Baby diary – breastfeeding stuff

I have an appointment booked with lactation consultant recommended by a colleague of Rafe ‘s. Incidentally, she is the same consultant I liked the look of from a list sent to me from the ever-supportive Kate. One of her special interests is milk supply issues.

she is on holiday ATM, but called me within an hour of me leaving a message and will see me either Tues or Wed morning, depending on when she gets back to Melbourne. In the meantime, it was such a relief to have someone echo what Rafe and I have been feeling which is that we don’t want to cut back on formula until we know that Zac is getting enough from me alone. The other midwives, hospital lactation consultants and Maternal & Chikd Health nurse have all tried drumming in the fact that every 50ml of formula is 50ml not being taken from my breast, which in turn affects supply. There has been a bit of “You can do it!” ra-ra, but the issue hasn’t been my confidence, it’s been my breasts! I understand how the milk usage generates supply thing works, but it’s not that simple at this point and at the end of the day, my son’s health is most important to me. Breast milk is awesome for babies, but only so long as they don’t go hungry whilst mum tries to stick to an ideal.

So, the background:
Day 3 and all was going well. Zac was measured and weighed in the AM; he’d lost less than 10% of his birth weight, which was fantastic. I’d tried going to the breastfeeding room for guidance on Day 2 & 3 – first arriving at a time when the consultant was on break. I’d had to be taken in a wheelchair, so going back to my room and trying again later was no casual feat, so I stayed, fed for about an hour, assuming a break would only be 20min or so. The consultant appeared just as I was organizing a wheelchair back to my room.
On day 3 when I went, the room was full. The consultant was very busy and simply advised that the blisters on my nipples were normal and I needed to attach properly, but didn’t show me how.

Zac started a feeding frenzy the afternoon of day3, which we were advised was normal; it’s how a baby encourages milk supply to come in and would last 12-24hours. 27 hours of Zac being at my breast, often for 2-3hours at a time, with breaks off my breast not lasting more than 30minutes and we were all exhausted. Cue arrival of the Thursday night nurse who actually twigged something wasn’t right.

Initially she thought Zac was being a lazy feeder, so she showed me ways to keep him alert and feeding. When he was still crying after her suggested 40 min of feeding, she tried getting me to express milk, first by hand, then by machine and not a drop came out. One of the hardest experiences ever was listening to my darling son crying from hunger, and being told that I absolutely had to get an hour’s sleep in order for my body to generate more milk. Rafe took Zac on an hour long walk of the ward and I forced myself to sleep, although every instinct in me wanted to jump out of bed and take my son back onto my breast.

I was able to feed him after that, but still he cried, at which point lovely nurse, Kristy, was also getting worried and suggested we weigh him just to see where he was at. He had lost an additional 300+ grams in the approx 36 hours since his day 3 weigh in, despite having been at my breast for most of that time.

That was when I first found out that my breast reduction may well impact my ability to breastfeed, even though I’d been assured at the time that it would’t. I wouldn’t change the past; the breast reduction changed my life and I would do it again. I just wish that one professional had warned me that there could be issues as I was taken completely by surprise; I had been so confident in my ability to breastfeed and thought my body was totally on board with that, an impression simply encouraged by it starting milk production back in December.

Kristy suggested that we try some formula as she was concerned that Zac was dehydrated and was amazed that he wasn’t jaundiced. In my reading since coming home, I’ve worked out that Zac had every symptom of dehydration *except* jaundice, and apart from Kristy, everyone commented that he wasn’t jaundiced therefore he was fine.

We gave him some formula, which he wolfed down, and he slept for 3 hours, a much happier and peaceful baby than we’d seen for many hours. I expressed some milk, slept and when we next fed him, he had breast, expressed milk and formula which he did not finish.

Kristy left us with a plan of feeding him breast milk, expressed breast milk, 60-80ml formula, and me expressing after each feed. Rafe picked up a hand pump from the hospital pharmacy and before heading home, on Kristy’s advice, I went to the breastfeeding room one last time to check my feeding plan before heading home. Kristy also gave us some bottles and formula to take home.

In the 10 minutes that the consultant was in the room before heading on h break, she assured me that I had plenty of milk, showed me how to get Zac properly attached (after I stopped her from just attaching him herself and asked her to show me how to do it), and insisted that the nurses had over-reacted and I didn’t need to use formula. When I asked how to tell if Zac had had enough she asked if the lumps in my breast had gone. When I said no, and explained that the lumps had remained through 27 hours of feeding, she just told me to feed him until the lumps vanished. At which point I gave up on getting any useful help there and thus Rafe and I brought home a crying, hungry baby on a Friday, probably the worst day to get discharged with a newborn.

Things went downhill when Zac stopped taking my breast at his 12am feed that night. Rafe, Zac and I spent most of the night awake, with 2 of us crying, Zac from hunger, me from desperation. Rafe started looking for numbers to call at about 8am Sat morning and finally reached someone after trying several numbers. The midwife I spoke with initially was not impressed that I’d come home with a baby on formula top-ups already, but as we talked and I described what was happening with Zac (urates in nappies, lethargic, crying, not taking the breast etc) she eventually agreed that we had a very hungry, dehydrated boy who needed feeding however possible.

Since then, we have been pretty much following the same plan; sometimes trying to cut back the formula in accordance with advice from the MCH nurse, but clearly Zac gets too hungry.

I have come to terms with giving Zac formula, and the fact that he won’t be receiving all the wonderful benefits of being exclusively breastfed for the first 6months. Like the choice with birth method, ultimately I want what is best for Zac, and the benefits of exclusive breast milk only work if I’m not starving my baby to give him those benefits. I did go through a day or so of feeling that between a caesarean birth and needing formula to supplement my baby, that I just wasn’t as suited to baby making as I had assumed. There is such a primal need to be able to feed your young that it can feel quite devastating to be unable to do so adequately. Fortunately I live in a time and place where alternatives do exist, and for that I am truly thankful.

speaking to Sue, the lactation consultant, was just such a huge relief yesterday. She also works in pediatrics, so has a healthy does of pragmatism where, yes breast is best, but a healthy happy baby is most important of all. She has worked with a number of post-breast surgery women and said that in her experience, women who had their surgery more than 8 years ago often end up using a combination of breast and formula, as there is usually more extensive nerve damage in the breasts than originally suspected.

Sue’s approach will be to throw everything at the getting my supply up: Chinese medicine, pumping with a hospital grade pump, western medicine, skin to skin, supply line etc, and go from there. Obviously best case scenario will be to generate enough milk to feed Zac from the breast 100%, but failing that, the task will be to work what proportion of his daily requirements will come from me and how much he will need topping up. Sue said that even if he’s getting just 10ml of breast milk each feed, that’s still 10ml of breast milk and all it’s goodness. This is the sort of attitude I’ve been needing to hear from a professional. .