Thursday, April 30, 2009

My Breastfeeding Story - Part 2

When Jude was about three weeks old, we met with our new LC Dora* for the first time. Jude had gained four ounces in four days. We were happy about his weight, and thrilled to find out that Jude was now getting more than a half ounce from a nursing session with me. Dora was amazing. I really think that working with her is what got me on the path back towards being able to breastfeed exclusively. At the time, that was the most important thing to me (since then, my perspective has changed somewhat - more about that later). She sympathized with the fact that pumping was so unrewarding for me, and suggested that we try tube feeding instead. Jude had begun to prefer the bottle to the breast (and why not? he got food with much less effort that way). It had gotten to the point where he wouldn't really bother to suck while I fed him - he was just waiting for the bottle. The tube solved that problem. Dora rigged up a bottle with a feeding tube - put the supplement in the bottle and stick the tube in his mouth towards the end of a nursing session. As far as he knew, he was getting the milk from me, so he worked harder and therefore increased my milk supply while nursing. Over the next few weeks, we managed to gradually increase my production to about four ounces per feeding by supplementing with the tube after every daytime feeding. At night, Jude slept for long enough between feedings that I always seemed to have plenty of milk for him. But while my supply was increasing, Jude's needs were increasing as well. It didn't seem like I was going to be able to stop supplementing anytime soon, and I really wanted to get to the point where I was providing all of Jude's food.

At some point, Dora made the observation that Jude seemed to have a tight frenulum. This means that the flap of skin that attaches the tongue to the bottom of the mouth was shorter than usual, which was preventing him from really being able to use his tongue to suck well. There's a good chance that this was the reason that my milk supply had dropped so low in the first few weeks of life - although I thought he was eating, he wasn't physically capable of extracting much milk. We took Jude to a surgeon who was able to correct the problem in less than a minute. I wasn't really surprised that Jude had this problem - I had had the same issue as a child and so did my father (and it is hereditary). The surgery seemed to help some, but not enough that we were able to stop supplementing.

We talked about medication again. The standard medication that is given to nursing mothers in the United States to increase milk supply is called Reglan. It works fairly well, but has some pretty bad side effects, including depression. I was already having some symptoms of postpartum depression; mostly due to feeding issues, I think. So I was reluctant to take anything that might exacerbate this situation. Dora suggested that I talk to my doctor about Domperidone. This is a drug that used to be prescribed to nursing mothers, but is no longer manufactured or sold in the United States. Domperidone is available in most other countries in the world, for the most part with no prescription required. We decided to try that route, and I convinced my doctor to prescribe it for me. There is a local compounding pharmacy that will make Domperidone if a doctor prescribes it. My doctor would only give me a half dose at first, because she wanted to see if that would work. Within a few days, I noticed a difference. Jude seemed to be eating more at each feeding and I could hear swallowing much more often. It took about two weeks, but we managed to get to the point where we were only giving him a supplement twice a day. I was still really motivated to breastfeed exclusively, and so I convinced my doctor to increase my dosage to the full dose. That did the trick - we were able to stop supplementing entirely within a couple of weeks.

Around this time, I started to think about going back to work, and so I wanted to build a supply of frozen milk to make sure we had plenty to feed Jude while I was away. I started to spend a lot of time pumping - in between feedings, at night after Jude went to bed, anytime I was away from him, etc. At this point, pumping was better than the last time I had tried, and I managed to collect two, three, and sometimes four ounces per session. By the time Jude was four months old, I was producing more than enough milk and had started to build a supply in the freezer. Around this time, we went on vacation to the East Coast for two weeks. Jude seemed less interested in eating, and often only wanted to nurse for 15-20 minutes at a time. This was fine with me since it took less time to feed him. But between his reduced nursing time and the fact that I stopped pumping while on vacation, my supply started dropping again. I got back from vacation and it was time to go back to work. Within a week or so, I wasn't able to pump enough during the day to keep up with his demands, so I had to resume pumping every night after Jude was asleep. Sometimes I would stay up just to pump, and I began counting the days until Jude started solid foods, hoping that he wouldn't need as much milk. We started giving him solids at around 5 months of age, but it didn't change his milk demands much. We had a vacation coming up, and I decided to stay on my medication until we returned so that I could nurse him on the airplane. He would be seven months old when we returned from vacation, and by then I was ready to let nature take its course and stop taking medication to keep my supply from dropping.

While Domperidone works really well, there are a few problems with using it. First, it is expensive and not covered by insurance. Second, I found that I had to keep taking it in order to keep my supply up. I tried tapering down a couple of times, and found that I started making less milk almost immediately. Finally, as I mentioned in my other post, I developed a voracious appetite and was unable to prevent myself from gaining weight while taking the medication. Despite these problems, I'm glad that I was given the option of taking Domperidone. I think that if I had never gotten to the point of being able to have an adequate milk supply, I would always feel that I had somehow failed Jude. Ironically, now that I've experienced "breastfeeding nirvana", I no longer think that it's as important as I once did.

Around this time, I read this article in the Atlantic Monthly. It really gave me a new perspective on breastfeeding. Pretty much everything that the author says resonated with me. I like her approach, which is that if breastfeeding works for you, that's great, but the benefits are not so dramatic that it's worth doing anything and everything to make it work. Formula may not be as good as breast milk, but it is a close second, and a perfectly acceptable alternative when a mother is not willing or able to nurse. Nursing is a huge commitment on the part of a mother, and sets up a dynamic of inequality when it comes to infant care, no matter how involved her partner may want to be. I know that there were times when I resented the fact that E Ben could disappear for hours at a time to do his own thing. Even when someone else was taking care of Jude, I had to be available to either nurse or pump every couple of hours, so I was never able to have true "time off". I now know that this was partly my own doing - it would not have been the end of the world to miss a feeding or use up some of my supply of frozen milk, but at the time it seemed like I had no choice. Hanna Rosin says it better than I - you should read the article.

I have been medication-free for the last month. I've noticed that my supply definitely has dropped. I used to be able to pump 8-10 ounces a day at work and now I'm lucky to get 4. I still nurse Jude 3-5 times a day, but he also eats three meals and at least one bottle of formula (right before bed). I no longer pump at night, or anytime except when I'm away from Jude for a full day. I'm sure that I'm not really making enough milk to fully satisfy Jude's voracious appetite, but we are lucky that he eats solid foods really well and seems happy to drink from a bottle when needed. Will I make it to a year of nursing? That was my original goal, and though I've revised it in my mind at this point, I can see myself continuing this level of nursing for the next four months, and perhaps even longer than that.

Up next: final thoughts about breastfeeding

* Not her real name...

1 comment:

Carla said...

Linden- You go girl for sticking w/ nursing Jude through so many obstacles. I've read that article too and am not a fan. I just think it grossly misrepresents research and facts. Pretty much every national health organization came out against the article and provided research that shows how beneficial breastfeeding truly is for an infant. I just hate to think a pregnant woman who wasn't well educated on the subject would read that article and then decide it wasn't important to breastfeed their baby. I sound like a nursing nazi now but I'm really not....I know it is a personal decision for each woman.