15 July 2011

Nursing Stories: Too Much Milk, Not Enough Babies - Oversupply and Imbalance

Today is the final post in my Nursing Stories Series, for now. The first two posts were about why I don't like Lactation Consultants and some tips and tricks for nursing with large breasts. You might also be interested in my thoughts on Nursing In Public and tutorial How to Make Your Own Nursing Bra.

Please know that I'm not bashing Lactation Consultants as a whole, I think it's a wonderful profession and doesn't have the regard or the influence that it should have. However, I am talking about my experiences which were less than stellar. I think if there were more demand for LC services then by sheer experience the LCs I have come in contact with would have been better equipped to handle my particular problems. I hope that my negative experiences will not steer women away from using an LC, but encourage them to ask for second opinions and keep looking for answers until a problem is dealt with. I also hope that if I have problems with future children that I will not allow these experiences to keep me from asking for help.

I was a bit naive when Jaron was born. I thought that after the tongue-tie issues with Aedyn, followed by a smooth and near perfect nursing relationship, my second breastfeeding experience would be a breeze. Boy was I wrong!

We got off on the wrong foot to begin with. After an unplanned C-section, an over-crowded L&D/Nursery, and nurses who wouldn't release him to come back when they weren't so overrun, I didn't even get to hold Jaron until he was around 2 hours old and 100% zonked out. From the first session he would eat pretty quickly and then sleep...a lot. His latch was perfect, but he was nothing like the Dyson imitator that Aedyn was. I fed him as often as he would nurse while we were in the hospital. It seemed odd to me that he didn't want to nurse to much, but when he was hungry he latched well and ate well.

My milk fully came in on the day I was discharged. Mild engorgement, nothing like I had with my first, but I'd expected that part to be easier. Jaron started being really gassy after eating, he was a pretty good burper, but for about 15 minutes after he finished nursing he'd fuss and make noises.

He was gaining weight and having the right number of wet/dirty diapers. So I wasn't too worried, but his poop was definitely interesting. And on the couple times I changed his diaper mid-office session, it was really weird, frothy to be exact.

He also started to hurt my feelings. He wouldn't comfort nurse and he'd sleep 6 hours at night. He wasn't a newborn. He was a 6 month old in all of his patterns. Something didn't feel right but I couldn't put my finger on it.

I worried about him getting enough milk, he could never even finish one breast. I always felt full and uncomfortable. He never drained me. Finally I pumped just to get everything emptied out. It was then I started wondering about over-supply. I started researching.

Over-supply and foremilk/hindmilk imbalance often go hand in hand with over-active letdown. I didn't have any letdown issues, so I kept looking. Finally, between reading all the info I could find on all three conditions and referring to similar troubleshooting parts of the Womanly Art of Breastfeeding, I realized that I was definitely dealing with over-supply and resulting imbalance. In a nutshell, just having large breasts dosn't mean you make more milk than the smaller chested mom next door, larger breasts give you the potential, for storing more milk. Like pumped milk fat rises and settles against the walls of the ducts/glands.

When baby first starts nursing he gets the foremilk, the milk that the fat had risen out of. This milk is lower in fat and higher in lactose. Normally, letdown occurs and as the gland and ducts contract the fat is released into the milk and baby gets everything he needs and his tummy likes it. In cases of imbalance, so much milk is stored that the baby gets full before letdown, or before he can get to the fatty hindmilk. It means excess lactose in his system without the fat to break it down giving him frothy stools, gas, and tummy pain.

In some babies, it cause high/fast weight gain because they wan to nurse more often due to needing more calories. In other cases, like Jaron's it caused low to no weight gain because they only nurse when they have no other option and eat as little as possible because it upsets their system.

Solution 1: Was only nurse on one breast a feeding. Well, I had always done that, moving on...
Solution 2: Nurse on the same breast for 2 - 3 feeding in a row (block nursing). Only pump on the other side to relieve pressure, but don't empty breast. I saw some results on the first day, but it wan't a complete cure. So...
Solution 3: Nurse on the same breast for an entire day and night. Pump only enough to relieve. This is walking the line with mastitis, but I really had no choice and it worked!

I was still pumping off quite a bit and because we don't have a milk bank here I was just dumping it down the drain. Yep. I said that. And I did it. I don't have freezer storage space. I offered it to women I knew in our church who had babies of a similar age, but in the beginning no one needed/wanted it. I didn't know about Eats on Feets or Human Milk 4 Human Babies at the time. It made me sick to my stomach, but I didn't know what else to do with all the milk.

I finally figured things out a couple days before Jaron's 3 month well-baby visit. (Oh, by the way, he also developed thrush while all this was going on) Our Pediatrician mention the slow gain, but when I told him what I had figured out and what I was doing, he said that that was probably it and he wasn't worried now that I had found what worked. (Thank goodness for pro-breastfeeding pedi's!) As long as Jaron was happy, developing, showing that he was appropriately hydrated (diaper news) then there was nothing to worry about.

I called the LC at my OB's office, to tell her what I was doing and see if she had any advice for me. Big mistake. Again. She didn't listen to me and spent 15 minutes telling me to do things that I had just told her I had already done. Then finally told me to start full hormone birth control pills or take decongestants. I'm sorry, but have you ever seen me on Sudafed? Childcare would not be happening, even on OTC meds and I really didn't want to deal with BC side effects, I've never been on a full pill before, don't really want to experiment right now, thanks. It wouldn't have been so bad, but she had the same condescending, self-important attitude that my previous LCs had, so add that experience to the others and you can see why I'm not all that impressed with LCs.

I went to my local La Leche League meeting. That wasn't very helpful either. I appreciated the support, but the only help I got was being pointed to the same sections of Womanly Art of Breastfeeding that I already had memorized.

So, I kept doing what I was doing, still dumping milk for another couple of months. Then a close friend with a baby slightly older than Jaron got pregnant again. Her supply dropped and she took me up on my offer, then another friend also needed milk. At my peak I was nursing Jaron and pumping 18oz a day to supplement 2 other munchkins. It felt as if my body had a purpose for producing so much, and it was a nice feeling.

Now we're 8.5months out. I've had a ton of issues with my pump, pretty sure the flanges aren't big enough, but I didn't realize the pump was the problem until I had to stop pumping. My supply started to drop for no reason I could think off about 3 weeks ago, or at least the amount I could pump dropped, and at the same time Jaron hit a growth spurt. Then I got thrush. Now I make enough milk for Jaron, but not really any extra.

I think I'd like to start pumping again, but now that all the pain has cleared up I'm not sure that I want to invite it back. I've also been thinking about becoming an LC. Maybe my experiences will help me reach the women that no one else has an answer for. It's as difficult as anything to meet the criteria, but if I really got involved with LLL and became a leader there it would be doable in a few years...I'm still processing that one, so we will see...

And that's it. For closure, the thrush has cleared up and other than Jaron trying to do headstands while he eats we're doing great! Almost 9 months down and at least 9 more to go!

What are your thoughts on LC's and becoming one? Have you ever considered milk-sharing? 

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