I have 2 children, my oldest is almost 4 and was born at 29 weeks gestation. My 2nd is 10 weeks old and born at 36 weeks gestation. I had low milk supply with my first and started out low with my 2nd, but have now made full milk supply and hope that I will be able to maintain it.
Although the story is long, I hope other mother's may find something of use if they are trying to build their milk supply.
- with my first child, I had not heard of anyone that had continued to breast feed and supplement. They usually just quit breastfeeding.
- The path of breastfeeding a premature baby is harder generally than feeding a full-term baby, and most mother's have no idea what that path is. It just seems permanently difficult with no relief in sight.
- Because I knew more the 2nd time (and because it was less traumatic and my baby was more developed before birth) I have been able to develop a full milk supply this time.
I got a lot of my information from a book called Making More Milk. It was very informative and gave information on how to identify what a mother's particular issue might be and what to do about it. They also have a very good web site called lowmilksupply.org. I used/use fenugreek (Nature's Way) and Vitanica's Lactation Blend. Due to my difficulty, I take quite a bit of both. Most women don't take so much and I wouldn't take that much without my lactation specialist suggesting it. I take 3 capsules of fenugreek 5x/day and 2 capsules of the Lactation blend 5x/day.
The story of Joshua
My pregnancy with my first child was uneventful until somewhere in the 2nd trimester, when it was decided that I should get off Paxil, and that it could have caused a heart defect, and could create flu-like symptoms at birth. I slowly weaned off the drug ( I was only taking a 1/4 of the regular dose to start with) and completed the weaning at 24 weeks gestation. That is when my blood pressure started to be variable, up to 140/80. I was 41 years old. At 26 weeks, I had a special ultrasound to check on my baby's heart. It was fine, but my blood pressure was not. It now would not come down. I was put on bed rest. They were unsure whether the blood pressure was related to anxiety (since I was off Paxil) or preeclampsia. I wasn't feeling anxious, suprisingly enough. At 28 weeks I went in for my check up with my list of bps I had been taking. They had been creeping up and I was put in the hospital. I was in the hospital for one week, when they said that my bp was as high as it could go and I needed to have the baby. I was put on magnesium, given 2 steroid injections for my baby's lung development and given pitocin suppositories over the course of 48 hours in order to try for a vaginal birth. The suppositories did not work. By the time we did the C-section, I was something of a rag doll, due to the magnesium. I couldn't see straight. When Joshua was born he was 3 lbs, 6 oz. I don't know what his Apgar score was, but it couldn't have been very high. He was quickly incubated and when they rolled his isolette by me, all I saw was a smudge of a baby in a plastic box.
I was very out of it. My time in recovery was very fuzzy and dreamlike. When I was back in a room, I slept a lot. I had to take the magnesium for another 24 hours and could not stand up to get in a wheel chair to see my baby. The nurses decided I was too fragile to start breastfeeding. I had not read that part of the pregnancy books to be wise enough to know how that would effect breastfeeding. I am not sure when they brought me a pump, but it was at least 24 hours after birth, if not more.
A friend went to the bookstore and found Dr. Sear's Premature Baby Book, got it for me and took the suggestion that I needed a picture of my baby. That was a very important to me and began to give me information I needed, along with giving me something to hang onto before I could see precious Joshua. 36 hours after Joshua was born, I was wheeled to NICU to see him. I tried to pump, but didn't really know what I was doing. I was also still pretty out of it and often dropped off to sleep and therefore missed a pumping time. I was given mixed information about whether to pump at night to get the milk to come in or sleep in order to recover. The lactation consultant at the hospital works only 20 hours a week. I think I saw her on the 2nd day after Joshua was born and got help in how to pump.
I got a little of colostrum, I got a bit of strength to make it down to NICU after every pumping. I was released reluctantly by the doctor 5 days after Joshua's birth. My blood pressure was still not well controlled. (it came down to normal a month later and I was able to stop bp meds.) I pumped regularly, I read how I was supposed to relax, look at the picture of my baby and it would help me 'let down.' I had no idea how I was supposed to accomplish that.
2 weeks after Joshua's birth I spoke again with the lactation specialist. I was making about 1/2 an oz. per pumping session. I was very touchy about the little amount I was bringing into NICU. I was amazingly jealous of the teenager that brought in bottles and bottles full of milk. I thought that was how much I should be bringing in. I was feeling like a failure at motherhood.
With the help of the lactaction specialist, I got past my feelings of failure and got to a place where I decided that anything that I could give was better than nothing. I started taking Reglan. Due to some regulations at the hospital, the lactaction specialist inhouse could not suggest the herbs to me. The Reglan doubled my production up to 1 oz per pumping session. The lactaction specialist set up a 'meet and greet the breast' session. Even though Joshua was still too small, just having him at the breast could give me and my body the idea of what was intended. Of course, since he was in NICU we did a lot of kangaroo care as well. During the 5 1/2 weeks he was in NICU, the lactation specialist helped me small step by small step to have Joshua at the breast, latching, SNS, adding one feeding at a time.
When we took Joshua home, he was feeding at the breast a couple of times a day with SNS, the rest were bottles. I would pump and my husband would give the bottle, or I would nurse with SNS and then pump. Then clean everything up and do it all again. Or at least so it seemed. Once Joshua was out of the hospital there is a breastfeedling followup clinic that I went to weekly. Most mothers go once or twice, but I continued the entire 5 months I was off on maternity leave. That is when I started taking Fenugreek. 3 capsules, 3x/day. I doubled my milk again, up to 2 ounces. It never got higher than that, but I breastfed until Joshua was 3 years old. He loved it.
Now I know all the obstacles that were set before me with Joshua. My age may have played a part, perhaps there is something amiss hormonally. But the trauma to my body, the difficulty I had recovering, how early Joshua was, not breastfeeding/pumping in the first 24 hours, inconsistent/ineffective pumping in the first 2 weeks, not starting herbs until 6 weeks after birth, Joshua's weak suck, Joshua coming home very structured to eat every 3 hours (due to NICU procudures), all made milk production difficult. But amazingly Joshua still had a wonderful nursing experience. He remembers nursing and comments on it now as he sees his sister nurse.
The story of Rebecca
I was ready this time. I had spoken with the lactation specialist prior to birth. I had some fenugreek on hand if I needed it. My breastpump was out and ready. I had been closely watched throughout the pregnancy due to the previous early birth. My blood pressure started to creep up (but not over 140/90) at about 30 weeks. They discovered I had gestational diabetes at 32 weeks. I was put on bedrest at 34 weeks, as my blood pressure began to get close to the 140/90 mark. However, at week 36 when it crossed the 140/90 line, we did not wait. My blood pressure was not coming back down and I had a C-section very quickly. No magnesium, no 2 days of waiting, no trying to induce (for safety reasons). Rebecca was born at 5 lbs 14 oz, and she was able to stay with me in recovery and then in my room. I got to nurse her in recovery. I wish I could put an emotional pause here. I got to hold her, see her, nurse her in recovery. Wow. She got something, because it brought her blood sugars back up, which had been falling due to the gestational diabetes. She got to stay by my bed in my hospital room and I was determined to feed her. However, my milk did not come in, so supplementing was started at the end of day 3 when her weight was dropping too far, with SNS (1 oz/feeding). The lactation consultant checked on me several times and we discussed options. I started fenugreek. When I left the hospital, I added Vitanica Lactation blend (which has goat's rue, which I think may be particularly helpful for my issues). I take 3 fenugreek 5x/day, and 2 lacation blend 5x/day. The lactation specialist in the aftercare program, loaned me a book (making more milk), which I read cover to cover. I was able to feed Rebecca on demand, which was confusing to me, considering my first experience, but I think I have the hang of it. I got up to about 2 oz per feeding and was worried that that was my capacity. At about 6 weeks I made 2.6 oz and the lactaction specialist suggested that I back off on supplementing. The following week, I supplemented no more than once a day based on Rebecca's need. And when I went in to the clinic, I made 3.4 oz. Another emotional pause. Hugs and tears all around. I had done it. I checked in the next week just to be sure it was real, and it is. No more SNS, no more pumping regularly. I can put away some of the bottles. I can nurse her and she can get what she needs from me. Wow.
I don't know why it was hard this time. She was still early. I think her suck improved dramatically just at the time that my milk increased, so she probably had a weak suck to start with. Through reading the book, the only other thing that seems to fit me is perhaps something hormonal. But this time I knew the path, it wasn't as daunting. This time I had my previous knowledge and quickly added more. I did my best to get a good milk production equation that could lead to full milk production. And it did.
Breastfeeding or not is a very personal choice, but if you decide to breastfeed and then run into obstacles it can be very disconcerting. Often the problems are easily remedied with a few herbs and pumping. But if the problem is more complex and isn't easily solved, it can feel like it is unsurmountable. I hope my story will provide hope and information for women who have a low milk supply and yet still want to continue to breastfeed.