Unexpected Outcomes: It’s about more than just the milk.

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The August 2013 NACEF conference was about making decisions when babies have other plans, and how to process unexpected outcomes in general.  As a new board member, I was going through my own unexpected outcome around birthing and a wonderful new grandbaby and really benefited from the various perspectives the conference provided to my situation.  Here is our story…

My daughter and her husband gave birth to our first grandchild in June. We were so focused on the birth…they graciously invited me to be part of their birth team and we all studied and planned carefully, copiously, and hopefully with enough flexibility to get us through.  The birth day came and lasted a very long time.  No easy cards were drawn in the mix but my daughter proved to herself and everyone around her how strong she really is.  With all the planning, teamwork, support and tools in the tool kit, baby Audrey arrived safe and sound after more than 24 full hours worth of HARD labor.  Phew!  I admit it’s been a while since I have donated a full night’s sleep and needed to be “on” for that length of time.

At first, postpartum recovery seemed to be rather anticlimactic, the way it should be right? Baby was skin-to-skin within minutes of being born and licked and nuzzled on mama’s breast for several hours. All parties were enjoying the baby honeymoon, resting, trying to sleep, eat, feed the baby, and beam with joy…. The new parents and new grandparents were all hanging out in that weird space of being wired and tired with this new little life in the mix.

Some sleep, some food, some processing of events, but wait…what’s this about no breast milk coming in?  Give it some time.  Let’s focus on demand and surely the supply will follow.  Day 2, another night’s sleep dedicated this time to helping put this new beautiful, awesome baby to breast as she awoke ever more hungry.  Sitting up in the hospital postpartum room with the new family seemed like the right thing to do, to ensure that every feed had an acceptable latch and the best possible chance of getting breastfeeding off to a good start.  After a 6% weight loss, they were discharged from the hospital with instructions to pump and continue feeding on demand. Will do!!

Day four, the new family is home in their nest and all seems to be going well. I receive an early morning call… “Please come over….we need help!”  Baby has been crying all night and seems so hungry! There still have been no bowel movements since the meconium from Day 1 and precious few wet diapers. Mommy was desperate to help her crying baby.  She still had no significant breast changes, and is only able to express drops on one side, a bit more on the other side in spite of frequent attempts, and what looks like a good latch from baby.  Let’s go see a lactation consultant…today!  It took some perseverance but we got in that afternoon.  Baby had a 12% weight loss from birth. After watching the baby latch and approving, the lactation consultant provided an SNS (supplemental nursing system) and some formula that saved the day.  Then began the feeding-pumping regiment, as my daughter was not willing to give up on breastfeeding. We saved each and every drop of breast milk we could to give to the baby.

After exploring every path that was available to us, we finally landed on an elusive reason for this lack of milk. What we never suspected was that during puberty our daughter did not develop very much, in fact precious little, mammary tissue.  Who knew?  Where was I?  What trick of genetics had been dealt that we just now have to deal with? I was mad…a secondary reaction to the deep frustration over realizing that this was likely the cause of the issues.  I was so sad…. can’t change it now…. I was desperate and reached out to everyone I could think of.  Finally…I knew we’d just have to wait and see what all the work that our daughter was putting into this would pay out.  My work was to support her emotionally, physically, and mentally and to stay as supportive and collected as I could.  Still, we kept searching for answers.

I talked to all the lactation consultants I knew.  We read everything we could get our hands on.  We bought all the herbs.  Our daughter went out on the Internet and purchased Domperidone and took it faithfully in increasing amounts as prescribed.  While she barely gained 16 pounds in pregnancy, the Domperidone made her constantly hungry and she gained weight beyond her term pregnancy weight…but emotionally was managing the drug.  We now had the reluctant support of a primary care provider.  What an odyssey!  Pumping, the SNS and hope pulled us through the days and nights…..

Now five months later, where are we?  What are the lessons learned?  I asked my daughter and here are her replies:

 

What has it been like to go through this process of feeding Audrey so far?

Very challenging, heartbreaking and exhausting, but also rewarding knowing that I (we) have done everything we possibly could to give us the best chance at providing enough milk. I have to keep reminding myself that it’s about more than the milk and what milk she does get is better than nothing!

It has been the biggest endurance challenge of my life but ultimately so rewarding because despite everything, I have been able to have a breastfeeding relationship with my daughter even though it looks completely different than what I had always imagined.

Those first days and weeks I had so much hope that my milk would just “come in” like all the books and experts said it would. It’s “rare” for a mother to simply not produce enough milk. According to the information out there, it’s usually something the mother is not doing, or is doing wrong, so we did it all (diet, herbs, chiropractor, endocrine specialist, massage, different pumps)!!  And checked and double-checked with as many experts as we could ask!  We also checked and worked with Audrey’s latch in case that was the problem, but she is a champion sucker!

Hour by hour, day by day we faithfully put formula in the SNS, hung it up on a pillow, taped the tube to my petite chest and our sweet Audrey had every single feeding by breast. I pumped after every feeding through the day and night. My husband got up with me every time without falter offering is support and he became a self-titled “milk recovery specialist” sucking every precious drop into a syringe that went to the slow-growing collection. 

Every feeding I would offer my breast without the formula to see if Audrey could get what she needed without the SNS, but every time after a few sucking attempts, she would pull off upset at the lack of flow. I was worried that if I let this happen too much that she would develop a frustration and negative connotation with nursing so I kept it to a minimum.

Eventually I came to peace that this is what our breastfeeding relationship was going to look like. I have let go of the thought that I am able to provide all the milk my baby will ever need, but I have not let go of trying to give her all the milk I can produce!! 5 months and two teeth later, her tolerance for the breast and SNS seems to be dwindling as bottles provide a much easier flow, but I am still pumping regularly (not through the night however) and am able to add some breast milk to nearly every bottle. I think of it as her daily vitamin and am happy to keep pumping to be able to provide what I can. Audrey is a happy, healthy, thriving baby and I am so thankful for her and hope that my experience can offer some support to other mothers who may have had to redefine their breastfeeding relationship. 

 

What has helped?

Mentally, reminding myself that it IS about more than just the milk, but that whatever milk she does get from me is really beneficial. Other moms I’ve talked to and read seem to have the mentality of “all or nothing” that if you have to supplement or introduce a bottle then you can kiss breastfeeding goodbye or that if they’re not getting 100% breast milk then you might as well not breastfeed at all. 

Physically, pumping with a more casual attitude towards it. If you can swing by your pump and do it for 5-10 minutes, that is better than putting off/delaying a 20 min session because you’re dreading it! Also, using the let down button a lot! Alternating between the two stages. (Both of these great tips are from the amazing Doris Onnis!) And, the herbs! Fenugreek and the lactation blends have been helpful.

I absolutely could not have done this without the unending love and support from my husband and mom (and the rest of our family and friends)!!

 

How can childbirth educators help prepare expecting moms and couples for breastfeeding and possible unexpected outcomes with breastfeeding?

Like everything else about mommy hood, trust your instincts and read your baby. If they’re not getting enough milk, don’t give up on breastfeeding. Go to a lactation consultant; get an SNS and keep trying because as long as both parties are willing to work for it, it’s worth every drop and it’s about more than just the milk!

 

Postscript:

As a childbirth educator, encourage the expectant mothers to talk to their healthcare provider about their desire to breastfeed and also to suggest the provider look at their breasts if the mom is telling them they have experienced very little breast changes during the pregnancy.  This may have helped us to be more prepared ahead of time, rather than feeling so caught off guard.

As a new grandmother, my heart glows and then melts to see baby Audrey snuggling up to her mommy’s breasts.  It’s been quite the process.  Each day is different.  Just today, my daughter texted to say she has pumped the most ever…almost an ounce!  We are not sure where this breastfeeding experience will take us.  So far it’s taken us to New Zealand, LA, and New York…this was just following the Domperidone (long story).  Kellymom website is so helpful and the book, The Breastfeeding Mother’s Guide to Making More Milk, by Diana West and Lisa Marasco now has a permanent place in our library. The La Leche League website helped, too.

It’s felt like a roller-coaster ride and so far we are still hanging on!

 

Cindy Crosby serves as the NACEF Treasurer, and is a Health Education Specialist for Salem Health’s Community Health Education Center (CHEC). Her first granddaughter was born in June of this year, and apparently wants a pony for Christmas.