30 January 2009

Things I've Learned - Breastfeeding and Formula

Before my son was born, I was absolutely, completely, without question, 100% committed to breastfeeding. I was so NOT interested in anything else that I skipped the sections in all the books about bottles and formula. Didn't even read them. "I'm not going to need that," I thought smugly to myself. I couldn't even wrap my head around why someone who could breastfeed would choose not to.*

I was so intent on breastfeeding that I wasn't even going to buy a pump to use for the occasional evening out. I was planning on being happily tethered to my child for at least a year, ready to sacrifice all to do the right thing.

The Boy was born on a Monday evening by emergency c-section (another part of the books I had skipped, so confident was I that I would be able to handle whatever childbirth threw at me). I was in post-op recovery for almost an hour before I was wheeled back to our hospital room to make our first attempt at breastfeeding. The Boy was a champion eater - although it was all new and a little scary for me, he latched on immediately like he knew exactly what he was doing. The nurse who helped us was satisfied that all was well and left us to it. I fed him from both breasts and he settled down for a sleep. I felt exhilarated, despite the pain from the c-section incision, the discomfort of the catheter (yeah, not so much with the fun there...), the exhaustion of 30 hours of labour (had I known it would end in a c-section, I might have skipped some of those 30 hours)... I had breastfed my child and that was a good thing. I continued to feed him on demand through the night and all the next day. He latched on well, and although it was painful it didn't hurt too much. In the last few weeks of my pregnancy, I'd been leaking colostrum from both breasts like crazy, so I was feeling pretty confident about the whole thing.

I tell you this just to help illustrate how absolutely crushed I was when on Wednesday my milk hadn't come in yet. At all. And the colostrum I was producing wasn't cutting it. The Boy was losing too much weight and the doctor was concerned about his low blood sugar levels. He was, essentially, starving.

It was awful. A technician came in every six hours to poke his tiny little heels to draw blood for tests, which made him shriek in pain, and made me cringe in anguish. The Boy got so that if you put him in his bassinet at all, he would start to cry, anticipating the pricks on his feet. The nurses insisted that he had to drink some supplemental formula just to get enough nourishment to thrive.

The sense of guilt I felt was extreme. I wept. I sobbed. I felt helpless. I felt like the worst mother in the world. I was incompetent. I was terrified my milk would never come in. I thought, "There must be something wrong with me. I can't believe that two weeks ago I was running a multi-million dollar company, and now I can't even nourish my own child." I worried about the cost of formula and how that hadn't been part of the plan, budget-wise. I couldn't sleep; my mind reeled with fear, anxiety, and self-recriminations (none of which, by the way, are helpful in producing breast milk).

I was devastated.

The hospital was completely on board with my continued efforts to breast feed. Nurses helped me get physically comfortable and showed me various holds and techniques. They helped me work out a feeding plan, track feedings, and supplied supplemental formula to The Boy only after he had emptied both breasts, not as a substitute for breast milk. The Boy's blood sugar was so low that he kept falling asleep before he got a decent feed in, and they helped me wake him up to continue. They were really amazingly helpful. I can't say for sure, given my mental/hormonal state at the time, that I wouldn't have given up without this army of incredibly knowledgeable and supportive people mustering to my side to make it all happen.

They also did whatever was necessary to stimulate my body to increase milk production, putting me on domperidone (which sounds like champagne but isn't), a prescription drug that stimulates lactation.

Then they brought in a breast pump that was truly terrifying in appearance. It was a big, heavy, industrial-strength, shiny with chrome and metal thing from a 1950's science fiction pulp magazine that rolled in on its own wheels. (It looked a little like the big bullying older brother of the pump in the photo below.)

I was to use this scary piece of equipment to pump after every feeding, 5 minutes at a time, alternating breasts, for a total of 20 minutes each. It was completely overwhelming.

And my husband, through all this, felt even more helpless than I did.

They let us leave the hospital the next afternoon - with the formula, The Boy's blood sugar had stabilized. We had to rent a hospital-grade pump to use at home, and continue with the domperidone and the supplemental formula. I kept hoping to feel the engorgement of my milk coming in. I would gladly have traded the guilt of failure for the ache of too-full breasts.

My doctor referred me to the BC Breastfeeding Centre, and we went to see them on Friday morning. I'd had such hope for the appointment; after the amazing support at the hospital, I expected it to be a La Leche League type of experience. In fact it was a very clinical medical environment, and while I do not in any way doubt the vastness of their medical knowledge, the style of their practice did not suit me at all. I left the appointment in tears, feeling like I never wanted to breastfeed again. Once home I watched The Boy sleep, dreading the moment he would wake up and want to feed. Fortunately the public health nurse (who was totally. awesome.) was scheduled to visit that afternoon, and she talked me off the ledge. She told me,

"No matter what happens, the most important thing to remember is that your baby will be fed. He will not starve. Whether it's formula or breastmilk, he'll get adequate nutrition and thrive."

That simple statement allowed me to let go of the guilt I'd been beating myself up with, and to move on to practical matters and focus on doing what I needed to do to feed my child. Three days later, to my eternal joy, my milk came in, and I've happily breast fed since. I visited a lactation consultant who recommended a great nursing pillow (Things I Love review coming soon) and helped us achieve an optimal latch. Now, when I'm cranky and tired, feeding The Boy in the middle of the night, I just have to remember how hard those first few days were and everything shifts into perspective!

Eventually, many weeks later, I recovered from the trauma enough to buy a small, cute, quiet breast pump (a conscious choice that was as far from the hospital pump as possible) for the occasional evening out or morning when my husband, a prince among men, watches The Boy and I go out and do my own thing for a couple of hours. I love it. (Proper review in Things I Love coming soon...)

The Take-away:
  1. Don't be rigid in your expectations. I didn't expect a c-section, and it never occurred to me I'd have trouble breast feeding. Much heartache could have been avoided if I'd been more accepting of circumstances earlier than I was.
  2. Guilt is not useful. It paralyzes you and stops you from being able to see beyond your own failings. It makes it impossible to be pro-active.
  3. The hospital staff is on your side. They want you to succeed.
  4. Contrary to what I somewhat foolishly and naively believed, formula is not evil.
  5. Pumping breast milk is not abandoning your child.
  6. And breastfeeding is not as easy as it should be. How did the human race survive all those millenia?

*I'm in Canada, which has a very generous government-sponsored maternity and parental leave program. Having that full year of paid leave makes breastfeeding a lot easier. If I'd had to go back to work right away, I don't know how easy it would have been to pump several times a day...


  1. Hi Lexi,

    I very much enjoyed this post. Sorry to hear you had such a rough going at first, but very glad to hear it worked out. I gave birth (C-Section also, but scheduled due to placenta previa) at BC Women's. If my memory serves me right, the nurse said to me that my milk was coming in on day 3, and I had read that it could take 3-5 days for milk to come in; and babies are supposed to lose weight (5-7%, up to 10% max, I believe?) in the first week. (How much did your baby lose by Wed?) So I was a little surprised to read in your post that the hospital told you on the Wednesday that your milk wasn't coming in. But I'm no expert; just glad it all worked out for you! I felt the same about breastfeeding, too, so I can appreciate how you must have felt. Anyways, thanks for sharing your experience. Looking forward to your future posts. I think your baby is 2 months ahead of mine (mine is 6 months) so I'm also hoping I can pick up some tips from your experience! ;)

  2. Wednesday was technically day 3 as he was born on Monday. The Boy's weight loss and blood sugar levels are what triggered the concern about my milk. He lost over 7% of his weight (the baseline for concern) within the first day, and subsequent blood tests showed that he wasn't getting enough nourishment from the colostrum I was producing. His blood sugar/weight loss remained of such concern that the hospital considered not letting him come home with us on Thursday. It was all so traumatic at the time - now I recognize it was at most a two week period of stress and angst, but with a brand new baby, time becomes very elastic and everything has huge importance. Glad to be through to the other side on that one!

    And yes, The Boy will be 8 months old on Monday!

  3. Thanks for the info, and happy birthday to The Boy!!