Just feed the baby, they said

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Warning: If you aren’t comfortable with boob talk or don’t want to read a bunch of detailed information about breastfeeding, feel free to skip this post.

In a recent post I mentioned that Wyatt is exclusively breastfed, and how I was proud of that achievement, since I never got there with Zoe and had to supplement with formula her entire first year. But it’s been a long road this time around, and we still have our struggles.

It started in the hospital when we learned that, like Zoe, Wyatt had both a tongue tie and a lip tie. (Ties are hereditary and my husband has a tongue tie.) I didn’t learn about Zoe’s ties until she was six months old, and so in the early days, when my milk supply was being established, she didn’t transfer enough milk, which killed my supply. I also had know idea what I was doing and didn’t seek help until it was much too late.

We were prepared with Wyatt and had his ties revised when he was 5 days old. But by then he was already using a nipple shield, because the lactation consultant at the hospital forced one on us, for reasons I don’t entirely remember, and because I was too doped up and exhausted at the time, I didn’t fight her. Anyway, soon he became too used to the nipple shield and wouldn’t nurse without it. In the meantime, he developed thrush, a fungal infection, and we spent several weeks sterilizing all bottle and pump parts after every feed and applying medicine to his cheeks and mouth four times a day, in addition to doing stretching exercises to helping his tie revisions heal.

Also for the first few weeks, he was incredibly sleepy and would fall asleep before he was full, so I had to pump after every feed and we would supplement with expressed milk, first in a feeding syringe, and then as he got bigger and ate more, with a bottle. He was so sleepy that it was often difficult to rouse him, or he would fall asleep halfway through, and feedings often took an hour. Apparently this is due to something called wimpy white boy syndrome, where, for example, premature white male babies require many more interventions in the NICU because they just can’t get it together. (My husband and I joke that this must be due to evolution, in that white males basically don’t even have to try, because they automatically get plenty of help, whereas African American baby girls, who are apparently the most robust in the NICU, have to fight for every little thing. Well, we joke about it, but sadly it’s probably true.)

Anyway, eventually we got past the sleepy phase and no longer had to wake him up for feeds, and eventually he got over the thrush. But then we were still using the nipple shield, which was preventing him from getting a full feeding, such that we still had to supplement with pumped milk. So I started to wean him from the shield, which took about a week, and for a few brief days things were great, as he was nursing without the shield and without supplement. But then without the shield serving as a barrier, nursing became excruciating, and this past weekend I had to switch to exclusive pumping and feeding him expressed milk with a bottle. We’ve since learned that he hasn’t learned how to use his tongue correctly after his revision and doesn’t bring it far enough forward in his mouth, and that’s why it’s so painful. We’re doing exercises several times a day, and hopefully I’ll soon be able to go back to directly nursing and we can put this last obstacle behind us.

A few days ago I said I wasn’t going to share a lot about Wyatt to protect his privacy, and yet here I’ve just gone and relayed a lot of medical information about him. But this is leading up to some tips I wanted to share with breastfeeding moms who are struggling, even though this is a grief blog, and not a baby care or breastfeeding blog. I didn’t know about any of this stuff when I was a first-time mom; I assumed you simply put the baby near the boob, and everything would just work out, so the amount of struggling we did hit me like a ton of bricks. Even this time around, I still had much to learn, so I hope it helps even one person out there. Pick none or one or all of these, if you like—whatever works for you.

Seek professional help. If you can only follow one of these tips,  let it be this: Schedule a home visit with an international board certified lactation consultant. A good IBCLC can not only assist you with latch issues but help you develop a feeding/pumping strategy, assess the suction on your pump, help you choose correct flange sizes for your pump, and recommend herbal supplements to boost supply if necessary. I’ve found that hospital LCs, while qualified, tend to be most knowledgeable about short-term goals of getting baby to have a sufficient number of wet and dirty diapers before leaving the hospital, as opposed to helping moms build a long-term milk supply. Likewise, LCs at pediatrician offices can be most concerned with making sure baby is gaining weight. And these are important goals, but if you are supplementing with formula because your bub isn’t efficient at transferring milk, and you feel that the hospital or pediatrician LCs are not sufficiently focused on helping you wean off supplementation, seek help ASAP from an IBCLC in private practice. You can find one here; the members of the IGT/Low Milk Supply Facebook group can also recommend one in your area.

While this is probably the single most important investment you can make on your breastfeeding journey, your insurance may not cover visits from a lactation consultant, so if you cannot afford one, consider asking friends and family for a bit of help—you can let them know you’d rather have this than more clothes, which you likely already have too many of anyway, or toys that the baby won’t even be able to use for months.

Invest in a hospital-grade pump. A hospital-grade pump is your single best bet for boosting supply, especially if LO is not good at transferring milk. You can rent one from your hospital, like a Medela Symphony or Ameda Platinum, or you can buy an affordable, high-quality one such as the Spectra S2. Under the Affordable Care Act, many insurance companies are even providing Spectras for free. With Zoe, I used an Ameda Purely Yours, then a Medela Pump in Style Advanced and eventually a rented Symphony from my hospital, as the Spectra wasn’t available in the U.S. at the time. This time I have the S2 and it blows the other pumps out of the water in terms of suction and comfort.

Have your LC test the suction on your pump using a vacuum gauge, and replace parts regularly. I’ve had to use my S2 frequently, so I replace the backflow protectors and duckbill valves about once a month. (Side note, the tubing that comes with the S2 sucks and constantly falls off the backflow protectors. I ordered the Nenesupply replacement tubing from Amazon and I no longer have that problem.)

Not every mom responds to every pump in the same way. Some moms actually respond better to hand expressing or manual pumps. So if you don’t have a lot of money to spend on multiple pumps, your best bet is to rent or to get a free one through insurance.

Pump after every feed the early weeks, especially if your LO has transfer issues.  Start as soon as you can in the hospital. This is a lot of work and can be time-consuming, and it can be especially challenging after your spouse goes back to work, and if you have more than one child, but you’ll figure it out eventually. Get a hands-free bra, consider hands-free pumps like Freemies, and learn how to pump while driving. If you have an older child, come up with special activities that they can do only when you are feeding/pumping. For Zoe, we created some craft boxes that we keep high on a shelf and bring down only during Wyatt’s feeding time.

Since breastfeeding is based on supply and demand, there is little that is more important in building your supply (in addition to using a pump with maximum extraction), especially if your LO doesn’t transfer enough. If you are supplementing with formula, pumping after every feed should eventually help build your supply to the point that you can start supplementing exclusively with breast milk.

Learn about herbal supplements. Fenugreek is usually the go-to supplement recommended for boosting supply, but for many moms it has no effect or, for those with thyroid issues, can actually decrease supply. There are other options, such as goat’s rue and moringay, and this is where an IBCLC in private practice can really help, as many hospital and pediatric LCs seem to be f fenugreek.

Enlist helpers. If you have a spouse or partner, now is the time to enlist as much of their help as you can. Up to this point they haven’t born the brunt of bearing your child. They weren’t pregnant, didn’t deliver the baby, and aren’t nourishing your LO directly from their body. So don’t feel bad about asking them to pitch in by washing pump parts, bringing you snacks, getting up with you for middle of the night feeds, or any of a thousand tasks.

Don’t stress, and don’t give up. “Don’t stress” may seem laugh-out-loud crazy, and I certainly am guilty of not following this advice, but seriously, make a plan, push through the hard parts, and try to trust that everything will eventually work out if you stick to the plan. Find a mantra that you can recite any time things get hard—this one has worked for me:

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Find other moms that you can connect with for advice and inspiration. I’ve gotten so many great tips on pumping from the Exclusive Pumping Mums Facebook group, and it also helps to know I’m not the only one who struggles.

If you’re having a bad moment and feel like giving up, see if you can postpone your decision to the next morning. You may find that with a little distance from whatever it was that was pushing you to the edge, you feel just better enough to keep going for a little bit longer. If you keep doing this, things may start to get easier until the woes of the early days are far behind you. Remember that with very young babies who are just figuring all this out, every feeding is different, so if you have a feeding where baby doesn’t latch or doesn’t transfer enough milk or it’s excruciating, try to push through it and forget about it as soon as it’s over, because the next feeding may very well go better.

But if you feel like you’re not enjoying your time with your baby, or that feeding and pumping are taking too much time away from your baby, or that you just want your body back and to get some sleep, there’s no shame in stopping. You can bond with your baby and be a great mom however you choose to feed. It’s your body and only you can decide how you want to nourish your child.