I thought I'd share my story with you all, and for the archives. I
am a LLL Leader and IBCLC. I nursed both of my two previous babies
for over 2 years with no major issues. I have no risk factors for
low milk production (well, I am overweight, but that is nothing
new!). No thyroid issues, no fertility issues, no breast/chest
surgery or injury, no issues with my menstrual cycle, no hypoplasia,
and no history of lactation failure. I had a normal healthy
pregnancy with baby #3, which culminated in a beautiful natural
delivery in a birth center at 37 weeks gestation (I do tend to
deliver early; my other babies were 35 weeks and 36.5 weeks,
respectively). We had immediate, continuous skin-to-skin with no
separation or supplementation of any kind. We breastfed as soon as
she started looking for my breast, within the first hour. She seemed
to have a great suck, normal oral-motor function, and was swallowing
audibly from Day 1. I did however have painful nursing on my right
side, and quickly developed a compression stripe, much to my
embarrassment as an IBCLC!
I went on my merry way, until Day 3 when I noticed no signs of
Lactogenesis II either in my breasts or in my baby's stooling. In
fact, she passed the meconium on Days 1 and 2, and then there was
nothing. She continued to have wet diapers with clear urine in
reasonable amounts, so she was staying hydrated. On Day 3 we went to
the pediatrician, and she had lost just a hair under 10%, but the ped
was supportive of waiting to start supplementation since she was
staying hydrated and I have a scale at home. On Day 4, she still had
had no stools, was still wetting normally, and had lost another
ounce. The ped wanted us to start supplementing. I said I would
think about it. Test weights were about 0.8 oz (20 ml) milk transfer
on my left breast and nothing on my right breast. (I was also
compressing the heck out of my breasts during the feedings and paying
careful attention to latch and to her rate of swallowing.) I called
my IBCLC friend in a panic and she stressed how important early
stimulation is, and said I should pump after every feeding (duh, but
I was still in denial that I could possibly be having milk production
problems, so I am so glad she emphasized the importance of faithfully
pumping 8 times/day after breastfeeding.) Pumping yielded 5-15 ml on
the left breast, and just a few tiny drops on the right. Hand
expression was no better.
My baby was starting to act hungry and unsatisfied after constant
breastfeeding, so I broke down and gave hydrolyzed formula by
periodontal syringe at breast. The next day (Day 5), she had 3
stools. On Day 5, I would get about 15-30 ml pumping my left breast,
and drops to 5 ml on my right breast. By Day 7, I was able to
produce enough on my left breast to cut out the formula and
supplement with breastmilk, but I was still getting only about 10 ml
every time I pumped my right breast (I did not nurse on that side
except maybe once a day, because it was so painful. The breast
tissue was much less elastic on that side). I started supplementing
with bottles, because my baby did not draw milk through the SNS well,
and I wanted to feed her efficiently so I could have enough time to
pump and spend time loving my baby and my older children. When my
baby would nurse on a "full" breast, she would still get around 20-30
ml, because the flow was so slow it put her to sleep. With the
bottle, I could make sure she got enough in a reasonable amount of
time. It wasn't until Day 9 that I confirmed that she could get 60
ml by breastfeeding. I was not able to cut out the bottles
completely until Day 15.
During this whole time, I was not having symptoms of retained
placenta, and blood tests showed pretty normal prolactin, thyroid,
testosterone, and HCG levels. I was not under extreme stress, except
the normal stress of adding baby #3 and being worried about my milk
production. I started More Milk Plus and lecithin just to be on the
safe side on Day 4.
My baby is now 1 month old, and we are exclusively breastfeeding, and
still only on the left side. The most milk I have ever gotten from
the right has been 40 ml, and that is after sleeping 8 hours with no
pumping or breastfeeding on that side. I plan to see a breast
surgeon to ask to have some imaging done, and possibly an
endocrinologist to look for subtle hormonal issues, but I have a
feeling that this is going to remain a mystery.
I have renewed respect for mothers who overcome much more difficult
situations than the one I faced, and compassion for mothers who
choose to spend more time with their babies and less with their
pumps. I also have renewed fervor for helping mothers nurse their
babies. It is really, really important work we are doing.
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