breastfeeding experience so far, I am not convinced that this is me (again I’m showing my abnormality). It is likely, however, that by feeding Andrew for this long, I’ve increased the amount of milk-producing breast tissue that I have, and so I may have a better supply than last time (given also that we’ll get any potential tongue-tie issue sorted asap this time). This is also one of the reasons that I have been motivated to feed Andrew for this long – every extra day that I feed him will hopefully lead to more milk production for his sibling. Whether I’ve done enough to be able to exclusively breastfeed without the need for formula supplements remains to be seen – I’d say I’m optimistic that it’s made some difference, but realistic that exclusive breastfeeding probably won’t happen.

The next step is actually doing something about weaning Andrew. Part of me is still hoping he will self-wean. According to my trusty borrowed book, it is fairly common that a breastfeeding toddler will wean her-/himself whilst her/his mum is pregnant again. In a couple of scientific studies on breastfeeding during pregnancy cited in the book, around a quarter to a third of the toddlers who started off breastfeeding in their sibling’s pregnancy self-weaned, and a similar number were weaned by the mum, leaving around a half to a third who continued to breastfeed alongside the newborn. There are certain changes that occur in the make-up and quantity of the milk during pregnancy, and these are thought to be a trigger of self-weaning. In the first few months of pregnancy, the milk is likely to become more ‘salty’ and less ‘sweet’ as the proportion of various salts and sugars changes in the composition – this is sometimes called ‘weaning milk’ (this name bodes well for us then). By around 20 weeks (half way through the pregnancy) the milk supply often declines considerably, so there is much less available for the nursling. These two factors may convince Andrew to give up on his own…..

Not looking much like giving this up yet....

If not, there will have to be a plan B, involving input from me! But so far, thinking about weaning is as far as I’ve got, so there isn’t currently an action plan B, just a metaphorical plan B. I’ll have more of a read of this book and talk to my LLL friends to get some practical ideas, and update you when I have more to say.

This pregnancy feels like a journey for three people, not two, and I’m aware that it’s my responsibility not only to look after and out for the baby inside me, but also to do the best I can for my nursling. I didn’t think I’d be the one to wean Andrew, but in the interests of all three of us, I know that is now the best option (if he doesn’t do it himself!) I’m sure Andrew will cope with standing aside and letting his brother/sister take over the role of nursling, it’s just a matter of figuring out how to help him cope and be the best mum I can be to him.

The not-so-crazy world of toddler breastfeeding

‘That’s it, I’ve become one of those crazy ladies who breastfeeds their walking toddler!’ I said to myself (tongue in cheek) as we walked back from our first La Leche League (LLL) toddler meeting yesterday. LLL is a network of mum-to-mum breastfeeding support groups, which exist in many countries across the globe. We meet to have a chat about breastfeeding and other things in life, and it’s a great way to share experiences and tips, and generally feel like you’re not the only one breastfeeding your baby/toddler. Once every 2 months the meeting is specifically aimed at those mums who are feeding their child into the second year of his/her life, and yesterday was the first of these ‘toddler meetings’ since Andrew and I fell into that description.

Both of us enjoying a feed before bedtime

When I first walked into an LLL coffee morning with my 4-week-old babe-in-arms, I admit I was surprised to see several mums breastfeeding toddlers who were 1 or 2 or even older. At that point I was really struggling with breastfeeding: Andrew was slow to gain weight, we were having to supplement with formula, and I was having a hard time reconciling in my head the fact that I desperately wanted to breastfeed him, I enjoyed having him so close and bonding with him in that way, but knew I wasn’t physically producing enough milk – the baby scales said it all. (If you haven’t read our breastfeeding story from the start, have a read of this previous post.) So I thought it would be amazing if we could make it to the NHS-recommended 6 months; it never even crossed my mind that we’d still be going beyond a year. I thought that I could never be, wouldn’t want to be, and wouldn’t even need to think about whether I should be, one of ‘those’ mums. How wrong I was. So it is with my tail between my legs that I come to write this post, looking back at how I judged others on that first LLL day.

In my defence though, I would say that I soon realised that these ladies were in fact lovely, intelligent, friendly and welcoming mums, and the initial feeling of surprise and awkwardness on my part soon faded. The vibes I was getting from the NHS, through contact with health professionals and reading the ‘Birth to Five’ book that everyone gets given, were that breast is best full stop, that formula feeding is OK if you’re a breastfeeding failure, and that mixed feeding is…no hang on, what on earth is that?!  On the contrary, LLL immediately made me feel welcome, accepting me into the group with open arms, despite the fact that I brought formula to the meetings. It did help that I used a supplementer rather than bottles though (again, see previous post), so I was in fact breastfeeding, just with a little extra help.

(NOTE: one of the lovely LLL ladies has brought it to my attention though a nice comment that this last sentence could be misinterpreted from what I meant. I did not mean that LLL would not have welcomed me if I had turned up with formula and bottles. On the contrary, I knew after I’d been that this was not true. What I meant was that this was my (and maybe a general?) preconception about breastfeeding support groups. I felt awkward at first, but soon realised I was wrong. I meant it helped me that I didn’t have to go with bottles the first time until my preconceptions were gone. Hope I didn’t give the wrong impression on this in the meantime.)

Every month (unless we were away), Andrew and I turned up at the regular meetings twice a month. I got so much moral support and helpful advice, and I believe the LLL ladies have played a big part in helping me continue to breastfeed until now. Was there any guilt tripping involved, like would I have felt bad about giving up when these ladies are so pro breastfeeding? Not at all. In fact I would say I would have felt less guilty about giving up in front of them and less of a failure than I would have done in front of many other people, including my midwife, GP and health visitor. And the reason? Because the ladies there know just how hard it can be, just how emotionally exhausting it can be when things aren’t going right, and how there is way more to it than simply getting food from mum to baby. That’s where the health professionals got me down – for them breastfeeding was all about Andrew gaining weight. And that’s where I came to realise, through LLL, that I could still have all the other amazing bits of breastfeeding, alongside the physical act of getting calories from mum (or formula tin) to baby.

It was very clear to me from the start that my friends at LLL are all intelligent ladies, who want to do the best for their child(ren) and have read up on breastfeeding and related issues. They’re not just feeding their babies beyond 6 months for no reason, or to be deliberately provocative to their numerous critics (believe me, we would rather not have to deal with criticism). They know that breastfeeding until the child weans him- or herself is normal when you step out of our society for a minute and look at things from a more global or human evolutionary perspective.

Did you know that the World Health Organisation recomends ‘exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond‘? Somewhere in the NHS recommendation on breastfeeding the second part of the WHO’s statement has got lost. I suspect too that the large increase in bottle feeding a couple of generations ago also played a part in changing our society’s view on what is ‘normal’ when it comes to the age we should wean a child. As a researcher myself, I always look for references in peer-reviewed publications when anyone makes a claim about something that should be tested with ‘scientific’ methods, and that includes breastfeeding. As well as being a mum-to-mum support network, LLL has many publications about various aspects of breastfeeding, all of which are backed up by referenced research conducted by scientists and health professionals around the world. This makes me 🙂

A quick search on the LLL international website for what is a ‘natural’ age that a child weans from breastfeeding gives an interesting article citing various studies. Some have suggested that a natural age is to do with when the child triples or quadruples their birth weight (average 27-30 months); others have suggested it’s to do with attaining one third of their adult weight (4 to 7 years); others have suggested it’s to do with our gestation length (i.e. 9 months) (average 4.5 years); others have suggested it’s to do with the eruption of adult molar teeth (around 5.5 years). In other words, quite a while then.

Look at how big he is - but not too big to snuggle up to mummy

That is not to say that I do not respect other mums’ decisions to either not breastfeed at all or to impose their own time-constraint on weaning. Every mum and baby pair is different, and believe me I know how hard it is to establish breastfeeding – it took us that first 6 months to really get going, so I totally understand why so many stop. (I think the words ‘give up’ sound too negative, and I don’t want to invoke feelings of failure because there is enough of that around as it is.) I also understand that not every mum enjoys breastfeeding so doesn’t want to carry on longer than she feels she has to, and that does not mean she is any less of a good mum. As I said we’re all different, with different personalities, different experiences, different situations and different ideas about what we think is the best thing to do at any given time.

In our case, one of the reasons why I love it so much now is that it was so hard back then – I appreciate good times more when I have a contrast with bad times. Ironically, if I hadn’t have had the problems at the start, I might not have gone to LLL and therefore might not have learnt that children self-wean when they are ready (this is often after when is generally acceptable in society), and I might have already weaned him. Every cloud has a silver lining. In a way, because it’s not always been for us just about ‘food’ for growth, it makes even more sense to me to carry on for as long as Andrew would like to get the comfort and pure mummy-time that he’s always got from it.

At the moment he feeds for about half an hour first thing in the morning (in bed with us so we all get to stay in bed longer – no bad thing all round), half an hour last thing in the evening before bed which sends him to sleep, sometimes in the night if he wakes (though he’s generally a very good sleeper), and sometimes in the day if he’s upset or tired. I know exactly when he wants to feed from me, because he’s very good at doing the milk ‘sign’ (we’ve done baby signing, I really must blog that one day) and pulling my top down! He must have a need for it, otherwise he wouldn’t ask for it. As a mum I want to meet that need for as long as necessary, because that’s my role in life, and I’m proud of it 🙂

And as it turns out, I’m not that crazy for feeling this way about toddler breastfeeding, when I talk with those who feel the same. Does anyone else have experience of breastfeeding beyond a year? Do you think it’s too old to still be breastfeeding? I’d love to hear what you think, whether you agree with me or think I’m crazy.

The hardest but best thing I’ve achieved in my life

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….

Breastfeeding Matters magazine - January/February 2012 (Do you recognise the handsome little fella on the front cover?! Photography credit: Mark Galloway aka Grandad!)

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.

SNS (supplementary nursing system) - a bottle that hangs round mummy's neck by a cord, and out of the lid (which is at the botton when hung) comes a length of thin tubing, which is taped for each feed to the breast, so that the loose end of the tube sits on the nipple. As baby sucks on the nipple, he gets all the mummy milk available, plus the formula in the bottle. Quite ingenious if you ask me!
Andrew (4 months) and mummy enjoying a feed, with the SNS around mummy's neck

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.

Update

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.