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Friday, December 30, 2011

Letdown & Ascension

During my first pregnancy, there was never so much as a shred of doubt in my mind that I would breastfeed. I looked forward to exclusive & extended breastfeeding. Throughout my pregnancy, I stopped in at the lingerie section waiting for my cup size to increase so I could finally get out of my too-loose B cups and find a bra that fit me in the band and was available in my cup size. My breasts did not change size at all. I wasn’t sure whether to buy a nursing bra pre- or post-delivery. I was assured by other moms that once my milk came in, I’d need a larger cup size so it was better to wait. It was like ‘Waiting for Godot.’ I just kept waiting.

The natural birth I’d planned for was derailed when I developed cholestasis and got so sick with a mystery illness I thought I was dying and only vaguely cared, which landed me in the hospital as a team of doctors tried to ascertain whether I had lung cancer, Hodgken’s lymphoma or valley fever. It was valley fever, and I had a medically necessary induction at 36 weeks. Unsurprisingly, my sleepy baby wasn’t interested in nursing. We had a rough start with latching. The Lactation Consultants asked if I’d experienced engorgement and letdown. I had not. The kind LCs asserted that maybe it was just late; sometimes moms didn’t have their milk come in until day eight.

We kept nursing on demand. The day after hospital discharge, I remember sitting in my daughter Alice’s unfinished nursery, with my feet up on a bin filled with cloth diapers, trying and trying to get her to latch while she screamed, beet red, in frustration. At her first pediatrician’s visit, we learned she had dropped from six pounds to a mere four-and-a-half pounds in just three days. I sobbed all the way home with the two grocery bags loaded with Similac at my feet. This was not what was supposed to happen. Day eight came and went with no change in my supply.

We tried the SNS but could not establish a latch with it. I set about a regime of nursing on demand for 45 minutes at a time or more, followed by giving Alice a bottle, and then pumping out about five drops over 20-30 minutes. At four weeks I asked point-blank whether my milk had come in and whether it was likely I’d increase my supply. My daughter had just latched beautifully, and the pre-and post-feeding weights indicated she had only transferred 1/3oz in 45 minutes. I decided to throw in the towel. We blamed it on the high dose of fluconazole I was taking for the valley fever, or the valley fever itself.

I felt shame every time I plunked down $20 for another four days’ worth of Similac or fed my baby a bottle. I avoided the baby groups friends suggested I go to to combat postpartum depression, because I’d have to feed a bottle to my daughter in front of other breastfeeding moms. I actually had a few women ask me why I was ‘choosing’ to formula feed my daughter. I smiled apologetically and then just as meekly explained my situation. I was told that ‘all women can breastfeed,’ and those who say that they can’t really just are either ignorant, lazy or don’t have a proper support network.

It was because of this same viewpoint, a popular one, that I had not prepared for the possibility of encountering any difficulty with breastfeeding. I had not known to look for the red flags of no breast change during pregnancy, no engorgement, no sensation of letdown. Instead of taking a proactive approach starting in pregnancy, I was caught off guard and reeling from the emotional devastation, complete shock and recovering from my illness.

My breastfeeding ‘failure’ was still devastating when I became pregnant with my second daughter. This time, I was determined to make it work. I took a breastfeeding class. I read books. I found colostrum crystals on my nipples in the third trimester and thrilled. I still held on to the hope that my issues the first time around were related to the valley fever.

With Picasso, I had the natural birth I’d been hoping for with both children. I was in a state of complete bliss during my labor and delivery and the days following. Picasso was attached to my breast from birth on. The nurses would come in to ask how long she’d been nursing, and I could never really answer. They all commended me for breastfeeding so well.

She’d lost a little weight when we were discharged. At her first pediatrician’s visit she had lost more than 10% of her weight. The supportive doctor encouraged me to continue trying and come back in five days for a weight check. At the next appointment she had continued to lose weight and was showing signs of dehydration. She was not wetting or dirtying her diapers often enough, and when she did wet the diapers were filled with reddish powder. I was told that supplementation was no longer negotiable. With a sinking heart, I called and made an appointment with the Lactation Consultant to get help with the SNS for that afternoon. We did a pre-and-post feeding weight to see how much Picasso was transferring: 1/3oz. Lugging the hospital-grade pump into the elevator, I sobbed all the way to the car, crushed that my breasts still were not able to do their job. We started supplementing with formula, and continued to use the SNS for each feeding for the next four weeks.

When well-meaning people had suggested using donor milk to me in the postpartum period with Alice, it felt too invasively personal. I was too devastated and felt worse when anyone mentioned it. People also liked to tell me that it wasn’t the end of the world to use formula – something I obviously knew, but it would have been nice to have had my body give me a CHOICE in whether to supplement or not. Others told me to get over myself and enjoy my baby, not understanding that I was grieving the loss of a relationship too beautiful to even put into words. No matter what anyone says, bottlefeeding is not comparable to breastfeeding. While I empathize with moms whose babies will not take a bottle, and understand how demanding it can be to breastfeed, it is not the same as losing that nursing relationship. Having one’s body fail to be able to fulfill this basic biological compulsion is devastating.

With Picasso, my last baby, I was ready to fight tooth and nail for her to have breastmilk. Although my husband and I were both unemployed, I spent hundreds of dollars on domperidone and herbal and dietary galactagogues. We rented a hospital-grade pump before getting set up to borrow the same pump from WIC for free. I used the SNS diligently and nursed and pumped around the clock. At two months postpartum, my desire for my daughter to have breastmilk transcended the burning devastation of only making a fraction of what she needed to consume each day to thrive. I did what had been emotionally unthinkable with my first daughter – I sought out milk donors. From two months on, she has been on donor milk in addition to what I produce, and we ditched the Similac.

At three months postpartum, I ran out of domperidone and could not afford to refill my prescription or to order more online (which is much cheaper than the compounding pharmacy’s price tag). My supply crashed from 9oz a day to 1oz a day and I went through two days of weeping at nothing, at everything. The morning after I decided to let my supply go, a woman in Canada offered to send me 700 pills of domperidone for free. My daughter had stopped nursing, but I kept pumping waiting for the dom to arrive. Another Godot experience – after a month of pumping several hours a day for 1oz total, I found out the domperidone was returned to her.

Some online friends pooled their money together to order me a couple months’ worth of domperidone, and when it arrived I literally jumped up and down. I worked at it and got back up to 4oz a day, and then after a couple months, to 9oz. I exclusively pumped from three months to just over six months.

For four-and-a-half of her six-and-a-half months, my daughter has been exclusively breastfed, although most of the milk did not come from me. We’ve been very fortunate to have found donors – so far 16.

At six-and-a-half months, I’ve had to make the difficult decision to pull the plug on domperidone and pumping. I’ve gained thirty pounds from the medication, and as someone overweight to begin with, I’m now experiencing some medical issues as a result of the sudden weight gain. It’s not realistic for me to continue to pump every two hours for twenty or more minutes at a time. I have two small children and if my husband had been employed, I have no idea how I would have managed this regime. I need to be a more present, accessible parent and partner. All of these are compelling reasons enough to quit, but the wound is still gaping. The pain still real and raw.

There’s fear, a frantic fear that a day will come when I won’t be able to continue cramming breastmilk into our freezer. I have put my entire being into producing milk for my child, to such an extent that I hope I’ve set a sort of inertia of milk-coming-our-way out into the universe. Waking in a room washed with colostrum-colored light, one day very very soon, I will be empty of milk. Please God, let the best milk possible fill my sweet baby’s beautiful belly. That’s all I’ve got. Finally - letdown, and ascension.


Edited 4 February 2012

I made it to seven months and ten days.

I came to the realization, when I tried to quit pumping cold turkey a few days before that, that while I was making only a very small amount of milk compared to others, it was a full supply *for my body.* I spent a few days weaning from the pump, with mood swings galore from the shifting of hormonal continents, and then stopped.

Postpartum depression has kicked in full force, which I now remember happened with my first baby! I really do believe lactation is protective against postpartum depression. I'm working my way out of it.



  1. What a beautiful and heart-wrenching post! I am so sorry you've been through this. You've done great for your girls. Hugs to you.

    1. Thank you for taking the time to read my story -- and for the hugs!

  2. Thank you for sharing such personal thoughts with us. Your feelings are universal and I completely empathize with you. As mom to my 8 months old daughter, I too was unable to make enough for her and it took 4 months of donor milk, dom+fenugreek, and around the clock pumping to finally sustain the supply. My doctors thought I was crazy. I cried on the day I realized that my supply was meeting her needs. I still pump once a day and have the "hoarding mentality" of keeping a safe stock pile of frozen milk. But after all the struggle, I am now able to become a milk donor myself since I have an oversupply! The effort is all worth it! Good luck and what incredible sacrifices you have made for your children.

    1. Thanks so much for sharing your story. I think it's incredible you were able to build your supply so greatly. How awesome! Kudos for you. And extra kudos for the donating. I always said, if I were suddenly blessed with an oversupply, I would donate donate donate. Alas, not in the cards for me.

  3. Thank you so much for sharing your story! I have to say, I had no idea under-supply was such a very real problem. I had always heard that every woman makes enough milk unless she has a thyroid issue. I believe I may have started out with a low supply. My daughter spent 16+ hours a day nursing and spent the time she wasn't eating rooting and crying. Congratulations to you for seeking out donor milk. If you are in need of any more, please let me know. My little one just started solids and I'm pumping about 4 ounces extra a day now.

  4. How awesome!!!! We started a blog here too looking for Donor Milk Called Breast Milk for baby Logan :)) It is awesome reading your story and seeing the similarities.