Supply and Demand?

   Beryt and Josh’s Story 

Before Josh was born, I could have taken or left breastfeeding. I knew it was the best thing for my baby, but I didn’t much like the idea of my being the only one who could feed him, and I also didn’t imagine the physical sensation to be anything I’d want any part of.

Then came Joshua Rush. After a long, but extremely empowering natural labor, I cradled his tiny, wet yet warm little body in my arms, and my doula helped put him to my breast.  Everything changed, watching him nurse. I was hooked.

I remember the first week as a total blur, like most new mothers. Josh had plenty of wet and dirty diapers, and his color was normal. At home, he seemed to be nursing all the time, but I knew that was normal for the first week. I never actually felt my milk come in, or any kind of engorgement, but my doula said that was okay. Josh was content and happy, and so was I.

The second week, Josh became more demanding. He nursed sometimes for 45 minutes on each side, and would fall asleep at the breast. When I’d take him off, he would cry hysterically. Since I couldn’t nurse all the time (sometimes I had to sleep or eat), my husband, mom, or step-dad would carry him around crying in the sling, until he finally fell off to sleep.

After 3 or 4 days of constant crying, my mom confided in me that she was afraid he wasn’t getting enough. She convinced me to call the pediatrician, whose nurse promptly told me that he had gas and was using me as a pacifier. I was to limit his nursing to 20 minutes on each side, and give Mylicon in between.

I was exhausted, so that sounded like a fantastic solution. Within a few hours on that schedule, he slept more and cried less. Eureka! That was the answer! I could have kissed that nurse.

But after about 24 hours, Josh was lethargic. He was sleeping almost all the time, and stopped crying at diaper changes. He even was quiet while we sponge bathed him. Something was wrong.

The next day, we took him in to the pediatrician’s office. He was 13 days old, and weighed 8 ounces LESS than his birth weight. The doctor asked me to breastfeed him for 10 minutes each side, and we weighed him afterwards to see how much milk he had gotten. He had not gained even an ounce.

I could see the concern in the pediatrician’s eyes as he gave my husband a bottle of formula. I cried as I watched Josh struggle with the artificial nipple, and finally begin to drink the formula. Then he guzzled the contents in minutes. He was so very hungry.

I felt confused, discouraged, and defeated, yet somehow determined. Over the next two weeks, I met with a La Leche League Leader friend and the hospital’s lactation consultant, talked to friends and read as much as I could get my hands on. Most advised to just nurse as often as possible, and that the increased demand would bring up the supply. It didn’t work.

I tried a different strategy every few days: pumping every couple hours, herbal supplements, staying in bed all day and nursing. Nothing seemed to help. Even my husband and my mom, who had breastfed me, were suggesting that Josh was doing fine and gaining weight on the formula supplements, so maybe I should just give it up.

At four weeks post-partum, I was about to give up hope. As a last resort, I called Sandie Lemke again, a lactation consultant from A Woman’s Work who had been too busy to meet with me when I had called two weeks earlier. We met, and after an extremely thorough consultation, she asked me to commit to following her advice for 12 days. If it didn’t work, then I would know for sure that I couldn’t breastfeed exclusively. I agreed.

I was religious about following her plan. First, she adjusted my latch-on technique ever so slightly. Then she advised me at each feeding to nurse Josh, then pump for 15 minutes to thoroughly drain my breasts, then feed him a formula supplement. I also began taking Domperidone, a drug that is not marketed in the United States, so I had to purchase it at a special compounding pharmacy. It’s an acid reflux medicine with the fortunate side effect of increasing serum prolactin. I was, of course, very nervous about taking any kind of drug while breastfeeding, but read everything I could, and finally made a decision to try it.

To make matters worse, Josh and I both had thrush, so nursing and pumping were both extremely painful. At times, it was all I could do to pump and feed the milk back to him in a bottle. Eventually, with the regimen of anti-fungals, flushing my nipples with baking soda and water, washing bras in hot water, and boiling bottle nipples, we were both cured and nursing again.

My days were filled with nursing, pumping, bottle-feeding, and sterilizing pump pieces and bottles. Talking on the phone every few days to a new person who had succeeded at the same challenge was essential to my will to keep it up.

I was pumping at least 8 times a day, sometimes 9 or 10 if I was feeling really dedicated. Most people thought I was crazy to go through all of that, on top of everything else to be done with a new baby. But it had become incredibly important to me. And the pumping? It just became part of my daily routine. It’s difficult to explain, but it was manageable- somehow.

By feeding back all of the milk I pumped, I was able to tell that I was 8-10 ounces short of meeting Josh’s nutritional needs, a little under half of his daily requirement at that time. But I saw improvement within one week, and each day I was feeding less and less formula. In three weeks I was feeding him all breastmilk! What a day that was, when I looked at my logs and saw that all of his nutrition was coming from Mommy!

The next task was to get Josh to take all of the milk on his own, which was easier said than done because he was used to being fed a bottle after nursing. While I continued the pumping 8-10 times a day, we spent the next three weeks giving him less and less in his supplement bottles. Sandie called it “giving the responsibility back to the baby.” Though this was a scary process, I eventually began to see that when I gave him a smaller bottle after nursing, he would come back to the breast sooner.

Eventually, I was nursing more, and bottle-feeding and pumping less, and by the time Josh was 2 months old, we were nursing exclusively!

For a while, I still pumped after a couple feedings a day. But without the “luggage” of bottles every time we went out, and without the pumping after every feeding, I was finally able to understand why everyone said breastfeeding was so much easier! I could finally relax and just nurse my baby.

And when I took him to his 4 month checkup and he had jumped from the 15^th to the 30^th percentile, I felt so incredibly proud that that increase was all from MOMMY MILK. He was finally thriving.

I began to wean down ever so slowly from the Domperidone and was finally off about two months later. To my surprise, there was never a decrease in milk supply- my body had learned how to produce the right amount of milk on its own!

While I consider my story to be a huge success, I did experience a setback. At that same 4 month check up, Josh’s pediatrician suggested that we “sleep train,” restricting his feedings between midnight and 6. She assured me that he would make it up during the day, but unfortunately my mild-mannered baby didn’t object much, and didn’t fuss to nurse more during the day.

I also had returned to work and was under a tremendous amount of stress, and both situations contributed to the dramatic decrease in supply I noticed. More urgently, though, Josh gained only 6 ounces that month- not enough for a 5-month-old baby. Luckily, resuming some of the pumping and night feedings brought the supply back up to normal, but also taught me two lessons… one, that I had underestimated the percentage of intake that he was getting in those night feedings, and two, that Josh knew what he needed, and that if I listen to him, the supply will meet his demand.

At the time of this writing, Josh is an active, talkative, happily nursing 2 year old. And I am a champion of breastfeeding- often found recounting my story to pregnant friends, so that they’ll do whatever it takes to establish their milk supply from the beginning. I’m also a strong proponent of La Leche League, since I received such incredible support and information from my local leaders) and the many friends I’ve made at meetings.

And then there’s Sandie, my ever-supportive, always-willing-to-listen, lactation consultant. I’m not sure how many times she told me, “Beryt, I know it’s hard, but you can do it.” Back at the beginning, when I was struggling and ready to give up, I remember a friend of mine wrote down Sandie’s number and said, “Call this woman. She saved breastfeeding for me.”

I can now say the same thing. Even though it’s true that Josh and I did all of the work, there is no way we could have done it without Sandie. I will forever be grateful for her loving, kind, and expert support. For Josh and I, she saved breastfeeding.

If there’s one thing I’ve learned about my personality, it’s that sometimes I appreciate things more when I have to work for them. I sometimes curse myself for that trait. But other times I look back at my experience and wonder- would I have chosen extended breastfeeding? Would I appreciate nursing as much as I do, had I not faced such challenges? I cherish every nursing moment, knowing that had I not worked so hard, we would not share such an incredibly special connection.

Beryt N. / Houston, TX