The end of nursing is at hand

I decided a couple of months ago that when I ran out of this batch of herbal supplements that I wouldn't buy any more. I figured that my milk supply would go down, but she would be almost a year old and so that would be ok.

A couple of weeks ago, I hit the point where almost all the supplements ran out at once. I learned that they really had been helping my milk supply. A lot. Once I stopped them, my supply rapidly went down to almost nothing. I stopped pumping at work because it seemed like way too much effort for very little return. That caused my supply to go down even further.

As it stands now, I'm still nursing with the lact-aid at night when putting S to bed. I nurse her in the morning before I leave for work. I don't think she gets much milk (if I had to guess, I'd say an ounce a session or less), but she still seems to enjoy a brief cuddle and nurse before heading off to do baby things.

Mostly, I feel good about it. I made it to a year (tomorrow!) nursing with very low milk supply. S got exclusively breast milk for several months and has had at least some milk every day for a year. We've done the best we could. I also feel good about it simply because I think about it less. Every time I don't nurse or pump is a time when I don't have to feel like a failure because I don't produce enough milk. Every bite of solid food that she eats is a success because it's less formula she's going to drink. I think with enough time, I'll get over the heartbreak of not being able to fully breastfeed. However, I'm not there yet. When I was pregnant, I just assumed that I'd be able to breastfeed. I mean, after all, isn't that what breasts are designed to do? When I wasn't able to, it was like that dream died. And like any death, it takes a while to fully work through it and complete the mourning process. A big part of me will be glad when we're done with breast- and bottle-feeding entirely. I think in a year, when she's eating solid food full time, I'll probably have put the whole thing to rest. But I'm not there yet.

Nursing update

9 months later, we're still at it. I feel like that's quite an accomplishment, seeing as I've never made enough milk for her. 

We've basically run out of donor milk at this point. I haven't been able to find anyone new to donate, probably because most people want to donate to younger babies. It makes sense, they need the milk more than a 9 month old who's doing well eating solids. However, she still needs to be taking in quite a bit more milk than I make. 

I'd been saying that I was going to get her on raw goat's milk after we ran out of donor breast milk, but our local farmers are in the process of drying off their herd so they can breed them for the spring. They didn't have any milk available. I did a little research and came up with this recipe for goat's milk formula made from dry goat's milk powder. I ordered a bunch of the ingredients from amazon and while I was waiting for them to show up, I put her back on powdered formula; the expensive organic Earth's Best kind. We had the same congestion issue that we had when she was just a tiny squee (the first time she was on it). I had hoped that she would have grown out of it, but apparently not. She got all snotty after a few days of formula instead of breast milk. We used the formula while we were down in California for Christmas and she did ok (not too snotty), but still more snuffly than I like my tiny squee to be.

Now that we're back home and I have all the ingredients for the goat's milk formula, we're feeding a combination of goat's milk formula and Earth's Best canned formula. I've been making up 16oz of goat's milk formula most days and then we supplement with Earth's Best when we go out (it's much easier to transport) or when we've used up all the goat's milk formula and need a bottle in a hurry (like the middle of the night). We've been doing a good portion of the feeding through the Lact-aid, although both goat's milk formula and powdered formula are a lot more irritating to use with it than breast milk was. The goat's milk formula has a bunch of added oil (coconut and olive), which solidifies when it cools down. If the Lact-aid is too cold, the oils clog the tiny sucking tube and TS can't get any liquid out. The powdered formula has a tiny little strainer that has to be used inside the funnel when the formula is poured into the bags. Otherwise, the undissolved formula gets stuck in the tiny tube as well. 

I'm still planning on changing her over to raw goat's milk once it's available. That'll probably be about the same time she turns one, which is when she's supposed to be able to start drinking plain dairy products as a beverage. Since I've got all the stuff to make the formula, I'll probably keep it up until I use some of it up, but it's nice to know that we've almost made it to the point where she can drink plain cow milk. 

My current plan is to keep nursing with the Lact-aid until she self-weans. However, I keep waffling on that decision. It's sometimes hard to rationalize all the trouble that I go through to produce a few ounces of milk. I have decided that I'm going to stop taking all the herbal supplements when she turns one, though. Then she can nurse whatever milk there is there and have a Lact-aid when she wants more (before naps and at bedtime, possibly). I keep hearing stories of babies who abruptly stop nursing and never go back to it, so maybe that'll happen to us. Or maybe she'll want to keep nursing forever (I hope not). At a minimum, I'm committed to continuing to take my supplements until her birthday, then letting her nurse through the summer. I'm torn about keeping it up through next school year - it'd be nice to not have to worry about pumping while I'm at work. That's a long time away in the life of a tiny squee, though. She'll be a totally different, much larger, person by then.

World Milksharing Week

It was World Milksharing Week last week. I meant to post earlier, but somehow was busy, what with it being the first week back at work and all.  Before I had Sterling, I didn't know that milksharing was a thing, much less that there was a whole week where one could celebrate it. If you look closely at the picture of the two nursing women, one of them is using an at-breast supplementing system similar to what I use with Sterling. I really like the fact that the two babies are holding hands. If we assume that the two babies are both getting milk from the blue mother, that makes them "milk siblings". That's not really a thing in our culture, but it still is in many cultures where infant formula isn't readily available and having a wetnurse or milk from another mother can really be the difference between life and death for a baby.

Wikipedia (my favorite source of information) says that "In Islam those who are fed in this way become siblings to the biological children of their wetnurse, provided that they are less than 2 years old. Islamic law (shariah) codifies the relationship between these people, and certain specified relatives, as rada'a; given that a child is breastfed five fulfilling (satisfactory to him) times, once they are adult, they are mahram, meaning that they are not allowed to marry each other, and the rules of modesty known as purdah are relaxed, as with other family members. But, laws of inheritance do not apply in the case of milk siblings." I think that's a pretty neat idea. If we were to follow that, Sterling would have a huge family. Let's count them up.

1. We got fresh (unfrozen) milk for several months from a wonderful woman with a baby girl only 3 weeks older than Sterling. It was really neat to watch the baby grow. It was like a preview of what Sterling would be doing in a few weeks. I saw them twice a week for several months and we spent a lot of time talking. It was nice to establish a relationship beyond just picking up milk. 
2. We picked up milk twice from a woman in Eugene with a baby boy a couple of months older than Sterling. She was the first person to agree with me that S had at tongue and lip tie (she'd had the same issue with her baby). That agreement led me to seek help from one more person, my wonderful Lactation Consultant Melissa Cole.
3. One of my colleagues from work was pregnant at the same time I was with a baby boy. We got into a discussion one day about nursing: I mentioned that I wasn't producing a lot of milk and she mentioned that the last time she was pregnant, she produced way more milk than she needed. When I decided to try donated milk, she was one of the first people I emailed. She's been pumping 4oz of milk for us a day for months now. She and I have gotten to know each other much better since our original discussion and we have a lot in common. I really enjoy getting together with her. 
4. We got milk from someone who lives very nearby and has a baby boy several months older than S. She pumps and donates to different mothers every time she collects about 100oz extra. When I walked into her house with S, her son was sitting in his Bumbo chair eating sweet potatoes and had them all over himself.
5. I picked up a whole bunch of milk from a woman in Vancouver. She was so sweet - we were meeting at Starbucks and I had the wrong one because I'm not familiar with Vancouver. It was about a thousand degrees that day and she drove to meet me (out of her way) at a second Starbucks to give me two full grocery bags full of frozen milk.
6. A woman who is hoping to adopt a baby has given me milk twice. She's induced lactation by taking medication and by pumping extensively. She's worked up from pumping a few drops to pumping about 13oz a day. Her plan is to continue pumping until they call her to tell her that they have a baby for her to adopt. It could be tomorrow or it could be a year from now. That's dedication. She always says she's happy that the milk can be used: she called a milk bank and they wouldn't take it because of the medication she has to take to induce lactation. 
7. When we were in Virginia, we got milk from three different people. The first was a friend who has a baby girl about a year old. I've gotten to see the baby grow up through picture on facebook, but haven't ever met her in person.
8. A work colleague of my mother-in-law's gave us milk before we got there and while we were there, when we started running low. She has a very healthy baby boy a few months older than Sterling. When we went to pick up emergency milk the second time, she was holding him and he looked at us very seriously.
9. I found someone in Sterling, VA through Human Milk 4 Human Babies - Virginia. I don't know whether she has a boy or a girl, but she was willing to share her milk with a baby that she'll never meet.
10. Another friend of mine from work brought over a 5oz bottle of milk that she had pumped (she exclusively pumps and then feeds her baby via a bottle because he finds nursing to be frustrating). It was an amazing gift because up until that point, she hadn't been pumping enough to fully cover his needs and she'd had to supplement with formula. That bottle was one of the first times that she'd produced over his needs for the day. Since then, she's gotten her supply up past his milk needs for the day and has offered to share the excess with Sterling.

This is what breastfeeding looks like for us.

All of these women are fabulous and I appreciate their generosity every day when I'm able to feed my baby on exclusively human milk. She's growing up happy and healthy and amazing. How could she not, when she's getting love from all of these amazing mamas?

Donor milk!

Mike just finished a major milk organization freezer project, which pushed his tetris abilities to the maximum. I'm very proud of him. We now have milk in the freezer from 4 different women and milk in the refrigerator from a fifth. Since babies get antibodies through breastmilk, I'm anticipating that Sterling will be immune to every disease known to man. 

I was getting a little concerned because our main donor (who we get the unfrozen milk from) had seen a drop-off in milk supply. We were burning through our freezer stash faster than I was comfortable with. 100 oz of milk *sounds* like a lot, but we use up to 15 oz a day, which means we could burn through that much in a week. 

I think it's sort of like wanting to have your cupboards filled if you've ever had a period of your life when you've been hungry. I want to know what I have plenty of milk so that my tiny squee won't have to go back on formula. The new goal is to keep her exclusively on breastmilk until she's 6 months old... longer would be great, but apparently their gut has matured to the point where formula isn't quite as bad by the time they're 6 months. That's about when I think she'll probably be starting solids, too.

These days, we're mostly bottle feeding with an occasional use of the Lactaid. The little tube is just so fiddly to keep in her mouth, since she's gotten a lot more active when she nurses. I haven't seen a huge decrease in supply since stopping the Lactaid, but there has been some decrease. I keep telling myself I am going to start using it full-time again, but the bottle is just so much easier. She's learning to hold it herself, too. We got her some handles to make it easier. 

Lactogenic Foods

I was reading this article about lactogenic foods (foods that are supposed to increase milk production). I made some barley water this evening by boiling a cup of barley in about 3 quarts of water for roughly 2 hours (until it had boiled down by about 50%). I strained out the very soft barley and just finished a cup of barley water. It tastes kind of like very thin oatmeal. It's not awful, but it's not something that I'd pull out of the fridge for fun.

I also read this blog post about a woman whose milk supply increased after drinking raw milk. I decided to check it out. The farm that supplies our eggs through our CSA also has two cows and a herd of goats. We went out to their farm today, met the cows and goats, and picked up three half-gallons of milk (two of cow, one of goat).

Raw milk is awesome (although the woman who wrote the blog post seemed to think it was pretty gross). I was expecting it to taste thick like grocery store whole milk does. It actually tastes less fatty than whole milk, which seems counterintuitive. At least an inch of cream separates out off the top of the milk when it's stored in the fridge, but it's easy to mix back in.

I'm guessing that neither of these things will have any effect on my milk production. I'd say that for women who have plenty of glandular tissue, but that tissue isn't producing optimally, might be able to "jump-start" milk production using a food-based approach. However, I'm pretty sure that neither will grow more tissue or help me out. However, both foods are nutritious and supposedly very healthy regardless of their (lack of) effect on milk production.

Tongue Update

It's three weeks since Sterling had her tongue and lip ties revised by the ENT Dr. I took her back in to the lactation consultant today just to check and make sure that everything looked good. She said it looks perfect and has healed fabulously. I was somewhat worried because I didn't do as good a job as I thought I should with the post-revision exercises. Now we just need to continue to do her tongue exercises so that she improves her range of motion.

I also picked up more lactation tincture as well as some herbs while I was there. I've been transitioning off most of the capsules I was taking in favor of the tincture. I felt like Sterling might be taking more supplement since I stopped one of the capsules, so I looked at the ingredients and found that the one thing I had been taking a capsule for that isn't in the tincture I'm currently taking is marshmallow root, so I got some capsules specifically of that. Marshmallow root increases the quality of milk, making it creamier and richer. It apparently doesn't have an effect on milk volume, but if the milk she's getting is creamier, she might need to eat less of it to feel full.

We also went for some good walks today because the weather was sunny.

Feeling Positive

This is what nursing looks like with the Lact-aid. 

This morning when I woke up, my boob was leaking! For most people, this wouldn't be cause for celebration, but it hasn't happened to me for a while. She nursed this morning, then I pumped 1.5 oz (0.5 from the side she'd nursed on and 1 oz from the other side). That's more than usual. I'm hoping it means that milk production is on an upswing. We've done some really quality nursing with the Lact-aid in the past couple of days. Sterling suckles really well for much longer than she used to because she actually gets milk out. It's a little bit fiddly to use; I keep having to adjust it because when she moves her mouth she sometimes moves the tube to a place where she can't suck milk through it anymore. She's much more effective at milk removal from the breast, though. I'm not sure if it's because she's suckling longer or if she's actually more efficient now that her tongue and lip have been snipped, but if I pump shortly after she's nursed I don't usually get much out. I used to pretty consistently pump about 0.5 oz after she'd finished.

Mike and Sterling reading together this morning.
Not related to nursing, but much cuter than
what I'm talking about in this paragraph.

I'm choosing to not look at the other possibility - that nothing has changed. It had been quite a few hours since she'd last nursed from the boob that was leaking this morning, so it's possible that it had longer to fill up than it normally does. For a couple of days after the first appointment with the LC, the amount of supplement she was taking went down by about 3 oz. That doesn't sound like much, but really it's one whole extra feeding that I was producing (or that she just wasn't eating). The last two days, it's been back up. I think that might be because she enjoys nursing more than she enjoys the bottle, so she'll just drink more that way. And it's possible that I'm not pumping anything after she nurses because production has actually gone down.. but I'm choosing to not focus on any of the things in this paragraph.

Follow-up with the Lactation Consultant

We saw the LC again today and she says that Sterling's lip and tongue look great. We learned how to do some stretches to keep them from healing back together again, as well as some exercises to get her tongue all trained up for expert nursing. Mike just called them suckercises.

Note: not my boob or baby.

I also got a Lact-Aid Supplemental Nurser. It's basically a bag for milk storage with a tube that goes out to the nipple. It's kind of like a baby straw. I can thread the tube into her mouth when she's nursing and she can suck the supplemental milk at the same time. It motivates her to keep nursing longer, which should stimulate my supply to increase (as much as it's going to). We also get special bonding nursing time.

She slurped up a bag of milk about an hour and a half ago, then fell asleep on my chest. I know I should put her down in her swing and go get something done... but she's so warm and cozy.

This is what I take in a day

This is the schedule of supplements that the lactation consultant recommended:

• Domperidone - 30mg capsules 4 x day
• Motherlove milk plus (ordered from amazon) - 1-2 capsules 3 x day
• Malunggay 350mg 2 capsules 3 x day
• Shatavari 400mg 1 capsule 3 x day
• custom lactation blend tincture - 2-3ml 3+ x day:
• contains: goats rue, fennel, fenugreek, blessed thistle, shatavari, lactva virosa, vitex, schisanda, yellowdock, saw palmetto, milk thistle, borage, nettle

So first thing in the morning, I take allergy medication (2 pills), then 5 or 6 capsules, and several droppers-full of tincture (which tastes pretty vile). Then at noon, I take a second domperidone capsule and another couple droppers full of tincture. At 3pm, I take various capsules and more tincture. About 6, I take another domperidone. Last thing (11 or 12), I take more allergy medication (2 more pills), 5 or 6 capsules, and more tincture. 

Here's what it all looks like.  I put the pills out in two tiny dishes  because they all sort of look similar: full of brown herby things.

I've been trying to pump at least twice a day and ideally more like 4 times. It's difficult to time because I don't want to pump right before Sterling wants to eat, but it's hard to determine exactly when she's going to want to eat. It's easier with the supplemental nursing tube since she's going to suck all the pumped milk while she's at the breast. 

When I'm going to be out of the house in the middle of the day, I leave with my pockets stuffed full of pills.

It makes my pee smell like I've eaten asparagus.

Lactation Consultant

We went to see a lactation consultant yesterday (Melissa Cole at Luna Lactation). She was fabulous and I wish we'd gone to see her right after Sterling was born. Here's what we got out of the meeting:

She agrees with me that Sterling has a tongue and lip tie. These are tissues that are supposed to have disappeared during development, but never did. She's the first medical professional that I've seen who actually agrees with me. I've thought Sterling had these issues since shortly after she was born (after I figured out that those were things that could affect nursing). I was certain that she had a lip tie, which is pretty easy to see (below):

Here's Sterling's lip tie (it's hard to get a picture of it because she moves).

She thinks that Sterling's lip tie is probably between a class III and IV.

I also thought that she had a tongue tie due to the way the end of her tongue looks and the fact that she "clicks" when she nurses (which is apparently the sound that babies make when they break suction due to the tongue not cupping correctly). Dr Liz said her tongue frenulum was sort of tight, but didn't think it would make that much of a difference nursing. Maybe it doesn't, but maybe it does. I haven't been able to get a picture of this because it's pretty far back. We're going to go talk to an ENT doctor about this and hopefully get her tongue tie cut (which is apparently not as traumatic as it sounds for a baby).


Melissa helped me optimize the herbs and things that I'm taking to try to increase milk production. She made me up a custom tincture to take along with the things that I'm taking now.


She gave me a feeding tube thing to use as a supplemental nursing system at the breast. One end of the tiny little tube goes into a bottle and the other end gets slid into the corner of baby's mouth while she's nursing. The suction she creates sucks milk through the tube from the bottle. We had tried a "starter SNS" supplemental nurser when Sterling was about a week old (maybe less). It was sort of fiddly and hard to deal with. It leaked and had to be attached to something at the same level as baby's head so it drained at the right speed. It was a pain and we gave it up after trying a couple of times. This works much better.. or I'm not so overwhelmed by everything else and just seems to work better. I like this. It makes me feel like my breastfeeding is accomplishing something because she gets to nurse AND she gets enough milk. It's also good for strengthening her sucking muscles. 


Overall, it was a very positive experience. We were there for about 2.5 hours and I'm going to recommend her to anyone I encounter who's having trouble with breastfeeding.

Milk Donation

At this point, I think nursing is about as good as it's going to get, which is to say, not very good. During the past week, Sterling has had roughly 15 oz of supplementation per day. One day she only had 11 oz, two days she had 17. 

Just before we left for Granny's I decided that I wanted to look for milk donors. This was a big step for me... it involved sharing the fact that I don't make enough milk with people that I don't know. I know it's not my fault (as in something that I've done), but I still feel inadequate for not being able to nurse my baby. Deciding to look for milk donors involved the heartache of actually admitting to myself that I'm never going to make enough milk for her. And it involves admitting that same thing to other people; people that I don't know at all.

Before we left for Granny's, I emailed the mom's group that I'm a part of. I also emailed a pregnant friend of mine who I know made a lot of milk with her first child. I found the Human Milk 4 Human Babies facebook group and posted there. I posted on milkshare.com. I looked at Eats on Feets (also on facebook).

Within 24 hours of posting on HM4HM, two different women had contacted me offering to donate their milk. Since then, I've picked up milk from both of them and my freezer now has probably close to 100 oz of breast milk in it. Well, it had that much anyhow. Sterling has been drinking it for the past few days, so there's quite a bit less now. 

The generosity of these women is amazing. They're taking time out of their lives to pump milk for someone that they really don't know and don't care about. In doing so, they're providing something for my baby that most people can't. They're giving her a chance to experience all the health benefits that come from breast milk and not from formula. I'm extremely grateful, but at the same time it makes me feel a little bit sad every time I make her up a bottle filled with milk that's not mine.

Relatives

We visited my dad yesterday. He's totally in love with Sterling. He's decided that he's going to go by Doodad (my brother and I have called him Doo practically forever).

Two of my aunts and an uncle (my dad's brothers and sisters) were visiting and they were also very impressed with the baby. I learned something interesting talking to one of my aunts - she didn't produce enough milk to feed her babies either. She's the second one of my aunts to tell me that. I remember my aunt who lives in Portland mentioning it when she visited us when Sterling was probably about a week (or maybe two) old, but I apparently chose to ignore it at the time. But now, having heard about nursing problems from two different aunts, I think it's fairly likely that there's some genetic component to my low milk supply.

This news is both depressing and relieving. It's sort of a relief to hear that there's some physical problem 

and that there's nothing I could have done to prevent it or to have made it better if I'd done something differently earlier on. It negates a lot of the "what ifs" that I've had running through my head. On the other hand, it means that there's nothing that I can probably do to improve my milk supply beyond where it is. That's really depressing. I'm going through a grieving process about breastfeeding. 

Pumping Experiment Results

The results of the pumping experiment are in. I nursed up until this morning. This morning, we had our last nurse right before getting out of bed. I wasn't quite ready to get up, so I let her nurse off of one side before I got up and changed her diaper. After she nursed, I pumped and continued pumping roughly every 2 hours for the rest of the day. Results can be seen below (of course there's a graph!).

There's a very strong correlation between time and ounces produced. Well, duh. That makes sense. Increasing time by 2 fold seems to roughly increase production by the same amount (60 minutes = 0.5 oz, 120 minutes = 0.7-0.9 oz, 180 minutes = 1.4 oz). There are also other variables that aren't being taken into consideration, such as time of day (I think anecdotally that I produce more in the morning), how much I've had to drink recently, and when I've taken medication / supplements in relation to pumping. So pumping more often doesn't produce a greater quantity of pumped milk, but it should help to stimulate further production (like tomorrow's results perhaps?)

The total pumped today is 7.3oz. Sterling consumed 24.5oz via bottle (including all of the breastmilk pumped). That's pretty much in line with what I had predicted, although the pumping results were on the low side. She took roughly 16oz of formula, which is on the high side of what she has been drinking. She is supposed to be more efficient at extracting milk than the pump is, so the results pretty much agree. I'd say that typically, she's getting about 50% of her milk intake from me and 50% supplemented via formula.

These results are sort of reassuring and depressing at the same time. I'm producing about 12oz of milk a day, which seems like a lot when I take into consideration that she only drinks 2-3oz at a feeding. However, 50% seems pretty low for the amount of effort that I'm putting into it. I pumped 8 times for an average of 17 minutes a piece. That means I spent 136 minutes of my day today attached to the breast pump.

Next Breastfeeding Experiment

Tomorrow, we're trying basically the opposite of the 24-hour breastfeeding cure. Rather than trying to breastfeed the whole day, I'm going to try to pump the whole day. It'll give me some idea of how much total milk I'm producing. It will also give us a baseline to see if production is going up or down (if we try the experiment again later on). We'll also see how much formula Sterling wants to eat during the entire day, which will allow us to sort of extrapolate how much she's getting from me.

Here's my prediction: I think I usually produce between 0.3 and 0.5mL of milk per hour. That means that I should be producing between 7 and 12 oz of milk per day. That agrees with Sterling's current formula consumption level - she usually eats between 10 and 15 oz per day. Most websites suggest that to determine the amount of milk a baby needs, you take 2.5 x pounds of baby. Sterling weighed about 8.5 pounds when we last weighed her. That means she should need about 21oz of milk per day, which fits in with my prediction.

Eating

Lacking sufficient breast milk, Tiny Squee is forced to seek other food sources.

24 Hour Breastfeeding "Cure"

I was once again googling things to do with low milk supply and I came up with this: the 24 hour breastfeeding cure. The basic idea is that mom stays skin-to-skin in bed with baby for 24 hours and does nothing but breastfeed and relax. The skin-to-skin idea sounded good. We haven't done as much of that as we probably should because it's been sort of cold. I haven't wanted to be naked and I worried about this poor tiny baby with no body fat getting cold.

Oxytocin is the hormone associated with love and bonding. It's also important for breastfeeding (needed for milk ejection, although it doesn't seem to be associated with milk supply). Oxytocin levels can be boosted by massage or skin-to-skin contact with the baby. Naps apparently also increase oxytocin levels, which makes sense to me. I always feel like I have more milk after a good nap.

I'm taking domperidone, which should increase my levels of prolactin (hormone involved in production of milk duct tissue and in milk production), if those are low. Spending the day nursing the baby skin-to-skin should increase levels of oxytocin as well as cause bunches of nipple stimulation and stimulate milk production. It didn't seem like a bad idea.

I began the experiment by sleeping skin-to-skin with the baby on my chest for most of the night. Either the skin contact or the pressure of the baby did stimulate milk production because I leaked all over the sheets. That was a positive start.

I decided it was probably unrealistic to go from supplementing with 10-12oz of formula per day to entirely breastfeeding, so I gave the baby 2.5oz in the morning. Then, we started our skin-to-skin nursing project. She nursed pretty constantly for most of the afternoon. She didn't nap much, probably because she was vaguely hungry... but she didn't really get fussy very much either. I finally gave up and gave her more formula about 7pm. That was a block of about 10 hours that we exclusively breastfed. According to our baby app, I nursed for just over 5 hours yesterday (and I know there was nursing time that I didn't enter into the app just because I was tired of doing it). We only supplemented her with about 6oz of formula, down from 10-12 over the past week. She doesn't appear to have lost weight during the day yesterday, but it's hard to say because her weight fluctuated by a couple of ounces between the various times we weighed her. My conclusion from the experiment is that skin-to-skin and mega-nursing time during the day are very valuable for keeping my milk production up, but it wasn't a "cure" for anything.

The downside is that I didn't get anything done except nursing. Not that nursing isn't valuable, but I can't spend 24 hours (or even 12, which is about what I managed other than overnight time) skin-to-skin on a daily basis. There are things that I need to do.

My guess as to the  milk supply problem is that I don't have enough milk-producing breast tissue and I don't have a lot of room for milk storage. I'm basing this partly on the diagnosis of the lactation consultant and partly on the (voluminous) things I've googled on the subject. The lactation consultant said that women with breasts that "look like mine" often have trouble producing enough milk. I've googled it and there is a breast shape (often described as "tubular"; the technical term would be hypoplastic) for which this is true. Whether or not that applies to me is hard to say. Some of the descriptions fit, but some don't. It seems like a reasonable diagnosis based on the fact that I'm not producing enough milk. The breast tissue I have seems to be doing its best - I almost always have some milk and will reliably be able to pump a half-ounce if it's been an hour since I pumped or nursed. However, it's just not enough to fulfill the entire demand being placed upon it. If the baby nurses the whole day, I can get nearly enough milk into her because she's always getting the small amount that's being produced. However, I don't seem to be able to produce or store enough milk to entirely keep her supplied.

My new plan is to feed her on demand, then if she still seems hungry after she's nursed, give her 1oz of supplementation. If she's still hungry after that, she can nurse again, then we can do another 1oz from the bottle. That way, neither of us is getting too frustrated.

Adventures in nursing, update

Still not producing enough milk. I started taking a drug called domperidone. It's typically used for something gastric, but one of the side effects is that it increases lactation in individuals where low milk supply is caused by low prolactin hormone levels. It's used to treat reflux in infants, so it's safe for the baby and all the evidence is that it's not secreted in milk except at very low levels.

I started taking it about a week and a half ago. I started at 20mg three times a day, then bumped up to 30mg a couple of days ago (at our last Dr appointment). The next bump will be to 30mg four times per day, which I will probably start doing sometime over the weekend.

I'm drinking Mother's Milk tea four or five times a day. People online complain about the taste, but I think it's actually fairly pleasant. It tastes vaguely licorice-y. I was taking fenugreek capsules (three, three times a day). I've now transitioned to More Milk Plus, which contains goats rue in addition to fenugreek. Goats rue is supposed to stimulate growth of additional breast tissue. I ran out of the tincture that I'd been taking from the birth center, which probably had some of the same things in it. The tincture tasted awful, so I'm not disappointed that it's gone.

I've been trying to nurse Sterling before every bottle so that she gets some from me, then just the extra she needs from the bottle. I haven't managed to accomplish that every time. I've also been trying to pump more, but that's also proved to be challenging. I've been nursing Sterling every 2 or 3 hours through the day, then trying to pump afterwards... but if I'm home by myself and she doesn't want to be put down, I can't really pump. I haven't quite figured out the logistics of holding her AND pumping at the same time. If Mike is here, it's much easier. I've been trying to either nurse or pump every hour when I'm home. I would say that I've accomplished that goal for maybe 3 or 4 hours a day for the past week or so.

Typically when I pump, I get maybe a half an ounce (if it's been a while since she nursed). I'm actually hopeful right not that something might be starting to work because when I just pumped, I got 1.7oz! That's like 3 times what I've ever gotten in one session before. It's at least enough to make me feel validated and like it's worth continuing with this whole project. It's really discouraging to spend this much time and not see any change in output. I'm spending roughly 4 hours a day trying to feed the baby using my boobs (nursing and pumping)... and still not managing it. I'm mildly hopeful that things might be turning around, but I don't want to get too excited about it in case they're really not and tonights pumping result is just some sort of fluke.

Weight gain!

Sterling weighs 6lbs 11.5oz as of our doctor's appointment this afternoon! Since the last appointment, we've been supplementing with 5-7 oz of formula / breast milk per day. Dr Liz says that she's still getting the majority of her nutrition from me, but that seems like a pretty sizable quantity to be getting not from me.   Basically, when she wakes up and gets hungry, I nurse her. If she's still hungry after nursing, which seems to be about 50% of the time, we give her a bottle. Typically she drinks 1-1.5oz per bottle feeding.

I tried to up the number of times I'm pumping per day, but it's tough to fit it in because I can't pump very well while I'm holding her. When I pump right after she's nursed, I get a trace amount of milk. If I wait for an hour, I get about 0.5oz (combined total). If it's been a while, like when she's only nursed on one side, I can get about 0.7oz.

I'm hoping that I'll be able to up the number of times that I can pump because we had a napping breakthrough today. Up until today, she was very reluctant to sleep unless someone was holding her. Today, she slept for an hour on her own in our hand-me-down baby papasan chair. It was lovely. I ate lunch, started a load of diaper laundry, and was able to pump. Unprecedented.

I'm currently drinking Mother's Milk tea, the herbal tincture from the Birthing Center, and taking fenugreek capsules every four hours. I don't know if it's helping, but it's not hurting.

Doctor's Appointment

Sterling hasn't gained any weight since her last doctor's appointment on Monday. Here's the plan as it stands right now:
-Add more supplementation. She's getting enough milk from me to hold her weight steady and to pee and poop regularly, but she's apparently not getting enough to gain weight. We've been supplementing her a little bit before bed (otherwise she won't fall asleep), but we're going to start doing it more. We're now aiming for a total addition of 4-6 oz from a bottle.
-Continue with Mother's Milk Tea and tincture from birthing center. I'm also going to start drinking protein shakes (sounds lovely).
-Try to pump more regularly. This is good for nipple stimulation and we can feed the milk back to Sterling.

Here's how I'm going to try to work our schedule:
Typically, Sterling wants to nurse again 2-3 hours after she's filled herself up. At that point, I'm going to nurse her for about 5 minutes on each side (or as long as she's actively nursing; she tends to slow way down and fall asleep after not too long). Then, we'll give her a bottle and see if she's still hungry. Once she's full, she usually falls asleep. After about an hour, I'll give pumping a try. An hour or so later, baby can nurse again and we'll repeat the process. Dr Liz says that the fact that she sleeps in 4-5 hour stretches at night is fine and won't affect my production, but I think I'm going to try to get in at least one pumping session at night, too. At least for the next couple of days.

We go back in for our next weigh-in on Monday.

Adventures in nursing

I've spent the last 11 days working on Project Nursing.

Sterling weighed 7 lbs, 3 oz when she was born on Friday. When we went in for our first official weigh-in on Monday, she weighed 6 lbs, 2 oz. Babies lose weight after they're born, but they're not supposed to lose more than 10% of their weight. My milk hadn't come in.

Dr Liz recommended Mother's Milk tea and we got a tincture of something-or-other from the Birth center. She also recommended drinking a hoppy microbrewed beer. I also got out the breast pump to give that a try.

Since then, my life has revolved around feeding the baby. Because I'm not producing all that much milk, she doesn't get full when she eats most of the time. She alternates from one breast to the other, then wants to go back to the first side. Periodically, we have to give her a bottle. Luckily, formula showed up on our doorstep. I'm not sure how the formula people knew we were having a baby, but we've gotten two containers of formula so far.

According to our baby tracking app, last week, I spent almost 19 hours nursing. So far this week, I've spent 10 hours. The past couple of days, I've been nursing on average every 2 hours. On the plus side, she sleeps for 4 hours or so at a stretch at night and we take a couple of good naps during the day.

Dr Liz thinks that much of the problem will resolve itself as Sterling gets bigger. She'll be more adept at nursing and, as we nurse more, I'll produce more milk.