Monday, August 1, 2011

When breast isn't best

During my second pregnancy I saw the slogans everywhere:

"BREAST IS BEST," was proclaimed on lanyards, posters, in newspapers, on blogs and in books.

I hadn't really noticed this with my first pregnancy. Back then I had every intention of fully breastfeeding. Formula wasn't even on my radar.

By my second pregnancy I knew better. I understood that the genetic lottery had dealt me a bad hand. My breasts don't produce enough milk, and what little there is comes out watery and slow.

We discovered the problem when my first daughter, L, was weighed three days after birth. She had lost 12% of her body weight; anything over 10% is cause for concern. Luckily we were in hospital to treat her jaundice, so I got help around the clock. Midwives observed as I breastfed. Our latch was good but L wasn't swallowing often - a sure sign there wasn't much to swallow.

We tracked her nappies. She often had urates in them - bright orange streaks that meant she wasn't getting enough to drink.

Still, I was determined that L wasn't touching formula. I had read too many negative things about it to give up so easily.

The midwives were worried enough to call in a lactation consultant and she wrote up a plan: Breastfeed every three hours, time how long the feeds are, express in between feeds, eat muesli bars and take Domperidone (a pill that is supposed to boost supply). I also took a natural supplement called Lactation AOK that my husband picked up from the health store.

Nothing worked.

20 minutes of expressing produced about 10mls of milk, but I kept it up in the vain hope it would stimulate my supply. Instead it turned me into a hysterical wreck.

I didn't sleep. There was no time to.

I was so wound up and I couldn't drift off knowing I only had a half hour window before the next feed. Hospital staff brought me ear plugs and an eye mask since I was in a shared room, but I still didn't sleep. They wondered if that was the problem with my supply, so as soon as a private room came free I was transferred into it. I still couldn't sleep.

It had been five days and I was so wired a doctor prescribed me a sleeping tablet. What a relief it was to finally switch off.

By day seven L's bilirubin (jaundice) levels had dropped to a safe level, thanks to a week of sleeping in a UV bed.
L sleeping in a UV bed to treat jaundice.

Her paediatrician asked us to stay one more night with L sleeping in a normal bed, to make sure her levels didn't spike again. They didn't, so we were set to go home.

However, her weight still wasn't going up and I finally decided to introduce formula. This was eight days after birth.

A midwife showed us how to give it to her using a lactaid, so I could breastfeed her at the same time. The milk was siphoned out of a bottle through a little straw that I slipped into L's mouth before latching her onto my nipple.
Trying out the lactaid for the first time.

Our hope was that as soon as she felt the formula coming in from the lactaid, she would suck more strongly and this would stimulate my breasts to produce more. L wolfed the milk down, finally getting a full tummy for the first time in her life.

We hoped to see improvement in my milk supply at home, where I would be more relaxed and able to sleep. Unfortunately that wasn't the case.

L gained weight quickly on the formula, but we had difficulty using the lactaid and in our second day at home we couldn't get her to drink from it at all. I was still breastfeeding each feed, and we wondered if she was resisting the lactaid because she was getting enough from me. Her next weigh-in with the midwife showed she had lost all the weight she had gained on day one at home. Obviously she wasn't getting much from me at all.
L getting weighed at home.

After faffing with the lactaid for a few days we gave up. It was the middle of the night and we had spent 45 minutes trying to get it in her mouth at the right angle along with my nipple. I had called Paul in to help because I couldn't get it in on my own. We decided to try a bottle instead and L downed the whole thing in less than 5 minutes.

Decision made. We scrapped the lactaid and used a bottle from then on in. I would start a feed by breastfeeding, and then switch to a bottle to finish off.

This lasted till L was almost four months old, at which point she realised the breast wasn't worth her time and refused to take it any more. She's been bottle feeding ever since and has been as healthy as a horse. All my worrying about the dangers of formula seem to have been for nothing.

Fast-forward a year to pregnancy number two.

We moved cities while I was newly pregnant with our second daughter, S, so I signed up with a new set of midwives. They didn't know my history with L and I had to try and explain that my breasts aren't wired right. It was difficult to convince them.

Most people assume that anyone can breastfeed, that it's just a matter of feeding and feeding and feeding to signal to your body it needs to produce more.

Part of me hoped it would be different the second time around, but I was prepared to give S formula if it wasn't.

We found that things were slightly better because she feeds strongly and didn't have jaundice to make her sleepy like L did. Sometimes I would express as much as 20mls - twice what I had with L but still not enough.

S is an unusually hungry baby and I definitely wasn't making enough to satisfy her. We gave her formula after just 24 hours, while we were still in hospital. And then gave her more an hour later because even that wasn't enough to satisfy her. By a few days old she was downing 50mls of formula and that quickly increased to 100mls, then 150mls.

No surprise, with all her feeding, at her eight-week weigh-in S measured in the 98th percentile for height, and the 91st percentile for weight and head circumference.

It's been so relaxing this time around as we haven't had to desperately time feeds and track nappies. I breastfeed S first thing in the morning, lying next to her in bed. Then she has a bottle and nappy change and goes back to sleep.
Snuggling up in bed with S.

I've been more focused on getting her into a good sleeping pattern, so at some feeds she just gets a bottle and goes back to bed. If she's looking sleepy and a breastfeed is going to overstimulate her, I don't bother with it. However, if nothing but the breast will comfort and settle her, I'm still able to offer her that too. It's the best of both worlds.

One of my midwives is a lactation consultant, so she has loaned me the manual attachment to my Medela Symphony breast pump. That allows me to express at times to help keep my supply up. I haven't been strict about using it. I just try to fit it in where I can. I made the decision that I'm not going to kill myself trying to boost supply from 10-15mls. It's just not worth it.

I think S is better off having a happy mother than those extra 5mls of breast milk.

The nice thing about formula is you only have to give it four-hourly, instead of three-hourly like breastfeeding. This makes life a whole lot easier. If S is up for one hour and settles straight away, I still get a three hour rest before her next feed. And if I'm desperate for a sleep, Paul can give S her bottle. I'm not indispensable to the process!
A satisfied S sleeping in her bassinet.

On an emotional level, it does upset me that I can't produce enough. I often struggle with feeling less womanly, less of a mother. Sometimes I wonder if I should even be a mother, since I can't feed my babies the way I'm supposed to, the way the posters tell me I should.

But then I look at my girls and see that they are healthy, happy, lovely, content and I think, what does it really matter? In their case, formula has been best. At least they have been fed! 


  1. Thanks for sharing this Emma, I hope it will help other mothers to not feel guilty in the same situation, you just have to do what you physically can and a happy mum is always going to be best. I hope you don't mind me saying, but it reminded me of struggling to get our first calf to drink from a bottle! It would be both me and my husband struggling to get the teat it the calf's mouth and the calf spitting it out and then us worrying that he wasn't getting enough. Its a great feeling when they finally work it out and you know they're going to be healthy (as you can see my experience is more with baby animals than baby humans!).

  2. It is such a good feeling when you know they're fed! And I don't mind the animal comparisons at all. :)

  3. Good on you for sharing this. There is so much pressure for us mums to only choose breast feeding. I have take a thyroid supplement which also causes a low milk production so with my first it was a battle and at 4 months she was losing weight very fast. We spent two months feeding her with a dropper because she wouldnt take me or the bottle. Fast forward to number two, a hungry boy. Within 9 weeks I gave up trying to keep up and take a whole lot of stuff to boost my supply. Taking the pressure off was the best thing ever. Surprisingly with my third feeding was a different story.. she breast fed for 9 months (not without a few hiccups).
    I think a happy Mummy and happy baby is the most important thing of all, and of course acceptance to do what we choose for our family.

  4. Hey Leonie, thanks for your comment. It's nice to hear that I'm not the only one who has struggled. I'm glad it worked out for number three. And you're so right, a happy mum makes such a difference to the home environment.

  5. Oh Emma! Poor you. Glad you found a healthy solution for both of you. I am so sad that this is still even a debate. Eight years ago when I had my son I was shocked at the horrible way bottle feeding mums were treated and it is still going on.

    We are all aware breast is best ... if you can do it. I have always been pro-mother - what is best for the mum. Happy mother = happy baby so if breast feeding is just not a healthy situation for mum then bottle feed. I was lucky to have enough milk to feed my son (and probably another baby too) so I breast fed. When my daughter was born 4 years ago I breast fed her too ... until she was diagnosed with a serious liver disease and then I was made to abandon breast feeding as she needed a special formula - her condition meant that she just couldn't absorb the fats and vitamins in my abundant milk. Even worse, she would not accept a bottle as I guess she felt so ill, so we had to put in a naso-gastric tube and she was not only fed formula but was fed it via a tube for a year and a half.

    I guess what I am trying to say is that you need to do what is best for you (or your child). I was devastated at the loss of breastfeeding but more for the fact I could not comfort my child than the loss of my milk as she was getting the nutrients from the formula.

    I'm so sad that mums are being persecuted by other mums for something so silly in the big scheme of things. Choosing formula or breastmilk is not a big deal, having a loving and connected mum and baby is.

  6. Hey Emma... I think you are very brave and extremely sensible in the decisions that you have made for your beautiful wee girls. I work as a nurse in the Newborn Intensive Care Unit at Auckland City Hospital. As a healthcare provider for women and newborns (particularly prem babies), we of course portray "breast is best"... But I am very much in agreeance that sometimes it is just pushed too far. There is such a high expectation on mothers to provide ONLY breast milk for their babies, and if they are struggling, always the hope that a "quick fix" such as domperidone with solve all the problems. But its not always the case! Mums often just end up trying too hard... Worrying about providing for their baby, not sleeping (like you said!), expressing the life out of their poor boobs! My heart aches for them... Sometimes, breast is not best, and I think people need to be more accepting and understanding of these circumstances. You and your family seem amazing - happy, healthy and loving the life God has given you. Good on you! x

  7. Hi Samantha, thank you for sharing your story. How is your daughter doing now?

  8. Hey Kathryn, thanks for saying that.

    It's such a tricky one because in Lily's case, I was determined not to introduce formula, and the midwives and nurses were trying to accommodate ME. I think they did a good job.

    We were so hopeful my milk would come in, and I'm glad I did everything I did because now I know beyond a shadow of a doubt that there was nothing more we could have done. (If that makes sense.)

    I'm totally happy with the care I received in hospital.

  9. It all sounds pretty reasonable to me Emma. This is a great resource for people to grab onto - I appreciate your honesty.


  10. I've already commented on face book, but good on you Em. After reading this again, I reckon you should send a copy of your story to the health professionals that looked after you first time around so they can see how this struggle made you feel. When I worked in NICU, I had to tow the company line, by, what felt like, almost forcing Mothers to breast feed, when for some of them, it was obvious, it just wasn't going to happen. This went against every moral fibre in my body! As a nurse, isn't my job to help and care for people? So how am I helping if I'm bringing Mother's to tears by pushing the 'breast is best' philosophy so hard that they feel like total failures!? You're right - some people just can't breast feed. For some reason or another, they just don't produce enough milk. It doesn't mean they are bad Mothers, it doesn't mean they don't care and it doesn't by ANY stretch mean that they aren't meant to be Mothers. It just means that they have little or no milk. Just like some people are fat, some are thin, some are dark and some are fair. Some people just won't breast feed. No big deal. Baby needs feeding at the end of the day. So consider sending the story in - would be interesting if you get a response. I'm super proud of you anyway. You're a great Mum!!!!

    Rebecca MacRae xxx

  11. Emma, my daughter is doing great! Four years ago she had a liver transplant, hence all the feeding issues which were minor in the bigger picture. After transplant, she was tube fed a couple more months but on karicare (normal milk) and I kept her on this (using sipper cups) until she was almost 3! We are just very grateful to have her thanks to our amazing medical team!

  12. Hi Emma,

    Your wee Sophie is looking so sweet! And you are looking great too! I think that you are right about making this work for your situation and I don't think that anybody should give anybody a hard time about a decision that they have made after weighing up all the pros and cons. I am pro-breastfeeding, it is important for me, very important, that this is what my babies get. This got very hard with my first daughter as she had severe food allergies, eczema over 95% of her body and severe reflux. She didn't sleep, she just cried and screamed, fed, then vomited until her next feed. All. The. Time. At 5 months she was five kilos, having dropped from 5.85. Not good. We were all shattered and wired at the same time (you know that feeling huh?). So we had to make a call and get her onto a formula that would allow her to gain some weight and not fail to thrive. So Neocate came into our house and it turned a dire situation around for us. For that I am thankful.

    This time around I have a baby who is healthy and happy and has ZERO allergies! Yippee. I have a great supply and she is thriving. I even have a bit to spare - this is where I think NZ could do with some help. I donate my milk to my friend, Jaynie, who is a midwife and just happens to be fighting breastcancer at the moment (her blog - She can't feed her baby so we help her out, because for her formula was not an option she wanted for HER baby. I think their is a place in NZ for milkbanks, where Mums who need Bmilk can get it for their babes. It would be great to even give parents the choice for this,because at the moment there is no alternative to formula if you are unable to supply your own breastmilk unless you have an ibformal arrangement. This is not meant to demean your decision, which is right for you, just a comment that another choice would be nice. ;-)

  13. Hey Bex, I appreciate your thoughts on this.

    I hope I haven't come across like I'm bagging the hospital staff in my post. I think they did a great job of looking after me. They really didn't push me to breastfeed at all. It was me pushing me. I sooooo wanted to be able to fully breastfeed. It just wasn't to be, but I was glad the midwives at the hospital backed me 100%. It means I know I gave it my best shot and that was all I could do. Love you,


  14. Hey Samantha,

    I'm so glad to hear your daughter is doing well!

    Bless you,


  15. Gosh Pip, I just read your friend's blog post about breastfeeding with cancer. It made me cry. And made me so grateful that I can breastfeed a little, and still comfort Sophie and help her drift off to sleep when need be.

    When I had Lily and discovered I couldn't fully breastfeed, I got really upset that NZ doesn't have a breastmilk bank. None of my relatives were breastfeeding at the time, otherwise I would have thought about asking them for milk.

    However, I've come to terms with the whole formula thing and actually I've been pretty pleased with it. We're using goats' formula for Sophie because cows' formula upsets her tummy too much and gives her dark green diarrhoea. Not fun! Lily had goats' formula for about the first 8 months (I think) and then switched to cows'.

    Based on how healthy Lily has been, and how well Sophie is doing so far, I'm thinking formula has a lot to recommend itself. The girls are getting the complete range of vitamins and minerals they need, plus fats and other good things. Of course there are negatives, but I'm choosing not to dwell on those.

  16. I've just randomly come across your blog and this post. It is so timely for me. Lots of what you describe in your story rings true for me and my experience with our two boys. This week I've been feeling really beaten up internally by the "big latch on". I would love to participate, really I would, but it would be so fake. N would latch but wouldn't get any milk (maybe two small mouthfulls) and then I would have to run around the corner and give him a bottle to stop the intense screaming. Beaten up on the inside. Like a dog with a bone refusing to let go of the feelings: useless body, poor mother, pity pity etc.
    Thank you for the encouragement to feel like a great mother and feed my boy the way he needs :-)
    Sorry to have to post as anonymous - blogger is having issues for me.

  17. Hi Catherine, thanks for commenting. I'm glad you found your way here.

    I only just realised this week was breastfeeding awareness week. Good timing for my post then, but totally coincidental.

    I think we mums give ourselves too hard a time. We are our own worst critics. Your boys are lucky to have you as a mother. If they are loved and fed, then you're doing your job. All the rest is gravy.

    That's what my husband tells me about our daughters, and most of the time I believe him. I still have the odd sad day, but I think it's getting easier since it's not something I can control.

    I've also come to realise that it can be just as hard for mums who have the opposite problem - too much supply. Life never seems to be quite perfect. It would be nice if it was!

  18. Hi Emma, great to see your comment on my blog about joining the herd share, I hope you'll write about it here too when you've had a chance to try it for a while. The raw milk should be great for your baby too, but there's always the worry about food poisoning, I'll be interested to see how you decide that one! (note that raw milk causes fewer cases of food poisoning than deli meat and raw seafood, so that might put it in perspective). Cheers, Liz

  19. Hi Emma! I wrote a very long, drawn out comment, attempted to post but I guess Blogger ate it. Oh well. Here's the short version: I can't thank you enough for sharing. I have a very similar story: Two girls, Lillie, 2 and Leila, 1 (15 months apart) Two c-sections compounded by breastfeeding struggles with both left me with a ton of guilt. I found your blog through a comment you made on I guess God knew I needed a bit of encouragement tonight. Good luck with your new running adventures!! :D Sending you warmth and sunshine, Carissa (Tampa, FL)

  20. Hi Carissa,
    Thanks for trying again with the comment! I'm so glad to hear this post was an encouragement to you. We mamas have to stick together! It's a tough job we do and we do it the best we can with what we've been given.
    Bless you,

  21. i know this is an old post, but thought i would comment too. i have PCOS a very common issue these days. 1/3 of women with it have an over supply, 1/3 have no problems and 1/3 struggle to produce enough milk, this was me. my story of my eldest is almost identical to yours except that at 4 weeks the domperidone seem to help and i could breastfeed for a small while before my daughter needed more than i could make. also second time round i didnt wait for a hungry dehydrated baby to start the formula! my mother had the same troubles and she had 4 children, making more milk each time. she thinks if she had had 10 kids maybe she could have fully fed the last one. people dont realise how common genuine low milk supply is, i am a trained well child nurse, and have given a lecture to plunket nurses explaining how common it can be!
    i have just discovered your blog from a friend of mine, its fantastic, i see we have come to many of the same ideals - whole foods, home made cleaners, organic gardens etc. your seem like my kind of gal :-)

    1. Hi Dana, I'm so glad you found your way here. I didn't realise that PCOS could affect breast feeding. It seems like there are a bunch of things that can make it go up the gurgler, so I'm glad you're advocating to Plunket for mothers who can't produce enough. I think it's an important message to get out there!
      Cheers, Emma

  22. There aren't enough of these stories in circulation! The Breastfeeding Brigade are in control of all new mothers out there, resulting in a lot of guilty emotional damage for those of us who can't produce. Breastfeeding should be our first option, help and encouragement should always be sought, but it's a lie to say we can all succeed.

    All the mechanics worked, but I could never get the volume needed, even with all the milk drugs and home remedies out there. I had to feed for an hour and a half, listen to the baby cry for 30 minutes, then start again. Can't believe I kept that up for 6 weeks with my first! Then I breast AND bottle feed for a week, which is a crazy way to live.

    Same story for my second baby, but this time I only flogged myself for a fortnight before giving in to the blessing of formula. Both times I went from 9 - 11 daily breastfeeds to zero the following day, and whatever milk I had vanished instantly. Sad.

    But I have two smart healthy kids, so to heck with the Breast Is Best statistics.

    1. Thanks for sharing your story! I'm listening to my wonderful girls playing together and thinking, they turned out just fine too.


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