Breastfeeding the second time around

It occurred to me the other day whilst feeding Joel that I haven’t blogged much about our breastfeeding experience in the first 5 months of his life. Before know it, and before I can cover the kitchen floor in some kind of food-repelling forcefield, he’ll be sampling some big boys’ food, and slowly the amount of milk he will require will decrease. Not that this necessarily means the end of breastfeeding him – I’m happy to carry on until he wants to stop, and his big brother is still going at 26 months. But this has made me look back on these past few months and reflect on what it’s been like breastfeeding my second baby and how it has differed from our experience the first time round.

I think the main reason I haven’t blogged loads about it has been that it has gone much more smoothly. It’s just fallen into place and fitted into our lives in a much more normal way than when Andrew was a baby, so it hasn’t crossed my mind often to blog about it. The two main reasons why it has gone so smoothly this time are: (1) I was much more practically and emotionally prepared for what was to come – I’d done it before and knew what to expect, including knowledge of my hypoplasia and low supply and being prepared with an SNS (or 2!) in the flat; (2) I had a support network already in place for if things got difficult and I needed useful and accurate help – this came in handy when Joel was readmitted to hospital with jaundice, and when I’ve come into contact with health professionals worried about his weight.

I only started blogging when Andrew was nearly a year old, but if I had have had a blog back in his first 6-ish months, I imagine I would have been doing weekly (or more frequent) updates about how breastfeeding was going and how we were finding our way along a very bumpy path. Some days I was very positive and felt like things were going well, and then I’d have bad days when I’d question why on earth I was doing this when it was so hard and I couldn’t see the bigger picture. Of course there have been difficult days when feeding Joel, but overall they are been much fewer and much more manageable than last time.

First time........ Second time
First time…….. Second time

One of the biggest helps this time is that I am an expert on our SNS! (Read all about what it is here). It took me a while last time to figure out various things about it, such as the fact that powdered formula made up with boiled and cooled water flows more easily through the tubes than the instant formula. Also I wasn’t confident enough to use it when we were out (other than at breastfeeding drop-ins or support groups), so Andrew was used to taking both breast and bottle for usually only one feed a day, and we didn’t go out to that many groups until he was about 5 months anyway – for the first child you can fit in around them much more easily than for the second. But this time, right from the start I’ve been more confident, and as we’ve needed to get out to groups to amuse Andrew, the SNS has come with us (though Joel rarely feeds when we’re out these days, but he did when younger).

This has meant that Joel has never had a bottle. In fact I tried to give him one a few times at around 3 months when I was worried that he was having to work too hard at the SNS and I wanted to compare flow with a bottle, but he refused to take one, no matter how many different things I tried (me/Tom, day/evening, warm/cold, 2 different brands of teat etc.) I think it’s pretty amazing that a baby who has quite a lot of supplement on top of breast milk is behaving like many exclusively breastfed babies do in this respect. And when I eventually did trick him into taking an ounce before he realised and spit out the teat, the flow was about the same rate for bottle and SNS, so my concern was quietened.

On the matter of supplements, how much is he having compared to what Andrew had at this age? The answer is I actually don’t know for sure. I didn’t write down what either of them have had as it’s just one more thing to think about. But it feels like Joel has needed less supplement over the first 5 months than Andrew did, which suggests that I have been able to provide more milk myself this time. The fact that we had to finish off some of Andrew’s feeds with a bottle as he was on a lot of top-up by this age, whereas Joel manages it all in the SNS very comfortably, also suggests that he’s needing less top-up as the second baby.

I should also say here, as an update to my previous post on weight watching, that at his last weigh-in a few weeks ago, Joel had put on a lot of weight and had gone up on the infamous centiles, so the health visitor at the clinic didn’t even say when I had to bring him back next to be weighed – this meant a lot to me, and took a lot of stress away, as we’d always been told to go back either fortnightly or monthly; the ball’s in my court now and I can decide when to next have him weighed.

When I reflect on breastfeeding Joel, I think about how much I learned from doing it before with baby Andrew. The first time around I just had to find my way as we went along, whereas the second time around I feel that Joel is benefitting from things I already know. In other aspects of being a baby, I sometimes feel like Joel is getting a rougher deal being the second child – he’s put down more often than Andrew was and has to share my attention; but then I think about the deal he’s got with breastfeeding, and I realise that he’s experiencing a mummy who is much more on top of things. First and second (and third etc.) children are all going to have different experiences, and that’s not to say that any are worse off than others, they are just different.

So all in all, as we approach the 6-month mark, when our society says that the end of breastfeeding a baby is in sight, I’m feeling very happy with where we are and how well we are doing. Plus I’m looking forward to the next stage when breastfeeding really isn’t all about calorific intake and the non-nutritional aspects like closeness, calming him down, getting him to sleep, immunological protection etc. become even clearer. Stay tuned for more updates as (/if) I remember to write them – I’m aware that I haven’t talked here about Andrew’s nursing at the moment.

My matching boys :)
My matching boys 🙂

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.

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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

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