I had my heart absolutely set on exclusively breastfeeding. Absolutely set.
I made the decision as a freshman in high school, in one of my pre-med classes. I remember my teacher, Mrs. Cohen, talking about the benefits of breastfeeding for both mother and baby, and it all just made sense. That's what I would do for my baby, I decided. Plus, my mother breastfed me. It's what mothers do for their babies.
I knew it would be hard, and I was prepared to do whatever it took to make it work. I took a breastfeeding class while I was pregnant and paid close attention to the different positions and how to get a good latch. I learned about the importance of skin to skin contact right after birth, the on-demand supply of breast milk, mastitis, nipple confusion, sore nipples and more.
Very shortly after Caleb was born (after he was suctioned because of meconium), I held him against my bare chest. His instincts kicked in and he began wiggling toward my breast and sucking for it. He knew just what to do but I was clueless, despite my studious training. I asked a nurse for help and he latched on right away. It was beautiful and worked just as it should have. I felt like a Mom, and it is a moment I'll never forget.
Caleb was an amazing breastfeeder. He had a good latch and a strong suck. I knew to listen for swallowing sounds, that sweet little "kuh" sound that is music to my ears. Everything was going great! We tracked Caleb's feeds on a piece of paper the hospital provided, and switched off between left and right. It seemed like he wanted to eat all the freaking time but that's ok, because that's normal for a newborn. "Cluster feeding," the nurses called it.
Our second night in the hospital, things started to go downhill quickly. The sleep deprivation was catching up to me (and John), and if Caleb wasn't latched on to my breast or in my arms, he was crying. I couldn't put him down, which means I couldn't sleep. After having gone through two days of labor, my poor body was so depleted and I needed rest desperately. My nurse told me he was using me as a pacifier and pressured me to put him in the nursery and give him a pacifier, both of which I told her I absolutely did not want to do. But I was so exhausted that I didn't trust myself to hold him anymore, so I gave in for two hours. (I still have major mommy guilt over this and cringe to think about it). I was so stressed about being away from him that I just laid there and cried more than I slept.
I was barely conscious the next day, but I remember being worried about his poop. He hadn't pooped in his diaper yet, but the nurses assured me that was ok because meconium counts as a poop. Still, a nurse probed his tiny little butt with a thermometer and coaxed out some poop. We all cheered.
I pushed hard to get a lactation consultant to come see me that day. For the life of me, I don't understand why there is not an abundance of lactation support in hospitals, but it's like pulling teeth to get help. She was the only lactation consultant in the hospital and she spent an hour with me. We worked on different positions, and she said we were doing amazing and she didn't foresee any problems ahead for us. I told her I was worried I had ruined our breastfeeding relationship because I let the nurse give him a pacifier, but he latched on like a champ and she said there was nothing to worry about. She also explained that newborns don't use breasts as a pacifier, that it's a natural instinct that helps jumpstart a mom's supply. The contradictory information was already starting. Still, I felt confident after meeting with her. I was doing a good job. I can do this, I thought.
We made the scary trip from the hospital to home, where there were no nurses even though grandma and grandpa were there to help. I was still in a daze and barely functioning, but kept breastfeeding round the clock. We had our first pediatrician appointment and Caleb had lost some weight, but was still within the normal range. It's perfectly normal for babies to lose weight at first, but they should be back up to their birth weight by two weeks. There were no worries.
When he was 6 days old, I went to "The TEA," which is a breastfeeding support group for new Moms that is free and sponsored by the hospital where I gave birth. I went a few times and began to worry that Caleb was not getting enough to eat. We still had to coax out his poop, and my breasts didn't get full and heavy like the other Moms were complaining about at Tea. I expressed my concerns, but other Moms assured me everything was fine. Another Mom didn't have the fullness either, but everything was fine with her supply. But I used the baby scale before and after a feed and he barely transferred any milk. Was it just a fluke? Sometimes babies just want a snack instead of a full meal, I'd hear. I tried the tea and the lactation cookies just in case.
My worries continued, so I set up another appointment with a lactation appointment. The two week pediatrician check-up was looming, and I was worried Caleb wouldn't be back to birth weight by then. In fact, he was still losing weight. The meeting with the lactation consultant was not promising. He didn't transfer much, and we talked about ways to increase my supply. We made an action plan. She casually said she didn't feel a lot of glandular tissue in my breasts; she said it so quickly and unimportantly that I almost missed it, and I didn't think much of it at the time. Caleb kept falling asleep at the breast, a common problem for newborns. We talked about ways for me to keep him awake (wipe a cold, wet washcloth across his back, and similar forms of torture). He was a "lazy eater," she said. It made sense this would be the reason for my supply issues. It all seemed very fixable, and I was ready to put our plan into action.
I started taking special herbs that help boost a mother's supply, mainly fenugreek and blessed thistle and I ate oatmeal every day. I saw my OB and got a prescription for Reglan, a medicine that helps boost supply. I started pumping and giving Caleb formula until I could get my supply up. I would breastfeed him, then give him a bottle of formula, then pump. The feeding process had gotten incredibly complex all of the sudden. I pumped and pumped and pumped, but only a pitiful amount of drops would come out. (Before I figured out how to go hands-free), I remember holding the flanges against my breasts and watching the drops in desperation, hoping that I could at least cover the bottom of the Medela bottle. I was sure there was never another mother on earth who made such little milk as I did. Two days after starting Reglan, I started shivering and shaking uncontrollably and I couldn't sleep or get warm; I felt like I was crawling out of my skin and losing my mind. Turns out, it was a reaction to the Reglan so I had to stop taking it - just as I was starting to see a slight increase in my supply.
The two week check-up came, and Caleb was not back to birth weight yet. I had failed my first test as a mother. I was starving my baby. What kind of mother was I? After everything I had gone through to get pregnant, my body was failing me again. And I was failing my baby.
I began to understand why our second night in the hospital was so rough, and why Caleb cried so much from then on. He was hungry. He had been hungry all that time. The mommy guilt kicked in, and nearly engulfed me.
I kept pumping. I almost never left the house because our feeding routine took so much time and I was always pumping. I kept waiting for my supply to increase. It never happened.
I went back to the LC and learned about an alternate drug to Reglan: Domperidone. It wasn't FDA-approved but I researched it and was comfortable taking it. So I ordered some online from Hong Kong and paid $40 for expedited shipping so I could start right away. I did more weighings before and after feeds and Caleb still wasn't transferring much. The LC mentioned that fertility problems can also cause breastfeeding problems, and taking Metformin sometimes helped.
I made an appointment with my reproductive endocrinologist (aka, fertility doctor) to ask him what he knew about this. After all, he was the expert on PCOS and fertility issues in general. But, he didn't have a clue. In fact, he had never even heard of such an issue. Women with PCOS can actually have a problem with oversupply. Are you kidding me? If only. I explained the little I had learned thus far about my lack of "glandular tissue" and how the hormonal imbalance can cause them to not develop correctly. "But, are your breasts underdeveloped?" he asked. Clearly, they are not underdeveloped by size by any measure. I was a DDD pre-pregnancy and was never lacking in the chest area, since around age 12. Bottom line: He was not comfortable prescribing Metformin for me since he wasn't familiar with any of this. It was back to the drawing board.
How could a woman with such large breasts not make enough milk? It didn't make any sense, and I had done everything "right," as much as I could, to support a healthy breastfeeding relationship. Why was this happening to me?
I felt like I wasn't getting help from anyone, and I couldn't understand why. I turned to Google. I learned that my issue has a name: Insufficient Glandular Tissue. It had a real name! That meant I wasn't the only woman in history to have this problem! Just learning that was validation for me. First, I learned there is very little information on this issue and it's somewhat rare but is unfortunately becoming more common.
I will probably go into more detail in another post at some point, but the short explanation is that my breasts don't have enough glandular tissue. Even though they are large in size, it's not the "right" kind of tissue. This is partially from my initial development during puberty and partially from my first trimester with this pregnancy. Something with my hormones went haywire, and the glandular tissue didn't form.
In other words, it's impossible for me to make a full supply, at least right now. There are many, many reasons a woman has supply issues and they are almost all fixable. Except this one. It's completely out of my control. Despite my will to do whatever it takes to exclusively breastfeed, I had to eventually realize and accept that.
It was an ugly road to acceptance, and some days I still struggle. Some days I see other Moms plop a baby under their shirt and effortlessly breastfeed and I wonder why that couldn't be me. Some days I think about all the Moms that are capable of breastfeeding but decide not to. Why can't they transfer that ability to me? I would put it to such good use.
But, for the most part, I am at peace with where we are today. Six and a half months in, and I'm proud to say we are still breastfeeding. I am a breastfeeding Mom, even if this is not what I envisioned.
I still offer the breast at every feed, though we are struggling through nursing strikes right now. I still pump, but not after every feed. I pump after his first feed, and after his last feed - for a total of an hour to an hour and a half each day. This allows me to leave the house during the day and actually have a life. I found a happy medium with the pills and only take a couple that seem to work the best for me. I store my pumped milk until it adds up to a full feeding and every other day (or sometimes even every day!), Caleb gets a full bottle of breast milk. And I feel great about that.