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I find my tongue tie resources out of date, though you can see my experience here.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.

Let’s talk formula

Because someone needs to.  So here it is from me- someone who wanted to breastfeed and supports breastfeeding where reasonable, yet used and uses formula for medical reasons. Maybe that makes me a mostly neutral party. Maybe not.

First off- everything I learned about formula is self-taught or I learned from a Lactation Consultant. A good LC, on seeing that you want or need to use formula should be able to give you some pointers. Theoretically all formulas should be pretty much the same, brand name or budget. The WHO is supposed to regulate the ingredients and basic proportions. However-sometimes things are not so straightforward.

What you want out of a formula is to have it be whey based. Not casein based. You want the from birth formula. The follow-ons  marketed from age 6 months + are not as well regulated and unnecessary (though they are often cheaper…). If your child requires supplementation beyond 1 year, full fat cow milk can be given (or mixed with formula if you are concerned about diet or intake).

Cow milk is recommended because growing brains need fat. If your child does not like cow milk to drink (mine didn’t), just be sure to supplement with other high fat foods alone or in cooking. Food such as- avocado, cheese, coconut oil or cream, peanut or seed butters, butter, cream, lamb, olive oils, and so on. For extra calcium try various vegetables like kale, alfalfa, etc and fish like sardines, salmon etc.

Back to formulas. Whey or milk solids should be the first ingredient. Maltodextrin is a common additive and should be around the 3rd-5th ingredient. It is sometimes seen as the first ingredient- this is not necessary and may make your baby eat more- its a carbohydrate that is digested quickly.

If you are combination feeding you do not need any special formula. Any birth to 12 month one that suits you is fine.

This sort of thing

4seURmZ

Image credit

Is straight up predatory marketing. I was always ambivalent about formula companies being big and bad and preying on the breastfeeding mother, but yeah. Not after seeing that. I’m pretty sure people are eating it up too. I’d hate to be more cynical but I’d imagine that if the one on the left cost more people would be paying for that too.

Let me reiterate: You do not need anything special to combination feed. No formula is better than any other. In fact less is often more.

Some reading on safe formula use can be found here http://info.babymilkaction.org/infant_feeding/formulafeeding

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.

 

Five days of faith

My anxiety over baby weigh ins is coming back. I’d more or less become at ease with having my toddler weighed until her last appointment. Here we have well child nurses who do the weighing and measuring. Most people seem to have ineffectual but harmless ones, a few people seems to have good ones, but mine is subtly malicious. I’d been putting off going for the 21-24 month check. I figured I was going to get a lecture on how bad it was for my child not to drink milk and another suggestion of doping the milk with chocolate or sugar to get her to drink it. Believe it or not I was told by a doctor to do that. Then I swapped doctors. Some kids don’t like cow milk and that’s ok. But milk is some kind of odd holy grail of child nutrition. Whatever. There are plenty of other dairy products and fats in her diet so I wasn’t worried about the lack of milk drinking, just annoyed I assumed I would have to sit through a lecture.

Boy was I wrong. When asked how much milk she consumed I said, none, she doesn’t like it. And I braced for the lecture that didn’t come. I was told that was ok. However, rather than feeling better my stomach dropped because I knew, knew, that the nurse was going to find something else. She always did. Every visit has been an exercise in criticizing something about my parenting.  So at the end of the visit there it was. ‘She’s too fat’. Cue jaw drop from me. My 12 kilogram (27 pound) 23 month old is too fat. I was instructed to stop giving her snacks and the usual anti-obesity advice about not letting her have soda or sweets. We’re a soda free household, child only drinks water, not even juice, eats reasonably well, e.g. not picky, only whole foods. As processed as it gets is store bought pasta. Needless to say I went home and cried. I may not have even made it home. I probably cried in the car.

But now, rather than being obsessed over her weight gain I find myself looking at her body, wondering where the extra weight is. Because she’s not even remotely a chunky child aside from toddler belly.  She’s a lot smaller than most kids her age even. I feel in some ways like my whole life with her has been an eating disorder by proxy. I used to have panic attacks before getting her weighed when she was a baby, terrified her weight wouldn’t go up and I would have to supplement more than I already was. I now compare her mentally to other children and I still can’t see anything wrong, but now I wonder if I’m just deluded. I hate it. I’m terrified I’ll let it slip in my attitudes or behaviors and she’ll pick up on it.

I wanted to enter this next baby’s life without that anxiety over weight. I knew I’d have to go through the 5 days of faith to see how milk intake and gain was going. But now I’m back to being a panicky mess over it. Back to where the thought of a weigh in makes me want to vomit.