Pregnancy diary: week 31 – breastfeeding update

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.

Andrew reading up on tandem feeding with the book Adventures in Tandem Nursing 😉

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.

Bump looks big in this! I think it's because it's a flow-y top though, because I don't think I look so big in a more fitted top. Lots of people are telling me that I look very 'neat' or 'small' for over 30 weeks!

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 🙂

 

Breastfeeding support: accurate info, practical help, listening ears

I am absolutely convinced that every mum needs support if she is going to reach her breastfeeding goals. Breastfeeding involves many factors (physical, hormonal, emotional, social, psychological etc.) that come together to create the unique journey of a breastfeeding pair comprised of mum and baby; the same mum can even have a completely different experience with two (or more) different children. Sometimes these factors create a very favourable situation, making the breastfeeding journey relatively straightforward, but in other cases these factors cause issues that make the journey a very difficult one.

The mums who do have a difficult time obviously need support, and I’ll come on to where you can find this in a moment. But even those who have no major issues need a certain amount of (perhaps subtle, in the background) support in the form of, for example, a helpful partner and/or family who understand why breastfeeding is important and how it works. As a society, we can all give moral support to all breastfeeding mums by making them feel welcome and normal in public places, not making them feel self-conscious and like they have to hide away. This is one of the most fundamental ways of supporting breastfeeding mums in general.

But on an individual level, what if you do encounter problems? What can you do about it, and where can you go to get support? The first thing to remember is that you are not alone – many mums experience issues ranging from relatively minor/temporary/easily fixable problems to more overwhelming/long term/unbearable problems. The second thing to remember is that there are sources of support out there, even though you might have to be quite pro-active in searching them out at a time when you’re already feeling exhausted. Our experience of breastfeeding could have been a lot worse and a lot shorter if we had not been lucky enough to find the right support at (more or less) the right time. I see breastfeeding support as encompassing three different aspects: accurate information, practical help, and listening to emotions.

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!

The obvious place you might think to look for support would be your midwife and/or health visitor. In our experience they were mixed in how helpful they were, and I know that this very much depends on the individuals and how much breastfeeding-specific training they have had and how recently they completed it. I gave birth in a midwife-led birth centre, and it was a very positive and empowering (as is currently the buzz word in birthing) experience. I cannot fault the support of the midwives there to get breastfeeding off to a good start: they allowed me to have a completely natural birth with no pain relief except a pool; Andrew was delivered straight onto my tummy and breastfed almost straight away by latching on of his own accord; we were not hurried onto the post-natal bay and were allowed lots of skin-to-skin time; they checked on us a lot during the night after he was born, constantly asking if I needed help with feeding, and even suggested I wake him after he’d slept so long without a feed – this was really important to stimulate my milk supply.

But we were only in hospital for about 12 hours after the birth. The problems came when I went home and we were in the care of my community midwife. She was (unfortunately) on annual leave during Andrew’s first week. Of course everyone needs a holiday and I’m not complaining about that, but when we rang her team because we were concerned that feeding wasn’t going well, we did not get the support we needed. Later that week he was admitted to hospital with dehydration and significant weight loss, and I felt let down by the community midwife team care.

When we came out of hospital the second time, and I was trying my hardest to give breastfeeding a go as well as continuing the formula supplements that the paediatricians had started, my community midwife told me that I should only keep him on the breast for 20 minutes at a time every three hours and then top-up with a bottle, to give my breasts time to ‘fill up’ again. At the time I believed her, but having read more about how breastfeeding works from La Leche League (LLL) resources, I know that this is rubbish! Breast milk is constantly being produced as soon as some leaves the breast – it’s more like a continuous stream than a bucket you have to fill, then empty, and then wait for it to fill again before taking any more out. Our health visitor wasn’t much better – with her it wasn’t so much the inaccuracy of her advice rather the lack of her visits. She came a couple of times, checked I was in a fit state to look after my baby, and then left us to get on with it. I could have made the effort to ring her, but by that time I had started to get support from my local LLL group and thought that was much more worthwhile than keeping in touch with a busy health visitor – these mums had time for me whenever I wanted advice (more on this in a moment).

However, the most crucial support we received in the first week was from the infant feeding specialist midwife at the hospital when we were on the paediatric ward. Looking back, it was, ironically, good that we went back into hospital. She introduced us to the SNS (at-breast supplementer that I talked about in my last post). Without this way of supplementing, with Andrew still getting as much breast milk as I was able to produce, I don’t think we’d still be breastfeeding today. This midwife’s support was helpful and, most importantly, she gave us accurate information.

So the moral of the story with health professionals is, in our experience, don’t be afraid to question their authority and seek a second opinion – in many cases their training on breastfeeding is very basic and often out-dated because it does not feature prominently in current training (even for midwives and health visitors). If you’re anything other than a perfect textbook case, you might find they give, out of ignorance, inaccurate or downright misleading information.

As I just mentioned, I got amazing support from my local LLL group. This is an international organisation represented in many countries across the world. In Great Britain there are groups who meet in various cities, towns and villages across the country. The mission of LLL is ‘to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.’ This is exactly what I found when I went to my first coffee morning, after I was lucky enough to meet one of the volunteer leaders at a breastfeeding drop-in clinic who encouraged me to come along as she knew I was struggling.

A flyer for our local LLL group, with lists of meeting and coffee morning dates inside, hanging on our notice board so I know where to meet each week 🙂

From what I’ve heard said by others, breastfeeding support organisations like this and others (e.g. NCT) in the UK can be seen as an exclusive group of well-off ladies who bang on about ‘breast is best’ and look down on those who feed their babies formula without persevering through difficulties. In my experience, nothing is further from the truth! I took formula (in the SNS) to meetings and was not shunned; I’ve seen mums take bottles to meetings and were not shunned. In fact it is mums like me that are made to feel particularly welcome, because mums at LLL meetings who have overcome problems themselves know exactly how it feels to be under all the different pressures and prejudices associated with how you feed your baby. All these mums wanted to do was help me in how I chose to feed my baby, by giving me accurate information, practical help and a genuinely interested listening ear when I was in floods of tears. At no point did I think that I would have been thought less of in that group for bottle feeding Andrew. Now they are some of my most respected mummy friends. I always look forward to seeing them once a week for continued support now that we’ve overcome our initial breastfeeding struggles and are into the toddler feeding stage, which comes with its own difficulties, such as the judgement from others that it’s not normal (it is normal – I’ll write more about this next week).

So the moral of the story with breastfeeding support groups is don’t be afraid to go – whatever your circumstances, your age, your income, your background, your breastfeeding journey (or lack of) so far, there will be other mums who would feel privileged to be able to help you in the way you need it most to meet your breastfeeding goals. It’s not just LLL groups (that’s what I had access to here in Cambridge); there are all sorts of other local groups run by mums for mums. Other organisations with such groups are the NCT and the ABM. Children’s Centres are a good place to look for these groups, as many of them meet there, or have links with the centres who put their leaflets/posters out. A google search would probably bring up a few hits in your local area. Or your midwife or health visitor might be only too pleased to pass on information about such groups if they are rushed off their feet with a huge caseload!

Last, but not least, I could not write a post about breastfeeding support without giving pride of place to Daddy and grandparents. I definitely could not have got through the hard times without Tom, my amazing husband. He has done everything possible to support me whilst breastfeeding, including practical help like making sure I had drink and food in the early weeks when I was constantly feeding, and emotional support by being my person to cry on at any time of day or night (he got very wet in the early weeks!) and making it clear to me every step of the way that he would be behind me 110% with whatever decision I made about feeding, whether I chose to persevere with breastfeeding or switch to bottle feeding. He never pressurised me either way, and has found many ways to help me and bond with Andrew without doing the feeding, for example bath time has always been Daddy and Andrew time. He understands how breastfeeding works (mainly from how much I rabbit on about what I’ve read about breastfeeding!) and is happy that I still feed Andrew now at 16 months – he knows it’s a natural thing because he sees on a daily basis how much Andrew and I get out of it. He also knows that I am now very passionate about sharing our experience of breastfeeding and supporting others, and doesn’t complain when I talk at him about it in the evening after a hard day at work 😉 Basically, Daddy is the best! He’s the most important source of support that I had and still have for breastfeeding.

Daddy with Andrew (aged 6 months)

But if your baby’s dad isn’t around for whatever reason, there’s no reason why you can’t have another person, for example your mum or another family member or close friend, to be that rock of support. I am also blessed to have very supportive parents who have been behind my decision to breastfeed despite tough struggles every step of the way. I guess they know me so well that they know there’s no point getting in the way when I’m determined to do something. In the early days and weeks they helped by doing lots of practical stuff for us, like housework, shopping and cooking, and they still do these things when they come to visit every few weeks on average. They too understand how breastfeeding works – it helps that my mum breastfed my brother and me at a time when there was much less support for it than there is now. This was particularly important in the early days: they weren’t the kind of family members who would come round and insist on constantly cuddling baby and questioning when I knew he wanted feeding; instead they of course enjoyed cuddles, but respected that I was the primary person who Andrew needed access to, to stimulate my milk supply and feed him as much as necessary. They knew that doing the housework themselves was more helpful than taking Andrew off my hands so that I could do it. Having people around you who understand these things is very important. Support is only helpful if it’s the right kind of support.

Granny and Grandad with Andrew (aged 14 months)

I hope that this post based on our experience of support for breastfeeding has been informative. Why not hop over to some other blogs and read about other sources of support that mums have found helpful? 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. Don’t forget to enter the competition below to have a chance of winning the grand prize.

Breastfeeding in England – Breastfeeding support groups

Mama Geek – Breastfeeding Support – Why it’s important and where to find it!

My gorgeous boys – Breastfeeding: Where to get support

Breast 4 babies – Ten Things My Midwife or Health Visitor Never Told Me About Breastfeeding

Diary of the Milkshake Mummy –  Together everyone achieves more

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