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4 month breastfeeding update

While my breasts don’t twitter, I know some of you have been following their functionality with interest.  And some of you (ahem, Brian, Finch) prefer not to know about my bodily functions!  Sorry guys–feel free to stop reading at this point. 

Breastfeeding after reduction surgery is unpredictable.  Supply can increase with each child; or may not.  While I had hoped to build a full supply of milk, I did not.   

Cedar:  Still getting breastmilk for all her meals.  I’ve been so blessed by milk donation.  She nurses off and on through the night and I do not have to give a supplemental bottle from about 8pm-10am.  During the day, it is challenging to get her to nurse.  She prefers to nurse with both of us lying down; which makes nursing in public difficult.  Ok, impossible.  It is infuriating because I’m all about women’s right to nurse in public and I want to promote our visibility.  Not to be.  At least right now.  And I will admit that I’m a tad embarrassed to feed her with a bottle in public so I often do that in the car.  Cedar’s other frustrating quirk is that she won’t comfort nurse.  Boo. 

Me:  I have weaned off some of the herbs and helps.  Currently, I’m on the maximum GRAS amount of fenugreek.  So, yeah, still smelling like maple syrup.  I decreased my dosage of domperidone.  I’m on 90mg/day.  I drink at least one strong cup of mother’s milk tea with caraway/fennel/goat’s rue/nettle/oatstraw/milk thistle every day.  And I take an alfalfa supplement.  Emotionally, I’m still processing the experience and my disappointment.  I need lots of reassurance that I did everything possible.  My friends have been super positive about my processing. 

I had one major meltdown last week when I’d planned an afternoon in Greer for playing with friends and running some errands.  I managed to spill all of Cedar’s donor milk.  My options were to buy formula or go home.  I went home.  And I was spluttery mad that my breasts wouldn’t make enough milk.  Irrational regret and beating-up-of-self. 

Still, breasts are so amazing.  Did you know that your breasts can regulate the different temperature needs of twins?  One breast will heat up for one twin and the other will cool down if needed.  It is called Breast Biosynchrony.  How incredible!  Men don’t have such cool super-powers.

The Continuing Milk Saga

IMG_c5251 copyWe are at the two month point.  And we’ve hit another blip on the BFAR journey.  First let me catch up.  We realized pretty quickly that I again did not have a full supply.  I wasn’t terribly surprised though I had been really hopeful this time.  By week four, I’d tweaked things enough to guess that I was making about a 2/3 supply.  Not bad.  Of course I still went through an angry grieving period.  My wonderful husband, mother, sister, friends, and strangers on the street listened to me process my feelings.   

Thankfully.  THANKFULLY!  We’ve been able to supplement entirely with donor breastmilk!  Amazing generosity.

I’m still taking a ridiculous number of herbs and the domperidone.

So what is the problem?  My smart girl is noticing that a bottle will follow a feeding.  Her nursing time is ever-so-slightly decreasing.  Her bottle intake is increasing.  And since she won’t comfort nurse except at night, I feel my supply is in danger. 

Two solutions.  1)  I’m going to begin pumping tomorrow.  2)  I’ve ordered an SNS to begin feeding her at the breast when we’re home.  The SNS will make her work harder than the bottle does and it will stimulate my breasts to (hopefully) maintain/increase supply. 

It isn’t easy.  Low supply stinks.  But it is worth it.  For both of us.

 

THE galactagogue plan

Or, Breastfeeding After Reduction Surgery–Part 2.  In case you missed it, part 1 found here.

My primary sources for choosing my milk-making plan are the books Defining Your Own Success, Mother Food, and The Breastfeeding Mother’s Guide to Making More Milk.  Please note:  this is MY plan.  It is not to be interpreted as advice to others.  Some of these herbs and medications are controversial and not without risk.

During Pregnancy

I’ve added Alfalfa to my diet.  Yep, the same thing farmers give to cows to increase production. 

Beginning in week 37, I will add Goat’s Rue tincture.  10-15 drops 3x daily.  Thank you Carey for sharing your homemade tinctures! 

Beginning in week 38, I will take 1 Chasteberry supplement daily–ending on Birth day.

Just before due date:  I’ll pick up a hospital grade pump so I’ll be set to go.

Postpartum

I’ve ordered Domperidone from Italy (where it is available over the counter).  Because of lots of FDA/big pharma politics, it is not available in the US except in compounding pharmacies. 

My babe will be skin-to-skin as much as possible.  If you’re visiting me postpartum, be prepared!  The Moby and My Baby Nest will be close friends.   

I’ll begin pumping as I can.  Hey, I remember the postpartum whirlwind, so I’m giving myself some leeway on this one.

I have a huge stash of Mother’s Milk Tea which I’ll mix with my nettles, caraway, and oatstraw.  I grew to love the taste of MM tea when Norah was itty. 

The trusty fenugreek and blessed thistle will make an appearance.  The sweet smell of maple syrup will be in the air.  And I’m toying with the idea of Shatavari.  Some sources suggest it might duplicate the work of domperidone.  Others say it does something different.  Maybe I’ll hold off. 

I will continue the alfalfa, my prenatals (containing spirulina), goat’s rue, and cal-mag.     

Food

If I can tolerate it, I’ll add blackstrap molassas to my mother’s milk tea.  I’ve been trying it for iron this week and it is a tough flavor to swallow. 

I’d like to find a coffee-substitute made with chicory, malt, and barley (all lactogenic).  Anyone?  I’ve heard the brand names CARO, Roma, Caffix, Pero or Dandy Blend.  But I don’t know where they might be sold.

Barley water is on the menu along with oatmeal, tahini, and pesto (for the basil and garlic).  I’d like to explore some ways to add millet to the diet but I haven’t worked with that grain much.  Ideas? 

Oh, and a sweet friend donated 200 oz of her breastmilk in case supplementation (hopefully) temporary is needed.  What a gift!!

Acupressure

I’ve looked at two points that might help with milk supply.  Cassandra, I’ll look to you for a lesson!  The points are Absolute Yin Meridian of the arm-Point 1 and Meridian of the Spleen- Point 12. 

Hypnosis

I completed my Hypnobabies training last weekend and will use some of these techniques including their breastfeeding hypnosis CD

Sounds overwhelming, yes?  Well, I have a small window to build a milk supply.  A short-term madness.  As a BFAR mama, I have one shot.  So, I’ll give it everything and then slowly back away from things as I evaluate success.  Scott is 100% certain and 100% supportive.  He understands that my only task for the first few weeks is building a milk supply.  And I have amazing friends and family who will surround me with love (and food!).

Breastfeeding after Reduction Surgery–Part 1

BFAR.  That is how we “survivors” refer to it.  This post is tough for me to write.  A little more intimate that I’d like to be.  But here goes. 

I had a breast reduction when I was 19.  When I found out I was pregnant years later, I scrambled to find information on BFAR.  I found Diana West’s wonderful book and website dedicated to the topic.  I learned and prepared–as much as a first-time mama can.  I knew it was a very real possibility that I would not have enough milk but I was determined to make it happen. 

My milk came in slowly.  Norah was a reluctant nurser and a fussy baby–how much because of supply, I don’t know.  We carefully recorded diaper output, weight, and feedings.  We worked closely with our midwives and the lactation consultant at our pediatrician’s office.  

On her 8th day, Norah’s blood sugar was low and our midwife gave her a bottle of supplement.  Of all the moments I wish I could change during that painful time, it is this moment.  With so many ways to feed a baby, why did it have to be a bottle?  It wasn’t even a good bottle–it was a bottle made by the formula company [read:  fast flow].  I bet you know what happened next.  Yep, nipple preference.  It would take another three weeks to woo Norah back to the breast.  The LC showed us how to use an SNS.  Norah was a smart one, though, and she learned quickly how to simply suck the SNS like a straw.  So, the LC gave us the life-saver:  a hazelbaker finger feeder.  There was no way Norah could eat from this device without getting a work-out.  No lazy gulping down milk.  It was tedious and awful; each feeding took close to an hour.  My smart little girl began to prefer another nipple then.  Mine!    

Of course, during this time, I was pumping with a hospital grade pump, taking fenugreek until I smelled like maple syrup, and guzzling mother’s milk tea.  But without the gold standard–my baby–I couldn’t reach a full supply.  The LC even prescribed Reglan which can increase milk supply (though with considerable side-effects; I would not take this drug again).  This LC told me with (I think) false optimism, “I think you’re going to be fine.  You’ll make enough.”  Then she sent me home with two cans of formula.  A second LC I saw offered the same happy message (sans formula).  Neither gave the kind of involved help I wanted/needed.  (Why didn’t I contact La Leche League?  I have no idea and cannot remember now.  I think I didn’t want to *bother* someone.  I was paying the other LC’s).     

Thus began a routine of nursing Norah at the breast and then supplementing.  And then pumping.  An exhaustive, emotional journey.  I would proudly nurse in public.  Then hide in a bathroom to supplement.  I furtively purchased formula and hid it under my other groceries like I was buying junk food.  I was so happy when Norah began solid foods and I could cut down the supplements.  And I threw a little party when she reached a year and I could stop using supplement entirely. 

It turned out that Norah was a boob-baby.  We enjoyed a nursing relationship until she was 19 months old.  And she would still choose to nurse if I had not made the decision to wean (pregnant with Leaf–I was a wimp–it hurt).  She still nurses her stuffed animals and has serious plans to nurse baby Cedar.  🙂

So what is the plan for Cedar?  Oh my, it is a massive and thorough plan.  Stay tuned…I’ll post THE milk-making plan in part 2.

THE breastfeeding podcast

Caryn–this post is partly a response to your request for milk supply musings.  Enjoy! 

Diana West, IBCLC, is my breastfeeding guru.  She wrote the book Defining Your Own Success and co-authored The Breastfeeding Mother’s Guide to Making More Milk.  She created a website for women who are breastfeeding after breast reduction surgery and a website for low milk supply.

Last year, I listened to a two-part podcast of Diana West discussing milk supply issues.  I listened to it again this weekend and remembered how wonderful it is!  She begins with a concise explanation of the biology of feeding before jumping into the specifics of galactagogues and treatment plans for problems.  While most women will not experience a biological or surgical supply issue, many women do find themselves with low or dwindling supply due to a lack of understanding about breastfeeding. 

I recommend this podcast for moms-to-be, nursing moms, and birth professionals.  It is free to listen online or download via the Motherwear Breastfeeding Podcasts on itunes.