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I find my tongue tie resources out of date, though you can see my experience here.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

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.

On congratulations, extended breastfeeding and weaning

I was asking around for weaning advice some time ago and someone said to me ‘you’ve done well to get so far, most women would have given up’. I was kind of flabbergasted. There are a few ridiculous things about that statement. This is an irritating topic for me because I’m reluctantly pushing weaning rather than allowing self weaning. But the idea that breastfeeding success is measured on length seems ridiculous to me. Ridiculous because after you work out the issues it is often far far easier to just let things happen than it is to actively wean. It’s laughable that after you get to 6,7,8 or more months that at some point you can still ‘give up’ breastfeeding. For one, it’s generally much easier by that point, and two, no, sorry, by that point you have a semi-autonomous person who has their own wills and desires to contend with. Also, that ‘most women’ phraseology drives me crazy.

To put this more in perspective: I’ve been breastfeeding for close to 16 months now. The first 8 were a struggle with me either trying to up my supply, or simply using the SNS multiple times a day. The past 8 have not been difficult at all. OK, not difficult in the same ways. Or rather, only difficult because I want different things than my baby at this stage. Like sleep. Yet there have been rather a lot more congratulations on getting ‘so far’ since I hit 12 months rather than dealing with the initial issues. I’ve noted before that serious issues seem to make people’s brains shut off. They either armchair quarterback it (you could have done better) or their eyes glaze over. I don’t really bring it up (except for here), because there’s no really good response I can think of. Basically anything anyone is likely to say is shooting themselves in the foot. I guess the point I’m making is I find these congratulations for extended breastfeeding so ridiculous because it’s not anything I did or didn’t do. It’s not some superstar parenting ability that kept us breastfeeding, it was me being lazy. As far as I’m concerned preferring the boob is mostly my child’s personality. I’d argue that while extended breastfeeding is an excellent parenting tool, parenting without the tools that breastfeeding affords one is more difficult. So here’s a tip of the hat from me to all those parenting without using breastfeeding or any simulacra thereof.

Honestly, stopping is proving to be more difficult than I bargained for. How hard? Put it this way, I wanted (well not wanted, but, well, planned…) to stop around 4 months ago. And I started gearing up to start 6 months ago. Well, I did, but my child really did not. I wasn’t willing to take it away from her at that point, so I let it go. Then two months ago I stepped it up a bit more and we’re still not there.

I tried asking around for weaning tips, but no luck. I have a difficult child in this respect as she will no longer take a bottle and dislikes all milk in any container but me. I mostly got the ‘not allowing your child to self wean is cruel’ type of responses, but I also got a fair amount of ‘I gave my kid a bottle/cup with cow milk and that was that’. Not really any help on either side. Then there were the people who told me to let my child cry it out for a few nights in regards to night weaning. Again, not helpful. My child does not respond well to being left like that. So here’s what I’ve learned about dealing with the difficult to wean child.

First, make sure your child is difficult. Try offering substitutions, cups of milk, bottles, etc. Maybe that will work for you and you won’t need the rest of this advice. Otherwise…

Start with don’t offer don’t refuse. This, depending on the child’s age will probably cut down on a few feeds right off the bat. Mine actually took a few months (I started don’t offer don’t refuse around 9-10 months) before she realized she could ask. Then she picked up again as she explored her new found skill. But it’s a good starting point. If you’ve already done that then…

Set associations. Baby sleep books talk about setting sleep associations, so I thought, why not set breastfeeding associations. We set associations that breastfeeding only happened on the couch and in preparation for bed (or in bed). We’d also had a breastfeeding to sleep association which was a nightmare for a few months until we broke it. It’s all well and good until your child gets too big to comfortably or easily put down when they fall asleep. Then it’s significantly less of an easy sleep aid. Read: feed to sleep for 10-20 minutes, hold for 15 minutes until you’re sure (haha) they are asleep, put down, baby wakes up, repeat for up to 3 hours. Yargh. If you’ve got one of those and you don’t want it, or you don’t want to develop one I can recommend Elizabeth Pantley’s book The No Cry Sleep Solution.

Consistency is key. This is where I’m really having a hard time because I’ll do things to make the  baby toddler sleep in my sleep. Which includes my best laid plans of wearing a shirt and a bra to sleep, I’ll wake up part way to find myself already feeding the baby. I’ve been really good about following our other rules for breastfeeding. Only after dinner, before bed, etc, but bets are off when I’m being a sleep deprived zombie.

Age: Weaning after 8-10 months for us has unfortunately been one of those things you have to want to make happen. Why 8-10 months? There are a few times in a child’s growth where weaning from the breast is thought to be easier. Around 9 months and around 18 months are two of those times. These are when babies are more likely to go on nursing strikes, have a lot of developmental things going on and cut down on breastfeeding naturally. At 12-13 months there is a growth spurt and in addition to eating like a horse, your breastfeeding child will give you a blast from the past, cluster feeding. So, what I’m saying is that if you miss that 9 month window, you may find yourself in a difficult situation from a weaning perspective after 12 months. Why? Because of the 12 month growth spurt and molars the child may have re-established breastfeeding as a source of comfort.

Distraction. Day weaning has been loads easier for us than night weaning. When she asked during the day I’d refuse, she’d cry for a bit, I’d give her a hug, a snack or drink, and within 5 minutes all forgotten.  It’s hard getting past those initial 5 minutes, but once you’re out the other side it’s easier to keep on doing it. After the first few times it’s like an ‘oh is that all?’ moment.  That has not worked for night times as the element of distraction is not there. If your child sleeps through the night or will take a bottle or cup at night this will be much easier for you. Mine does not and will not, alas. Pacifiers have also found some limited success here. My child has not been terribly interested in them (mainly as she can’t keep them in her mouth), but I’ve found them a nice oral distraction (though she mainly chews them-we have these wholly silicone ones) when she just wants a little comforting sucking.

Being firm, with limits: A lot of applying some of these things is knowing your own child’s limits. I found that mine might fuss for 5-10 minutes when not given the breast, but then would move on. I set a personal limit of 15-20 minutes. If after 15-20 minutes fussing and demanding of breast was still going on then I would accommodate her wishes.

Tough titty, the big guns: This is where you start the hardline tactics when the others have failed. When nothing else has worked. This is where I’d put allowing my child to cry it out, but then the goal is no boobies at night so that didn’t seem quite appropriate.  Things you can try include lemon juice or vinegar on your nipples. This totally didn’t work for us. I felt really mean, but then mine was all, yum, lemons (she will chow down on whole lemons including the peel if I let her). Doh.  So when I feel like I’ve exhausted my options and what I’m comfortable trying I revisited some things that I’d previously failed at.

What finally worked: So I revisited consistency. I made sure I had a bra on and a long shirt and tried that. As long as I was firm I could rub her back back to sleep and it worked fine. Also a water cup is key here. You may be able to bribe them with a drink of water if they are thirsty. Mine takes it some times, other times she just screams and hits me in the face.  Such is life. So once I got that working I had really bad insomnia for a few nights because I didn’t have those fancy breastfeeding sleepy hormones. But it got us through the no feeds between 8pm and 5am week. She still wakes up, but getting her back to sleep isn’t that bad. Reposition in her bed, tuck her back in, rub her back, maybe turn on a lullaby toy…

I met her halfway (really I wanted to sleep some more) and decide that she can have a feed any time after 5am that she wakes up. That one however will be the next to go. I thought, hey, the bed time feed is kind of nice us time, let’s keep that one and work on the middle of the night ones.  I also knew how to deal with the bedtime feed because I’d already dealt with it in a different form when I removed the nap time feeds, so I wanted to save that one for last. Now I know, sort of, how to deal with the sleep-time feeds.  Weaning is a fairly individual process, much like defining your breastfeeding relationship.

It’s sad. I’ll be able, most likely, to write down the day we stopped breastfeeding. After what we went through to get here I can’t help but feel awful. If it were not for my pesky lack of ovulation this post would not be. I’ve armed myself with some extra information for next time, but I do suspect that our feeding issues have something to do with it. Even at 16 months she is an inefficient feeder, sometimes staying on the breast for 30-40 minutes for her single feed of the day. Perhaps next time, with oral issues attended to early, this will not be a problem.

Before this post came out I got an 11th hour pardon. Literally one week remaining in the weaning plan and my cycles seem to be starting up again. It seems that our week or more of no feeds between 8pm and 5am was enough to get things started. We’re down to one feed before bed and I’m happy enough with that for now. Stopping is no longer in our immediate future. But, these are still good tips for weaning. Extended breast feeding doesn’t have to be about complete surrender of control.

How can you say no to this?