then comes baby

May 02

[video]

May 01

the story of how my baby got “other mommy milk”.

I always thought the term “mommy milk” was kind of cheesy, but here we are. I’ve got a few drops to give Camila of my mommy milk, plenty of canisters of the artificial stuff, and now bags upon bags of donated liquid GOOOOOLLDDD!!! (You gotta say it like you’re a soccer announcer)

This came about during a whirlwind of a week… you may have caught wind in the minor insanity going on inside my head in my last breastfeeding posts. Partially it was because no one likes to think that they’re starving their baby (Have you seen my girl’s scrawny little arms? I’ve seen newborns who could give Camila a fair fight). And partially it was because I was needing these once again. Lucky me, right?

But that stupid hormonal shitstorm yielded something truly remarkable. Jeremy, for the first time in years, reactivated his Facebook account so he could plead with the kind ladies of Human Milk 4 Human Babies to donate us some of their liquid gold. Okay, so I might have first pleaded with him (“Look at this story- this doula wants milk for a newborn baby whose mother is in a coma! How can I compete?”) to post on Camila’s behalf. And what would you know? Ladies like dads who like their babies.

so, pcos and breastfeeding don’t mix well.

I have been more forthcoming about my history of PCOS back when we were trying to conceive because my condition was more obvious to us and to doctors. In particular, I was on two different medications to induce my cycle before ultimately needing to go on Clomid to conceive. I’ve stayed on one of those medications, Metformin, for years now. I briefly weaned from it just before Camila was born, but resumed because my body was telling me I needed it. Metformin has also been shown to have modest positive implications for breastfeeding.

I thought that was the extent of it. Whatever annoying symptoms of PCOS, whatever future problems we may encounter in trying to conceive, can all be dealt with by continuing Met, avoiding hormonal birth control, and discussing Clomid early in the TTC period. So, I kind of stopped talking about PCOS. Never mentioned it to Camila’s pediatrician and never discussed it with lactation consultants.

But as you know, I’ve been doing a lot of breastfeeding troubleshooting lately. And time and time again, I came across a reason for low milk supply: PCOS. I don’t want to blame my condition for all my breastfeeding problems, but I can’t ignore the fact that I suffer from hormonal imbalances, and a hormonal imbalance could be the reason I’m not producing what Camila needs to sustain healthy growth.

In fact, after running through the checklist of EVERYTHING I could be doing to help produce more breast milk (herbal and food galactogogues, staying well hydrated, hand compressions, pumping, pump maintenance, frequent feeding, etc etc etc), I’m nearing the conclusion that not only is PCOS still a major pain in my ass, it’s not doing any good for my daughter, either.

I don’t know what to do about that. PCOS is treatable but not curable; that’s why I always refer to it as a condition. Like I’ve said, I’m on a high dosage of the most effective medication to treat the symptoms of PCOS. I made a number of dietary changes and stuck with most of them over the years (no fast food, less processed food, less soy, more organic, switched to all whole wheat, etc). And to be blunt, my breasts never changed size in pregnancy, and they’re definitely not much larger now (for what it’s worth, an LC told me I could be looked at for having low mammary tissue, signs of Insufficient Glandular Tissue, which goes hand in hand with low milk production).

Again, I hate to sound like I’m making excuses for having problems breastfeeding, but I know now the issue isn’t with “user error”. I’ve done everything, am doing everything I can. Knowing that an ongoing condition is behind my low milk supply isn’t making anything easier.

Although PCOS isn’t uncommon, only a third of women with the condition suffer from low milk supply. I’m not into self-diagnosing, and I’d admonish you not to, either. Some links for you to discuss with your heath care providers and lactation consultants:

http://www.lalecheleague.org/llleaderweb/lv/lvaprmay05p27.html

http://kellymom.com/bf/concerns/mother/pcos/

http://www.mobimotherhood.org/mm/article-pcos.aspx

http://www.breastfeed.com/breastfeeding-problems/illness/breastfeeding-pcos

https://www.breastfeeding.asn.au/bfinfo/polycystic-ovarian-syndrome-and-breastfeeding

http://kellymom.com/bf/got-milk/supply-worries/insufficient-glandular-tissue/

http://gotpcos.wordpress.com/tag/igt/

Apr 27

time to chub up…

This baby’s got herself some donor milk!

the neverending “troubles with breastfeeding” saga: part 5.

I’m sure you guys are tired of hearing me stress about breastfeeding, but this nightmare of a battle isn’t ending. It’s just getting more complicated, if that’s even possible. Bottom line, as much as I have hated how difficult breastfeeding was and is, the alternative sucks even more for us (formula). We have to keep trying.

Camila went in for a weight check at 5 months and again one week later (today). At five months, she weighed 12 pounds (6 ounces gained in one month, under the 3rd percentile). One week later, after having put into place our supplementation plan of roughly 12oz a day of formula, she still had only gained 2 ounces (then we came home, and I changed a dirty diaper). Our pediatrician said it was imperative that she receive more calories, less it affect her development in a negative way. I can handle having a small baby, but I don’t think I could handle knowing I’m to blame for any delayed development.

I took her to a drop-in clinic to see an IBCLC and another lactation consultant/La Leche League leader, both of whom Camila has met with twice before. She was weighed just before a feeding.

The LC watched Camila feeding, and immediately noted she was latched well and sucking vigorously and well. My position was good, my hand compressions were good. But every time Camila would pull away (my let down has always been slow, so she often pulls away in the beginning, unless I pump first), the LC would remark that we should be seeing at least a little milk in the nipple shield. I have never noticed milk pooling in the shield, to be honest.

I have started taking the shield away again during feedings, and Camila very surprisingly has been able to latch on and stay latched for minutes at a time. I fed her almost entirely without the shield for the next 15 minutes or so, both sides, continuing hand compressions.

During that time, I gave her the general rundown of how things had been going for us, how Camila’s wet diapers are getting less frequent and less wet, and how we had started supplementing 1oz after every feeding. I shared my history of polycystic ovarian syndrome to see if there could be a link. To my total shock, she said this is a clear case of low milk supply and was likely due to my hormonal condition (the PCOS is hormonal). Not improper latch, not nursing too infrequently, not a distracted infant, not anything “user-error” related at all, really. Which still doesn’t make me feel any better.

Oh, you know what really really didn’t make me feel better? Her weight after nursing- it showed that 20 minutes of nursing yielded a .4oz of breast milk intake. Seriously?! (I will be trying this weigh-nurse-weigh test again on a different scale in the morning for hopefully more reassuring results.)

The IBCLC urged me to supplement Camila with 2oz of formula instead of 1, and the pediatrician fully supports that request. I’m facing this huge mental block, one that is prohibiting me from accepting the need to supplement at all, much less supplement up to 24oz a day. Denial? Fear? Depression? It’s something. I AM supplementing and will continue to, but I’m miserable about it.

In the meantime, I have these options, discussed with Jeremy and I by both the LC and the ped:

Donor milk. It’s an option I would be thrilled with, but we would have to totally rely on the goodness and selflessness of strangers. We can’t afford the $4-5/ounce price of pasteurized milk from milk banks (12oz a day would be the minimum we’d need to stop supplementing, and that would be a minimum of $48/day or $336/week); they also give priority to premature or sick babies. So, milk sharing from a donor or donors. A temporary, non-stable way to supplement, but it’d be a dream for Camila to receive more breast milk.
Supplementing Nursing System. An SNS is a device that allows the baby to nurse while simultaneously getting supplement through a syringe. This way, the breast are still stimulated and the baby is nourished. We’re already nursing at the breast then supplementing with a bottle, so it’s not much different, but it’s a valid option. And the LC and LLL leader both said they’d do whatever they could to help baby and me to adapt to an SNS (they can be very tricky to use).
Prescription medication. Yeah, I know. Sounds awesome. But I’m 100% not a candidate for Reglan, the one medication approved for use in the US. Anyone with a history of mental illness or depression should keep away. The other medication has an off-label use (meaning it’s not intended for increasing breast milk supply) and isn’t available here in the US unless you bring a prescription to a compounding pharmacy. Possible but unlikely given that my pediatrician and LC are not in communication with my doctor that I see, like, never. An easier way to obtain the medication is online from Canada or New Zealand or any other country that isn’t the US, basically. Promise you won’t judge me if in a few weeks I say I got a baggie of pills mailed to me from another country?

I really just hate this. I hate that I feel so powerless in this, so out of control. I hate feeling like I’m harming my daughter when I don’t take the advice of medical and lactation professionals who clearly have more knowledge and experience than me. I hate that I hated breastfeeding so much in the past and now would do anything just to be able to successfully nurse at all. I hate that some pregnant woman could be reading this and doubting their own desire to breastfeed. I hate that my daughter smells like formula. I hate that a formula feeding mom could be reading this and feel guilty for any reason. I hate that I’ve ever heard people say that formula is poison, that I just need to try harder. I hate that I have PCOS, that it has no cure, that I would even blame this mess on that stupid condition to begin with. I hate that Jeremy is suffering. I hate that Camila is doing everything right- dear God, that sweet little baby is doing everything good and right and it’s still not enough because my body is failing her.