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Supply and Demand

Beryt Nisenson
Houston TX USA
From: NEW BEGINNINGS, Vol. 20 No. 3, May-June 2003, p. 91

Before Josh was born, I could have taken or left breastfeeding. I knew it was the best thing for my baby, but I didn't really like the idea of being the only one who could feed him. I also didn't imagine the physical sensation to be anything I'd want any part of.

Then came Joshua Rush. After a long, extremely empowering, natural labor, I cradled his tiny, wet, warm little body in my arms and my doula helped put him to my breast. Everything changed while watching him nurse. I was hooked.

The first week was a total blur. Josh seemed to have enough dirty diapers and his color was normal. At home, he seemed to be breastfeeding all the time, but I knew that this was normal. I never actually felt my milk come in or any kind of engorgement, but my doula said that this was okay. Josh was happy and so was I.

In the second week, Josh became more demanding. He nursed sometimes for 45 minutes on each side, and would fall asleep at the breast. When I'd take him off the breast, he would cry hysterically. He never seemed satisfied after nursing. Since I couldn't nurse all the time because I needed to sleep and eat myself, my husband, mother, or stepfather would carry him around in the sling as he cried, until he finally fell asleep.

After three or four days of constant crying, my mother, a registered nurse, told me that she was afraid he wasn't getting enough milk. She convinced me to call the pediatrician, whose nurse promptly told me that he had gas and was using me as a pacifier. I was to limit his nursing to 20 minutes on each side and give Mylicon in between. I was exhausted, so that sounded like a fantastic solution. Within a few hours on that schedule, he slept more and cried less. Eureka! That was the answer! I could have kissed that nurse.

But after about 24 hours, Josh was lethargic. He was sleeping almost all the time, and stopped crying at diaper changes. He was even quiet while we bathed him. Something was wrong. The next day we took him in to the pediatrician's office. He was 13 days old and weighed eight ounces less than his birth weight. The doctor asked me to breastfeed him for 10 minutes on each side, and we weighed him afterwards to see how much milk he had gotten. He had not gained even an ounce.

I could see the concern in the pediatrician's eyes as he gave my husband a bottle of formula. I cried as I watched Josh struggle with the artificial nipple, and finally begin to drink the formula. He guzzled the contents in minutes. He was so very hungry. I felt confused, discouraged, and defeated, yet somehow determined. Over the next two weeks, I met with a La Leche League Leader and the hospital's lactation consultant, talked to friends, and read as much as I could get my hands on. Most advised me to just nurse as often as possible, and said that the increased demand would bring up my supply. This didn't work.

I tried a different strategy every few days, pumping every couple of hours, herbal supplements, or staying in bed all day nursing. Nothing seemed to help. Even my mother, (who had breastfed me) and my husband were suggesting that Josh was doing fine and gaining weight on the formula supplements, so maybe I should just give it up.

At four weeks postpartum, I was about to give up hope. As a last resort, I called a lactation consultant who had been too busy to meet with me when I had called two weeks earlier. We met, and after a thorough consultation, she asked me to commit to following her advice for 12 days. If it didn't work, then I would know for sure that I couldn't breastfeed exclusively. I agreed.

I carefully followed her plan. First, she adjusted my latch-on technique ever so slightly. She advised me at each feeding to nurse Josh, then pump for 15 minutes to thoroughly drain my breasts, and feed him the pumped milk or a formula supplement. I also began taking Domperidone, a drug that is not marketed in the United States, so I had to purchase it at a special compounding pharmacy. It's an acid reflux medicine with the fortunate side effect of increasing serum prolactin, which can help with milk supply. I was, of course, very nervous about taking any kind of drug while breastfeeding, but I read everything I could and made a decision to try it.

To make matters worse, Josh and I both had thrush, so nursing and pumping were both very painful. At times, it was all I could do to pump and feed the milk back to him in a bottle. Eventually, with a regimen that included antifungals, washing bras in hot water, and boiling bottle nipples, we were both cured and he was breastfeeding again.

My days were filled with breastfeeding, pumping, bottle-feeding, and sterilizing pump pieces and bottles. Talking on the phone every few days to a new person who had succeeded at the same challenge was essential to keep me going. I was pumping at least eight times a day on top of everything else that needs to be done with a new baby. It had become incredibly important to me. The pumping just became part of my daily routine, somehow manageable.

By feeding back all of the milk I pumped, I was able to tell that I was eight to 10 ounces short of meeting Josh's nutritional needs, a little under half of his daily requirement at that time. But I saw improvement within one week, and each day I was feeding him more and more human milk. In three weeks I was feeding him all of my milk! What a day that was, when I looked at my logs and saw that all of his nutrition was coming from me!

The next task was to get Josh to take all of the milk on his own, which was easier said than done because he was used to being fed a bottle after breastfeeding. While I continued the frequent pumping, we spent the next three weeks giving him less and less in his supplement bottles. The consultant called it "giving the responsibility back to the baby." Though this was a scary process, I eventually began to see that when I gave him a smaller bottle after nursing, he would come back to the breast sooner. Eventually, I was nursing more and bottle-feeding and pumping less. By the time Josh was two months old, we were exclusively breastfeeding.

For a while, I still pumped after one or two feedings a day. But without the "luggage" of bottles every time we went out and without pumping after every feeding, I was finally able to understand why everyone said breastfeeding was so much easier! I could relax and just nurse my baby. And when I took him to his four-month checkup and he had jumped from the 15th to the 30th weight percentile, I felt so incredibly proud that the increase was all from my milk! He was thriving.

I began to wean myself slowly from the Domperidone and was off it about two months later. To my surprise, there was never a decrease in my supply. My body had learned how to produce the right amount of milk on its own.

Now, Josh is an active, curious, happily nursing 15-month-old. And I am a champion of breastfeeding, often found recounting my story to pregnant friends so that they'll do whatever it takes to establish their milk supply from the beginning. I'm also a strong proponent of La Leche League since I received such incredible support and information from my local Leader and the many friends I've made at LLL Group meetings.

If there's one thing I've learned about my personality, it's that I appreciate things more when I have to work for them. I sometimes curse myself for that trait, but other times I look back at my experience and wonder, would I have chosen extended breastfeeding? Would I appreciate nursing as much as I do now had I not faced such challenges? I cherish every nursing moment, knowing that had I not worked so hard, we would not share such an incredibly special connection.

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