Wednesday, January 23, 2013

Boosting your milk supply, does it really work?

There are a million articles I've read on this subject. When I had to start supplementing Lucy, the Pediatrician suggested that I drink Fenugreek tea three or four times a day. She had used the tea with great success and assumed that I would naturally have an increase in supply if I did the same. I don't know how many of you have tried the Mother's milk tea, but let me tell you, if you'd like to replicate the taste, go to your back yard, clip some grass and brew it up. Add the scent of maple syrup, but not the taste and you have yourself a cup of good ole' boob milk boosting tea.

One problem, it doesn't always work.

So I decided to take matters into my own hands and I researched online what I could do. I had already started eating oatmeal every morning, which I hate by the way, and upped my water intake up to the point that I was disgusted by the taste. I started drinking juice, milk, anything to change it up. I supplemented with Fenugreek capsules and blessed thistle AND bought the More Milk mixture from Whole Foods that tasted like grass vodka. I was mainlining all the "galactogogues" I could get my hands on. I took nursing vacations on the weekend, we did skin-to-skin every night in the tub and I slept with her in just a diaper against my bare chest for two months. Nothing worked. So I took the pumping route and I did something that probably aided in the decline of our breastfeeding relationship. I had been recommended the Avent bottles by my sister-in-law, who had a daughter several months older than Lucy. I decided that I would abandon my Tommy Tippee ones that I had registered for, and go with the Avent.  They had been recommended to her by a lactation consultant as the most breastfeeding friendly of all the bottles. (I am not sure if this claim is true in retrospect. I am going to buy several bottles and do drip tests before the next baby to put my mind at ease.)  Fast forward to my breastfeeding difficulties with Lucy, I did some more snooping online and came up with another major error I had made when Lucy turned two months. Naive me had bought the number 2 nipples for Lucy when she turned two months. I had been giving her faster flow nipples and had thus, encouraged her bottle preference. No one had told me earlier that breastfed babies should stay on the slowest flow nipple the entire time they are breastfeeding. The logic is that your own milk flow does not change, therefore the bottles should be similar to your own breasts. Stupid, stupid, stupid mommy.

Rookie mistake....ugh...

From there, I switched back to the number 1 nipples, but the damage had already been done. She stopped latching except for once in the morning. That was hard to deal with. There is nothing like the sight of your baby screaming in horror when you try to breastfeed them. I tried a supplementor, but she wouldn't latch. At that point she was too independent to get close to me and wasn't mindlessly rooting around anymore. After a bought of Rota virus when she was five months, I had completely dried up. I guess all the frequent trips to the bathroom to have my body do things I didn't know were humanly possible, my breasts had said "f-this" and decided to stop producing.

Looking back on everything that happened, I have done a lot of research. I mean, crazy, obsessive amounts of research on how you can boost one's milk supply. Every woman is different, and it seems that a lot of women have great results with Fenugreek and Blessed Thistle. Most take the capsules three or four times a day, usually several at a time. Most seem to believe four capsules three times a day plus one capsule of Blessed Thistle is the right combination.

So what about those of us who have tried this and didn't see an increase in supply? Well, there are a few at home remedies, and a few medical interventions.

At home
Lactation cookies with brewers yeast and oatmeal, some also put in Fenugreek (belch)
Dark beer
Goat's rue
Fluid, fluid, fluid
Make sure you are eating 500 calories more than you did pre-pregnancy. Now is not the time to start dieting.
Pump after every feeding for five minutes. The idea is that breastmilk is all about supply and demand.
Take a breastfeeding vacation-Lay in bed with baby and have them feed or suckle as much as possible for several days. Skin-to-skin is also helpful when doing this.

Medical
There are two drugs that are used most frequently with boosting milk supply, they are Domperidone and Metoclopramide. Both have side effects and I have read that the former is not used in the US. You should also talk to your pediatrician about the use of these and possible underlying causes that could effect your milk supply.

Here is a quote from the Academy of Breastfeeding Medicine taken from this article on other causes of low supply:



Evaluate the mother for ‘‘medical’’ causes of hypogalactia:
Pregnancy, medications, primary mammary glandular
insufficiency, breast surgery, polycystic ovary syndrome,
hypothyroidism, retained placenta, theca lutein cyst, loss
of prolactin secretion following postpartum hemorrhage,
heavy smoking or alcohol use, or other pertinent conditions.
Treat the condition as indicated, if treatment is
available
12 (Level of Evidence II-2, II-3, and III).

I already have plans to try making a lactation cookie of my own that is not at all healthy, but tastes delicious. I've also heard of breastfeeding cupcakes, which could also prove to be interesting. I'll be working on those two in the next month, so stay tuned! Any guinea pigs want to test them out for me?

Sunday, January 20, 2013

Moooo, moooo pump that milk



As promised, I will impart my pumping, no supply wisdom to those of you real moms who are struggling with juggling a newborn and figuring out how to balance breastfeeding and freedom. Now, when I saw freedom, I mean those precious moments at the beginning of newborn's life, when you really do feel like a cow. Sleep deprived, probably still in pain from whatever form of labor and birth you had, adjusting to this new being that is constantly glued to your body. You're in love and could stay lying on the couch forever watching your little precious bundle sleep. While at the same time, you're silently screaming inside to get out and move, but you just can't find the time to take a shower. Before I get to pumping, let me give you a piece of advice that was passed down to me from one of my mom friends while I was still pregnant. She told me, "Everyone tells you about how great breastfeeding is and that they feed every two hours. No one ever tells you that it takes them an hour to eat. That means you've got one hour of rest before the next feeding."

Just let that sink in.

Now, I don't want this to come off as anti-breastfeeding. I am very pro-bfing. I just want you to understand that you are really going to have to be mentally strong and prepared for the challenges you are going to face the first few months. We bed shared for the first three months, which made the late night feedings very easy. But, you may be one of the lucky ones whose newborn sleeps for three, four, maybe even six hour stretches right off the bat. If you are, just keep that between you, your pediatrician, and God if you believe in him. No mother with an infant wants to hear about your baby who is sleeping through the night by two months. We hate you behind your back and you don't want us to do that.

Okay, now what you've all been waiting for......pumping! What kind of pump should you get? How often should you pump? What do you do with the milk? Can you freeze it? Make ice cream with it? Should you start pumping early to build up a supply? Should you introduce the bottle early to get your baby used to the bottle since you'll be going back to work? What about bags or bottles? How do you thaw the milk? How long can it sit out? Breastfeeding hurts, why? My nipples are bleeding, I think I should stop. What is thrush? What is mastitis? When will my milk come in? I'm so frustrated, help!!!!

Those are a lot of questions and I'm not a doctor or a lactation consultant. However, I had problems with milk supply so I read my fair share of books, articles, and blogs about the art of breastfeeding. I'll let you know what I've found and point you to some practical solutions that I think will help you troubleshoot when you really do find yourself having issues.

1. Pumps

There are all manner of pumps out there on the market. If you have insurance, I would strongly recommend calling your insurance company and seeing if they will pay for your monthly rental for a hospital grade pump. They are the best on the market and will get the most milk out. You never know if you are going to have supply issues, and hey, why not get the best pump for free instead of spending hundreds of dollars on something inferior?

2. Shields

If you are going to go back to work to pump, you are going to have to determine when you will have time to pump, where you will be able to do it, how you will clean your equipment, and how you are going to store the milk. I was a teacher and was lucky enough to have my own room that I could use during my free periods. The downside was, I didn't have a private place to clean all my breast shields. I also am very lazy when it comes to doing dishes, so I decided to buy enough shields to last my entire day, avoiding the need to do embarrassing dishes in the faculty lounge.

If you can't afford to buy several sets of shields, just realize that you will need to sanitize them in between each use. Medela makes these awesome bags that will sanitize all your accessories in the microwave! Each bag can be used up to twenty times, so it's pretty convenient and economical. You could also buy one of the Avent sanitizers and keep that at your work if you don't mind having it sit around all day.

3. Storage

I'm just going to let La Leche League take the lead on this one. Here are the basic guidelines on how long you can keep breast milk in the fridge or freezer.

From the website:

Storage Guidelines

All milk should be dated before storing. Storing milk in 2-4 ounce amounts may reduce waste. Refrigerated milk has more anti-infective properties than frozen milk. Cool fresh milk in the refrigerator before adding it to previously frozen milk.
Preferably, human milk should be refrigerated or chilled right after it is expressed. Acceptable guidelines for storing human milk are as follows. Store milk:
  • at room temperature (66-78°F, 19-26°C) for 4 hours (ideal), up to 6 hours (acceptable) (Some sources use 8 hours)
  • in a refrigerator (<39°F, <4°C) for 72 hours (ideal), up to 8 days (acceptable if collected in a very clean, careful way)
  • in a freezer (-0.4 to -4°F, -18 to -20°C) for 6 months (ideal) up to 12 months (acceptable)
Here is the link to the web page.

Okay, now that you know how you should be storing your milk, here are your options and here is what I did.

a. Bottles v. Bags

This is personal and will depend on how much you are pumping and how much you want to store. If you are not the most productive cow, you might just go with bottles, since they won't be in your refrigerator for more than one day. If you go this route, you will need to use the bottles that correspond to your pump. I used Medela products, so I typically used the 5 oz bottles they sell. They also offer a nipple that you can attach to the bottle, which is convenient as you don't loose milk transferring it from one bottle to another. Medela also offers a nipple that attaches to these bottles called the Calma, which is supposed to simulate breastfeeding. I tried to use this nipple with Lucy, but she was already too far gone and went on a feeding strike. Next time, I possibly will use this nipple from the beginning and see if we fair better with transitioning between bottle and breast.


Bags on the other hand can be a great option for the high producing momma or for the low producing mom who wants to use a different bottle. Again, I am totally not a Medela spokesperson, but I used these products and can give you the pluses and minuses. The Medela Pump and Save bags are a great option if you don't get out 12 oz at a time, these can be a great option to pump straight into a bag and then freeze and thaw as needed. They have handy little adaptors to attach to your shields, so you skip having to use bottles, which means less dishes. If you are a big producer, you can also use the Lansinoh bags that hold twice as much, but they do not attach to the Medela shields.



4. Hands free pumping bra

God bless the hands free pumping bra. Now you can surf the Internet and pump! Go get one of the immediately if you are going to use an electric pump. Go now and thank me later. This is a great way to just relax and make pumping a little less boring. I have pumped for over thirty minutes using one of the these puppies.




5. Pumping schedule: When do I start?

I'm not a lactation consultant. I started pumping maybe a week after my daughter was born, to try giving her a bottle. In retrospect, I think that was foolish. My daughter ended up expressing a bottle preference and I can trace that back to the first bottle feeding and my low supply. You don't know if your little one is going to express a bottle preference, so I say, wait until right before you are going to go back to work, or two to three months before you introduce a bottle. If you don't care if your supply wanes or not, then give a bottle. It's really a personal choice. I'm just hoping to outline my mistakes, so others can learn from them.

6. How often should I pump?

Ideally, you should pump whenever you would normally breastfeed. If you are trying to boost your supply, pump after every feed for at least five minutes. Working moms will probably not have a schedule that allows them to pump whenever their baby is actually feeding. In this case, do what you can. It's better to pump more frequently than to pump for long periods of time. You need to relax while you're doing it. A little funny tidbit about breastfeeding is that you need to have an emotional reaction to have "let down." The release of oxytocin is what causes let down and is harder to achieve with your pump. So, keep photos of your baby around and visualize holding him or her, while imagining "waterfalls of milk." I kid you not I read that in a breastfeeding book. I don't remember which one, but I've always found that imagery hilarious. Unfortunately, no matter how many Niagara Falls of breast milk I envisioned, I never had an increase in supply.

7. When to introduce the bottle.

The question that has a million answers. I'm going to answer it from a mom whose daughter expressed a bottle preference early on. If you can, hold off giving a bottle for as long as you can (and a binky). I would wait until two weeks before you return to work. Also, try not to give your little one the bottle if you can, so your baby doesn't associate bottle with mommy. I started my daughter out with the bottle after a week with pumped breast milk. By four months, she was down to one early morning feeding and by five months, she had completely weaned herself. I had a really hard time with this and went through anger and feelings of rejection. Breastfeeding was important to me and I didn't want to give up that special time with my daughter. Just know that if you are enjoying breastfeeding, try and establish the best relationship you can with your baby before giving a bottle. You won't know you have a baby that is going to express a bottle preference until it happens. By then it might be too late. You just never know, and if you don't want to risk it, don't give the bottle for at least two or three months.

8. A pain in the boob

Engorgement, nipple pain, bleeding, mastitis. Breastfeeding can be really painful and there are a number of problems that cause each of them. Most breastfeeding pros will say that an improper latch is the cause of breastfeeding pain. Other moms I've talked to say that it wasn't the latch, they just had to get used to the feeling and for their nipples to toughen up. By the way, breastfeeding in the first few days has an added perk of shrinking your uterus back. However, the way this happens is by way of contractions...Remember those? For some women, this can be quite a shock to feel the baby latch on the first time and feel those dreaded things you just finished having! My mother remembers having to pull me off several times because the pain was too excruciating at first. Other women don't feel as bad or have copious amounts of pain meds to numb the pain. I had a c-section because my daughter was breech, and I was so drugged up, I couldn't remember if I was having conversations in my head or with the people around me. I'm so thankful to my mother and husband who kept my daughter and I both safe while I was recovering.

If you are suspicious your pain is caused by a bad latch, call up that lactation consultant that you already have or go down to your local La Leche League meeting and pick the brain of some of the other moms.

Finally, Mastitis is something every mother should be aware of. Thank God my OB explained to me the symptoms during a prenatal visit and begged me to call him as soon as I had them so he could get me on antibiotics. God bless him and God bless antibiotics. Sorry for all the gods, I just really really really had a hard time with Mastitis and the treatment made me feel a million times better. It basically feels like the flu, and having a baby while having breast pain, flu like symptoms, and working full-time can be beyond draining. Talk to your doctor about the warning signs and what you should do if you suspect you have it. Do this BEFORE you have your baby. You'll thank me when you get it on the weekend. 

That's all I have for now on pumping. Next blog I'll write about how to try and boost your milk supply. I say try because I did almost everything you can think of and I never was 100% EBF (exclusively breastfeeding). I have a couple new tricks up my sleeve for next time, and I'll share them with those of you who are suffering or have suffered in the past with low supply. To the rest of you future and current mommies, good night and happy pumping!

Friday, January 11, 2013

Breastfeeding?

In honor of my best friend announcing her pregnancy and entering her second trimester, I thought I would write about breastfeeding from the perspective not usually heard from in the breastfeeding blogosphere. If you have read any of my earlier posts on this subject, you will know that I had a hell of a time with milk supply. I was lucky enough that Lucy latched on great from the get-go. In that, I am truly grateful. However, by one month we started supplementing, and by four months, she had completely weaned herself. It was really hard for me to deal with, and I tried everything to get her to come back to b-fing. Everything, except for two things, that probably would have either saved our relationship, or saved my milk supply at six months when I completely dried up.

1. Have a lactation consultant who will make HOUSE CALLS. I am yelling that in print because I talked to several on the phone and I didn't get anything out of the phone calls that I didn't already know. Believe me, I became a booby expert after we started having issues. My goal in life was to be a milk machine, and instead, I just started to smell like maple syrup. I am sure that some of our problems with reflux and my little hungry hippo could have been solved had we had someone who could come over and help me coax my daughter gently back into breastfeeding.

2. Find a local La Leche League group and GO! Why I didn't do this, I will never know. I should have gone while I was pregnant and started learning and building a support group before I ran into problems. To be honest, I didn't really know. I read the La Leche League book, The Womanly Art of Breastfeeding while I was pregnant. It helped me understand more of what to expect from this new frontier, but it can come across condescending at times, especially if you run into serious problems.

The best advice I can give to someone who is on the fence about breastfeeding is talk to someone who has done it, or is doing it that you respect. This choice is very personal, and breastfeeding is not for everyone. It can be an amazing experience if you are open to it. It can also leave you heartbroken when it doesn't work out. Welcome to motherhood.

That being said, most problems can be solved with the right support system. I may look into asking my pediatrician for a prescription for Reglan or Domiperidone next time around. Whatever you decide to do, just know that your child will grow up happy and healthy with formula or breast milk. Regardless of what you may read, you are not going to poison your baby if you give them formula. However, breastfeeding can be one of the most amazing moments you will ever have as a mother, and if you want to give it a try, I say go for it! You may run into bumps, but with a good support system around you, you'll hopefully sail over them with ease. Later I'll post about pumping. I was a working mom, and I turned pumping into a science and so can you!