Monday, September 23, 2013

Not enough milk: one mother's story

A blog reader, Michelle, sent me her breastfeeding stories. She has four children and was never able to nurse exclusively, despite trying everything. I'm so glad she was willing to share her experiences. Some women cannot produce enough milk for their babies. For those who want to nurse but cannot, the regret and frustration can be overwhelming. 

Michelle commented to me: "I am very grateful that I was able to nurse my girls for however long I could. I wish I were still nursing my fourth! I am glad to that I finally decided to pursue all solutions because I needed to realize that nothing I did would help. That knowledge helped alleviate a lot of guilt. If I ever have another child, I won't beat myself up so much and just enjoy what I can give them!"

I want to encourage anyone who can to donate breastmilk to mothers in need. You can go through a milk bank, or you can donate directly. I chose the latter option because milk banks charge upwards of $4/ounce and they pasteurize the milk. I was screened for any common infectious diseases (the same ones that milk banks screen for) and shared the results with the donor family. You can visit Human Milk 4 Human Babies to connect with families in need.


My first pregnancy was very easy. The only unusual thing about it was that my breasts didn't grow, but since it was my first, I didn't notice. After a traumatic delivery with 4th degree tearing, I struggled getting my baby to latch but she eventually did. 72 hours postpartum, my milk came in and we started our nursing relationship.

At five weeks postpartum, my milk supply suddenly dropped. I thought it was because of two reasons-- the first being that at two weeks postpartum, I had gone back to school to finish my last year of college and, since I didn't have a breast pump, instructed the babysitter to feed my daughter formula when she was hungry. The other reason, I thought, may have been because my daughter was going through a growth spurt.

After two weeks of near-constant nursing and lots of crying, I realized I needed to supplement. I had been co-sleeping, drinking a lot and taking brewer's yeast (the solutions suggested to me by my lactation consultant) but I simply wasn't producing enough. I started supplementing a lot but continued nursing a little until we weaned at eleven months.

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My second pregnancy was also easy and this time my breasts did grow a little. I had a much easier labor with very little tearing and nursed almost immediately after. My milk came in at 48 hours and all seemed to be going well until I got mastitis twice the second week postpartum. After that my milk never recovered and I started supplementing at three weeks postpartum. I also experienced postpartum depression, which negatively impacted my milk supply and my daughter weaned herself at 7 months. I was very sad, but my daughter was finished.

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My third pregnancy was a joyful one and healing in many ways. My breasts grew a lot and I had an easy, natural delivery. My third daughter latched easily and nursed well. My milk came in well at 48 hours. I was determined to do everything right and nurse full time, so I obtained a hand pump and for the first six weeks, I would pump one side while nursing on the other--even in the middle of the night. I got mastitis but caught it early enough that it didn't affect my supply.

At six weeks I figured that I had established a good supply and stopped pumping. At around four weeks my daughter had started crying every night for hours and was growing slowly, but I felt like I had enough. When I stopped pumping, however, I saw a very fast decrease in my supply. At seven weeks, I began taking fenugreek daily to help my supply, which I did until she was about four months old. At that point I had to start supplementing, in spite of the fenugreek. Once I started supplementing, my daughter stopped crying at night and started growing faster. We supplemented and nursed until she was 14 months old. Supplementing brought about a huge personality change in her and she turned into a happy, easy baby.

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My fourth pregnancy was harder. There was a lot of stress, some antenatal depression, and I had incredible hip/sciatic pain. I would crawl to the bathroom in the middle of the night because it was too painful to walk. I was determined to breastfeed, but I started getting concerned when I couldn't express any colostrum one month before her birth. My breasts grew, but not nearly as much as my third pregnancy.

Her birth was an amazing, unassisted home birth. She started screaming as soon as she was born and didn't stop for 30 minutes. I tried to get her to latch and finally she latched at 30 minutes postpartum, but didn't nurse well or frequently the first 24 hours. I kept her at the breast for nearly 36 hours, but she struggled with her latch and bobbed on and off. She figured out her latch around 72 hours. My milk also came in about then, but I wasn't engorged. I never suffered any engorgement at all.

At 6 days postpartum, we received a call from her pediatrician stating that her newborn screening results had come back abnormal. We spent the next 3 days meeting with doctors and specialists, with a huge amount of stress and very little sleep. She was diagnosed with MCADD, a rare but fairly easy to manage metabolic disorder. One of the management techniques was frequent feeding, every three to four hours. She was a good sleeper, so I had to set alarms throughout the night to wake up to feed her.

By the time she was 10 days old, I was on Reglan to increase my supply. We were in the middle of selling our house and the stress of that, combined with the stress of her diagnosis and lack of sleep, impacted my already tenuous supply. My supply had dropped the few days we were learning about her diagnosis and I simply couldn't keep up.

In order to build my supply back up after taking Reglan, I started sleeping nine to ten hours a day, consuming about 100 ounces of fluid and about 3000 calories. I put on weight. I obtained a double electric breast pump and pumped in between nursing sessions. I co-slept, took my Reglan prescription (even convinced my doctor to give me a refill) and began taking the MoreMilk Plus tincture. I nursed her as frequently as she wanted, often sitting for three to four hours in the evening just to get her to sleep. I continued this regimen of milk-increasing tactics until she was 9 weeks old. By this point, we were getting ready to move and she was so hungry she screamed all day in my arms. I would nurse her every 45 minutes for 20 minutes, pump during or in between and do all the other things I had been doing. She would bob on and off, cry the whole time we were nursing and was not satisfied after. She would scream most of the day and nursed constantly at night. I was completely exhausted, mentally and emotionally.

In order to make our move easier, I began to pump instead of nursing so people could feed her while I was packing. I have an overactive letdown reflex and can easily pump. It was then I realized that I was only producing seven to ten ounces a day in spite of everything. I had only been supplementing with four to six ounces of formula a day up to this point. I realized her crying wasn't because of colic, but because of hunger. I was basically keeping her fed just enough to avoid a metabolic crisis.

So at eleven weeks old, six days before our move, I stopped nursing. The first day on the bottle, she ate five ounces every two hours. I wasn't even engorged. We realized that she was starving. We also realized that as part of her metabolic disorder, she was only able to use a certain amount of her food as calories and needed to eat twice as much as my other children in order to get enough calories. Even now, at four months, she is very petite but eats voraciously. I wasn't producing enough to feed a regular baby, much less one who needed extra calories.

That decision proved to be the right one. We were able to move much more easily. She started putting on weight. She hadn't smiled much but she began smiling more. I could finally take a short shower without her screaming. I could even put her down to do the dishes!

The biggest difference was her personality change. When we bottle fed her, she stopped screaming. She was still a needy baby, but she was actually content in my arms or a carrier. She slept peacefully. She cooed at me. She was a different baby.

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In the midst of the challenge with my fourth daughter, I came across some articles that talked about lactation failure and insufficient glandular tissue. I don't have all the physical characteristics, but I do have very wide set and small breasts. I found that there were almost some genetic markers in my family that could have clued me in too. In talking with my father's mother after the birth of my fourth daughter, I learned that her breasts never changed during pregnancy and her milk never came in with any of her three children. My grandmother has three sisters, and none of them had their milk come in. My great-grandmother and great-great-grandmother were also unable to nurse and relied on other things to feed their babies. My great-great had 13 children and gave them all meat broth!

It has been two and a half months since we weaned. I so desperately wanted to nurse all of my children, and, despite exploring every option, I simply can't nurse. The realization that I will never be able to nurse a baby successfully has been excruciating. I truly love nursing. I treasure the moments of closeness. Cuddling skin to skin in the middle of the night. I miss the peace that comes from nursing.

I also feel guilty. Looking back on my third daughter, I realize that I wasn't producing enough for her. I feel a lot of guilt over my selfishness in wanting to nurse her and being unwilling to see she wasn't thriving. I feel guilty knowing that I'm not providing antibodies for my fourth daughter. I feel guilt that I'm using formula.

I pleaded with God to change my body, to help me nurse my babies. I pleaded that He would give me a miracle. But it seems that this experience has been one to humble me.

Breast is best and I love to breastfeed. I am grateful for the times I was able to breastfeed my daughters. I will always cherish those moments.

9 comments:

  1. Do not worry dear!!! every thing will be fine. All the best for your future.

    Aaron |
    Mobile Massage

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  2. Thank you for sharing your story. My best friend wasn't able to nurse due to DMER, and even though she knew she was making the best decision (having panic attacks and sobbing every time her milk let down), she felt horrible about not breastfeeding "enough." I exclusively pumped for my daughter (she is 4 now) and I still feel bad about that... what if I had done this, or talked to that person? My son has been ebf since day one so there has been a bit of redemption for me in my own experience, but now I'm feeling bad because I really want to wean and he is not ready! Perhaps we are hard-wired for guilt no matter how we slice it. :)

    I know how difficult it is to not be able to nurse, but it is honestly very refreshing to hear stories like yours. Sometimes I think the loudest "lactivists" are the ones who had the easiest time with breastfeeding.

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  3. Thank you for sharing your story! Your children are blessed to have you!

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  4. I have IGT too and even though I wish no one else would experience it, I'm always thrilled to see these stories on main stream natural birthing type blogs. That kind of exposure is what we need so the idea that "Everyone can breastfeed" will end and we can stop being shamed by people who dn't know what they're talking about. Way to go for sharing!

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  5. I had a girlfriend who was a similar situation to yours, she looked at the breast milk that she was able to provide as the vitamin boost to her children. She fortunately learned early on that she was not going to be able to provide 100% for her children solely from nursing so she used to call it vitamin boost time. Corny but the perspective change helped her to get over the guilty feelings. I was not able to nurse my 3rd now 18 months due to palate issues with him and unfortunately I'm not a good pumper so he only had expressed milk for about 8 weeks, but I'm okay with that and grateful that I had an alternative to offer him.

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  6. Clearly, Michelle, put a lot of effort into breastfeeding and loves her babies very much. That is what matters. I hope she is not upset about not meeting her goals. She must be a wonderful mother to try so hard despite so much adversity, especially during situations when many of us would have given up much sooner.

    I would like to comment, though, that from the limited information provided here, this doesn't actually sound like a case of not being able to produce enough milk due to a physical issue -- a lot of it reads to me like mismanagement of supply, as well as a lack of initial education and adequate support. From her descriptions, she actually started out with a good amount of milk (so much that she actually experienced multiple bouts of mastitis from too much milk not being drained frequently enough) and had other things -- booby traps -- that cause her supply to falter. I wish there was more education available to women before they get into those situations, and I wish there was more knowledgeable support available to help them rebound from tough situations when they do occur.

    Michelle, if you are reading this, please do not blame yourself or your body. Our culture and medical community failed you and your girls; you did an amazing job and none of this is your fault.

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  7. Wow, just wow. Thanks for telling your story. It is true that some women have physical problems that will inhibit or prevent adequate milk supply. From Reardon and Wambach's text, they site anemia from post partum hemorrhage, sever hemorrhage can cause Sheehan syndrome, insufficient glandular tissue, inverted nipples,retained placental fragments, thyroid disorder, polycyctic ovarian syndrome and diabetes to name a few. Your Lactation consultant, if she is an IBCLC should have picked up your wide spaced nipples right away.
    It is also true that for years the medical community has told women that everyone can breast feed. And that simply is not true. It is unfair to women to not have more medical professionals educated in lactation. A huge government push in America is not occurring to train Doctors and Nurses in the physiology of human lactation, but a gape in knowledge still exists.

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  8. Thanks for sharing your story! I sometimes wonder about the phrase "tried everything"...I don't see any mention of blessed thistle, yet my IBCLC said I had to take both fenugreek and blessed thistle together....is there any resource out there that really can cover "everything" a mom can do? Kudos to you though for trying so much!!!! Too many moms don't even find out that there ARE ways to (usually) boost supply, though some info is easy to find.
    I was stunned to read that feeding your 4th "frequently" meant every 3-4 hours! For a breastfed newborn?! That's crazy. Frequent, to me, with a newborn, would be every 2 hours at the LONGEST. It's little things like this in the medical world that makes me wonder if breastfeeding will ever be seen as the "norm" again (despite the fact that aprox 70% of newborns ARE breastfed, it just doesn't seem to be portrayed as the norm anymore).

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    Replies
    1. Yes, 3-4 hours does seem really infrequent. Ivy is 6 months and still nurses every 2-3 hours during the day and every 3 hours at night (she might have one longer stretch when she first goes down).

      The frequency of nursing really matters. My MIL had 7 kids. With her first 6, she "didn't have enough milk" and had to quit breastfeeding when they were around 3-4 months old. With her 7th, she didn't. What was the change?

      With her first 6, she followed her doctor's advice to nurse every 4 hours. She said they were starving all the time. The medical wisdom had changed by time she had her 7th. Her doctor told her to nurse her baby as often as the baby wanted to. The baby nursed every 90-120 minutes around the clock, and guess what? She had plenty of milk and never needed formula.

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