Musings... #3

Sunday, October 25, 2009

Thanks for all the sweet comments to yesterday's post. While we dont always feel the stress because we are trying to stay focused on the positives of our situation, I think we both realize that there is an underlying current. I'm sorry we fought but maybe we needed to just vent out our frustrations and there wasnt another way. I dont know. We're at an impasse with what we fought over so we just made the choice to let it go. We stopped prior to going into the NICU and had a few more (much calmer) words and then decided there was no where to move forward in our argument. What's the point in staying mad? There's just so much energy involved... energy we just dont have to give. It's easier to move on.

***

Here are 2 of my favorite pictures from yesterday...
It's MY bottle... Don't even think about taking it, Lady.

Oh... It is such hard work being a baby...

***

Thank you, Body, especially you, PCOS, for trying to take the one remaining, normal pregnancy/post-pregnancy thing from me.

So. Breast milk production has been the one thing that I've been kind of good at the last 6 weeks. This, of course, means that my body has decided to no longer play nice and cooperate. Bear with me as I try to articulate the issues.

Remember how I said that the babies would suckle so well and then we'd weigh them and they'd show a 0 transfer? I'm beginning to think it wasnt them- it was me. I started reading a book called "The Breastfeeding Mother's Guide to Making More Milk" and, as I was reading, I started noticing that our babies were displaying some of the behaviors they mentioned of babies who couldnt get enough milk from the breasts. I decided to pay close attention to them during our next breastfeeding time and, sure enough, they worked hard, finally started thrashing as though they were ticked off, would give the breast another chance, then just stop sucking altogether. Because they'd suck for a good 15-20 minutes, we weighed them and zero transfer. I even talked to the nurse afterwards about just giving them the bottle of pumped milk instead of breastfeeding because I didnt want to lower their daily percentages when it was obvious they could and wanted to suckle. But the nurse, a lactation consultant as well, said no, to put them to breast every time and that the issue was probably their immature sucking, not my breasts, since my production was good. So it must be them... Not me... Okay... We can work on this... Yet, every bottle, they do the same thing and transfer a good amount, but okay...

Over the last couple of days, though, I noticed my milk production starting to drop off. At first, it wasnt that noticeable. Instead of each breast filling at 60ml bottle at about 3 hours in between pumpings, it would only hit 50-55ml. My nighttime pump, if I got a good "long" sleep of 4.5-5 hours, went from being 200ml to 180ml (total). I didnt think much of it. But then, yesterday, my marathon pump only delivered 150ml. Strange, I thought... Then my next pump only gave me about 45ml per breast. So, I decided to pick up the book and keep reading.

  • Around 6 weeks, apparently, drop off is normal in mother's of preemies who have to pump as their almost exclusive breastfeeding method.
  • Women with thyroid issues tend to produce less milk.
  • Women with PCOS tend to have issues with production and let down. They also, if they have larger breasts, may have breasts with a higher fat content and less mammary tissue.
  • Women with PCOS may find that their breasts dont enlarge post pregnancy, which could be a sign of the lack of tissue.

I could go on, but suffice it to say, I was reading in horror. I'm using a galactogogue (MotherLove More Milk Special Blend) and I'm still seeing a reduction in milk. This isnt good... The MotherLove has the main herbs associated with improving milk production in women with PCOS (it is specially blended for that). I decided to buy saw palmetto to add to it, since the book notes some increases in women with PCOS who started to lose their milk. I figure I can try that this week and see if it works before talking with Dr Bailey on Friday. Another book suggestion was to pump very frequently to try and convince my body that the babies were eating all the time. Yesterday, I tried this by pumping 3 times in a 2 hour period. I didnt really notice a huge increase but you have to give this method some time. I pumped again 3 hours later and then again 3 hours later, and didnt notice an increase over my recent standard amounts. I'm plugged in now and wondering if this megapump will give me closer to 200 or closer to 150...

If the babies were home, this wouldnt be much of an issue. I am producing what they are eating ever 3 hours (40ml for him and 38ml for her), but because they fortify 200ml of breastmilk at once, they have to have larger quantities. Some of the nurses say I'm a great milk cow, others make it seem like they are running on empty. Which doesnt help emotionally. In the freezer at the hospital, they have about 300ml; as of last night, they had enough to get through the 8am/9am feedings in the fridge, without thawing anything. My pumping at home last night made only 75ml combined; I dont know what this pump will give, but assuming a minimum of 150ml, that at least gives a bottle to fortify, which will handle 2 feedings plus a bit.

The nurses told me yesterday I need to produce approximately 700ml to feed one baby and pump every 2 hours to try and get that up to the amount needed for twins. I'm not sure how I can manage this, although, I'm trying to figure it out. I desperately dont want to formula feed them. (Not that there is anything wrong with that... I was formula fed and so was Peter. This is just the last thing that I have really wanted to give our children and so far, it was the only thing that seemed to be working right with my body. The idea that I'm going to let them down (no pun intended) in this too is excruciating.) They also recommended keeping a list of when I pump and how much I get so that I can notice an increase/decrease, as well as see how I am doing getting in my 12 pumps a day (they put a minimum at 10 pumps a day, if I want to sleep more than 2 hours at night). They (like the book) also recommended "power pumping" (multiple pumps in a short span for 10 minutes each time or pumping a bit every hour) to try and trick my body into thinking the babies need to eat more frequently because I am emptying more frequently.

I am willing to do whatever it takes. I dont want to give up on the dream of having them at breast versus only breastmilk in a bottle, but if I am not having an ejection response that lets the milk flow right now, then that is something I will let go for the sake of having enough milk to bottlefeed them. We've pretty much made the decision that, until I get my production up, we shouldnt "hold them back" per say by trying to at-the-breast feed them and should give them their bottle and then have nipple time that isnt being scale measured. Last night, they were both so frustrated as they tried and tried to breastfeed and couldnt get enough to satisfy their hungry tummies. Their sucks are hard now and they are perfect little latchers, but no transfer. Not one drop. We ended up gavage feeding them while I kept them on the breast. I couldnt help but cry. I just wanted to give Bobby (who was the second fed) to Peter so I could go and pump and hope that I got a large amount. I didnt get a large amount, only a total of 75ml for both. Yep, I cried. That was after 45 minutes of pumping and hoping I'd have a second letdown.
So, this coming week, I'm going to live at the hospital. This is the only way that I can give them breastmilk instantly so that they wont run out, and it will also save me time so that I can pump well. I figure I can try the following schedule, but that only gives me 8 pumps in 24 hours.

5am-5:45am: pump at home
6:45am: leave for hospital
8am: Maya's care time
9am: Bobby's care time
10am-10:45am: pump at hospital
11am: Maya's care time
12pm: Bobby's care time
1pm-1:45pm: pump at hospital
2pm: Maya's care time
2:45pm-3:30pm Shift Change/ pump at hospital/grab a bite to eat
3:30pm: Bobby's care time
4:30pm-4:45pm: pump at hospital
5pm: Maya's care time
6pm: Bobby's care time
7pm-7:45pm: pump at hospital/ Peter arrives
8pm: Maya's care time
9pm: Bobby's care time
10pm-10:45pm: pump at hospital/grab a bite to eat/leave for home
Midnight-12:45am: arrive home/pump at home

To try and add in a ninth pump, I could try setting the alarm for 3am, but I'm thinking that I'm really going to struggle with a 3am-3:30am pump time, after going to bed at 1am and needing to get up by 5am to get pumped and on the road. But right now, I'm struggling to get 6-7 pumps in a day because of travel time. So, this will at least get me up to 8 regular pumps a day. And the time at the hospital flies by. I think there is no other way for it to be, since everything is divided into one hour per baby, and then I have an "off hour" which is filled with pumping. Even if I only get 50ml per breast, that is what they are eating, so being at the hospital allows me to keep up with them. And I'm hoping that the herbs along with the regular pumping sessions that arent interrupted by driving, etc, will help. The saw palmetto is reported to help with letdown. If that happens, then I could start putting them to the breast, which would help with the whole pump-every-2-hours thing. If I were breastfeeding one baby each hour (one per breast) and then pumping the third hour to try and empty whatever remained, that would be awesome. So, that is the goal I am shooting for. Send a prayer to Our Lady of La Leche for me.
(BTW, I just stopped my hour long pump and got 80ml per breast/160ml total. This is from my nightime stretch of 5 hours of sleep. I was so tired; I thought I'd actually be waking to alarm at 5am, which would have been only 4 hours in between pumping, but the arm wasnt set. So my body didnt wake up until 6:25. :( Not good. I'll do some power pumping this morning, since we wont leave until 9:30-9:45 to make the 11am/12pm care times, since we missed 8am/9am. Damn.)

Is it too much to ask that my breasts just work the way they are supposed to? I mean, really? Can I not even manage that? (While I know it is true, I'm not in the mood for hearing that it isnt my fault and that I cant control what the PCOS and Hashimoto's does, etc. I'm really just pissed off at the situation, saddened that exclusive breastfeeding up to a year and continued bf'ing through 2 years is most likely not going to be possible and that I will be really lucky if I can produce enough to breastfeed them through 6 months before introducing some solids. I feel like so much has happened and that I cant even give them this. I've already given them less-than-the-best start in life by not being able to carry them longer and now the idea that I will have to give them less-than-the-best to eat is killing me inside. Please just say a prayer that my diligent pumping at the hospital and the galactogogues will help. Please oh please oh please.)

***

Okay, so I've whined enough this morning. Time to do laundry so that we have clean clothes to wear to the hospital...

***

(Oh and some stats on the little ones... As of yesterday, 10/24, at 6w2d old...
Bobby weighed 4lb 9.2oz and nipple fed 39% of his daily intake
Maya weighed 4lb 2.1oz and nipple fed 30% of her daily intake.
Go babies!!!)

36 comments:

Stace said...

I know the breastfeeding/pumping frustration well. I do not produce much either-- both from poor pumping right in the beginning when Connor passed away and because I've been back at school so pumping time is rare. But part of it is really just a preemie thing... we're not with our babies 24/7. That hurts production. As far as feeding... are you using a nipple shield with them? It helps Colby ALOT because he has a hard time. Good luck!!

Seraphim said...

Michele, I love you. Alot. And I understand why you are passionate about this. I absolutely do. But you must make sure you are getting enough rest and I am not sure adding in extra pump sessions will allow you to do that. Can I suggest the supplement Domperidone to you? Just a thought. xxxx

Michelle said...

I felt the same thing when mine was about 6 weeks old too, got so much conflicting advice as to how to increase my milk supply but the pumping wasn't helping, i got out so little. sure pumping more often helps, but only if you get a let down. the trick is in the let down and how many of them you can get. I was a first time mum too so didn't know the "tricks" of the "trade"..another lady told me to fondle the nipple after you finish the pumping session until you get another let down. don't stress! that makes it worse too...though it's a bit hard not to control that one. Did I just self proclaim that I fondle myself?? shame for your babies is worth it. I sometimes even get 3 or 4 let downs per session now.
Anyhows, I over produce now and my boy is a fat tank. I wouldn't even consider pumping if I hadn't gone back to work.

Alisha said...

I am sorry you are struggling with this. I know there are some meds the docs can give... Also, eating oatmeal helps your milk supply. Damn PCOS! I hope you can keep up with it ;)

Michelle said...

WOW I did not know PCOS also could rob you of that. PCOS really sucks. I am going to have to look into that stuff to when/if I get pregnant. I really hope it starts to work better for you! Sending prayers.

AKD said...

Praying for you...

Dose said...

Don't give up!!! Granted I didn't have preemie twins but one little girl but I really struggled to keep up with her too.

I honestly believe that the more positive you can be, the less frustrated the better you will do. Breastfeeding is oddly so connected to your body that even the slightest thing can give you some off time. Think about your precious babies when you pump, how they feel, how they smell, how much you love them and less worrying about how much you are making. I don't know if it will work as well as it did for me but once I let go of that pressure it seemed like my milk production started to increase again. I made it for a whole year even through my daughter's health conditions when everyone told me I couldn't!

So hang in there and we will be praying that you can get tons of milk! :) *hugs*

Jessie said...

I had similiar issues (not the PCOS, but trouble pumping for preemie twins). I was told one of the biggest kills for supply is stress, which is rampant in NICU mommies. Try to spend a few minutes before pumping destressing and visualizing your babies nursing. It helped me alot...hope it works for you as well. Good luck!

Tina said...

Grow babies grow!! Love the pics, sorry you are having to deal with this on top of all the other stresses you have in your life. I hope it gets better soon. xx

Kate said...

Oh Michele, my stomach hurt reading this. I have PCOS too and I've noticed my breasts while a little bit bigger, are not nearly as big as other pregnant counterparts. Now I'm scared. Like you, that's the one thing I'm counting on my body to come through for me. I've dreamed of breast feeding my children. I hope it works out for you and that the new method you are trying works. *hugs* You are in my thoughts.

Molly said...

Michelle, do you have a hand pump? If so, try to start pumping before you start breastfeeding the baby and when the milk starts flowing then latch the baby. The milk will continue flowing into their mouth as the process had already started by the pump. I dont think its possible for the baby to suck for 20 minutes and not get a single drop. First, the baby would definitely trigger the flow, and second, no baby, especially preemie would last 20 minutes hungry, sucking, without getting the reward. Something is not right with what the nurses and scales are saying. We also had a rocky start with breastfeeding, but as soon as the baby started sucking (if, cause in our case, my preemie was not a great sucker, but milk supply was awesome), the milk started pouring. Remember, baby is way more efficient then the pump. Maybe ask for a different scale, too.

Anonymous said...

I will take this occasion to "delurk". First: Hello and even more important: CONGRATULATIONS. Bobby and Maya look very very cute and it is wonderful that everything goes so well - despite all the difficulties. And I think you are doing a magnificent job in being there for them and loving them. Which is more important than anything else.
I just wanted to comment regarding the breastfeeing worries: it might not be a sign at all that breastfeading in general will not work - it seemed to go great thus far and there will always be times when supply issues will come up. I had quite some problems getting breastfeeding to work at all and was always fighting supply issues. The only thing that helped was pumping/feeding VERY often, but for shorter times in a differenet rhythm (instead of every 3 hours for 30 min, 3 times for 5-10 min each side followed by a 20 min break, then a 1 hours break, then again). Not all day, but once or twice at least. And when my children were older it then sometimes developed in "nursing non-stop"...
I hope everything continues going well - all my best wishes to you!
Eva

Just Breathe said...

Sorry about your problems with breastfeeding. I went over and said a prayer for you. I can't believe how much they weight now.
It is truly a blessing from God.

Kristie said...

Exclusively pumping with babies in the NICU is exhausting. Try as much as you can to get enough rest, food and water. I monitored my milk production like hawk while C was in the NICU and agonized over pretty much every change. Perhaps you've seen a drop, but you'll hold out at this new level. You're doing an awesome job providing milk for them. Remember though, that you need to stay sane and well rested to take care of them too!

k@lakly said...

I used the herbs but also added Reglan (a prescrip med that has as a weird side effect an increase in milk supply) I've been taking it since Cason was around 5 months b/c I was so paranoid about not being able to produce enoughfor him and not wanting to risk allergies to formula. It worked really well and has no side effects. I don't think you can get the domperidone in US, I may be wrong.
Also, being tired and run down can hurt your milk supply. Make sure you are drinking A TON of water and eating really well and SLEEPING. And go easy on yourself. This has been so stressful for you guys. You're entitled to an occasional meltdown.

The babies are BEAUTIFUL! Love the pics!
xxoo

Busted Tube said...

I'm so sorry that you're having to struggle with this Michelle! The last thing you need to be worrying about as you care for your babies and watch them grow and begin to transition out of the NICU! I hope that you can find some good solutions, but you also need to keep yourself rested! Good luck.

sonja said...

I am sorry you and Peter fought, but I'm glad to hear you both let it go. Your schedule is completely crazy, and I think that any couple would fight sometimes under such circumstances.

As for the breastfeeding -- is it possible that being too exhausted is part of the lower production? The stress of your schedule is really high right now, I'd imagine. And your drive home from the hospital is so long ... is there anyway you can stay at a hotel occasionally to give yourself a break? Or if you're nearby you could stay with us. Or even a place to catch a nap in the middle of the day?

I'm sorry you're feeling so frustrated, but you are an amazing mommy and your milk production does not affect that one bit. I know you want to do this for your babies, and I admire you for it, but if it doesn't work out, you are still a great mom!

Praying for you!

mybumpyjourney said...

Stoopid PCOS. Good luck with the ta tas. I don't have anything good to add that you don't already know. :) Lots of water and pump when the babies would eat. That is wealth of my information. I will pray for you guys though!!!!

Reba said...

oh michele...i know that desire so well, of wanting to be able to nourish your babies from your body. i think it's like we're almost trying to make up for not being able to keep our babies inside for long enough. i think your plan to increase your milk production sounds like it should work great. just know as someone speaking from "the other side," formula-feeding has not been the evil that i had sort of off-handedly thought it to be. i think when things are meant to be a certain way, you can just tell. i knew the moment i put the bottle to the ham's mouth that this was IT...this was the right way for me to feed her. it's hard not to be disappointed when you feel like your body has let you down yet again. but i hope it is some small comfort to know that you can still have a wonderful bond with your babies even if their nourishment doesn't come directly from your body. HUGS.

Anonymous said...

I know you've probably been told/know this, but make sure you're drinking PLENTY of water. Like, more than you think you need to.

Christy said...

I'm a lurker, but I wanted to leave a comment and tell you that you should get some domperidone. If isn't marked in the US, but you can order it from New Zealand--I use InHouse Pharmacy--they have a website. You should also go to kellymom.com, and bfar.org for tips about galactalogues. That second website is for moms who are attempting to breastfeed after a breast reduction, which I know doesn't apply to you, but there is a lot of information about domperidone. I've been taking it since my daughter was born and its the only thing that allowed me to have enough milk to make sure she gets some every day, even if I do have to supplement. Oh, also--if you talk to your doctor, he or she will probably prescribe Reglan, which is not as good as domperidone, but still effective--but be careful with it--one of the major side effects is that it can make you depressed.
Hope this wasn't too much unwanted advice--I just wanted you to know that someone else has suffered with this and that it IS possible to help yourself out quite a bit.

addingtothepack said...

I am so sorry that you are dealing with feeling like your body is betraying you again.

Lachlan's Mum said...

I'm sorry things aren't as easy for you as I wish they were. I think you've been doing a really fantastic job working to make milk for your babies. I don't have any advice, just ((hugs)).

Also, Maya and Bobby are looking so well! They don't look like premies anymore, they are growing so big! I hope that they'll get to come home soon. Thinking of you.

greeneyes said...

Dear Michele.... i came across your blog and i decided to read them from the beginning.... my whole heart went out to you from the very beginning to this moment. there are so much i want to say to you that i dont know where to begin. i sincerely hope that i am able to say all the right things.

congratulations on your wonderful twins. you and your children are trully blessed and so deserve each other. may all of you be blessed with health, wealth, lots of love and happiness that would last for an eternity. your are the best parents your children can have and for all that you have gone through, GOD bless your family.

whatever challenges that you are facing, take them as they come with calmness. don't push yourself too hard...you wont be able to enjoy the moments of your parenthood. i was stressed with my firstborn so much that i wasn't able to be a mother properly. i wasn't successful at it and there were not much support available. i breastfed partially only and by the time i became level headed, it was close to 3 months later. the system didnt start off right and i ended up only breastfeeding for 6 months. it was rather different with my second baby (who was prematured 1 month due to Strep B with lung infection and stayed in NICU for 3 weeks), i was able to breastfeed till about a year. take it easy, do the best you can and the best is not as what you expected, it is ok, enjoy the moments while you can coz they grow up so fast.

for breastfeeding, drink lots and lots and lots of water, pump as often while keeping them latched, do take Domperidone after consulting a doctor. i did for my son, the best of doctors prescribed it and it did wonders but dont depend solely on it. it is part of the effort to increase milk. take the herbs as well. even if you are able to breastfeed 70%, it is so much better than none at all. 100% would be great, though but shouldnt matter as the package you already have is great. Read the book "what to expect" series, such a help to me. Happy parenting.

i am sorry about your other babies. rest assured that they are in the heavens playing with other children and GOD while waiting to be re-united with their parents. they are with the angels. let them be darling. dont carry the sorrow of losing them for a lifetime. look forward to your life in this world knowing that you will meet them one day.

with lots of love,
Basaria

Leah said...

Beautiful pics of the babies. :-D

I'm sorry about your milk production. It's always so frustrating when our bodies fail us.

Thinking of you!

Anonymous said...

I am so sorry that you are starting to have milk problems. That just really sucks. My daughter was born at 36 weeks, and although she was not all that early, she had a rough start at life and needed 2 blood transfusions and spent the first few nights of her life in ICU being tube fed. Because of this, I too had milk problems. She never latched so I was forced to pump and unfortunately, eventually I ran out of milk. It sucked and I was angry that I couldn't provide for her what I felt she very much needed - her mother's milk. She is now 6 months old (and very healthy and chubby from formula) and I decided to make her baby food. What I've learned is that it makes me feel like I am giving her a second chance at giving her the best. It makes me feel like I'm making up to her the fact that I couldn't breat feed for very long. It has also become quite an addiction making her food! I can control what she eats and what is in her fruits and veggies. It sounds weird, but it has surprisingly really helped me heal being able to do this for her. Perhaps it could be for you too? Take care and try not to get down on yourself - it truely is not your fault!

p.s. So glad to read all the happy updates!

Anonymous said...

Lots of water helped me and I also had a really hard time with let down. I started pumping for a minute before feedings and the milk would start flowing then I would put the baby on. I found some success with this method.

Hope this helps!

Lisa said...

As a mom of two kids who refused to latch, trust me when I say I've been there. I pumped exclusively with both my kids, so here's my advice.

Don't feel like a failure (though I know how easy it is to beat up yourself. My sister had no problems and I have two kids who the la leche people couldn't even get to latch. Stress and being exhausted also will lower your supply. Also, if you exclusively pump, it is extremely hard to keep up your supply because it isn't the same as breastfeeding (I don't remember who told me this).

Supplementing with formula does not make you a bad mom. Just think of all the benefits they still are getting from your breastmilk.

Just know that we are all rooting for you and the kids.

Barefoot said...

I'm so sorry to hear about the breastfeeding frustration. Interesting about the thyroid connection -- I hadn't read that yet but probably should as I've got Hashimodo's as well.

I'm also sorry to hear about the tension with you and Peter. I'm actually amazed that you made it as far as you did without any fights -- you're going through such an unbelievably intense time. Thinking good, peaceful thoughts for you both.

Fran said...

Michele my dear, I cannot believe that after all the support you have showed me in difficult times I completely missed the birth of your babies! And for so long!! I am utterly sorry and I can only say that you and Peter have done an amazing job, they are both absolutely wonderful. Well done my friend and may life be a little easier for you from now on. Much love, Fran

Anonymous said...

Delurking here, but I wanted to share with you something that worked for me. I don't know how long your drive to and from the hospital is, but you know... you CAN pump in the car. Yes, while driving. Just get a car charger for your pump and a hands free pumping bra, and you're all set! Do drive carefully though; I would NOT want to explain that one to a cop if I got pulled over. But it will definitely help you produce more for your babies while otherwise, you'd just be driving. Good luck!
~Lori

Anonymous said...

use Domperidone! works really well to get milk supply up!!!!!!!!!

Holly said...

I am hoping that your milk will increase!!!

sara (Angel Anthonys mom..with Alyson on the way) said...

Im right there with you on the milk supply issue. Granted, Alyson wasnt "preemie"... but she was "early born" at 38 weeks via csection and I didnt even produce ANYTHING for the first 4 1/2 days.... I never got her to latch effecietly to continue nursing (we had a good few days) .. so, I pumped... well, she is 6 weeks old today .. and I am all dried up. I too have read that this is normal at 6 weeks. Count your blessings that Maya and Bobby are able to latch and that you have some saved already. Just keep getting them to suckle and hopefully your supply will increase.

Fishsticks and Fireflies said...

I am so glad to read that the babies are doing well. I don't have much to add to what everyone else has said . . . lots and lots of water, lots of rest, hands-free pumping in the car . . . those are all great ideas. The stress one is particularly important . . . let down comes much easier if you are relaxed and well rested - both of which are probably hard to come by right now. I assume you are using a hospital grade pump? If not, look into renting one from the hospital (some insurance companies will actually cover the cost of pump rental in cases such as yours.)

Check out kellymom.com for lots more information, as well as for other herbal helps - I am a big fan of Fenugreek, and have taken it while nursing each of my kids (2 capsules, 3 times a day.)

(P.S. Most women notice a drop in supply in the week prior to starting their period. I don't know if that could be an issue for you at all, but it is something to consider.)

KerryLee said...

Oh my, they are so beautiful! ALL of your babies are beautiful. Purple is definitely Maya's color!