A personal case study- a success story

A self case study on Metformin use in pregnancy and lactation outcome.

History: 35 year old female on 4th pregnancy with 2 living children. Previous low supply with undiagnosed cause. Child #1 needed 400 ml supplement daily (while using at breast supplementing device), child #2 needed 300ml/day. Child #2 was treated for ULT and PTT and mother did herbal regimen (including alfalfa, goat’s rue and others) during and after pregnancy with minimal improvement.

 

Lots of previous trouble losing weight. Prior to starting metformin normal but slightly high cholesterol, triglycerides and sugars. Always passed glucose tolerance tests. Started metformin (1500mg) when child #2 was 3-4 months old (approximately February 2013). Weight 110-115kg (lost 5kg by cutting down on carbohydrates).

Over the next year lost over 30 kg with minimal diet changes. Increased metformin dose to 2500mg/day.

Maintained this dosage throughout pregnancy.

Things I noticed during pregnancy:

Breast growth from 106cm at 5 weeks to 122cm at 39+2 weeks (delivery day). On day 9 postpartum breasts were 126cm in circumference, but have since reduced to 122 cm.

Significantly noticeable darkening of areolas during pregnancy. In previous pregnancy were only slightly darkened. Darkening faded somewhat toward 38-39 weeks.

Weight gain was slowed from previous pregnancies. Not much gain until 10+ weeks (previously up to 5kg gain in first trimester) and 15kg gain overall. Not ideal, but much reduced from 20-30kg gains experienced in past.

Morning sickness was lessened from previous pregnancies (all same sex), with much less vomiting and reduced queasiness.

Birth was elective c- section (previous two births were urgent/unplanned c-sections while in labour).

Overall summary and observations:

Baby gaining 100g+ weight per week from end of week 1 to week 6. Feeding, eliminating normally. Growth slow. Supply may be a bit low, but also have genetics for petite slow gaining babies as on demand supplementation hasn’t led to huge gains in the past.

This result required no pumping or other heroic measures. Just putting baby to breast on a 2-3 hourly schedule.

370g loss from birth to day 6, different scale variation at play as well. 700 g total gain by 6 weeks of age on the same scale.

Feel that metformin has made a noticeable difference in various ways.

Tongue tie was less significant and more easily corrected (75% anterior with thin membrane and little submucosal anchoring as opposed to two primarily submucosal ties in other children)

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Adequate milk supply for the first time across 3 live pregnancies

Food intolerances are lessened. Past babies had intolerances to brassica family vegetables (including mustard for one baby), gluten, citrus, tomato, garlic, onion and possibly other things. Only minor irritation observed in baby from onion and tomato (excess gas).

Weight gain was less- 15kg gained as opposed to 30kg and 20kg with other two pregnancies.

Colostrum was clear in previous two pregnancies, but was golden yellow for this one, though there were clear times. This may also be related to breastfeeding child #2 at least once 1-2 weekly until 38 weeks pregnant.

More normal post birth hormonal progression- feeling desire to have another baby despite not wanting one and so on.

No change in gestational diabetes status (negative all times). All other blood work similar to previous pregnancies (normal with minor low platelets).

 

Weekly logs of weight gain, breast and belly growth, other supplements taken and symptoms were recorded.

Self case study logs and notes

Case study data and graphs

 

So. I’m amazed. I have a hard time believing this is real. But things are going normally, and I’m incredibly proud of myself. Not because of breastfeeding, because honestly this current experience is much easier than my past two experiences, but because I figured it out.

 

I would certainly like to see clinical trials of metformin use in women with histories of insulin resistance, hyperinsulinemia, or undiagnosed low supply.

Executive Summary

I had a thought today that I would like to know the answer to. With so much publicized research being done on the properties of breast milk (antimicrobial, stem cell properties, brain development and so on), where is the research into real lactation problems? Where is the safe approved drug to increase milk supply (Metclopramide isn’t really ‘safe’ and Domperidone isn’t really ‘approved’), where are the actual diagnoses for supply problems? Maybe companies would rather head toward synthesizing the properties of breast milk rather than helping to fix bodies to produce it. After all it’s only several hundred thousand women a year, and formula does exist (my tongue is so far into my cheek it might poke through…)

I don’t know. I suspect there is not a satisfactory answer.

So I leave you with this. A short guide to various posts that are intended to be helpful.

I need help:

How to interview a Lactation Consultant

11 things a Lactation Consultant should know how to do (IMO).

Do I need help?

I find my tongue tie resources out of date, though you can see my experience here. For better information I would urge joining this Facebook group. They maintain lists of providers and are fairly knowledgeable about what is to be expected. If a provider is not on their list people can often recommend local alternatives (for instance I know of at least 4 laser tongue tie release places in New Zealand now, but none has made the general list. Do see the New Zealand Tongue Tie resources page instead.)

I need to combination feed-how do I do this?

The big fat Combo feeding FAQ

Walking the line

Benefits of

With low supply

SNS tutorial

Nipple confusion

Managing long term

Formula

Solids

Weaning

Body Image

What is causing this?

Able

Potential causes

Birth complications

Rare vs Undiagnosed

My most popular post

Making Milk beads

And the rest of my life.

I think I no longer feel bad, because it isn’t something I did wrong. It’s purely a medical issue.  A medical issue that some people would have me believe is my fault. A medical issue I cannot get satisfactory treatment for and that is largely undiagnosed. That makes me mad.

I lie. I still feel bad and somewhat inadequate, but I no longer feel guilt. I do wonder how much of my feeling bad is a normal level for someone suddenly faced with a non-life threatening failure of a body part. Somehow I can’t imagine people feel a mix of loss of gender identity and self loathing after losing a kidney or having a splenectomy. Or losing a finger or a limb. I’m sure there are other mixed feelings but I wonder how often self hatred/loathing/failure is a part of that.

Moving on from low supply.

Other than the frustration of feeding my second, things went well all things considered. I mean I had moments (many) I wanted to stop and it was more difficult in several ways. One because I had more support.

Back to that in a minute.

Another one was that I knew what my end goal was. With my first I was struggling on because I had been told I couldn’t, that I would fail. With Miss M I knew I could come out the other side and have a time of normalcy with a nurseling. And besides, she would love me no matter what.
Back to the more support thing. I lined up a supportive midwife and didn’t really have anyone around me telling me that I was terrible for using formula or anything. I had some stress in the hospital as midwives argued about how things would turn out, and brief moments of false hope that things would be normal, but it was not to be. My midwife I think thought I was crazy and wanted to give me permission to stop. I had a great online due date group (note: I highly recommend getting one of these. I joined a local parenting forum, mine was associated with a magazine, and when I became pregnant joined the month due date group. We formed a facebook group, there are about 30-35 of us, and it’s fantastic. Local is key, because you can swap tips about sales and local brands. And meet up! With my first I was a member of parenting community primarily UK and US based. So not really local at all. Also much larger and impersonal. I really think 30ish is the ideal number of people to be civil online.), and a weekly breastfeeding group attended by an IBCLC who was familiar with major breastfeeding issues. All around I felt like no one would judge me if I did stop. But I knew what I was aiming for so it was all personal drive, not some misplaced feeling of needing to prove I could do it. I knew I could. And if it turned out I couldn’t there would be people there to say well done you. If I had had that support with my first I would have stopped I think. But I didn’t and that’s how I have succeeded twice now. But wanting to stop is not a form of failure, nor should it be a source of guilt. It’s just a symptom of frustration. This time I knew my frustration was temporary.

I’ve come to think that so much mommy war crap is very first world problem-esque. Even low supply. Yes, it’s a big and valid problem, that is not as open, treated or acknowledged as it should be, but the guilt and regret is very much a western world bullshit thing to feel bad about. A bit of a tantrum which is negatively reinforced if you will. Our perceptions are skewed by the way we live. Yes, we have an inability to nourish our babies alone but in ‘the wild’ we would not be alone. Ok, not unless you were homesteading or repopulating the world. Much like we aren’t meant to be alone in the weeks and months after having a baby, and yet we often are. Yes it can feel raw and horrible and heartbreaking, and I’m not disputing that, but I posit that those feelings are a mixture of betrayal and being thwarted in our choices, combined with various breastfeeding movement backlash baggage. Betrayal as we’ve been told that we can do it-and then we can’t. Breastfeeding backlash baggage in that even though the issue is becoming more well known it still is not widely accepted so you have people disbelieving you, questioning your commitment and motivation. As if it’s a contest, or endurance event, rather than keeping a baby alive by any means necessary. Thwarted in that this was something you made the choice to do and that choice is taken away from you. I think the emotional repercussions from that is largely a construct of the other two. If you could not do some other choice would you feel so bent out of shape about it? Not likely…until people disbelieve you, question you, badger you and tell you the option you do have is wrong, repugnant and harmful. That leaves you as a sad little ball of raw despair.

All I can really say is that parenting is so much more than the first few years, yet these years are consumed with ideals to do things the right way and when the right way, like breastfeeding, does not work out, or goes poorly we become bitter; consumed with sadness, guilt and regret, because honestly we don’t have bigger problems. Our first years ideals mean well, but the jealousy, the warring, the guilt of if you are stimulating your baby appropriately, enough, right, the worry if you are doing things the ‘best’ and frankly, fashionable way…. it’s all so much bullshit. There are righter ways and wronger ways to do things but so much of the hype sold to us in packages, physical or conceptual, is entirely irrelevant. Babies need touching, feeding, cleaning. To be comfortable and comforted. To be responded to. Kids need a hell of a lot more than that. You haven’t failed as a parent until your kids don’t call you after they grow up. They won’t even remember the first years. The first years are a start but what shapes a child into a person is ongoing interaction.

With that I will leave my next post with a compilation of links on various topics. This blog is not so topical to me anymore and no one likes an irregularly updated blog. I have moved on from low supply. I hope others with this issue can as well.
Oh, it will be a fact of life with my future and last child, but that’s all.  It’s moved on from being an emotional problem to purely a medical problem. I’ve accepted it is not fixable. I will never have a diagnosis (well not unless I can find a breastfeeding clinician). And I guess it doesn’t matter. My kids don’t care that they had to be born via cesarean section, that they weren’t fed 100% breast milk. My main focus now is actual parenting and I don’t know that I will have time or motivation to navel gaze about that. I’ll be learning as I go, and my right ways, or even the ways that things go aren’t for me to judge or write a how-to manual for anyone else. It’s just going to be regular difficult from here on out, so I don’t think my musings are going to be particularly relevant.

Cooking with Milks

Another consequence of my second child being such a fuss butt was that when I went back to work she refused a bottle. I feel like a meme belongs here.


Anyhow, in two children I’ve learned to use up my milk. It was hard to come by, be damned if I’m going to tip it down the drain.

Milk jello.
This sounds so grody, but it’s a reasonable option. I tried it first with formula, but it will work well with expressed milk too. A half and half mix with powdered or concentrated formula will likely work best for technical reasons.
Add gelatin to boiling water and dissolve. This is the technical reason I mentioned. Gelatin dissolves a lot slower in milk than water. So you could boil your breast milk and dissolve gelatin into it. But it will take longer. Add appropriate amount of formula for the amount of water the gelatin is dissolved in. Add your milk. Pour into containers and allow to set. I found 14g (1/2oz) ad 200ml far too firm. My baby could pick it up but couldn’t really suck bits off. I doubled it (you can melt it back down in a double boiler set up. If you don’t have a double boiler a frying pan with water and a pot in that will work just fine) and it was still a bit too firm. Follow the directions on the package. Use within 3 days.

Milk custard.
One version requires your child able to have eggs so after solids are more established perhaps. You can omit the egg and make the custard more of a roux instead though if you do that I would definitely make it in a pan stove-top.
The smallest amount is about 100ml of milk, 1 egg yolk and 2 tsp of corn flour or corn starch(I wonder if you could use tapioca/arrowroot or other flour for this instead). You can even do this in the microwave. Mix ingredients and whisk. Heat for 1 minute in your microwave and whisk again. heat for 30 seconds and whisk again. Repeat until it starts looking thicker around the edges. It should be setting up by this point. If doing in a pan just heat and whisk until setting up. Cool and serve or put into containers to set. To double it use 200ml milk 1 egg yolk and 2-3tsp flour. After that you will need another egg. Also more flour. Feel free to add extras-fruit, sugar etc. This was intended to get fluids into my non-drinking kid so I started out with basics. Keeps for 2 days.

Muffins
This is what I did with all my lipasey milk from my first child. She wouldn’t drink it so I baked with it.  I also made some jewelry…

Anyhow.
1/2 cup flour, 1 small egg, 1/2 cup milk, 1tsp baking powder, 1 tbl oil and whatever fruit, spices and extras you want to put in there. This recipe doubles as a pancake recipe. Our favourites were apples and cinnamon, pumpkin, lemon zest, berries etc. Keeps for up to a week and can also be frozen.

Human milk proteins, carbohydrates and fats are still good, so if you need to use up some old or slightly off milk cook with it. I use these techniques on milk that for example is lipasey, has not been drunk all day at daycare etc.

We also found soaking some bread in the milk worked well. Pretty much the cereal principle, but for the Baby Led Weaning self-fed child.

After 3 weeks of fussing, losing weight and playing around we found a sippy cup (just a cheapo plain one) that she would take that made daycare happy. But I’m still pumping milk and occasionally need to use some of it for non-drinking activities.

Take 2: When you think you know what to do and are so very wrong.

Now that we have put the SNS away at home, a little earlier than with the first kid, I should get what I learned from my difficult second child down somewhere.
Well I say difficult, but she was difficult only because of my milk supply issues.
She developed very minor jaundice early on. Not enough to worry anyone but enough to get really really sleepy.

By 6+ days old we had to institute a waking and feeding schedule and we had to continue waking her for feeds until well over 2 months of age. Yay baby sleep you might think. Yes, on one hand this was nice because my first did not sleep and instead ate all the time. Sleep also makes it possible to do hard things. Like lots of pumping. But with low supply you do want an eager baby stimulating your supply. So every 3 hours I had to wake her up and then came the 1-2 hour long ordeal of keeping her awake through feeds just in time for the next feed to start. Every 3 hours 24 hours a day. Blargh. Wet cloths, undressing, blowing in her face, and even icepacks on her feet. And because she was so sleepy and not able to get enough from me part of this routine came to involve force-feeding with a bottle. She came to hate the bottle. In fact she hated anything not a breast in her mouth. Maybe having her tongue tie and upper lip tie lasered at 3.5 weeks oversensitized her but she developed into an orally particular baby.

As I knew how to use the supplemental nursing system I was eager to do that rather than bottles, but she became quite particular about the tube in her mouth. The medium tube which had a faster flow was not acceptable and occasioned screaming if it even touched her. The small tube was never fast enough initially (not that she seemed to care…) and often feeds would take over an hour to complete (even into her 4th+ month). Instead of latching her with the tube near her upper lip I started sliding it into the corner of her mouth around 7-8 weeks and that was the only thing that would work. If she detected it she would fight to get it out, preferring plain breast but of course that wasn’t an option. She developed aversions to one breast and for a while even one position because of association with the tube and I had to exclusively use it on the other one.
She made feeding my first look easy. Sure with number one I had low supply and I was learning as I went but after working out the initial technical problems and difficulty it became routine and predictable. Not so this time. Things were always irregular and a struggle if not an outright fight. I was tracking her intake, output and weight gain until nearly 7 months, where I pretty much stopped the tracking with my first by 3-4 months as things were so routine. The part that bothered me most was that she could not be trusted to self regulate with milk. she would stop and if we let her do that she would not gain appropriately so there were minimum intake volumes she had to meet. This often required waking her up and trying to get more milk into her. So it was a chore.

Things that helped with this difficult baby?

  • Primarily putting the tube in the corner of her mouth. Here is a short and not very good video.

She so very much hated the texture of the tube that putting the tube against her upper lip lost us some breastfeeding positions for a while as she came to associate them with tubes in her mouth. The latch wasn’t great but it was hard to fight about drinking and fight about latch. Especially when she preferred to slip down.

  • Using the NG (naso gastric) feeding tube in a bottle. I was at the point where she would not feed in several positions, would not take the Medela SNS tubing the ‘right’ way and would not take a bottle and I thought I would have to finger feed her or start syringing milk into her mouth. Its a very frustrating position when you want and need help but you know that you know more about alternative feeding methods than any professional you might ask for help. I got one of these NG tubes-which by the way is fairly stiff and inflexible- and stuck it in the corner of her mouth…and away she went. It wasn’t bothering her.

So I then learned how to sneak the SNS tubes into the corner of her mouth. The SNS medium tube is far more flexible than the NG tubing but not nearly as thin and flexible as the small SNS tubing (case in point I have been through multiple small tubes as they develop pinholes just from regular use. At least 2 per child. I have not had to replace the medium SNS tubing through 2 children, but then I don’t use it every day either). But I learned to stick both of them in the corner of her mouth. And things worked. Mostly. Sure feeds took 20 minutes for ~60ml supplement on a good day (and 40-60 minutes on a not good feed- keep in mind this is after 10-20 minutes of regular breastfeeding). And the tube would wiggle and it would need a lot of adjusting (this is why I was happy I had the Medela SNS because when liquid is being consumed you can see air bubbles. Not possible with NG tube in a bottle method), but it worked. But maaaan was I glad to put it away.  No excitement that I was finally meeting her needs (+solids), just relief to be done with such a tedious fussy feeding regime. She’s been fine with plain breast. Which was part of the problem, as that is what she preferred and was not an option because of my supply.

Lesson learned. Never think you know what you are doing.

Not trying hard enough

Not trying hard enough is a phrase that has haunted me most of my life. For a long time it’s been applied vaguely at me in regards to weight loss. Despite my counting calories, and measuring or weighing most everything I eat and seeing no results. I bought into the idea that I must be doing something wrong and that I wasn’t trying hard enough. Now that I’ve finally (finally!) been diagnosed with PCOS I can give myself a little bit less of a hard time.

When breastfeeding went wrong and people actually said to me that I needed to work harder and that I wasn’t trying hard enough (also see: lazy, uneducated, and so on) I again bought into the idea that I wasn’t trying hard enough and it ate me up inside. I mean so many people were saying (mostly without knowing the specifics) that there must be something I was doing wrong.

Thing is, in a normal situation these things are not rocket science. They are simply not that hard. When you aren’t in a normal situation though, all bets are off. There are lots of variations on not normal, so be cool and give support.

This time around has been a really different experience for a lot of reasons. If I had more time I could write guides about horrible sleepy fussy babies with oral particular-ness and how much more this low supply gig sucks when you also have a toddler.  Most importantly though I know this time I am totally awesome and actually pretty damn hardcore for being able to do this.

I ran into some internet comments the other day espousing the same old tired bullshit that low supply is ultra rare and that people who say they have it are all a big bunch of lazy liars and blah blah blah. It made me a bit weepy because I’d forgotten how many of that type of ‘lactivist’ there still are. Here I’d been thinking that recent media exposure on the prevalence of breastfeeding issues had somewhat changed the landscape in the past two years. Ha, I say. Ha.

Someone else in the same stream of comments said something along the lines of ‘Well 99% of pancreases work so diabetes is ultra rare and you only think you have it’. Someone else countered with ‘Don’t eat 50 donuts a day and expect your pancreas to work’. I then thought, if anyone told a type 1 diabetic that eating donuts caused their disease they would just be convinced that person was a moron. Put it all in perspective for me. Anyone who ever thinks I didn’t or I’m not trying hard enough I can automatically dismiss as a moron.

Phew.

A fate worse than death

Sometimes I feel like not being able to breastfeed is viewed that way. Losing milk supply is a major worry for breastfeeding mothers. It rubs me a bit the wrong way when people who have successfully breastfed children so far start taking supplements and munching lactation cookies when their breasts don’t feel as full. Especially those whose babies are gaining well above the 140-210g/week.  Seriously makes me wince and/or want to pull my hair out.

Meanwhile all along I’ve been drinking teas, eating a lactation friendly diet, popping pills and pumping quietly. Quietly because when you are open about your lactation insufficiency people don’t know where to look. It’s something people openly say they fear and worry about but when it happens no one is sure what to say. Is sympathy the right response? Is telling people that it doesn’t matter if they breastfeed or not appropriate? Not really to either of them. Simple sympathy- I’m sorry- is probably the safest. Lately I feel that it’s almost more acceptable to talk about death than persevering through lactational insufficiency. It just makes people feel awkward. Some of them want to tell you you are wrong, others it scares.

But when people with normal supplies ask about how to help their milk supplies I grit my teeth and give them tips.  If no one else has given advise first. I admit I drag my feet. I mean I think I understand. I have to meticulously track volume and my child’s weight and I worry when top-up volume is dropped. But when you are fully breastfeeding you don’t have any type of gauge other than output, and intermittent weigh ins, which may not be all that satisfying. So hard breasts means there is plenty of milk there for the taking and is thus a comfort factor. I must be unusual in that I initially trusted my baby and my body to do what was correct despite evidence to the contrary. Over-education isn’t all great.

 

Deficient.

I do often wonder if there is something mentally wrong with me for doing this mixed feeding malarkey. In my cynical moments I see myself as a mother willing to risk starving her child out of stubbornness. At this point I know my breasts do not lactate appropriately. There is no tricking, hoping or stimulation that is going to make that not be the case. I don’t think formula is that bad or I’d maybe motivate myself to get some donor milk. Despite that I am now citrus, tomato, brassica, onion, garlic, pulse, and gluten free to keep my baby reasonably happy. Yeah if you’d told me ever that I would be on a restricted diet feeding a baby through a tube I would have thought you were crazy. But here I am. Anyhow. But at some level I can not let go of breast feeding and go completely over to the bottle and formula. Now that we are at the point where it isn’t complete hell to mix feed (seems to be 12 weeks is the magic hump) I seriously wonder what is wrong with me.

I see mothers blithely (so I imagine though I’m certain the reality included tears) say that they stopped breastfeeding due to low supply and I wonder why not me? Since this method is definitely not the standard way of dealing with low supply I do wonder of those that have low supply how many would like to be educated about management option and how many prefer to stop outright.

Last time I persevered because it was a giant fuck you, a because-I-can to everyone who told me I couldn’t. This time, in light of a tricky, overly sleepy baby who is not easy to feed and is orally particular, I wonder why I am so stubborn and dangerous.

I do know that once solids are established my feeding rig will be packed away and things will be…normal. Is that reason enough though? To deal with 6-7 months of difficulty for another year of unfettered breastfeeding before I have to encourage weaning and do it all again?

It’s certainly been harder with two. The mixed feeding takes more time than a healthy breastfeeding relationship so the older child misses out. We had planned three children when we were being logical (before kids) but the idea of doing this feeding regimen again is depressing at minimum. The only thing that makes me consider doing this mixed feeding thing again is that we can self wean. The perks of being the youngest.

The great tongue tie caper


Or how I feel like I stumbled into a cult.

I mentioned my second child having a tongue tie previously. Well after the snip with the scissors I was still having pinchy latch feelings  as well as latch slipping and I knew the lip tie was still around. After wondering about long term management of my not entirely tongue tie related low supply problems on the MOBI message group I was prompted to revisit my research  into laser release.  I emailed them and asked if I could send along some pictures and see if they saw any problems.  They did. So in a whirlwind I made an appointment to see them, booked flights and planned a 12 hour day in Auckland with a 3.5 week old.

We flew up there, I found where the place was and I proceeded to hang out. This baby is incredibly laid back and sleepy, so armed with a baby carrier there was no problem.

Here is the lovely park we spent far too many hours at.

 

I’m glad it was a nice day.

Anyhow, the Laser procedure was fairly straightforward. The Doctor/dentist was nice, his staff was nice as well. The whole thing was very posh. Posh is a good word. It was really over the top for me. I felt a bit grubby in my jeans and sweatshirt next to the fleet of designer suited office assistants in an obviously expensive office block. The procedure was also quite expensive. But I rationalized it by thinking it’s about the same amount some people spend on a designer stroller or a smartphone, and this is more beneficial. Well at least I hope so. I still feel several weeks after the procedure that the whole thing is a bit faddish and people’s behaviour is a bit cultish as well. Oh, no doubt my child had a tongue tie and a lip tie. And no doubt many people who also have tongue and lip tied children have much more severe symptoms than we did. The ties didn’t hurt me that much, though they were a bit uncomfortable. I didn’t have anyone doing test weights so how much they helped milk transfer is debatable. It certainly didn’t fix everything. But I still feel vaguely taken advantage of.  Preyed upon even. Us poor women with breastfeeding problems doing everything we can to make it work. Not necessarily by that doctor, but in general. My midwife is a bit displeased I went ahead and did the laser. She thinks I’ve been taken in by a fad. And maybe I have been. We plan one more child and right now I can’t say definitively that I would do the laser again. Or if I’d have it done for my older child. I know for some people the result is unquestionable, but for us, not so much.

There’s a huge hole in terms of what most professionals will or can treat and it’s being filled somewhat by self diagnoses and things that are expensive with dubious benefit. And I’m finding the associated peer support a bit questionable as well with certain things that must be done and it’s sort of like if you aren’t doing the whole laundry list then you have only yourself to blame when things don’t work out. I’ve found myself at odds with others in this situation before. I do draw a line as to how far I am willing to go and for some that makes me less dedicated, but I also go further than many others do and for some that makes me a tad bit crazy.

Anyhow. Here are the before and after pictures of the tongue and lip ties.

Lip tie

Tongue before scissors

Tongue after scissors

A few days after lasering

Lip tie

Tongue

A week after lasering

 

 

Why a correct diagnosis is important.

Or how wait and see doesn’t cut it.

For the first 8 months of my first child’s life I thought I had low supply, probably from insufficient glandular tissue. I wanted a definitive diagnosis though and couldn’t find anyone to give me one. Then around 8 months, after we’d transitioned to just solids and breastfeeding and put the SNS away in the closet I noticed something that led me to believe that a posterior tongue tie might be the real problem. I couldn’t get a diagnosis for that either, but the more I read and researched a tongue tie did seem to be present. That discovery filled me with hope. Hope that next time would be different, that there was something I could do to make things better. So I planned my next breastfeeding experience around that. I lined up tongue tie release, made my midwife aware of my history and suspicions and mostly did as I was told- to wait and see because this time things might be different. I was told different child, different mouth shape, maybe no problems this time. I was dubious, and didn’t use as my midwife anyone who refused to take my concerns seriously, but I did get some variation of wait and see from everyone I talked to.

Just to hedge my bets I drank various teas throughout my pregnancy and made all my postpartum meals full of lactogenic ingredients.

And then I had my second baby, not how I planned, in fact things went in a way I hadn’t thought to plan for, but I had her and it was ok. Not great, not bad, but ok. And there was an obvious tongue tie, not a posterior one, and there was some waffling about whether it would cause problems from the hospital lactation consultants, and my midwife went to bat for me and we got it snipped anyhow. It made the latch a bit better and things were going normally. We were proceeding with caution, and I was getting some varying opinions on whether intake was good. Some people said looks good, some people were concerned about swallow frequency. I was a little stressed out, but I was assured that if I hadn’t had any history that no one would be worried. I was cautiously optimistic. Things were already different and better by leaps and bounds in terms of latching and output and weight loss.

After 5 days we went home. My milk came in, though there wasn’t engorgement as such, just a feeling of fullness and heaviness. I wasn’t too worried. After all some women don’t have much engorgement, right? Yes, but. Be concerned when you keep running into signs and symptoms that by themselves don’t mean much but when accumulated paint a more dire picture.

We’d had 8% weight loss by day 6. Well within normal ranges. Considering last time we’d had 11%+ by day 5 and more after that, 8% was fantastic. Output was good, my optimism was increasing. There was still concern about swallow frequency, but things seemed to be going well.

By day 11 only 60g (2oz) had been gained. Normal newborn weight gain should be at least 30g/day. I’d been expressing milk on top of feeding to boost my supply and to give as top ups to combat the cluster feeding. My midwife wanted me to get more than 2 hours sleep per day to help my milk, and also because having a toddler and a newborn isn’t sustainable on 2 hours of sleep out of 24.

The baby was sleeping more and more. We were feeding on demand, but where #1 had screamed and cried and never slept unless held, this one would sleep for 4+ hours, fall asleep at the breast and was generally very lethargic. I was pumping 4-6 times per day on top of feeds, and giving that milk via the SNS. Output was still good.

And day 15 came and the weight was the same as at day 11, 210g below birth weight. And the baby was so lethargic at that point that getting her to take a bottle was over a 1 hour affair of cold cloths, stripping, changes and so on for 60ml consumed.

So now we went into disaster management mode. I was to give 60-100ml via bottle every 3 hours day and night and pump afterward. We practically have to force feed the baby at this point.

It’s been a few days of that and hopefully birth weight will be regained in another day or two and we can revisit other feeding options, or even go back to feeding on demand.

And that’s where we are now. I wish we’d known before that IGT was the issue. I wish I’d been able to get that diagnosis. I could have been using the SNS from around day 10 or before and doing test weights to measure intake rather than disaster management of a lethargic and dehydrated baby.

Now I’ll likely have to contend with nipple confusion, breast refusal and possibly losing any kind of breastfeeding relationship. I might still be able to pull this situation out of the fire, but a diagnosis last time would have made this easier.