Liquidity

Grace is thriving. Having lost a fair bit of weight in the first week she is now gaining nicely. I estimate that this time around I have at least a milk 50% supply. Supplementing with the Medela Supplemental Nursing System (SNS) is a absolute genius. This is an at breast supplementer so the baby gets the forumula supplement through a small tube while nursing at the breast. It means that she only ever has a bottle when we go out and so isn't getting nipple preference like Olivia did and my milk supply gets extra stimulation to increase. Hopefully this should mean a longer and more effective breastfeeding relationship this time around.

I didn't but this till Olivia was about 9 weeks old and she had already established quite strong nipple preference for bottles by then and was a very fussy nurser at the breast and so I found it very hard to get her to latch while using the SNS. Grace is a good feeder with a strong latch and so I have had lots of opportunity to practice and perfect the technique of using the SNS. I don't tape it on though, but just keep it in place with my finger until she latches.

When I do use a bottle, when out and about, a feel almost apologetic and feel the need to justify it by stating that I do actually breast feed but have low milk supply. No one has ever challenged me on using bottles, it is my own perception that people will think badly of someone who bottle feeds rather than breast feeds. You could argue that I made my own bed by having breast surgery in the first place but at least I am trying ot do my best and make sure my babies have got the most breast milk they could. I guess I do carry a certain amount of guilt around about what it would have been like if I had never had the surgery and could breast feed normally.

Having said that, what is done is done and I just have to make the best of it , learn from my experiences with Olivia and try to establish a good breastfeeding relationship with Grace.

Take the Right Drugs

Now that the baby had turned head down the only issue to solve before we could relax and wait for the big day was trying to get the Domperidone prescription to enable me to increase my breastmilk once the baby is born.

I had been to see the GP a while ago to ask for the prescription and you'd think I had asked for his life savings! The conversation went something a little like this...

K_: I would like a prescription for Domperidone please
Dr: What do you want that for?
K_: To increase my breast milk once my baby is born please. I had a breast reduction 10 years ago and I had low milk supply with my first baby, which was dramatically increased by using Domperidone.
Dr: I don't know anything about that, you need to ask your obstetrician
K_: Um....what obstetrician?
Dr: The one you usually see.
K_: I haven't seen an obstetrician, I have midwife led care
Dr: There will be an obstetrician where you usually go to clinic
K_: I've only ever been to this surgery for the midwife clinic...
Dr: The hospital where you are having the baby...
K_: I'm having the baby at home and only see midwives.
Dr: Well I don't know anything about it so I'll have to speak to the obstetrician and get back to you.

So off I go, hopeful that I will get a satisfactory resolution soon...

2 weeks go by and I don't hear anything so I phone to be told that the Dr has gone on holiday and that I should phone the following week. So I phone back and cannot get hold of him. When he finally returns my call I am at work, very busy and a bit flustered. Without referring to the fact that I had asked him for Domperidone, he announces that he has spoken to the obstetrician who has recommended Metoclopramide and I can pick my prescription up at the desk. This drug rang an alarm bell in my head but without any of my research with me I was unable to respond to this and just said I would take a look at what it was.

Once I got home and checked the fact I realised that my gut feeling of alarm bells was certainly justified. On the face of it Metoclopramide is a similar drug to Domperidone, it is a dopamine receptor antagonist stomach drug which although unlicenced for this usage does have a side effect of increasing lactation. That is where the similarity ends. Whereas Domperidone has a very low side effect profile with headache and dry mouth being the most common, Metoclopramide is a very nasty drug indeed. Although it is prescribed to increase breast milk this is generally very short term (2 weeks or less) usage in mother of premature babies to get their milk established. The main difference between Metoclopramide and Domperidone is that Metoclopramide crosses the blood-brain barrier and has documented Central Nervous System (CNS) side effects including anxiety, depression and even suicidal thoughts. Then incidence of negative CNS rises if Metoclopramide is used for more than 4 weeks. Metoclopramide is not recommended for those with a history of anxiety and depression.

I had NO intention of taking Metoclopramide as I have a history of anxiety and depression. Although drpression would not necessarily be recorded on my medical records as I have avoided being prescribed antidepressants, my medical history includes treatment for arthritis caused by extreme nightime teeth grinding and use of sleeping pills to manage ongoing insomnia. It wouldn't take a genius to work out that I may not be a great candidate forMetoclopramide at the best of times, but the danger of postnatal depression makes it even less of a brilliant plan.

There was also the concern that Metoclopramide is for very short term use, due the the side effect profile. Quite what the GP expected I would do after the 2-4 weeks maximum usage was up I am not sure.

M_, the midwife, and I discussed things and I emailed her some of the evidence I have collected on the use of Domperidone to increase breast milk supply. She was also not happy for me to take Metoclopramide got on the case and spent several days trying to get hold of the GP. We had been hoping that he might be willing to learn more and discuss the relative merits of the drugs but once she finally got to speak to him he wouldn't even discuss the evidence with her and told her to just take it up with the obstetrician. I'm note sure if he has even bothered to read my notes or find out about either drug. I didn't expect him to be an expert on increasing lactation but I did at leats expect him to be willing to find out more and to discuss clinical evidence with another medical professional.

M_ has been brilliant and got straight on to the obstetrician who works out of the local hospital. He was happy for me to switch to Domperidone and is arranging for a prescription to be available for me to pick up at the hospital. Once I have this I will then be able to request repeat prescriptions from the GP surgery.

Success at last and big thanks to M_ for her efforts in sorting this out for me.

The Bottle and the Doctor Get You Through the Day

The Supplemental Nursing System I ordered recently arrived on Monday. I had a go using it on myself but it didn't go well and after about 10 minutes of fruitless trying Olivia was purple and screaming, and we were both pretty frazzled.

Not one to fall at the first hurdle I went to see a breast feeding specialist at out local Sure Start clinic. Sure Start is a government initiative to run childcare and health education for families. Our local clinic runs a variety of initiatives including the baby massage we do on Thursdays and a Wednesday breastfeeding support group. The counsellor showed me how to latch Olivia onto the breast while also using the tube to supplement the breast milk. The idea is that the baby receives the normal top-up of formula or expressed breast milk while latched on to the breast so they still get the food they need but the mother's milk supply is also stimulated at the same time.

Anyway, this time we actually got her to nurse while using the supplementer and she took 3oz of expressed breast milk. I think that the supplementer is something that would have been much better in the beginning few weeks when a real difference could have been made to the supply. It is also fairly faffy and time-consuming and probably better suited to those first few weeks when commitments were minimal and I had F_ around to help out with things. I will try it again on my own but I don't think the SNS is going to be totally replacing the bottles as the medium for supplementing her. The breastfeeding support worker who also come to help me put has asked me if I would be willing to speak to some of their groups in the future about my experiences with breast feeding after a breast reduction.

A lot of the things I am trying at the moment will probably benefit baby no. 2 (no I'm not up the duff after 8 weeks - I'm talking hyperthetically!) more than Olivia as hopefully next time around I will be able to try a lot of what we have worked out through trial and error from the beginning rather than faffing around so much.

Things I have found have increased supply:
Taking the prescription drug Domperidone
Pumping to increase demand and therefore increase supply - although next time I will hire a hospital grade pump to maximise effect for minimum time and effort.
Frequent feeding at the breast - although next time I will use the at breast supplementer as well to ensure maximum stimulation of the milk supply

Next time around supply is likely to be better anyway as lactation encourages formation of new lactation tissue and can also stimulate severed connections within the breast to regrow.

Anyone needing info about breastfeeding after reduction should definitely check out BFAR and I would also strongly recommend the La Leche League book 'Defining Your Own Success' by Diana West. The cheesy title aside this book is crammed with useful tips and info as well as success stories from BFAR mothers.

General breast feeding resources I have found useful are :
Kellymom.com - a website packed full of useful articles and handouts on all aspects of breast feeding
Also the instructional materials of Dr Jack Newman, which can be linked from a variety of websites, including Breast Feeding Online . Dr Jack's handouts cover a variety breast feeding topics while his video clips offer a useful audiovisual resource with practical demonstrations of various apsects of feeding.

Did You Drink Too Much Too Soon?

We recently changed Olivia's formula from SMA Gold to Hipp First Infant Milk.
When I was pregnant I wanted a few small ready mixed cartons in case I needed them in a hurry. In a push to support breastfeeding (and the cynic in me says there might just be an element of cost cutting) our local hospital equires you to bring your own milk if you want to bottle feed and I wanted to be prepapred in case I had to transfer in a hurry and the breastfeeding didn't work out. These came in very handy when we were told by our midwives that we needed to supplement Olivia with formula. Once they were used up F_ went off to the shops as I wasn't back on my feet and asked the ladies in the chemist what formula was best only to be told something along the lines of 'oh they are all the same so just use whatever'.

Now on closer inspection they are NOT all the same. Once I sat down and read the ingredients on a tin of baby formula my jaw dropped at the zillion ingredients. Although lots of these were vitamins etc. I was left wondering what the hell the rest were! In the early days post delivery we used Waitrose Deliver a few times to stock up on nappies and food.

Without digressing too far onto a topic which could keep me busy for hours lets just say that I strongly believe in the ethos of Waitrose, their environmental stance, support for local products, fair attitude towards producers etc. and would not give my money to certain other major supermarkets. If you want to know more then click here and also check out the excellent 'Sold Out: the True Cost of Supermarket Shopping' by William Young. Without showing myself to be the Guardian reading, polenta eating, tree hugger that I secretly am we believe in recycling, biodegradable (and if her belly button ever heals up washable) nappies etc., farmers markets, supporting local producers and independent shops etc. We also get organic milk and eggs delivered by our milkman and seasonal organic vegetables delivered by Abel and Cole. Ok so I lied, I did digress...

Anyway, whiling away time on the Waitrose website I discovered the Hipp organic baby food range. Never having spent much time in the baby aisle in supermarkets I hadn't really thought about organic baby food at this stage. I knew we wanted to ween Olivia onto home made organic baby food but for some reason it had never occurred to me that there was such a thing as organic formula. So now she has that in addition to breast milk.

Now maybe I am naive in my recent state of motherhood, and will be eating my words in a few months time, but I always find it really annoying when people say things like 'oh, little Johhny will only eat oven chips'. WHY will little Johnny only eat oven chips - surely the adult, the one in charge, and sets the agenda for is eaten by...um...buying it. Unless little Johhny is off down Iceland (a frozen food emporium for our US readers) when Mummy's back is turned buying McCain's finest then where do said oven chips come from???? I know it isn't that easy because my firned never let her baby have sweets, preferring to give her dried fruit as her sweet treats, which all worked well until she went to nursery and saw the contents of everyone else's lunch box! Having said that, thanks to recent government initiatives (nothing to do with jumping on the Jamie Oliver bandwagon - much, honestly) many school no longer allow the packet of Monster Much and Wagon Wheel, which along with Nutella sandwiches of cheapest white bread were the staple foods in my day. So maybe, especially where we will, Olivia will grow up coveting her neighbours roasted vegetable and houmous salad???

So, after another little rant there, the upshot is that Olivia now eats organic food like her Mummy and Daddy. Meanwhile Mummy and Daddy live in fear of the day when little Olivia is invited to her first childrens party at McDonalds...

Loving by the Pound

Olivia has finally exceeded her birth weight. As of Monday she weighed 8lb 10. Took four weeks but we got there is the end. The daily drama of guessing how much formula to give her after a breast feed proved too much for all concerned. The previous week she had only gained 3 ounces and we just couldn't go on with her not putting much on. Now I give her a big breast feed in the morning when I have a decent amount of milk, followed by just a few ounces of formula, and then the rest of the day she has her full formula feed followed by as much time as she wants on the breast. She is still getting the benefits of breast milk and the comfort and bonding (or Mummy Loving as it is known in our house:) but we know that she has the calories she need to grow.

Here she is looking positively blooming!

Food, glorious food

Well it's been a funny few weeks.

We always knew that I might not have a full milk supply due to surgery I had in my early twenties. I always found the idea of breastfeeding a but ikky in abstract but as soon as I got pregnant I knew that I wanted to breastfeed my baby. We knew that the medical complications would mean that we would have to monitor Olivia's weight gain carefully to see if we needed to supplement her diet.

Out she came and she took to breastfeeding straight away. I had already started to think there might be a problem on the 4th day when I thought my milk had come in but she was feeding every hour all days and half of the night but still didn't seem satisfied. By the evening of the 5th day I had a big panic and we tried her with a bottle, which she wouldn't take. When she got weighed on day 6 she had lost 14% of her birth weight - not good. The upper limit that is considered acceptable is 10% so we knew there was a problem and started topping her up with formula after each feed.

We were worried about giving her bottles before breastfeeding had become established as babies can start to prefer the ease and fast flow of a bottle feed and refuse to go on the breast so we started off cup feeding. We both found it amazing that you actually can give a newborn baby milk in a cup and they will lap it like a kitten. We did this for about 5 days before a long day left us both exhausted by midnight and out came a bottle. The problem was that it took about 90 mins to coomplete each feed, which gave you about an hour before she wanted to be fed again and the whole roundabout started again. You tended to spend this hour cleaning her and changing her clothes as she was covered from head to toe in formula. It was also very difficult to get any worthwhile amount down her as she tended to get too sleepy to drink and most of it was down her front anyway.

So, now she has a bottle after she has been breastfed and she is perfectly happy. I love breastfeeding her as not only does she get the immune system and numerous other health benefits of breast milk but also it is such a bonding experience and allows us lots of skin to skin closeness. She looks so happy and peaceful and I could just stare at her for hours. It was of course very disappointing that I don't produce enought milk, and tears were shed as I felt I had let her down, but her welfare is our primary concern. I try to express after feeds so that we can supplement her with breastmilk as much as possible and to encourage my milk supply to meet the increased demand. I'm also trying herbal tintures and prescription medication to try and increase my supply so we can supplement less.

It has all been an emotional rollercoaster. We both started crying when she was weighed for the second time and we saw that she had gained weight. I don't think we realised how much we had been stressing about the situation. She is gaining weight well and yesterday she was back to within 7% of her birth weight. The midwife said that they look for the babies to have regained their birth weight by 3 weeks so she is well on target as she seems to be gaining about an ounce a day at the moment.

An aside on the generalities of breastfeeding - I have a REALLY low embarrassment threashold and really don't feel comfortable breastfeeding in public. I guess we kind of have the best of both worlds as it does mean that if need be then I can give her a bottle when we are out and about if she needs it but she is still getting the many advantages of breast milk. Plus in this country we have a ridiculous law which says that women can be asked to stop breastfeeding in public!!!!! Scotland has passed legislation allowing women to feed in public. Although it isn't my personal choice to feed in public I think it is totally wrong that such a natural process is not protected. Oi government - sort it out!