A great blog for nursing mothers

I just wanted to let you know that one of our former writers, Krista, now has her own website and blog called Nursing Nurture: Breastfeeding Advice and Support.  It is a fabulous resource and I've learned a lot from both her blog and the articles that she posts on facebook.   Please check it out and you will be encouraged!

Too much milk! (And other things I learned breastfeeding...)

My first breastfeeding experience was difficult - as many are! The learning curve was HUGE and I was totally unprepared after Will's early arrival. I was determined to breastfeed and thankfully the NICU nurses and doctors were very supportive. I just didn't realize how hard it would be! I'm very glad to report that we did end up successfully breastfeeding after overcoming the many hurdles...

-pumping 24/7 the first two weeks of his life

-learning to feed a 3lb baby using a nipple shield (I do not endorse this product. :) 

-still pumping after every feeding because of said nipple shield

-nipple confusion because of the many bottles (with fortified breastmilk for weight gain) and nipple shield

-pumping at work from months 3-10

-severe reflux (another preemie thing) that caused major issues with feeding his first year of life

Fast forward to my second breastfeeding experience. At first, it was a dream compared to the first! Adeline was an excellent nurser and being full term had no weight gain issues or reflux. The only problem we had in the first few newborn days was my overactive let down, but we learned to wait until the milk was slower before latching her on again. Our biggest problem after that was that she never took a bottle! However, she was our super colicky baby with nightly scream fests lasting from 6-11pm until she was about 4 months old. 

Long after I quit nursing Adeline (at 15 months), I learned about the importance of the balance between the "skim" foremilk and "fatty" hindmilk. (Thanks to Krista and another friend!) I also learned that having too much foremilk can throw a baby's digestive system out of whack. They will be fussy (Adeline). They will have green, frothy poops (Adeline). They will act as though they are in pain (Adeline during her nightly spells). 

I was sad that I didn't realize this earlier and could have helped her be more comfortable for all those months! The solution is simple - be 100% sure that you are allowing the baby to empty the breast and not switching too often. Otherwise, baby will fill up on foremilk and not get enough of the fatty hindmilk. Even offering only one breast per feeding is ok! Your body will gradually adjust, producing less milk. You can also pump a little milk before feeding - but this will actually add to the problem in the long run as you're not signaling to your body to slow down the milk production!

I'm now 5 weeks into nursing Anna. She is showing the SAME signs that Adeline did. Fussy nights, green poops, pain, etc. The docs don't worry about green poop, but it does signal that something might be off in baby's system. Just today I started only nursing her on one side per feeding and I'm still waiting to see a yellow poop again. 

Today I did some more research and wanted to share some articles in hopes of helping someone else! I was floored to find an article (through LaLeche League) discussing some research done that suggests a relationship between imbalance of fore/hindmilk and COLIC! 

This morning, Anna and I were at the pediatrician for her one month check up. The little chunker weighed 9lbs! She's up more than 3lbs from birth. I asked about the green poop (really just to see what our doc would say!) and he was, as I suspected, not worried. He did give me all the reminders about colic..."We don't know what causes it"..."It comes at 2-3 weeks and passes around 2-3 months"...etc. I'm hopeful that she and I can work this out and she will not be as colicky for as long as Adeline was! Here are the articles: 

Finish the First Breast First - article from LLL on the relationship to colic

LLL on Oversupply

LLL - Too Much of a Good Thing - a personal story

LLL on Foremilk and Hindmilk - including how it is produced

Do you have a breastfeeding experience you'd like to share? Something you learned that may help someone else? Please share!! 

The Uniqueness of Breastmilk

Breastmilk is incredibly unique! In fact, all mammalian milk is species specific, i.e. the mother animal makes milk that is perfectly suited to her baby's requirements for growth and development. For example, a baby elephant seal feeds once every four days, but needs to quickly gain fat for protection against the cold, so its mother's milk has a very high fat content. A baby calf has to gain muscle strength quickly and also be left to sleep quietly and safely while the mother wanders away from it to feed. So the cow produces milk high in protein, particularly casein containing casomorphins, which induce sleep.

The human baby is born in a relatively immature state with kidneys and liver not yet able to process high protein feeds, and a brain that will triple in weight in the next two years to achieve 80% of its final size. And so the human mother's milk is low in protein, but highest of all milks in lactose necessary for appropriate brain development.

Societies in developed countries are caught between knowledge and belief. While they know the rhetoric “Breast is Best,” they believe there is little difference between artificial infant formula and breastmilk..

The milk which is fed to infants who don't receive breastmilk may be derived from a number of sources – cow's milk, goat's milk, soy beans or even almonds and rice. Components are added and removed and the milks are treated to be assimilated by an infant. It is a very complex process to change the milk of one species (or plant!) to make it suitable for another.

These modified and added components stimulate a different type and rate of growth and development compared to normal optimal growth of children fed breastmilk.

The following is a quote from Ebrahim, a senior lecturer at London's famous Institute of Child Health:

"Artificial feeding carries risks. Infants who are fed artificially are biologically different from those who are breastfed. Their blood carries a different pattern of amino acids, some of which may be at levels high enough to cause anxiety. The composition of their body fat is different. They are fed a variety of carbohydrates to which no other mammalian species is exposed in neonatal life. They have higher plasma osmolality, urea and electrolyte levels. Their guts are colonised by a potentially invasive type of micro-flora, at the same time as they are exposed to large amounts of foreign protein resulting in an immunologic response. In addition they are deprived of the various immune factors present in human milk. All these factors need to be taken into account every time a decision is made not to breastfeed an infant, for inherent in that decision are known and unknown risks to the infant."

During our discussion of breastmilk this week, it is in no way my intention to make someone feel hurt because of the term “artificial.” And I do realize there are times when the mom truly is unable to breastfeed and donor milk is not available so artificial milk is necessary. However, I am saddened at how quickly pediatricians encourage moms to supplement, or tell them formula is just fine too so there’s no need to really persevere, and the beginning of the end of the nursing relationship is put into place. I have many dear friends who were not able to nurse as long as they had hoped and others should not make them feel guilty or pass judgment. We should support them, help them grieve, and then to persevere.

Yet, breastmilk is the norm. It is the way God designed babies to be fed. Anything other than breastmilk for a baby is, therefore, artificial (defined by Merriam Webster as “humanly contrived often on a natural model”). I know nursing can be exhausting, difficult, and just plain hard – especially in the beginning, especially without support, especially with a preemie, an emergency c-section, a pediatrician who is not sold on breastmilk, when you are surrounded with others who are not encouraging, multiples, sleep deprivation, pumping, cracked nipples, clogged ducts, a crying baby, and so much more! Ultimately, it takes determination and perseverance to overcome the odds. . . but for those who do I applaud you and, more importantly, you have given your baby a gift that truly will last a lifetime.

Different take on Supplementing

First of all, I started to post this as a comment - but decided to turn it into a post. I was writing in response to Krista's post, Effects of Supplementing. You can see my previous breastfeeding posts here and here. In short, my first experience was with my 32 week preemie and we encountered many bumps in the road. My second had a few bumps as well thanks to my health, but we maintained a strong nursing relationship from the beginning...despite two tiny supplements. :) That's why I'm posting now...

I have to admit that I was flat out confused by the "artificial baby milk" term! I thought it was some new version of formula renamed to make it more appealing to BFing Moms. Haha!

But I did want to add my thoughts on Krista's post. First of all, I think that breastfeeding for a year or more is the ideal situation for all babies. (Many would argue longer even!) Support is key and the support of family, friends, nurses and LCs can make or break a Mom's desire/motivation to breastfeed.

That said, I can totally see a case for encouraging breastfeeding by saying that it is ok for Mom to supplement on occasion. I know that seems counterproductive to many - but I see it like this. If Mom is discouraged completely from supplementing - many Moms will see it as an all or nothing situation. Isn't it better for baby to get even a few weeks of breastmilk versus no breastmilk at all?

I am specifically thinking of Mom's with little support at home, working Moms and Moms that are struggling with other illnesses (including PPD).

I was SO determined with my 2nd to have a smooth breastfeeding course. I did not have a smooth course with Will after struggling through his prematurity, nipple confusion, weight gain issues, reflux, low milk supply b/c I worked, etc. Although we did successfully work through each of those issues and he got breastmilk in a bottle or nursed until 11 months.

When my 2nd came along, I had never nursed from day 1. (Pumped from day 2 with son - too sick to do it earlier.) I had no idea how difficult it can be to have a screaming baby, sore nipples and no milk to speak of yet. I was set on breastfeeding and after a brief moment of turmoil, decided to offer her a tiny (1oz) formula supplement via syringe in the hospital. That helped her settle just long enough to give my nipples a break. I think we ended up doing this (1oz via syringe) one more time at home. My milk came in GREAT and we had no trouble nursing from there on out. Even through MANY health troubles. She did end up having formula for a few days around one month of age thanks to unexpected gallbladder surgery that left me in the hospital for 4 days. Still, she returned to nursing just fine and eventually refused a bottle never to take one successfully again after that brief time!

All that to say that while I am 100% for exclusive breastfeeding and have breastfed my children to 11 months and 14 months (which many of my friends think is NUTS) - I am thankful for formula in those two circumstances. I would also like to suggest that while breastfeeding education/support could be improved in our country - there is a fine line between discouraging formula and maybe ultimately discouraging breastfeeding.

Effects of Supplementing

I thought this research was interesting and wondered if anyone might enjoy reading it as well. It pertains to the effects of supplementing in the hospital with bottles of water, glucose water, artificial baby milk, or adding supplements to the mother's milk. Some of the reasons for this include the following:

• to give the mother a rest
• because the mother doesn't have her milk 'in' yet
• to prevent hypoglycemia
• to prevent or reduce jaundice

None of these are indications for giving supplements, with some having the opposite effect to the desired result. Yet a 2005 study found that close to half of infants received artificial baby milk in the hospital!

Here are some of the effects on breastfeeding (and these effects were noted even if the baby received only one supplement!):

• Supplemented babies are significantly less likely to be exclusively or fully breastfed after hospital discharge.
• The risk for shortened duration of breastfeeding is increased 4-fold when supplements were given in hospital, even when the supplement used is predominantly donor breastmilk.
• Exclusively breastfed newborns are fed more frequently then breastfed-plus-supplemented infants. 93% of moms remember which brand of artificial baby milk was used in hospital and most will use that brand. Parents may interpret the use of artificial baby milk as an endorsement by hospital staff, despite clear verbal messages promoting breastfeeding.

So. . . if you hope to succeed in breastfeeding, do everything you can to make sure your baby rooms-in with you and doesn't receive any supplementation. . . both in the hospital and after you go home!

The Language of Breastfeeding

Watch Your Language!
By Diane Wiessinger, MS, IBCLC
(Reprinted from the Journal of Human Lactation, Vol. 12, No. 1, 1996)

"The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. These are difficult words, but they have an appropriate place in our vocabulary."
The lactation consultant says, "You have the best chance to provide your baby with the best possible start in life, through the special bond of breastfeeding. The wonderful advantages to you and your baby will last a lifetime." And then the mother bottlefeeds. Why?
In part because that sales pitch could just as easily have come from a commercial baby milk pamphlet. When our phrasing and that of the baby milk industry are interchangeable, one of us is going about it wrong...and it probably isn't the multinationals. Here is some of the language that I think subverts our good intentions every time we use it.
Best possible, ideal, optimal, perfect. Are you the best possible parent? Is your home life ideal? Do you provide optimal meals? Of course not. Those are admirable goals, not minimum standards. Let's rephrase. Is your parenting inadequate? Is your home life subnormal? Do you provide deficient meals? Now it hurts. You may not expect to be far above normal, but you certainly don't want to be below normal.
When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, "So what?" Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy--and thus safety and adequacy--of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.
Advantages. When we talk about the advantages of breastfeeding--the "lower rates" of cancer, the "reduced risk" of allergies, the "enhanced" bonding, the "stronger" immune system--we reinforce bottlefeeding yet again as the accepted, acceptable norm.
Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful. Smokers have higher rates of illness; increasing prenatal folic acid may reduce fetal defects. Because breastfeeding is the biological norm, breastfed babies are not "healthier;" artificially-fed babies are ill more often and more seriously. Breastfed babies do not "smell better;" artificial feeding results in an abnormal and unpleasant odor that reflects problems in an infant's gut. We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.
We must not let inverted phrasing by the media and by our peers go unchallenged. When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a "special bonus;" but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial milk just "to get him used to a bottle" if she knows that the contents of that bottle cause harm.
Nowhere is the comfortable illusion of bottlefed normalcy more carefully preserved than in discussions of cognitive development. When I ask groups of health professionals if they are familiar with the study on parental smoking and IQ (1), someone always tells me that the children of smoking mothers had "lower IQs." When I ask about the study of premature infants fed either human milk or artificial milk (2), someone always knows that the breastmilk-fed babies were "smarter." I have never seen either study presented any other way by the media--or even by the authors themselves. Even health professionals are shocked when I rephrase the results using breastfeeding as the norm: the artificially-fed children, like children of smokers, had lower IQs.
Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then a is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for "25% less,"the price becomes 75. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study (3), which found a "25% decrease" in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public.
Special. "Breastfeeding is a special relationship." "Set up a special nursing corner." In or family, special meals take extra time. Special occasions mean extra work. Special is nice, but it is complicated, it is not an ongoing part of life, and it is not something we want to do very often. For most women, nursing must fit easily into a busy life--and, of course, it does. "Special" is weaning advice, not breastfeeding advice.
Breastfeeding is best; artificial milk is second best. Not according to the World Health Organization. Its hierarchy is: 1) breastfeeding; 2) the mother's own milk expressed and given to her child some other way; 3) the milk of another human mother; and 4) artificial milk feeds (4). We need to keep this clear in our own minds and make it clear to others. "The next best thing to mother herself" comes from a breast, not from a can. The free sample perched so enticingly on the shelf at the doctor's office is only the fourth best solution to breastfeeding problems.
There is a need for standard formula in some situations. Only because we do not have human milk banks. The person who needs additional blood does not turn to a fourth-rate substitute; there are blood banks that provide human blood for human beings. He does not need to have a special illness to qualify. All he needs is a personal shortage of blood. Yet only those infants who cannot tolerate fourth best are privileged enough to receive third best. I wonder what will happen when a relatively inexpensive commercial blood is designed that carries a substantially higher health risk than donor blood. Who will be considered unimportant enough to receive it? When we find ourselves using artificial milk with a client, let's remind her and her health care providers that banked human milk ought to be available. Milk banks are more likely to become part of our culture if they first become part of our language.
We do not want to make bottlefeeding mothers feel guilty. Guilt is a concept that many women embrace automatically, even when they know that circumstances are truly beyond their control. (My mother has been known to apologize for the weather.)
Women's (nearly) automatic assumption of guilt is evident in their responses to this scenario: Suppose you have taken a class in aerodynamics. You have also seen pilots fly planes. Now, imagine that you are the passenger in a two-seat plane. The pilot has a heart attack, and it is up to you to fly the plane. You crash. Do you feel guilty?
The males I asked responded, "No. Knowing about aerodynamics doesn't mean you can fly an airplane." "No, because I would have done my best." "No. I might feel really bad about the plane and pilot, but I wouldn't feel guilty." "No. Planes are complicated to fly, even if you've seen someone do it."
What did the females say? "I wouldn't feel guilty about the plane, but I might about the pilot because there was a slight chance that I could have managed to land that plane." "Yes, because I'm very hard on myself about my mistakes. Feeling bad and feeling guilty are all mixed up for me." "Yes, I mean, of course. I know I shouldn't, but I probably would." "Did I kill someone else? If I didn't kill anyone else, then I don't feel guilty." Note the phrases "my mistakes," "I know I shouldn't," and "Did I kill anyone?" for an event over which these women would have had no control!
The mother who opts not to breastfeed, or who does not do so as long as she planned, is doing the best she can with the resources at hand. Shemay have had the standard "breast is best" spiel (the course in aerodynamics) and she may have seen a few mothers nursing at the mall (like watching the pilot on the plane's overhead screen). That is clearly not enough information or training. But she may still feel guilty. She's female.
Most of us have seen well-informed mothers struggle unsuccessfully to establish breastfeeding, and turn to bottlefeeding with a sense of acceptance because they know they did their best. And we have seen less well-informed mothers later rage against a system that did not give them the resources they later discovered they needed. Help a mother who says she feels guilty to analyze her feelings, and you may uncover a very different emotion. Someone long ago handed these mothers the word "guilt." It is the wrong word.
Try this on: You have been crippled in a serious accident. Your physicians and physical therapists explain that learning to walk again would involve months of extremely painful and difficult work with no guarantee of success. They help you adjust to life in a wheelchair, and support you through the difficulties that result. Twenty years later, when your legs have withered beyond all hope, you meet someone whose accident matched your own. "It was difficult," she says. "It was three months of sheer hell. But I've been walking every since." Would you feel guilty?
Women to whom I posed this scenario told me they would feel angry, betrayed, cheated. They would wish they could do it over with better information. They would feel regret for opportunities lost. Some of the women said they would feel guilty for not having sought out more opinions, for not having persevered in the absence of information and support. But gender-engendered guilt aside, we do not feel guilty about having been deprived of a pleasure. The mother who does not breastfeed impairs her own health, increases the difficulty and expense of infant and child rearing, an dismisses one of life's most delightful relationships. She has lost something basic to her own well-being. What image of the satisfactions of breastfeeding do we convey when we use the word "guilt"?
Let's rephrase, using the words women themselves gave me: "We don't want to make bottlefeeding mothers feel angry. We don't want to make them feel betrayed. We don't want to make them feel cheated." Peel back the layered implications of "we don't want to make them feel guilty," and you will find a system trying to cover its own tracks. It is not trying to protect her. It is trying to protect itself. Let's level with mothers, support them when breastfeeding doesn't work, and help them move beyond this inaccurate and ineffective word.
Pros and cons, advantages and disadvantages. Breastfeeding is a straight-forward health issue, not one of two equivlent choices. "One disadvantage of not smoking is that you are more likely to find secondhand smoke annoying. One advantage of smoking is that it can contribute to weight loss." The real issue is differential morbidity and mortality. The rest--whether we are talking about tobacco or commercial baby milks--is just smoke.
One maternity center uses a "balanced" approach on an "infant feeding preference card" (5) that lists odorless stools and a return of the uterus to its normal size on the five lines of breastfeeding advantages. (Does this mean the bottlefeeding mother's uterus never returns to normal?) Leaking breasts and an inability to see how much the baby is getting are included on the four lines of disadvantages. A formula-feeding advantage is that some mothers find it "less inhibiting and embarrassing." The maternity facility reported good acceptance by the pediatric medical staff and no marked change in the rates of breastfeeding or bottlefeeding. That is not surprising. The information is not substantially different from the "balanced" lists that the artificial milk salesmen have peddled for years. It is probably an even better sales pitch because it now carries very clear hospital endorsement. "Fully informed," the mother now feels confident making a life-long health decision based on relative diaper smells and the amount of skin that shows during feedings.
Why do the commercial baby milk companies offer pro and con lists that acknowledge some of their product's shortcomings? Because any "balanced" approach that is presented in a heavily biased culture automatically supports the bias. If A and B are nearly equivalent, and if more than 90% of mothers ultimately choose B, as mothers in the United States do (according to an unpublished 1992 Mothers' Survey by Ross Laboratories that indicated fewer than 10% of U.S. mothers nursing at a year), it makes sense to follow the majority. If there were an important difference, surely the health profession would make a point of not staying out of the decision-making process.
It is the parents' choice to make. True. But deliberately stepping out of the process implies that the "balanced" list was accurate. In a recent issue of Parenting magazine, a pediatrician comments, "When I first visit a new mother in the hospital, I ask, 'Are you breastfeeding or bottlefeeding?' If she says she is going to bottlefeed, I nod and move on to my next questions. Supporting new parents means supporting them in whatever choices they make; you don't march in postpartum and tell someone she's making a terrible mistake, depriving herself and her child." (6)
Yet if a woman announced to her doctor, midway through a routine physical examination, that she took up smoking a few days earlier, the physician would make sure she understood the hazards, reasoning that now was the easiest time for her to change her mind. It is hypocritical and irresponsible to take a clear position on smoking and "let parents decide" about breastfeeding without first making sure of their information base. Life choices are always the individual's to make. That does not mean his or her information sources should be mute, nor that the parents who opt for bottlefeeding should be denied information that might prompt a different decision with a subsequent child.
Breastfeeding. Most other mammals never even see their own milk, and I doubt that any other mammalian mother deliberately "feeds" her young by basing her nursing intervals on what she infers the baby's hunger level to be. Nursing quiets her young and no doubt feels good. We are the only mammal that consciously uses nursing to transfer calories...and we're the only mammal that has chronic trouble making that transfer.
Women may say they "breastfed" for three months, but they usually say they "nursed" for three years. Easy, long-term breastfeeding involves forgetting about the "breast" and the "feeding" (and the duration, and the interval, and the transmission of the right nutrients in the right amounts, and the difference between nutritive and non-nutritive suckling needs, all of which form the focus of artificial milk pamphlets) and focusing instead on the relationship. Let's all tell mothers that we hope they won't "breastfeed"--that the real joys and satisfactions of the experience begin when they stop "breastfeeding" and start mothering at the breast.
All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is...watch our language.

References
1. Olds D. L., Henderson, C. R. Tatelbaum, R.: Intellectual impairment in children of women who smoke cigarettes during pregnancy. Pediatrics 1994; 93:221-27.
2. Lucas, A., Morley, R., Cole, T.J., Lister, G., Leeson-Payne, C.: Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339 (8788): 261-64.
3. Fruedenheim, J.L., Graham, S., Laughlin, R., Vena, J.E., Bandera, E., et al: Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994, 5:324-30.
4. UNICEF, WHO, UNESCO: Facts for Life: A Communication Challenge. New York: UNICEF 1989; p. 20.
5. Bowles, B.B., Leache, J., Starr, S., Foster, M.: Infant feeding preferences card. J Hum Lact 1993; 9: 256-58.
6. Klass, P.: Decent exposure. Parenting (May) 1994; 98-104.

Nursing Preemie Twins

We're dealing with breastfeeding this week. This will be the third year we have discussed this topic, which is a little unreal for me to believe! Seems like just yesterday I was typing this post on my experiences nursing Lydia and the benefits of breastmilk. Since that time, I've experienced nursing preemie twins as well as begun my coursework and clinical hours to become a certified lactation consultant! If someone had told me five years ago I would oneday work as a lactation consultant I would have laughed. And now. . .well, I absolutely love it.

I've thought long and hard about what direction to write about. I've completed 60 hours of coursework in lactation and everything I've studied has been so fascinating. I wish I could just share all of it with you. But, even with this information, I think that sharing my nursing story with the boys may be the best way to encourage a new mom, or mother of multiples, or mom of a preemie to hang in there and keep going and not give up. Later this week, I will post an article on the "language of breastfeeding" and why our culture has come to believe that while, yes, breast is best, formula is a fine alternative.

My boys were born at 32 weeks, 3 days gestation in a third world country. This was not my plan but, four days before I was flying back to the states to have them, my body spontaneously went into labor and, 2 1/2 hours later, our twins arrived. I new nothing of breastfeeding twins (except that it could be done), nor of the challenges with preemies. Actually, I'm glad no one told me how hard it would be (not that it would have deterred me) but, being the eternal optimist that I am, I just figured tomorrow would be easier :). So, there were actually two big issues going on: the fact that I had twins and the fact that I had preemies. Each of those presents its own challenges, in addition to all the other challenges one can have nursing. I remember talking with the pediatrician the day after they were born and him asking how I was going to feed them. I told him unequivocally that I would exclusively nurse. While he hoped I would, I could tell he'd heard that from other moms who quickly changed their minds. Little did he know who he was dealing with . . . :) So from that conversation he said, "Well, let's get started." (I later learned that I had 6 of 11 factors that make nursing challenging and moms give up. . . greater than that, though, I had determination which will help you beat all the odds!)

After being under an oxygen bubble the first 24 hours the boys were only in the NICU to monitor nursing before discharge, and then to go under phototherapy. All in all, we ended up being in the hospital 6 days. I should also say they were 3 lbs, 15 oz and 3 lbs, 13 oz respectively when they were born, although they lost weight in the hospital because it takes more energy to nurse than they could take in, in calories so we brought them home at 3 1/2 pounds each. During the 24 hours after birth before I started nursing they had an IV with fluids but never received anything orally, including formula. (Okay, I realize it would be different in the states b/c they would give a feeding tube and help get their weight up, which would make nursing easier. . .the five pound mark is a great milestone for efficiency in nursing. . . but, again, I wouldn't trade where they were born or the size we were able to bring them home for anything in this world!).

(Here's a picture to give you an idea of their size.)

Those next few days involved walking up the hallway every couple hours to try to nurse. Being preemies, they ofcourse were always asleep. The nurses were watching everything I did, wanting to make sure they could suck, swallow, and breathe at the same time (I didn't know this then, but this is a developmental skill that babies learn between 32-35 weeks. . . although current research is fascinating. . . with preemies that are in 24 hour kangaroo care - aka skin-to-skin - the skill can develop much earlier!!). Many times they would weigh them before I nursed and immediately after and I'd be "scolded" for them not taking enough milk. I pumped quite a bit in the hospital to help build my supply since they weren't able to eat much in the beginning. Little did I know this was the beginning of a freezer-full of milk! (Months later, after dumping some and sharing a 10-day supply with a friend, I still had 13 gallons!) I then began nursing first and finishing with putting my milk in a bottle to top them off. Once they could eat 20 cc's at each feeding (this isn't much) we prepared to take them home - complete with creating our own little "NICU at home" including coil heater in their room keeping the temp at 79 F, air filter, and digital scale. Oh, there's so many details from this time I could share. . . I'm going to try hard to stay focused on the nursing portion. . .

Once we came home we fell into a routine: every 3 hours I'd feed babies. First I'd try to nurse, then I'd give them a bottle, then I'd pump, then we'd sterilize pump and bottles. . . then I'd have one hour (sometimes 1 1/2 hours) and the routine would start all over again. This was 24 hours a day, 7 days a week. It was crazy! The longest stretch of sleep I got for the first 6 weeks was 2 hours! I can remember so many days wondering how I was still functioning and knowing it was only by the grace of God. I called one of my friends in the states who also had preemie twins several times for encouragement as well as a lactation consultant. Because I had nursed Lydia, I knew the goal: I knew it would get easier and I looked forward to the day I had two champion-nursing boys. Yet I still needed to hear they would get there. In the meantime, I was one incredibly sleep-deprived mama who wondered if that day would ever come. With my "one hour" between each feed I would try to eat, sleep, shower, do laundry, be a mom to my then 2 1/2 year old, talk with our families back home who longed to know what was going on, entertain visitors, talk to my husband. . . after a few weeks it was not uncommon for me to fall asleep with my alarm on my pillow and me not even wake up. One time, my alarm woke up Josh from the other end of the house and he had to come and wake me up.

Why did it take so long to feed? Well, they were tiny and couldn't eat efficiently. The bigger they got the quicker they ate, but getting them from 3 1/2 pounds to 4 1/2 pounds took A LOT of hard work, sleep deprivation, prayer, grace, love, and now, amazing memories. I was so worried about nipple confusion I always wanted to start with nursing at the breast. (Knowing what I now know, I would definitely let family have given more bottles of my pumped milk and not tried to nurse at every feeding so I could've gotten more sleep. Also, once my supply was built, I could've dropped a pumping. . . but hindsight is 20/20.) And, every preemie is different. For example, when they were 4 1/2 weeks old (so 37 weeks gestation) I quit pumping and put them exlusively to the breast. Luke thrived but James' weight stagnated and he quit gaining. Because I couldn't nurse one and pump for the other, I had to return to the pump for both until they were 40 weeks gestation. (At this point, I changed the routine and gave them a bottle first - as an "appetizer" - and then put them to the breast for their "dinner." It worked well, and, by this point there were at least one or two feedings a day that I could just nurse them and not pump.)

It was hard because I was sleep deprived and sitting at a pump for 2 1/2 hours a day, staring at a wall, not being able to interact with Lydia was draining. But, there was never, ever a single moment I thought of not persevering. I knew when they were able to nurse at the breast it would be so much easier and wow, is it! And, I must say, nursing twins is amazing! (When you nurse, your body produces oxytocin which, among other things, relaxes you. I never noticed this with Lydia but with the boys, wow, I could fall asleep everytime I nurse them I get so relaxed. It is an amazing feeling! I've learned how to nurse them lying down and that is a common nursing position for us.)

I packed my pump up when the boys were 3 months old and, PTL!!, have not had to get it out since. Nursing now is a dream. Their milk is always fresh, ready, and available. I don't have to worry with sterilizing bottles, measuring formula, paying money for their milk, or packing it when we go places. I'm able to bond with my sweet boys in such a precious, God-given way. Oh, the look in their eyes, how their faces light up, their excitement, when I ask them if they want milk. . . I would do it over a million times even for none of these rewards but oh, just to experience these even once (much less every day!) there is no greater thing than nursing your baby!

In a few weeks we will talk about introducing foods and weaning so I'll save those topics for a later time. But, I'd love to have a great discussion this week so please share your stories, experiences, questions, and comments and let's dialogue together.

Breastfeeding while Pregnant

My two cents for this week deals with breastfeeding during the early months of pregnancy as well as child-led vs. child-encouraged weaning when mom becomes pregnant. My first post on breastfeeding, found here, has some great links to other resources if you want more to read.

My son Samuel was 10 months old when I found out I was pregnant with my second son. I started my period again when Samuel was 6 months old and only had it three times before I became pregnant again. Samuel was a great nurser and didn't show any signs of slowing down. I began to investigate 'tandem nursing' as a possibility. I spoke with some of the moms at my La Leche League group and read two books on the LLL reading list about tandem nursing. I wasn't sure if I would do it or not, but I wanted to know more about it.

First off, it is possible to continue nursing through pregnancy. Your body will continue to make milk, although there will most likely be a drop in production around 20 weeks. You should speak with your pediatrician about your child's nutritional needs. If you do experience a drop in milk production you may need to supplement. It is so important to make sure you maintain a good diet and drink plenty of water. You should be eating an extra 500 to 650 calories per day for your nursling, as well as the 350 extra calories in the 2nd trimester and 450 in the 3rd. God has made your body so that nutrients go first to your growing fetus baby, second to your nursling, and third to you. Eat up!

The next thing to consider is that breastfeeding can become uncomfortable once you are pregnant. It is possible that you will have sore nipples while nursing. It is also possible that nursing will be incredibly uncomfortable and annoying to you. This happened with me. Sometimes my skin would be absolutely crawling while Samuel nursed. This feeling passed eventually, but it was tough to get through. Another thing that you may experience is sexual arousal while nursing during the first trimester. It will totally wig you out, but it is normal and it will pass as well.

When you experience a decrease in milk production, or the taste of your milk changes, your child may cut back on nursing or refuse all together. If your child is 12 months or older at this point, you can decide to gradually or abruptly wean. If your child is younger than 12 months, you will need to talk to your pediatrician about supplementing with formula.

Some women decide to continue to nurse for comfort and the immunological benefits of breastmilk. Once your baby is born and your milk supply returns both children will be able to nurse without adversely affecting the other. This is what I was considering at first. It is a personal decision you will have to make yourself. There are definitely pros and cons of each.

I ultimately decided to let Samuel self-wean once I was into my second trimester. Technically, it was probably a mix of child-led and child-encouraged weaning because I initiated some of the cutback. After Samuel's first birthday, towards the end of my first trimester, I noticed that Samuel was nursing for much shorter periods of time. I had always initiated a nursing session with him (I was still nursing every 3 hours during the day), so I decided to let him go for awhile and see how long it would be until he fussed to nurse. Over three days I saw that time greatly decrease until he no longer fussed or indicated that he wanted to nurse. At that point I was only nursing him in the morning when he got up and at night before bed. I cut out the morning feeding next by feeding him milk and breakfast as soon as he got up. He didn't fight it at all. I finally cut the night feeding by just cuddling him for a bit but not rocking him and then putting him to bed awake. He did fine (mind you, this is also the time we finally did CIO with him - they coincided). He didn't nurse for three days after that. I offered once more to see what he would do. He put his mouth to my breast, looked up at me and giggled, and that was it. He was done. I didn't experience any engorgement because my milk was almost completely gone at that point.

Please ask questions or share your weaning while pregnant stories if you could. There is definitely variety on this point of breastfeeding.

If you want some further reading, check out La Leche League's collection on the topic:

La Leche League Breastfeeding During Pregnancy

Breastfeeding #2

My first experience breastfeeding was not a piece of cake. I wrote about it here. In short, breastfeeding a preemie meant all kinds of things I was clueless about at the time. Supplementing, pumping (round the clock!), nipple shields, low milk supply, reflux, etc. I knew that I would be a stay at home Mom with my second and hoped our breastfeeding experience would be easier. Even though I was just as determined to breastfeed, I think I was somewhat more laid back, making things much easier!

Praise the Lord - the most difficult challenge we've had with Adeline is that she WILL NOT TAKE A BOTTLE OR A PACIFIER! I consider that a pretty easy challenge and one I'm thankful for!

Adeline is now 10 months old and we're nursing 4-5 times a day and she's a sippy cup champion. Here's our story:

In the beginning she latched on right away and was a nursing champ! The only rough patch I had in the hospital was when she literally nursed for about 4 hours straight on day 2 and would scream if she wasn't latched on. My nipples were SO SORE. This was something I had not experienced with Will. Basically, my milk had yet to come in and she was just doing what she knew to do in order to make it come in!

I agonized over it and did finally give her a small amount (less than 1oz) of formula through a syringe to give my nipples a break. Jacob advised that we do this and I'm sure glad we did. (I know some of you are squirming in your seat right now...but she turned out fine! :)

She nursed wonderfully and on demand for the next three and a half weeks. When she was not yet four weeks old, I began having trouble with my gallbladder. I ended up having my gallbladder out when she was four weeks old, exactly. Because of the ER visits leading up the to the surgery and then the three day hospital stay - she had her first bottle before four weeks old! She took it like a champ and even had to have a few formula bottles since I had yet to pump any breastmilk!

This is where it was doubly a blessing that we chose to give her formula in that syringe....they gave us more formula to take home from the hospital and I took it knowing I would never choose to use it - but could give it away! Ha! We ended being FORCED to use it! Although I must add that I did not like it one bit that she had to have that formula or that I had to leave her so much over that week. But we survived the whole ordeal and I would do it all again if I was ever in that much pain!

After I was home and recovering from my gallbladder surgery - nursing resumed and we picked up right where we had left off! She did great and it never occurred to me to give her a bottle for practice during that time. So when I had to return to work for three weeks when she was about 10 weeks old - she pretty much refused the bottle. She eventually got used to it and would drink just enough to get by until I got home. Occassionally now, Jacob can get her to take a bottle.

We are still going strong now at 10 months and I plan to continue at least through May (14 months) in order to get through flu season. It was amazing when I quit nursing Will - he promptly contracted every illness and bug within those next few months! I've even considered giving him breastmilk with his regular milk to try to keep him well! (Never have done it though!)

I've noticed two things again this time around now that my period has returned! With Will I got my period around 4 months old (darn pumping!) and this time it held off until really 7 months. Two things occur during my cycle:

1. My supply dips during my period.

2. My nipples get sore again when I'm ovulating. Ugh - this is worse than the first few days of nursing! Kellymom mentions this problem here, and suggests taking evening primrose oil or a calcium supplement. I tried calcium with Will and it didn't seem to work. Has anyone else had this problem or tried evening primrose oil?

I've enjoyed the discussion on breastfeeding so far this week - keep the comments, suggestions and advice coming!

*One more note to add - I have NOTHING to share about weaning. Will was so unattached to me and my supply so low, that it just happened. The biggest thing we did was avoid the rocker (where we nursed) during normal nursing times. This usually meant Jacob rocked him to bed for a few nights and then he was over it! Hopefully, Leah can add more to this topic!

Milk Supply Issues

Here is a list of antigalactogogues (things that decrease your milk supply):

• alcohol
• caffeine
• drugs for colds/allergies (decongestants, antihistamines, anti-inflammatories)
• stress
• barley sprout (fried)
• bugleweed (leaf/stem)
• cabbage leaf externally applied (crumple leaf and apply to engorged breast)
• chasteberry (fruit/leaf)
• mint (leaf and essential oil)
• fava bean (flower, well cooked bean)
• flannelweed
• greek oregano
• jasmine (flower) externally applied
• mugwort
• osha root
• parsley
• peppermint
• pigeon pea
• pygeum
• rosemary
• sage
• shakuyaku-kanzoto (peony and licorice)
• urva-ursi
• velvet bean
• water mint
• white sage
• yarrow

For increasing your milk supply, La Leche League recommends fenugreek (3 capsules, 3 x per day) alone or with Blessed Thistle (3 capsules, 3x). It usually takes at least 24 hours to begin to see any effect.

In Egypt, home to the fenugreek research for increasing women's milk supply, the common wisdom is to cook fenugreek (it looks similar to wheat) like you would oatmeal and then serve with milk and honey. All new moms drink this regularly after giving birth.

For any mamas with supply issues, please let us know if you've found any of these to be true and what has worked for you!

Breastfeeding and Weaning

We originally discussed this topic on Prayer of Hannah in November 2007. Here is the link to my original post where I shared about my experience nursing Lydia, the incredible (and unequaled) benefits of breastmilk, and practical steps you can take to ensure success. I don't want to duplicate that information, but really encourage you to start with this post as an introduction to our discussion this week.

When we originally dealt with this topic, I was still nursing Lydia and wondering about weaning. So, I'd like to take this opportunity to share my experience with weaning. . .

Lydia loved to nurse just as much as I loved for her to nurse. Around 11 1/2 months she finally began to eat food and, pretty much without resistence, cut down from 6 feedings a day to 4. We stayed like this for several more months, but I never got my period. We wanted more children and I was anxious to see if cutting out more nursings would start my cycle. Around 14 1/2 months I cut her down to 2 feedings a day - morning and night. She objected, but in a couple days adjusted and we were both happy to have those two precious cuddle/nursing times a day. My husband and I talked about it and decided 18 months would be our goal for me to wean her. When she was 16 1/2 months old we traveled to Thailand and, during that 2 1/2 week trip she nursed like crazy! I decided not to worry about it (and isn't it amazing that your body's supply can adapt like this!) and, when we got home returned back to our 2 times a day schedule. Gradually I would try to drop a night time feeding - by giving her milk in a cup during her bath and making sure she was full and then reading books and distracting her from the idea of nursing before sleeping (the morning feeding was the last one I dropped). When Lydia was 20 months old I had to travel for 4 days without her so I decided to just go ahead and nurse her until 19 months - which would give her a month to be weaned before I just "cold turkey" left her alone with Josh. I was hormonal and cried and sad to wean her, but, again, thought about the goal and knew we were not getting pregnant while nursing - which is probably the only thing that gave me the strength to not give in and keep nursing her until she weaned herself - whenever she might choose that (I do think infant-led weaning is super cool and would love to do that one day!). Eventually I would just nurse her at some random time every other day, and that was mainly because I would be in pain and need to have the milk eaten! (Interestingly, I never got an infected clogged duct in my breast until I started the weaning process.) It was hard for her and me (I noticed her being more clingy) but, ultimately, I was the parent and had to make the decision. I stuck with it and, within a week of weaning, she seemed adjusted and fine. Today, when she sees my chest she'll say, "Baby's milk" and we talk about how soon I'll be feeding her two brothers :).

I am a major advocate of breastfeeding. Breastmilk truly is God's perfect food for our babies and there is nothing else that even comes close (I do NOT consider formula an equally good or even close alternative). I do understand, though, that there are, in rare instances, special circumstances that necessitate the need for formula. Praise God there is that option there in these circumstances!!

I hear many women say they just didn't produce enough milk to feed their baby. I was reading recently about the quality and quantity of milk your body can produce. The question posed was, "If a mother's diet is lacking in certain vitamins, will her milk also be lacking?" Answer: No, her body will still make milk with all the vitamins/minerals it should have. However, the QUANTITY of milk she will be able to produce will definitely be affected. It made me wonder if our fast food, junk food culture had even given second thought to whether or not the lack of nutrition we give our bodies affects even the quanity of milk we are able to give our babies. . .

I am now pregnant with twins and can't wait to get to nurse these two little blessings. My goal and prayer is that I will be able to nurse them just like I was able to do with Lydia - and never need to supplement with formula. The next time we revisit this topic, I hope to be able to write on my experience nursing multiples!

Hollie's Breastfeeding Experience

Hey readers! I have missed you! I must apologize for my delayed post this week. I'm in Georgia visiting my side of the family and have just now found the time to post concerning breastfeeding.



I have always wanted to breastfeed. I knew breastfeeding was going to be challenging, but I was determined to hunker down and get the victory! Since Laney was sitting-up-looking-pretty in her breech position, I had to have a c-section. My milk started to come in on the fourth day, but really not full-force until the fifth and sixth day. I believe this delay was due to the fact that my body did not go through the natural progression of labor and the natural hormonal change, signifying to my body that it needed to prepare itself to provide food for my baby. This caused so many problems with breastfeeding Laney, problems that I did not anticipate. Laney was STARVING in the hospital. She was born at 7 lbs, 8 oz and lost over a pound in the hospital, which was not good to say the least. This brought on stress and stress can affect your milk supply.

Since Laney was still coughing up a lot of the fluid in her lungs, (due to the fact that the fluid was not squeezed out of her through natural childbirth, like it was meant to) we were a bit hesitant to sleep at night with her in our room. The sound of that fluid gurgling in her throat was enough to make my heart stop. Thus, we sent Laney to the nursery at night to be watched by the staff. I remember waking Hugh up from our deep-state of sleep, as I heard her coming down the hall SCREAMING her head off. Hugh would ask in desperation (in hopes of getting more zzzz's), "How do you know it's her?" Oh, I knew. I just knew it was her. I remember the nurses commenting on the fact that my baby "sure had a temper". (That wasn't a very smart thing to say to a new, very hormonal mother, who just had her abdominal cut wide open, who had not gotten any sleep whatsoever, and who was on codeine sporting a catheter. Ha!) She was so hungry and had a very strong suck, which was great, but I was bleeding by the end of day one and the consultants were astonished! I tried to ask for all the advice I could get, but I noticed that everyone had conflicting breastfeeding advice, which was a bit confusing. There was no doubt about it, Laney was losing weight, I had no milk (just colostrum), and the staff was pressuring us to do something about this weight loss. I knew that if I was to give her formula, we would be starting a terrible habit and creating a drastic toll on my future milk supply (that was non-existent, mind you), but I had no choice. We syringe fed Laney formula in the hospital as a supplement (.5 ounce) until my milk came in. I was already feeling defeated at this point, but I was sure that things would iron out after a few days.

Well, they didn't. We were going to the pediatrician every other day for a weight check (in the middle of flu season). We had a lactation consultant come out to help get the ball rolling. By the time it was all over with, they had me buried in mass of pillows, and as soon as I was all comfy, sitting amongst my 18 pillows strategically placed for breastfeeding success, the phone would ring, Laney would decide to coat my shoulder in spit-up or I would need the breastfeeding/poopie log that was out of arm's reach. More often than not, I felt like the little kid on "A Christmas Story" whose arms were so stuffed by having too many coats on, that they were hanging in limbo straight out to each side. Needless to say, pillow-land didn't last long. lol.

On a more serious note, Laney would constantly pull off, scream uncontrollably, and arch her back every time we'd nurse. She didn't have thrush. I had a good supply of milk and the let down was there. The let down wasn't too strong. I just figured she had terrible gas pains. Right about then, the tears would begin to flow. Just when everything was as it should have been on day two, things were still going awry. What was wrong? We stayed in this state of confusion and tears for almost three months. I had a hard first three months of Motherhood. Hearing and finding me crying in Laney's nursery, with my baby asleep in my lap and my head in my hands was a common occurrence for my husband. Hearing, "This is so, so hard. Why? What am I doing wrong?" were daily occurrences. I knew I wasn't depressed, since my baby blues wore off after 10 days, but I cried so much for three months that I just didn't think I could cry anymore. I thought that this was what Motherhood was going to be like. I thought that every feeding for the first year would be just like this and yet I still was fighting tooth and nail to make it work. Deep in my heart, I still wanted to breastfeed. However, one minute I was all about it, an hour later I was telling my husband that I can't take it anymore and that I'm going to quit. Well, I just couldn't quit. I couldn't. I knew that I had milk to give and I was going to find a way to nourish my daughter with it. By this point, I had more negative experiences with my daugther than positive ones (or so it felt), for all you do is breastfeed and sleep. I needed relief, and I needed some positive moments with my baby girl. Something had to give though, and my sanity was not going to be it. So I surrendered to the pump. What a liberating day! I felt like a million bucks. Who would have thought that a little machine could bring so much happiness. Ha! I was able to go from breast to bottle for a little while, but very quickly Laney realized how much easier it was to drink from a bottle than to nurse.

To my dismay, the struggles did not end there. Laney still was a very difficult baby to feed, even through the bottle. I didn't feel too much rejection though, since it was not my breast that she was rejecting. I could handle this. She was still arching her back, only drinking half of the bottle(aka: snacking), and crying a lot through feedings. She would burp like grown man and pass gas like....like a grown man. LOL. Definitely nobody but Hugh and I could feed Laney and public feedings just didn't happen, even using the bottle. She made the biggest scene. Something was still very wrong. Finally, after a bit of research on the internet, I realized that Laney had a milk-protein allergy. The protein is called "casein" and she was getting torn up on the inside from all the dairy I was eating. Only 1% of babies are allergic to lactose, so I figured it wasn't the lactose. How come the consultants didn't even mention this? I thought dairy would make them have actual gas, but I didn't know that it would affect Laney's actual nursing. Please know that dairy will ruin your breastfeeding experience if your baby has any sensitivity to dairy. I had to go off all dairy for a few months until her system matured a bit.

In a few days, Laney will turn one year old. Praise the good, gracious Lord! I'm so thankful to Him for giving me perseverance and for allowing me to breastfeed Laney, even through a horrendous three months of breastfeeding and pumping for nine months. I've learned so much in this first year, for it definitely "broke me in" to Motherhood. Hee-hee! Since we are again on the brink of flu-season, I will pump once a day after she turns one year old(once I can get my supply down) until March to get her through the flu-season. Pumping once a day will be a BREEZE! I tote my "breast friend" everywhere I go. We are pretty close, but I will say that I won't be sad when we go our separate ways.


What would I change?

• I'd request a pump while in the hospital, and I'd pump like a maniac to get that milk supply in faster. We did in fact request the pump, but the nurse looked at my husband like he had two heads. We didn't know the push the matter, but hind sight is 20/20. Next time I'll be sure to push as hard as I can get that a hold of that pump at the hospital. My friend who had a c-section was in the hospital at the same time I was and she pumped like crazy so the nurses could feed her baby at night while they slept. Their baby was in NI CU and had to be fed through a nasal tube. She had a good supply of milk after a few days and before she left the hospital.



• I'd start on the herbs "fenugreek" and "alfalfa" much sooner to help bring in my milk supply. These are herbs in capsules that are safe and very effective for boosting your milk supply. I started these when Laney was around one month old and slowly weaned myself off about after she turned three months.



• I would bathe my breastfeeding experience in prayer while pregnant. I am already praying for my next breastfeeding experience and I'm not even close to being pregnant again. Please consider this very important factor in preparing yourself and your baby for breastfeeding.



• Relax more: I feared that Laney would wither away in those first few months. Every weight check was nerve-racking for me. She was a lot smaller than a lot of babies for the majority of her first year, but she has caught up and is now sporting big, chubby thighs! God is in control, not me. I would live out Phil 4 by trying to not "be anxious about anything" and by trusting the Lord more. I'd give the Lord my burdens instead of carrying them around and realize that His yoke is easy and His burden is light. Boy, I wish I would have lived that lesson out in those first few months.



• Open up more: Call a friend and pour your heart out to them. Ask for prayer more. Open up and pour out your tears about your struggles. It's not healthy to keep those feelings bottled in. I had my handful of very close friends that I called and cried my head off to for an hour, or left voice mails into the wee hours of the night hoping they'd pray for me come morning, but I would do it even more had I to do it all over again. I wouldn't just keep it to my "handful" of friends. Other women need to know that you're not "Super Mom" and that you do have struggles. Young mothers and mothers-to-be need to see these struggles in your life and how you overcome them. All too often women camouflage pretty much everything that shows imperfection and that has caused so much insecurity among women.



• Formula as a supplement: If you intend/hope to breastfeed 100% of the time, try your best to steer clear of any supplement, esp in the first few months. You need all the stimulation you can get to tell your body to make more milk, so as to keep up with the needs of your growing baby. Knowing that I'd get my hands on a sweet, hospital-grade pump next time around (hee-hee), my hope would be that my milk would come in sooner, and I wouldn't even have to go through the agony again of having to decide to supplement or not.



• Laugh: I'd laugh more. WAY more. I laugh a lot now, but when the rubber met the road and I was getting "squeezed" by stressors out of my control, there wasn't much laughter(once my codeine wore off.) You HAVE to find relief. I encourage you to find humor in the every day occurrences in life.

I realize that there are so many factors that play into breastfeeding our babies. I could never have pumped had I had other children to raise as well. I believe you have to take in every factor in every Mother's experience to feed her baby. Formula is an answer to prayer to so many people. It was an answer to my prayers in the hospital when my newborn was losing weight fast, even though I was encouraged not to accept it. I will tweek the situation next time, but it definitely was an answer to prayer. I agree with the other authors on here that we must respect everyone's choice to how they want to provide for their baby. Breastfeeding isn't for everyone, but I highly encourage it. The time spent pumping, cleaning, toting, (and entertaining your crawling child who is tugging on your pump tubes) was twice the work and a big thorn in the flesh, but I'm so happy that I made the sacrifice. I was incredibly sad those first few months for I wanted that special, calm, gentle bond that Mother and Baby share while breastfeeding. I can say that I DID have those special breastfeeding moments, but they were far outweighed by the stressful experiences. Being able to pump allowed me to still feel connected and bonded to my baby girl. I also chose to rock Laney to sleep and now you know why. I simply needed that sweet time with her. I cherish those moments. I encourage you to fight the fight if you have an iron will to breastfeed. You can do this. The outcome may not turn out the way you envision it, but I encourage you to do what you can within your realm of influence. You have no idea how delighted I am to know that Laney will have breast milk past her first year. I consider it a true blessing. This 12 month mark seemed like an eternity away and now it's here. Praise the Lord for His faithfulness to keep me going when I didn't think I could!

Having Peace — When things don’t go as planned.

Hi, my name is Jen Potter. I am a friend of Leah’s, and she asked me to do a guest post on this topic. I have three kids, ages 3, 2 & 10 months, and have had three very different feeding experiences. I have really enjoyed following this blog, so I hope sharing my perspective and experiences will encourage other mothers in their goal of doing what’s best for their babies, their families and themselves.

Breastfeeding is a wonderful thing. As the other ladies have cited, there are so many God-given, God-planned benefits, it seems like a no-brainer. I really enjoyed breastfeeding. But my daughter (my second child) was the only one I breast fed for an extended time (8 mo). If things had gone differently, I would have loved having that same experience with my other two. But sometimes things don’t work out like we plan, do they? So here’s my story:

I feel like I had a pretty realistic and balanced understanding of breastfeeding before my oldest son, Liam, was born. I had always wanted to breastfeed my children and sought to be as prepared as I could be before his arrival. I read books, talked to lots of other mothers, and went to a breastfeeding class. I remember telling my friend as we left the breastfeeding class that I thought the instructor had painted a little too rosy a picture for this group of first time moms. She focused on how babies ALWAYS know just what to do, and how it would all come NATURALLY to us as well. “It will be so EASY.” While I believed that it might be true for many people, I personally knew too many women who had a less than “easy” experience. I didn’t think she gave justice to that fact.

One friend struggled for months and months to breastfeed her baby girl who had a weak suck. She went to classes and support groups and practically joined the LaLeache league in her effort to have “success” at breastfeeding. She (the mother) in this case was doing everything right—everything she could—and yet it still didn’t work. Through no fault of her own, her baby just wouldn’t nurse effectively. I admired this friend for her persistence in trying to do what she believed was best for her child. She persevered for months. In the end her experience was nothing like she had planned. But she was content knowing she had tried her best. I was thankful for her example. It prepared me for the possibility that it could be REALLY hard. Was I committed enough to slug it through like her?

I knew breastfeeding was often hard (I’d now say more often than not). I had heard plenty of stories of sore nipples, latch on issues, thrush, low milk supply, poor let down. It was so helpful to hear how each mother dealt with the obstacles that arose as they pursued their goal of breastfeeding. It meant so much to know that if I had issues, and things didn’t go as I planned, that I was not alone. I was comforted too by the fact that all of these women’s children—no matter how long, or even IF, they were breastfed—were all happy healthy babies, toddlers and kids. In fact, I also had a friend who flat out and unashamedly decided breastfeeding was not for her. She gave it a try, her baby did great, yet she just didn’t like it. She gave herself permission for that to be okay, in the face of horrified family and friends who couldn’t believe a stay-at-home mom would CHOOSE such a thing. And it WAS okay. It was the right choice for her. I was thankful for her example of not letting others make her feel guilty for making a choice that was right for her and her family.

So when Liam was born in February 2004 everything seemed to be going great. I brought him to the breast shortly after birth and he did well. I tried again a few hours later when the lactation consultant was there. She was pleased with how Liam was latching on and was amazed that this was my first baby—that I seemed to know what I was doing. I asked her lots of questions and got a few pointers etc., and asked her to come back for the next feeding. I was excited to be off to what seemed like a good start. That all changed however when he was about 8 hours old. I was holding him on my lap when he let out a loud cry then suddenly turned deep purple. I immediately buzzed the nurses’ station. All I had to say was, “My baby’s purple” and a slew of them came literally running. He was rushed off to the NICU. Long story short, he was diagnosed with a heart defect called valvular pulmonary stenosis. (He is doing great now.) Anyway, they really wanted to give him some formula. I can’t exactly remember now what their “very important” reason was. But in the midst of that scary situation I said it was fine. I told them I intended to nurse. They assured me one bottle wouldn’t cause a problem, which I knew. Here’s where I should have asked for the lactation consultant again. Although when your baby’s health and life are at stake, somehow your ideals on breastfeeding get pushed aside a little. In the following days (Liam was in the NICU for 1 week) I was able to nurse him during the day, but at night he received bottles. After I was discharged, there was no where for me to stay at the hospital, so to get some rest we drove 20 minutes home after his evening feeding every night and came back for his first feeding the next day. The doctors were very concerned with knowing how much nourishment he was getting and I think they had me supplement with bottles some during the day. Well it wasn’t too long before Liam realized which he preferred! He definitely knew he could get a full tummy with a lot less effort with the bottle. So they gave me the lovely nipple shield. And that was the beginning of the end for us. I managed to keep nursing/pumping for about 6 weeks until my milk supply was so low and I was so sick of pumping, that I didn’t see any point in continuing. The day I gave myself permission to be done was a good one. I felt like I had done my best and that 6 weeks was better than nothing. I also didn’t have a big problem with formula necessarily. I think you would be hard-pressed to argue that formula is the better choice over breast milk. But I don’t think it is bad alternative. But I’ll save that discussion for another day. Suffice it to say, I think it is important to be at peace with your choices no matter what they are. It would be bad to heap guilt upon yourself every time your child gets a cold. “If only I had kept pumping. If only I had been able to nurse.” It would be equally as bad to feel bitter being chained to the pump for months on end if your heart wasn’t in it. My point is, it is YOUR choice and YOU need to be okay with it.

If I had the chance to do it over again there are some things I would have done differently. So maybe someone can learn from my experience. One thing they kept saying was, “It’s either a bottle or we have to put a tube down his throat.” In retrospect the tube would have been the better option. It seemed scary at the time and an awful thing to put my newborn through. But it really isn’t as bad as it sounds. I realize this even more now after 5 months of personally putting a Nasal Gastric Feeding Tube down my third child’s nose and throat. Another great option a friend told me about after the fact would have been to insist we give him the supplement feedings with a syringe. It wasn’t the extra nourishment I was against, or even the formula per se, but the nipple confusion ended up being a big problem for us. I think things would have been different if I had already had a successful nursing experience. I would have realized much sooner the problems the nipple shield was perpetuating instead of “helping” as the nurses were suggesting. Again, I wish I sought help from the LaLeache League or something after we went home and gotten some advice from a different perspective. I think almost all the “support” I got at the hospital was not as pro-breastfeeding as would have been necessary to get us successfully nursing. Overall, bottles were really pushed. All in the name of my child’s health I might add.

Well on to story of kid #2. Kate was born in July of 2005. I was determined this time to be as pushy as I needed to be to get those lactation nurses in there to help me until I got it right and was completely comfortable. Kate had some problems with proper latch on, but I kept at it and she was doing great rather quickly. “If it hurts, they’re probably not latched on correctly,” was great advice. But you need to know what a good latch looks like to be successful. Again, ask for help. I am so glad I did. Kate and I had a wonderful nursing experience for 8 months, when I weaned her because we wanted to start trying again and I hadn’t gotten my cycle back. Now I would say I think Kate had just as many colds as Liam did as an infant. So take that for what you will. I don’t know if he was bringing home more colds and giving them to her or what. Although I enjoyed nursing Kate there were definitely advantages to bottle-feeding that I missed. I for one really liked it that my husband could share the feeding responsibilities with Liam. With Kate I was the one who had to get up in the middle of the night and early in the morning EVERY TIME. Also, I think other family members had really enjoyed being able to spend special time feeding Liam. And he was able to stay for longer periods during the day and stay overnight with grandparents. Kate was not able to as frequently. She had to be with me, or I had to pump. I only did that when I had to. She did switch well between breast and bottle (of breast milk). For several months I pumped every morning after her feeding and froze the milk. I used the frozen milk for Thursday afternoons when she was at the babysitter’s while I worked. That stash lasted us 2 weeks after she was weaned. It would have been longer, except my entire stash had been wiped out when our electricity was out for 13+ hours when she was 5 months old. Our poor old freezer couldn’t keep it cool enough. They all thawed. It was so painful to dump all that out.

So now on to the curve ball... Kid #3, Owen. God has used Owen to teach me a lot about Himself and His amazing peace. I was looking forward to breastfeeding again, but it was not meant to be. We found out at 25 weeks that Owen had bi-lateral cleft lip and palate, spina bifida and hydrocephalus. At first the perinatologist was sure he had some fatal genetic syndrome. But both spina bifida and cleft palate are present in my husband’s family. Long story short, as we suspected, Owen just happened to get both things. His chromosomes came back normal. So I spent the remainder of my pregnancy preparing to care for this child with his many special needs. We were already somewhat familiar with his problems, so that helped. But a lot of things have changed in the medical world since Eric’s brother was born with cleft lip and palate. My mother-in-law wasn’t even given the option of pumping and giving him breast milk. They just told her she had to give him formula. The problem is babies with a cleft palate cannot suck. Imagine having no roof of your mouth, air flowing freely between your mouth and nose. They end up having to more or less chew a bottle nipple to eat. It can be very exhausting for them. They had all kinds of problems feeding Eric’s brother. I read everything I could about it and was pleasantly surprised to read that some people have had success nursing babies with clefts. But usually they only had a unilateral cleft lip and/or only a cleft in the soft palate not the hard palate. Owen had the worst possible scenario for nursing to be a possibility. I had a really hard time this time letting go of the thought of being able to nurse. I held out hope until I actually heard the developmental peds nurse practitioner tell me, “He will never be able to suck enough to nurse until his palate is repaired.” I pumped from day one for him. And in the back of my mind kept the possibility that if only I could pump until his palate repair, maybe I could teach him to nurse then. Of course palate repair surgery is usually done between 12 and 14 months. But he would not be able to suck a bottle until then either so he’d have to relearn sucking anyway. And I theorized, why not learn how to nurse at that point. I knew it would be a little old to start nursing him and highly unlikely that I would succeed in this endeavor. That is just how desperately I didn’t want to give up and say it couldn’t be done. So I committed to pump for as long as I could. We rented a Medela Symphony, which truly is the Cadillac of breast pumps. The other hospital grade pump just didn’t work as well for me. I pumped every 3-4 hours and 6 at night. We stayed at the Ronald McDonald House for 15 days. I took the pump home with us and kept it up, but it was a real chore. I have so much respect and admiration for those moms who can make this work! Our lives were anything but normal at that time and pumping was taking my last vestiges of normality away. Try pumping for 15-20 minutes while your 1½ year old and 3 year old want you to play. Then rig up the feeding tube to feed your infant, who is also on oxygen and a heart monitor. Then washing everything. It all got to be too much when Owen was about a month old. I had to quit pumping for my sanity and the sake of my other kids. And as laborious as it was at home, it made my already all too frequent trips to Indy even more complicated. Pump, drive, pump, doctors appointments, pump, drive, pump. Yeah right! Plus you can’t pump in public very easily. It’s not like you can easily sit and just cover up. I wasn’t about to take my three kids into a public restroom to do it.All in all, it just wasn’t worth it for me. And in the end, it was the right thing for me to do and I was, and am, okay with that decision. I gave my son 4 weeks of God’s perfect milk and that was a great gift. One thing I did want to add though, I did enjoy using some non-nutritive feeding techniques early on. Non-nutritive feeding means letting him suckle at the breast knowing he won’t get any nourishment from it. Doing it solely for the benefits of closeness for him and to increase my milk supply. I really only did it a handful of times. Selfishly it was a good way for me to say goodbye to breastfeeding. Owen was fed completely by NG tube for 5 months. We diligently dipped his pacifier in milk or formula while he received his tube feedings so he would associate sucking and the taste with getting a full belly. Remaining faithful in that has helped us along the way as he has increased his feeding skills. Owen has had many feeding issues as you can imagine. He now can take about 6 oz by mouth, 2x a day with a special feeder bottle (the rest is through his G-tube). He uses a mix of chewing and sucking, but he gets the job done. He has learned how to keep it from going up his nose. At 5 months we had a G-tube put in, which is like a little beach ball valve that goes directly into his stomach. Hopefully we will get that removed sometime next year when he is able to take all his food by mouth. I tried to limit my comments on Owen to breastfeeding here. If you want to read more about Owen’s journey you can check out our caringbridge site: www.caringbridge.org/visit/owenpotter


In closing, I think it is important to keep perspective on life. Be thankful for healthy children. Be respectful of each other’s choices. Be at peace with your parenting decisions. Know that even when things don’t go the way we’d like, God has a plan. He is in control. He is faithful even when we’re not. He is capable of doing more than we could ask or imagine. He loves our children even more than we do. Ask for help. Seek wise counsel. Get support. Reach out to others. God uses us. We are his hands and feet in the lives of our children and those around us.

My Experience Breastfeeding a Preemie

My experience with breastfeeding started off in the NICU when my son was born at 32 weeks weighing just over 3 pounds. I was not prepared (obviously!) and hadn't even made it to the breastfeeding class my husband and I had signed up for! I knew I wanted to nurse, but that I would have to pump once I returned to work. I had gotten some advice - a lot of it good - and I think I was relatively prepared for breastfeeding to be a challenge. I was determined to nurse if for no other reason than the fact that I refused to pay for formula! Like Leah said, my passion for breastfeeding has since grown with my experiences and I am so looking forward to nursing my baby girl in March!

To be quite honest, nursing a preemie was extremely stressful but I am SO GLAD to we persevered through all of the trials.



This picture was taken the first time I was able to hold my son skin to skin. This was at 3 days old. He did show some signs of rooting during this session, but was still too small to suck, swallow and breathe at the same time. He was getting all the breast milk (pumped courtesy of the Medela Symphony - the Cadillac of breast pumps) he could through his feeding tube. Actually - interesting side note - before my milk came in the doctors tried giving him formula in his feeding tube. His tummy did NOT tolerate it well and they waited to try feeding again until I had some colostrum to give him.


Around 1 week old, we were able to start trying to nurse. It was also around this time that he received his first bottle. The bottle was truly a necessity in order to get enough calories into him (without having to use a feeding tube) to allow him to come home. The breast milk he received in the bottle was basically fortified with a special formula. Because of his small size and difficulty latching, I ended up using a nipple shield. Please know that I am NOT endorsing this product. Many women are given these to use without being given the knowledge on how to use them properly. I truly do not recommend a shield unless it is an absolute last resort. For us, it was the only way to get him to latch properly until he grew a bit. Weaning from the nipple shield proved to be one of our biggest nursing hurdles and I will avoid it at all costs when nursing next time around.

Once Will left the hospital (after 2.5 weeks) our routine included alternating between nursing sessions (with a shield) and the bottle of fortified breast milk. We were told to continue this for around 2 months - until he would have been full term. So, we did. Of course I had to pump after EVERY session in order to keep my supply up. (This is part of the evil that is a nipple shield. That and all of the washing and sterilizing of pump parts, bottle parts and nipple shields that my poor husband had to do!) I really hated pumping at night and made it my goal to have him weaned from the nipple shield by his due date. Weaning from the shield was not easy because simply put - he had nipple confusion. A shield is very similar to the bottle nipple. He wanted nothing to do with me. We later found out that his refusal to nurse (or take a bottle) for those first weeks was also due to his reflux. His reflux was also bothered by the formula that we had been fortifying his bottles with.

Oh yeah, Leah mentioned weight checks - we also had to do every other day weight checks at the doctor for quite a while...but Will only weighed 3lbs, 12 ounces when he came home so I understood the need to be sure he was gaining well. In fact, it took him a while (partly because of his reflux) to start packing on the pounds. Weight gain has had its highs and lows for Will and continues to be a battle as we round 18 months old and barely pushing 20 pounds.

After several appointments with a lactation consultant - we slowly made progress with weaning from the shield. I don't remember exactly when he weaned, but boy was it so great!! Eventually we got into a routine that involved no pumping or bottles. At least for the few final weeks before I headed back to work...

When Will was 12 weeks old, I went back to work full time. I am so thankful that I had 12 weeks off with him. I am convinced that we would not have succeeded with nursing had I not had some extra time with him.

At first, pumping at work was a chore to say the least. But I quickly fell into a routine and it wasn't so bad. We did have to continually battle low supply and this was definitely frustrating. I think my supply was negatively affected by the start we had with the need to pump (versus skin to skin contact nursing - does wonders for the hormones!) and the use of the nipple shield. I was constantly using the resources that Leah and Krista have already mentioned (kellymom.com and the la leche book).

We successfully nursed until around 11 months. I think it was a little longer before he totally dropped his before bed nursing. Around 10 months we started introducing formula in his bottles. Slowly we transitioned him and he did great. I was bummed that we didn't make it to a year, but my supply had gotten so low I could no longer keep up with his needs by pumping at work - despite all efforts short of hormone replacement (only kidding - sort of...).

Breastfeeding Will was definitely one of my favorite parts of being a mommy in those first few months. I am convinced now that we would have battled many more illnesses had I not breastfed him for those 11 months. Not to mention possibly more serious reflux and weight gain issues as a result.

Krista and Leah have already given some great practical advice. The only part that I would like to reiterate is to seek out help!! It is not as natural as it is made out to be. You and baby have to LEARN. But in the end, it is so worth it and I wouldn't trade the hardest parts for anything in this world.