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 🙂

 

Pregnancy diary: week 21 – bits and pieces

As I’ve come to sit down and write this post, quite early on in the week (although I’m posting later), there aren’t really one or two particular things that are happening or are on my mind that are specifically to do with pregnancy. So this week’s post is mix of a few bits and pieces…..

The reason I’m getting the bulk of writing done early in the week is because I’m going to the BritMumsLive 2012 bloggers conference on Friday and Saturday. This in itself is very exciting, and I’m definitely looking forward to going and meeting up with people I know mostly just from virtual conversations. But it’s not specifically to do with pregnancy. I have just found out, though, that a lovely blogger, Louise, whose blog I came across only recently, is organising an informal get-together for pregnant mums at the conference. She is only a few weeks behind me in pregnancy, so it’s great to read her posts too and know that someone else is going through similar thoughts/feelings/physical changes. From what I’ve seen on twitter, it looks like there’ll be quite a few other pregnant mums joining us. Pregnancy is generally something that inspires people to blog. I thought it would be a nice record of a journey for me, baby, Andrew and Tom. Although I didn’t think about doing this with the last pregnancy (probably because I hadn’t come across the world of blogging and what I could get out of it and what others could get out of me), I’m really enjoying writing down my thoughts each week so far. And it turns out I’m not alone – there are plenty of other pregnant mum bloggers to link up with. I’m sure I’ll post more about the conference at some point, and I’ll include a bit about the bump meet-up.

One thing that’s been on my mind from time to time this past week is breastfeeding, both weaning Andrew and preparing for baby, but I haven’t come to any real conclusions! It’s still something that I keep tossing around my head when I get time to think. I said that we’d get to 20 weeks, then reassess where Andrew was at in terms of showing signs of self-weaning, and think about what to do from there. Well, we’re now at 21 weeks and he’s not feeding less than he was before pregnancy. I explained in my previous post on thoughts about nursling (self-)weaning that he was generally feeding twice a day – once first thing in the morning and once last thing before bed, for about 20 minutes each time (I guess – I don’t clock-watch, but roughly). Ironically he then started feeding more in the early weeks of pregnancy! I’m not sure if it was because he was teething molars, or because he actually liked the ‘weaning’ milk that starts to be produced in early pregnancy (which tastes less sweet and more salty than before pregnancy), or because I was so sick and tired that all I would do in the afternoons is lie on the sofa and watch him play (in between running to the toilet) so he was more aware of milk just being there to drink with no distractions like going to the park like we usually do. Or quite possibly a combination of all these things. Whatever it was, this seems to have worn off again, and he’s back to the two main feeds a day (plus the odd short one if he’s upset and needs calming down).

On the one hand, I see the fact that he’s still feeding as a good thing. It means we’re maximising the chances of me developing more breast tissue and therefore producing more milk for baby than I did for him, and minimising the gap between him stopping feeding and baby starting feeding. On the other hand, I’m concerned that if he feeds into the third trimester, he’ll start drinking some of the milk (colostrum) that I’m producing in preparation for baby. If I didn’t have hypoplasia, this wouldn’t be a bad thing because my breasts would produce plenty; but given that my milk supply is not necessarily going to be enough for this baby either, even with all the knowledge and support I have this time round, I really want the newborn to have everything that I can produce. The one (kind of) conclusion that I’ve come to is that I need to talk to some experts about this, because we’re a special case and I can’t decide what’s best to do based on books and online reading.

Bump getting bigger....

Another thing that’s been on my mind (and therefore Tom’s given how much I’ve brought it up in conversation) is what we might need to buy for baby. Of course as Andrew is only 16 months, we have most things already. But the two things that I’ve been researching are nappies and a sling.

I posted a while ago about cloth nappies, and told of their greatness! As we only have enough for one, we’ll need to expand our stash. Recently Andrew has been becoming a heavier wetter than he was, because he’s suddenly discovered the taste of squash (thanks primarily to his childminder!) and drinks it like there’s no tomorrow. I’m generally happy that he does this, because I think he can’t really drink ‘too much’, but it is possible to drink too little, and this has always been at the back of my mind since he was a 6-day old baby in hospital with dehydration. The nappies have started to leak sometimes, because we haven’t put (m)any extra booster layers inside, since the style we have get quite bulky with extra layers. So we’re thinking that it could be a good plan to buy some more absorbent but slim-fitting ones for Andrew, and use the ones we already have for baby. I’ll write more about the specifics of what I’ve researched on nappies when we’ve bought them, as it’ll need a post in itself.

When Andrew was a baby, we were given two slings second hand from friends. One was the Baba Sling, and one was the Baby Bjorn. I used both of them a bit, but neither of them were very comfortable to use for more than quite short distances or short periods around the house. By the time I stumbled across the wonderful world of ‘babywearing’, Andrew was a toddler and it wasn’t long before I was pregnant again. I discovered that there are many types of sling different from the two we had, which looked far more comfortable and came with excellent reviews and recommendations from what I could see in all the online babywearing information. I’ve done some research on what would suit our needs, and we’ve decided that instead of buying a double buggy, we’ll buy a good quality, comfortable sling that I can carry baby in and Andrew can continue using the single buggy. We can then reassess when baby is older; by that time I think it’s likely that Andrew will be fine on a buggy-board and baby can go in the buggy. Given that people ‘wear’ their babies right through into toddlerhood, this initial arrangement could last us quite a while. One of the prizes in last week’s Keep Britain Breastfeeding Scavenger Hunt posts was a Moby sling (or ‘wrap’). As this is one of the choices of sling that I have narrowed down to, I’m waiting until after the competition winner is announced before I go any further with going about buying a sling. Again, I’ll write another post specifically on this at some point.

I think that’s enough rambling for this week. Hopefully I’ll have some more decisions made on weaning, nappies and a sling over the next few weeks, so I can update you with what we’re doing.

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.