BREASTFEEDING: HOW HARD CAN IT BE, RIGHT?
BY TANYA IVKOVIC
It sounds simple and many of us think that something so natural should just come naturally, right? This is what our bodies were designed to do, so how hard can it be?
30th August 2018
I was fortunate enough to have friends who had children before me, so I didn’t go into this experience blindly. I was very aware of how challenging breastfeeding can be for so many, but on the flip side I also had a lot of friends for whom it just seemed to come easily.
When I found out I was pregnant, the one thing that I was certain of was that I was going to breastfeed. Being the planner that I am, I signed up to a breastfeeding basics workshop to set myself up as well as possible. I listened intently and really soaked it all in. It was fascinating to learn so much about this magical, live substance that is so uniquely tailored to our baby and their needs. I read all the handouts, I watched the YouTube videos, and it made me even more determined that this is what I was going to do. But even though I knew the challenges, I just always thought for me it would be second nature.
I remember the night I went into labour like it was yesterday. I prepared myself for this too and took antenatal classes, because let’s face it, I like to know what I’m in for. I was really scared of labour and the delivery and I had mentally prepared myself for the worst - painful and very long! What I got was a relatively quick labour and a straightforward and easy delivery. Contractions were uncomfortable but it was definitely not the excruciating and nauseating pain that so many people go through. Very lucky, I know, and this is not me in any way boasting. My own mother was in the delivery room with us and she was as shocked as I was at how smooth it was going, because the way she recalled her labour with me, she felt like she was going to die! No joke! But guess what? My mum found breastfeeding an absolute breeze; for her it was the most natural thing in the world. But for me, it ended up being one of the most challenging aspects of my early days and weeks as a new mum.
How our troubles began: early separation and jaundice.
My baby girl was born fairly small at just over 3kgs and she was born with fluid in her lungs, so I wasn’t able to have much “skin-to-skin” time initially. She didn’t have her first breastfeed until 4 hours after she was born. Then, on day 3 when I was expecting to be discharged, I was told she was jaundiced and needed phototherapy treatment. The initial plan was for 2 days, but due to her bilirubin levels not decreasing enough, this ended up being 4 days.
The hospital’s policy is that you can breastfeed your baby during phototherapy treatment, but only once every 3 hours and only for 15 minutes, which really isn’t the “on-demand” feeding I had prepared myself for. I was also told that if my baby didn’t get “enough” during these 15 minutes every 3 hours, the nurses would need to top-up with formula.
They sent a lactation consultant to explain this to me and have me sign a waiver that I agreed to give my baby formula. When I think back, that lactation consultant could have and should have told me more about the potential problems with this situation: that this approach isn’t best geared towards encouraging breastfeeding but that they would do everything in their power to minimise the detrimental effect. She should have told me how important skin-to-skin contact was in the early days, not just for bonding, but for encouraging my milk supply to come in. And because I couldn’t have this critical skin-to-skin contact and on-demand feeding, she should have explained to me that I needed to express frequently, not to extract a lot of milk, but to encourage my milk supply to come in. I knew this already, from the breastfeeding workshop I took, but at this point I was exhausted and worried about my baby and these things didn’t come to mind for weeks! The only thing I seemed to remember at the time was nipple confusion, and I was told they would supplement her with formula through cup feeding so this would not be a problem.
Discharged with no support plan.
To cut a long story short, I was discharged from the hospital with a baby who had lost more than 10% of her birth weight (11% to be precise), the clear instruction to continue “mixed feeding” (i.e. topping up with formula) and absolutely no plan in place on how I may be able to phase this out and exclusively breastfeed my baby. And I want to add a side note here – in my view, there is nothing wrong with feeding your baby formula if that is your plan or the decision you made. But it was not my decision and it seemed as if it had been decided for me. Hence my determination to change it. I knew that I would try everything at my disposal to get back to my original goal of exclusive breastfeeding, and I did.
The next week or so was a total blur.
I responded instinctively to my baby and whatever she needed. I fed on demand, I slept when she slept and I was lucky enough to have my mum there who constantly fed me all the good, wholesome food that was supposed to help my milk supply. I was also taking Moringa supplements, drinking Galactovit tea, eating lactation cookies: you name it! We took Ava to get weighed once a week. I tried so hard even in those early days not to give her any formula, but usually about once a day I just couldn’t avoid it. At her weigh-in, she was gaining, but slowly. The midwife said I should top-up a few more times a day to help her gain weight. I wasn’t happy about it but I just kept thinking "if I can just get her over 4kgs, she will be stronger and will feed better." I was also working with a lactation consultant who provided me with guidance, both at home with visits and through messages whenever I needed. She knew my goal was to exclusively breastfeed. And it was her that I ultimately turned to after a couple of weeks looking for an alternative to cup feeding, which led me to an “at-breast supplementer”.
Supplementing at the breast.
This made a huge difference to me, not only because after cup feeding it seemed easier, but also because it meant that my baby continued to stimulate my breasts even though she was being topped-up. I started off with a homemade version, involving a feeding tube and a bottle but ended up buying the SNS (supplemental nursing system) by Medela, which was a lot less fiddly! What it entailed was taping the tube to my breast with medical tape, placing the tube end at the end of my nipple and putting the nipple in my baby’s mouth. So baby feeds “at the breast” but consumes the contents in the bottle, whilst at the same time stimulating your breast to make more milk for next time.
Don't be so hard on yourself!.
The SNS made my life A LOT easier in the house, because I really enjoyed breastfeeding. But, I was scared about leaving the house because I never knew if she’d need a top-up (obviously awkward and unpractical to even attempt using the SNS in public!). I was lucky because it was usually only once a day that she needed topping up (once she had regained her birth weight) and usually in the evening, so I knew I’d be ok during the day, but I was still nervous. And I couldn’t help comparing myself to all the mums who were so active and getting out and about all the time! Anyway, all I kept saying to myself was – “She’s gaining weight, she is getting stronger, you will be able to phase out the formula, don’t be so hard on yourself”. But every day that I had to give her formula, I felt like my body was failing me for not producing enough milk for my baby. My husband thought I was crazy. He kept asking why I was beating myself up about it, babies drink formula all the time. And he was right, why was I being so hard on myself? I have friends who formula feed and I don’t judge them, not at all! But I guess for me it was just that this was never my plan or my decision. I was determined to exclusively breastfeed.
Tonge tie: the next challenge.
Around week 5, I noticed my baby getting extremely fussy and desperate for milk in the morning as well as the evening, showing the exact same signs that there was no milk! I quickly set up a follow-up visit with my lactation consultant. She came and observed a morning feed and saw that my baby wasn’t drinking and was struggling. But when I put the SNS on, she went for it, obviously hungry. She noticed my baby’s latch wasn’t as deep as in the early weeks and noticed a very slight posterior tongue tie. She said this could be the cause of the drop in supply because this (albeit slight) tongue tie could mean the baby wasn’t fully emptying my breasts with each feed, which in turn signalled to my breasts that they didn’t need so much milk. And over time, they started to make less.
She referred me to an osteopath to assess and do some light body work, as sometimes this can release the tie enough to not need a cut. But the osteopath suggested the cut might be necessary and really noticed her latch wasn’t “full suction” as he described it. A GP who was also a lactation consultant performed the procedure. She made sure I understood it wasn’t guaranteed to fix the feeding problem. But she thought there was a good chance so I went for it. It was so quick and there were some tears (from me and my baby) and the couple of days that followed were hard, as she had to practically relearn how to latch. I kept feeling guilty (mum guilt is real!) that I had done this to her, thinking to myself … “Is this pain she is going through worth it just so I can exclusively breastfeed. Why am I being selfish?”, but two weeks later when I went back to the osteopath, he saw a tremendous improvement in her latch and could see that the tongue tie release was the right thing to do! This made me feel a lot better.
Doing everything I could possibly do to make more milk.
I soon noticed her feeding better, and needing fewer top-ups. I was also, as instructed by my lactation consultant, pumping frequently but for short sessions, immediately after some of the feeds, to really empty my breasts. The GP had also prescribed Motilium to help increase my supply. I was literally doing everything one could possibly do to try and make more milk! By about this stage, my baby was 7 weeks old and I felt comfortable enough to stop using the SNS and start giving her one bottle when she was extremely fussy. This was always the last feed before bed (around 7pm). It gave my husband the opportunity as well to get to feed her. Slowly but surely, I was able to start pumping more and replace the top-up of formula with a top-up of expressed breast milk. I still was determined though to not need this bottle, and to actually just breastfeed her from the breast for every feed. But no matter what, come 7pm, she would fuss and I would call for the bottle. I started to feel like maybe I was mentally relying on it and created the need for it when there wasn’t one. Especially when I got to the point when I could squirt milk out of both boobs at this time, but just could not get my baby to feed off of my breast.
When my baby was just under 3 months’ old, we flew to the US to visit my husband’s family. Needless to say mum and baby were both jet lagged and didn’t know what time it was, or when “the dreaded 7pm feed” was meant to be. Three days in, I realised she hadn’t had a bottle at all! And that’s when it hit me that I was finally exclusively breastfeeding. What a sense of pride and accomplishment that was for me. I finally did it. I almost couldn’t believe it! Since then, she has had a bottle when I’m not with her, but it has never been because of my supply. I slowly weaned myself off the Motilium and haven’t looked back since.
Ava is now 12 months old and she is a very happy and contented little lady, while it’s not been without its challenges – her distraction, the fedding in public (I think half of Dubai has seen my nipples!) and a nursing strike at around the 4 month mark… But we celebrated her first birthday last month and are still going strong with breastfeeding. I’ve made the decision to slowly reduce pumping at work as it has been a long 6 months of 3 times a day, 5 days a week. We continue to co-sleep, and I really am grateful that this works for us as it’s the best time to reconnect with her after being away from her for most of the day. At this stage, I plan to try night weaning when she is 18 months’ old and then slowly go from there.
Support and information.
If every mother who wants to breastfeed could be lucky enough to have the resources and the support that I had, I am certain that the percentage of women breastfeeding would be higher. I feel pretty knowledgeable on the subject now after what I’ve been through, but my knowledge barely scratches the surface. Even still, I hear of GPs and pediatricians and midwives and health nurses giving bad breastfeeding advice to mums all the time. And of course you listen, because you expect them to know better than you! It’s really a shame but hopefully something will change soon.
Perseverance and pride.
I remember saying to my lactation consultant in those early weeks that breastfeeding was my least favourite and most favourite part of being a mother. She said she knew exactly what I meant. I read an article recently that said we should be able to feel proud of our breastfeeding achievements. And with so much “mum-shaming” that goes on, I couldn’t agree more. To be proud of breastfeeding doesn’t mean you shame someone who doesn’t breastfeed. If breastfeeding isn’t for you because you chose not to breastfeed or you were physically unable to breastfeed, and this was an informed decision, than that is what is best for both you and your baby. We all have our limits as to what we can handle and how far we can push ourselves, and I know that if I had not had the support I did, and if someone had told me in those early weeks that I just don’t have enough milk, I might have accepted it! But for me personally, it was never a question of “if” I’ll be able to exclusively breastfeed, it was only a matter of “when”. I pushed on and persevered and it took 3 months before I was able to achieve my goal. It took about 4 or 5 months before I could finally say breastfeeding is “easy”. With challenges still, but compared to what I went through in the beginning, it definitely became “easy”.
xxx Tanja & Ava