So, Breastfeeding… (Round 2)

We’re now 9 days into life with little miss Charlotte and things are good! But breastfeeding, again, is not so good…

For the first four days, breastfeeding really seemed to be going better this time around. It hurt and I wasn’t injury-free, but I managed to avoid damage to the point of bleeding. Charlotte was eating 8 times a day and peeing and pooping like a champ. My milk came in. And she seemed satisfied — she ate, she slept, she didn’t fuss. I was really optimistic that it was going to work this time!

But then late Saturday night Charlotte stopped pooping entirely. She was still peeing so I knew she wasn’t completely dehydrated, but newborns are “supposed” to go once per day at bare minimum (and she’d been pooping multiple times per day up to that point) so it was a little worrying. After almost 36 hours with no poop, I talked to the pediatrician’s on-call nurse on Labor Day morning. She suspected Charlotte probably wasn’t getting quite enough to eat.

So, we started supplementing on Monday with half an ounce of formula after each feeding, and Charlotte gulped it down. After another 12 hours and four more feedings and still no poop, I upped it to a full ounce. Still nothing. On Tuesday morning — going on 60 hours with no poop — we took her to the pediatrician for her previously scheduled first week checkup. Her doctor wasn’t panicked about the no-poop situation, but did suspect it indicated a slight lack of calories and recommend that we continue supplementing. Charlotte weighed 6 lb 14 oz, which was the same as her hospital discharge weight (and a half pound lower than birth weight). She hadn’t gained weight, but at least she hadn’t lost any. Her bilirubin level had risen, but only slightly, and was within normal range so there was no jaundice concern.

I went straight from the pediatrician’s office to the hospital’s nursing mom’s group to get a better idea of exactly how much milk Charlotte was getting from me. We weighed her, fed her, weighed her, fed her again from the other side, and weighed her one more time. And guess what? She got a minuscule 0.25 ounces from each side for a grand total of half an ounce. And when I came home and pumped a couple times that day after feedings, I got LESS than half an ounce total. She’s getting what she can, but that’s just not enough.

(On the plus side, she finally started pooping again as I was getting ready to leave the mom’s group. I was very relieved.)

Sooooo: different baby, same story. I’m just not making enough milk. When this realization hit me on Tuesday, I reacted poorly with lots of anxiety and lots of tears. Jose and I talked through all the options on Tuesday night, and I cried some more. Rationally, I knew this — the stress, the crying — was exactly the reaction I intended to avoid this time, but emotionally (and hormonally), I couldn’t help it.

But Wednesday morning I woke up calmer, re-read that post about my experience with Emma along with my letter to myself, and decided two things.

First, there is clearly something about my boobs that just doesn’t work in the ideal way. Obviously there are many women who don’t struggle with supply, and it would be silly of me to think that they are all somehow doing it “better” than me. I did several things differently this time in hopes of a better result — avoiding nipple shields, making sure to feed from both sides each time, keeping my activity level low, hydrating like crazy — with no success. I don’t know why my boobs don’t make milk very well, but it seems rational to conclude that there is something specific to my physiology at play here, and that it’s not just the result of me not doing things “right.”

Second, I’ve been far less stressed in these early days than I was with Emma. This is a VERY good thing and it’s important to me to maintain it as much as possible. I know it’s only been a bit over a week, and I know there are many things I could try to increase supply since it’s still early — but the bottom line is that I’m not willing to jump through as many hoops as I did last time. When the lactation consultant at the mom’s group brought up a supplemental nursing system, I said no. I tried it last time; it was a major hassle and therefore a major hit to my sanity level. And I’m also not willing to feed PLUS pump every 2 hours. Again, I gave that a shot last time; it left me with basically NO time for sleep, turned me into a sobbing crazy person, and didn’t sufficiently increase my supply either.

(I really REALLY take issue with the “every 2 hours” recommendation because I think it pays absolutely no regard to the mother’s needs. Plus, if milk supply is already low, I feel like any benefit gained from increased feeding/pumping is at least somewhat negated by the stress of getting NO SLEEP. I find it hard to believe that my milk supply can increase by leaps and bounds when my body is stressed to the max.)

This leads to one conclusion: if I’m not interested in trying the full laundry list of options to increase supply, then my supply will likely not increase (duh), or at least not enough to keep up with Charlotte’s needs. This means I am accepting that we will be supplementing with formula from here on out. I choose to be ok with this — after all, it’s exactly what we did with Emma.

After that, there is only one remaining question: do I want to keep breastfeeding at all? I’m considering 1) continuing to feed her at the breast and supplementing after, 2) switching to only pumping, getting whatever amount of breastmilk I can, and bottle feeding both milk and formula, or 3) just going 100% formula.

I’ve been doing #1 for the last few days and for now I’m continuing with that while I consider all three. There are pros and cons to each — #2 is what I did with Emma for most of my maternity leave, and #3 is what I shifted to when I went back to work.

I’m pretty certain I’ll do either #1 or #2 for the next few months while I’m home, because I do feel like Charlotte benefits from breastmilk, even if only a little. But I’m on the fence about whether there is really a significant difference between the two. She gets breastmilk either way, and #2 has the time advantage since it’s quicker to pump than feed (because I can pump both sides at once). So I’m leaning towards just pumping…but just haven’t made that jump quite yet.

As expected, I have many mixed feelings about the whole situation. Satisfaction that the actual “at the boob” experience has been better. Disappointment that my supply once again is failing to keep up with demand. Resignation that my babies just flat out need formula. And relief that I was able to pull myself together quickly enough to make some decisions and move on.

And finally, an addendum: I went back to the mom’s group yesterday. Charlotte weighed 7 pounds even, so the supplemental formula has left her happy, healthy, pooping(!) and back on track to hit her birth weight sometime next week. Interestingly, she got a full ounce from me this time so my supply went up even with no real effort on my part. (Still not enough, but hey, it’s something.)

While I was there, I couldn’t help but notice another mom feeding her daughter. Her daughter was screeching and refusing to latch on. The mom stepped into the other room for a moment…and started crying, clearly stressed to the max. A few minutes later, she came back in and the lactation consultant helped her set up her supplemental nursing system. She told her to drink tea that apparently tastes bad enough that they recommended just holding your nose and downing it like a shot. She gave her the same paper about triple feeding (feeding-pumping-feeding at 2 hour intervals) that she gave me on Tuesday. And I watched, feeling an odd sense of clarity, knowing that I’m comfortable with my decision to NOT try all of those things.

Later, that mom and I ended up standing in the vestibule waiting for our husbands to come pick us up. (It was pouring rain, and the cars were backed up waiting to pull under the covered entrance to the building.) I asked her if this was her first baby, and she said it was.

“I was right there with my first daughter too,” I told her. “It’s so stressful.”

She smiled slightly and nodded her head.

“My older daughter got mostly formula and she’s fine. And it looks like it’ll be the same for me with this baby. You just have to do what works for you. You’re doing a good job. Good luck.”

She said “thanks” as Jose drove up, and I left, but I’ve been thinking about her ever since. I hope she gets some sleep, and I hope she has some success with her efforts, and I hope that if it’s not enough, she finds some peace in just doing whatever makes sense for her family.