“Breast might be Best”, when it works…

When I was pregnant I was certain that I would breastfeed our baby for at least 9 months, which is when I was going to return to work.  Breastfeeding was good for Baby, good for Mama, free, “portable” for all the travelling we planned to do, etc…  I read Ina May’s Guide to Breastfeeding to make sure I was ready and even pictured what it would be like in my head.  Breastfeeding was what nature intended.  So, as long as Baby and I had enough skin to skin contact right after birth and in the first few weeks and the baby’s latch was good then everything should happen as nature intended, right?

Things started out good with Hudson and I.  We had lots of skin to skin contact immediately after his birth. With the help of the midwife, Hudson latched on well at the hospital a few hours after he was born and seemed to continue to breastfeed well in the next few days after his birth.  We had to return to the hospital on day 2 (February 24) to have Hudson’s blood tested again for jaundice (which came back negative) and while we were waiting for the results we saw a lactation consultant.  She confirmed that Hudson’s latch was good and gave us some pointers for different feeding positions to try and deepen his latch a bit to help with the tenderness in my nipples. 

On day 3 (February 25) the midwife came to the house and weighed him and he had lost about 7% of his birth weight, which is normal.  She also observed us breastfeeding and thought things looked good.  My nipples were still a bit tender so the midwife suggested that we may want to see a lactation consultant again just to make sure Hudson’s latch was good.  We went on February 26 to see another lactation consultant at the clinic in Trillium hospital.  Again, we were told that the latch was good and that the only thing we could try and do was to get Hudson to latch a bit deeper.  So based on all of this things seemed to be on track.

However, on day 5 (February 27) the midwife came again and weighed Hudson and he had dipped below 10% of his birth weight, to 7 pounds, 14 ounces.  Based on his weight loss it appeared that I might have a low milk supply.  Effective immediately we started an aggressive feeding supplement strategy and I started pumping for 10 minutes after every feeding.  The plan was to continue breastfeeding Hudson, but now we would insert an SNS feeding tube into his mouth after he had latched so that he would get the supplement while breastfeeding. This way of supplementing was to avoid “nipple confusion” because the hope was that my milk supply would increase and eventually I would be able to exclusively breastfeed again.

Needless to say, this was a very stressful time for us.  I was extremely emotional, stressed and felt like I had failed as a mother.  As a result breastfeeding Hudson did not go so well after the midwife left and we opted to finger feed with the SNS feeding tube during the next 24 hours.  Kurtis was amazing and did all of the finger feeding.  I helped him by holding the syringe and/or bottle that contained the expressed breastmilk and formula.  

How could I not have known that I was starving our baby?!  Day 2 was a fussy day for Hudson but everyone told us that this was normal as he was just getting used to life outside the womb and my milk was still in the process of coming in.  However, he continued to be fussy in the evenings and at night for the next few days.  At the time, we just thought we had ourselves a fussy baby, but it turns out we had a hungry baby. Hindsight is 20/20.

Feeding formula was not even on my radar until we had to start supplementing. Everything I had read while I was pregnant seemed to say that baby wouldn’t be as healthy, emotionally stable, smart, etc if he or she was formula fed.  I even remembered reading a blog post that a couple had written about travelling with their infant and they had mentioned that they were feeding their baby formula.  At the time I had judgemental thoughts towards that couple and wondering why they weren’t breastfeeding their baby (and doing what was best for their baby).  And now here we were giving formula to our baby, but he needed to eat.

The midwife came back on day 6 (February 28), roughly 24 hours after we started supplementing. She weighed Hudson to see how we had made out.  He was 8 pounds, 3 ounces!  He had gained 5 ounces, which was a huge amount in 24 hours (normal weight gain for a newborn is between 1/2 to 1 ounce a day).  She actually weighed him twice because she didn’t believe what the scale had said the first time.  We had stuffed the boy!  His weight gain was a huge relief for all of us.  Now that we had Hudson’s weight gain under control the focus shifted to my milk supply.  The midwife suggested that I start taking Fenugreek and Blessed Thistle herbal pills, 3 pills of each 3 times a day, which I started that evening.

After the midwife left and my stress level had come down I was actually able to successfully breastfeed Hudson with the SNS feeding tube.  This way of feeding him was a 4 handed job.  I would get Hudson latched on my breast and then Kurtis would insert the tube into the side of Hudson’s mouth.  Kurtis would also look after the syringe or bottle containing the supplement of either expressed breastmilk or formula.  As soon as Hudson was done eating, Kurtis would take him and I would then use our double pump for 10 minutes.  Each feeding was quite a process!

During the next few days I was consistently pumping between 15 and 40 mL, which seemed to confirm that my milk supply was low.  We went back to the lactation consultant at Trillium in the afternoon on March 5 for another follow-up and to weigh Hudson before and after feeding him to try and see how much breastmilk he was getting.  Everyone kept saying that pumping was not the best way to gauge my milk supply because the pump was not as efficient as Hudson would be. Hudson got about 30 ml (1 ounce) during the 40 minute feeding, so either he was less efficient at getting my milk than the pump or my milk supply was indeed low.  In any case, it confirmed that he was still not getting enough from me and we would need to continue supplementing.

Kurtis’ first full day back at work since Hudson was born was March 5.  Thankfully Grandma and Grandpa Arnold came for a few days to help out.  I was actually able to manage feedings on my own by this point.  It was a bit of a tricky process but it got easier to do by myself as the days went on.

In order to see if the herbs I was taking had any impact we returned to the lactation consultant at Trillium hospital in the afternoon on March 9 to do another weigh in before and after feeding.  This time Hudson got about 38 ml.  So still really no improvement in my milk supply.  We checked in with the midwife and she called in a prescription for Domperidone for me that I would start taking immediately.  We also talked it over and decided to go ahead and make an appointment at the Jack Newman Breastfeeding Clinic.  Luckily we got an appointment at the JNBC on March 12.  

Since February 27 I had been pumping for 10 minutes after every feeding and we had been feeding Hudson every 3 hours, waking him if necessary and letting him have one 4 hour stretch at night.  It was a very tiring process to feed him. We had different suggestions on how we should feed him and introduce the supplement from both midwives as well as the lactation consultant at Trillium. Each had a slightly different suggestion. Feed him first on each breast and then introduce the supplement on the second breast, feed him on one breast first and then introduce the supplement on that breast, feed him first on each breast and then switch back to the first breast to introduce the supplement.  We tried it all.

On March 12 at the JNBC he had a weigh in and he had surpassed his birthweight, at 9 lbs, 1 ounce. This was another huge relief!  During our appointment we saw a lactation consultant student, a certified lactation consultant and a paediatrician.  We were told I could stop pumping and that we could start feeding Hudson on demand since his weight gain was no longer a concern.  No more waking him every three hours to eat and no more pumping!  Those two things alone lifted a huge weight.  They also gave us some great tips for feeding positions which meant no more using breastfeeding pillows (they felt that they caused bad positioning).  The paediatrician also examined Hudson and noted that he had a very slight tongue-tie but nothing of real concern. This appointment gave me a much needed boost to keep up with supplementing using the SNS tube as it seemed like there might be some hope that I could maybe get to the point where I would breastfeed exclusively.

We had two more follow up appointments at the JNBC on March 19 and March 26. They upped my Domperidone dosage each week until I was at the maximum dosage (4 pills, 4 times a day) by the third appointment.  Hudson’s tongue-tie was discussed a bit more at the second and third appointments.  They offered to do the procedure to release the tongue-tie however no one there could definitively say whether or not that would improve things.  Other than my low milk supply, there were no other real signs that Hudson’s tongue-tie was causing any issues (I didn’t have nipple soreness and he had a good latch).  As a result, at the third appointment we told them we were not going to do the procedure.

Each appointment at the JNBC continued to give me a bit of hope, they would offer different strategies for feeding him.  Switching between breasts more frequently, breast compressions while feeding, etc.  But as the weeks went on, nothing seemed to really change with the amount of supplement that we were giving Hudson at each feeding.  It was starting to look like my plan to breastfeed exclusively was not going to materialize.  I decided I would continue with the SNS tube supplementing until Hudson was at least 6 weeks old.  Feeding with the SNS tube was not very portable and going to far from home was awkward.

In between appointments I would Google about breastfeeding issues trying to find answers about low milk supply and if there was anything else I should be doing to try and increase my supply. This seemed to only leave me with mixed feelings and more questions.  And pretty much everywhere you looked I continually felt like I had done something wrong along the way.  Maybe we didn’t get Hudson latched soon enough after birth, maybe I should have done more skin to skin, maybe I had not been feeding him frequently enough in the first few days, etc, etc.

It was also a very emotional process coming to terms with the realization that I would not be able to exclusively breastfeed.  There were some supportive websites that I did find about breastfeeding issues and one thing I remember reading was that stopping breastfeeding can be like going through the grieving process.  Looking back on it now I think that was very true.  I had to take the time to mourn the loss of breastfeeding and come to terms and accept that we would be bottle feeding formula.  I started doing Google searches about formula feeding and healthy babies and found some good resources that made me feel better about it.

http://www.babble.com/baby/benefits-of-breastfeeding-baby-formula-feeding/

http://www.newrepublic.com/article/105638/amy-sullivan-unapologetic-case-formula-feeding

http://www.nydailynews.com/opinion/stop-feeding-moms-breastfeeding-myths-research-formula-perfectly-fine-infant-health-article-1.147532

http://www.huffingtonpost.com/whitney-fisch/my-formula-for-relief-why-i-stopped-breastfeeding_b_4410060.html

On April 4 we gave Hudson his first bottle.  I breastfed him first and then gave him the bottle.  He struggled with the bottle a bit but eventually he got the hang of it.  We were very relieved that he took to the bottle so well. Giving him supplement by bottle made going out and about much easier to manage than the SNS feeding tube system.

Over the next several days though Hudson became more and more frustrated at my breast.  I can only guess that the flow of breastmilk wasn’t as fast as what he was getting from the bottle.  If for whatever reason we happened to wait until he was really hungry, breastfeeding did not go so well and he would only stay latched for a few minutes before he would protest.  Based on Hudson’s queues I decided to start weaning him.  Another clue that my milk supply was low was that the weaning and drying up process did not take very long. 

Hudson’s last time at my breast was on April 16 and he has been exclusively on formula by bottle since then. There are certainly some benefits for Mama of feeding formula by bottle – sharing some nighttime feedings with Daddy, having an alcoholic drink and not worrying about it, being able to let someone else take care of Hudson for a little while and not having to be back within a specific time to feed him, etc. Hudson has also been thriving and is growing like a weed.  At his first doctor’s appointment for his 2 month immunizations he weighed 14 pounds (60-65th percentile) and was 62 cm long (85th percentile)!

This was a journey that I was not expecting to go through.  It was certainly tough but I’m glad we stuck it out as long as we did.  This whole experience taught me a lot about myself.  And as they say “what doesn’t kill you makes you stronger”!

One thought on ““Breast might be Best”, when it works…

  1. I am very proud of you!! Trust me you turned out great with breastfeeding and formula . You are doing a great job,mama!!

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