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My baby Todd is now one month old as I finish this post about my experience with breastfeeding.  As the title suggests, I am no longer breastfeeding.  It’s been incredibly difficult, but I’ve somehow made peace (well…almost!) with the fact that breastfeeding did not work for us.  I cried and cried over this, until I finally could cry no more.

To put it bluntly, this really sucks (pun not intended!).  As soon as I knew I was pregnant, there was never any question about whether I would breast feed or formula feed my baby. “Of course” I would breastfeed! It was the only choice.  Everyone knows that “breast is best!”  Why would I even consider formula when it is so inferior?  Of course I would want my baby to have the very best food!

Not being able to breastfeed just added insult to injury.  First, I felt like a failure when my body wouldn’t initiate labor until I gave it the castor oil treatment at the end of week 41, day 2 of my pregnancy.  Second, I felt like a failure in childbirth.  Todd’s moment of birth wasn’t the joyous event that I’d hoped it would be.  And now, for the triple whammy, I felt like a failure when I couldn’t adequately feed my baby from my own breasts.  The failure to breastfeed was 10 x worse than the other 2.  To make matters worse, this crushing blow came when I was in the midst of my post partum hormone crash as well as the throes of sleep deprivation.  That’s a recipe for post partum depression, for sure!

Again, I know I should count my blessings.  First, I didn’t have any trouble getting pregnant at the age of 42, and, in fact, this whole thing was unplanned to begin with!  Lots of people try and try to conceive and never can.  I know I have been blessed.  Second, I did have an easy pregnancy with zero morning sickness and zero complications.  I ended up with a healthy baby and so why should I complain?  Yes, my logical brain accepts all this.  But who could blame me for just wanting to “have it all”?

When I prepared for baby, I’d read that breastfeeding does not always come naturally.  I was definitely prepared for the possibility that it might take some time and some work to figure out.  I was hopeful that it would come easy, but realistic that it might not.  Everything I’d read stated that, even if it was hard in the beginning, if I just stuck with it, then it would get easier.  I didn’t even entertain the thought that it might not work out at all.  But now I know that sometimes it just doesn’t work out, despite putting forth the effort.

So, here is the story of my bottle baby…

Breastfeeding starts at birth, and we had a very poor start.  As I recounted in the previous post, Todd’s Birth Day – 8/21/14, we had no opportunity to attempt breastfeeding right after birth.  Todd went right to the NICU and I went to my separate hospital room.

Todd was born at 7:08 PM, and by the time I got up to the NICU to see him it was after 9 PM.  I regret that I don’t specifically remember that first visit, and I don’t have any pictures.  I think the visit was brief and I think he was sleeping.  We were both exhausted from the day.  I could do nothing more than sleep that first night.  None of the nursing staff encouraged me to do anything else.  I think Todd was getting glucose via IV, in addition to his IV antibiotic.

I went to the NICU at 7:30 AM the next morning (8/22/14).  This was our first attempt at breastfeeding.  The nurse helped as much as possible.  She gave me a nipple shield because Todd wasn’t getting a proper latch without it.  Even with the shield, I wasn’t confident that it was correct.  In retrospect, I should have requested a consult with the lactation nurse for me and Todd while he was still in the NICU.  But I didn’t know any better.

7:50 AM – 8/22/14 – 1st breastfeeding attempt

Each time that day that I went to visit Todd in the NICU, I tried breastfeeding:  10:30 AM, noon, 2 PM, 6 PM.  Each time, I wasn’t convinced that Todd was getting anything through the nipple shield.  I wasn’t concerned, because I knew it could take time for my milk to come in.  Also, the NICU nurse informed me that Todd’s drive to breastfeed would improve once he was off his IVs.

5:58 PM – August 22, 2014

In my own hospital room, I was seen that day by the lactation nurse.  She provided some verbal instruction.  (Again, I should have asked if she could visit me with Todd in the NICU instead.)

I tried using the hospital breast pump a few times during my stay.  All that came out each time was a drop or two of colostrum.  One nurse used a syringe to capture the drop, and she took it to Todd.  In retrospect, I probably didn’t run the pump for long enough, but I can’t remember how long I let it run.  I didn’t get much instruction on pumping.

Before Todd was discharged from the NICU, his IV lines were removed.  He needed to have 2 good blood sugar readings before he could leave.  The first one was okay, but not too far over the minimum.  The staff was afraid that his second test would show an unacceptable drop unless he was given a supplement.  We consented to the supplement (soy formula) in the afternoon because we wanted to maximize his chance for getting that second good blood sugar reading.  (If he didn’t get it, they would have put him back on the IV, necessitating an even longer NICU stay.)

Todd’s second blood sugar result was good, and he was brought to my room around 9 PM.  I got up a few times that night to try to breastfeed him.  The night nurse also kind of insisted that he needed another serving of formula.  I said okay.

Another thing to note is that the NICU used a pacifier the whole time Todd was there.  My sister pointed that out.  Bad idea?  When the nurse tried to give him the pacifier in my own room on night #2, I requested that she not do it.  He slept just fine without it.

On Saturday, August 23rd, before we were released to go home, I requested a visit from the lactation nurse (thanks to my sister’s suggestion) so she could work with me and Todd.  That visit turned out to be critical.  Todd finally got a good latch without needing the nipple shield.

A final note about being in the hospital:  My nutrition wasn’t the best.  I had vegan options, but I know I didn’t eat nearly enough.  And, I was weakened by eating so little on the day Todd was born.  Eric brought in my Mother’s Milk tea for that second day and night.  I had several cups.

Todd’s birth weight was 6 pounds, 15.8 ounces, and he left the hospital weighing 6 pounds, 10 ounces.  At home, later that Saturday, I was confident that Todd was getting a good latch each time I would breastfeed him.

August 23, 2014

I started using a nursing phone app to track the feedings.  I fed him about every 3 hours like I was supposed to.  He’d always stay latched on for as long as I’d let him.  I’d keep him on for ~15-20 minutes per side. Usually he seemed pretty sleepy and often it appeared that he wasn’t really sucking effectively.  I also hadn’t yet felt my milk “come in.”  I figured we were both still waiting for that to happen.

On Sunday, August 24th, we had a follow-up appointment with lactation.  Todd’s weight was down to 6 pounds, 5.2 ounces, which was a 10% decrease from birth weight.  They recommended increased number and duration of feedings, and pumping to resolve any engorgement.  I started keeping Todd on each breast for up to 30 minutes instead of stopping him at 20.

August 24, 2014

Ashley gets Todd undressed at the lactation appointment – August 24, 2014

On Monday, August 25th, we had our first appointment with the pediatrician.  Todd’s weight stayed at 6 pounds, 5 ounces.

August 25, 2014

By Tuesday the 26th and Wednesday the 27th, I was getting really run down and sleep deprived.  I still didn’t feel like my milk had come in, and that had me even more stressed.  I was super emotional those 2 days.  My post partum hormone crash was happening.  On Wednesday I tried pumping, and I got 9 ml out of the left breast and 7 ml out of the right.  I fed that little bit (~1/2 ounce) to Todd with a bottle.  I pumped a 2nd time that evening and got 8 ml out of the left and 3 ml out of the right.

August 26, 2014

Pumped breast milk

August 27, 2014

On Thursday, August 28th, I pumped and got 5 ml out of each breast.  We went back to the pediatrician’s office for a weight check.  I was disappointed to learn that Todd had lost more weight.  He was down to 6 pounds, 3 ounces.  I pumped another 10 ml + 7 ml later that day.  I fed him the pumped milk with the bottle.  I kept breastfeeding.

On Friday, August 29th, we went back to lactation for a 2nd appointment.  There, they would weigh Todd before and after feedings on each breast, to determine how much milk he was getting per feed.  He weighed 6 pounds, 3.3 ounces at the beginning of the visit.

Based on that visit, the nurse determined that Todd was not getting nearly enough breast milk to gain weight.  He needed an extra 20-25 ml per feed of pumped milk and/or formula.  I was instructed to pump for 10-15 minutes after each feed during the day and once at night.  I would feed Todd the pumped milk and formula using a syringe and SNS (Supplemental Nursing System) tubing at the breast.  The hope was that Todd would suck at the breast more vigorously as he simultaneously received fluids through the tube.  The added breast stimulation would then increase my milk supply.  I left that appointment feeling very encouraged.  It seemed like a foolproof plan.

In practice, it was NOT so simple…

We were able to administer a full 25 ml during the first feeding after we returned home.  Good…right?  However- when Todd was due for his next feeding, he cried, refused the breast, and was too sleepy to feed.  This happened again at the next scheduled feeding.  I tried giving him 5 ml of pumped milk via the tube at the breast, but all I ended up with was a puddle of liquid on the pillow underneath him.  Eric finger fed him 10 ml of formula via the tube.

On Saturday, August 30th, the challenge continued.  The barrier to our success was Todd’s excessive sleepiness.  Todd was able to latch on well, but he’d fall asleep and not suck.  He would only nurse so long, and in that time I could only administer so much via the tube:

•  At 2 AM, he breastfed 18 minutes + 13 minutes and took 5 ml breast milk + 5 ml formula via the tube.  Eric bottle fed him another 5 ml formula, but Todd wouldn’t take any more than that.
• At 5 AM, he breastfed 17 minutes + 15 minutes and took 5 ml via the tube.  Another 5 ml leaked out.
• At 7:30 AM, he breastfed 15 minutes and took 5 ml via the tube.
• At 10 AM, he breastfed 20 minutes + 20 minutes and took 10 ml breast milk via the tube.
• At 11:30 AM, he breastfed 7 minutes + 14 minutes and took 5 ml via the tube.
• At 1 PM, he breastfed 15 minutes on one side only, and took 5 ml via the tube.
• At 2:30 PM, he breastfed 9 minutes + 10 minutes and took 5 ml via the tube.
• At 5 PM, he breastfed 18 minutes + 7 minutes and took 10 ml breast milk + 10 ml formula via the tube.
• At 7:30 PM, he breastfed 26 minutes + 32 minutes and took 5 ml breast milk + 15 ml formula via the tube.  He actually seemed hungry this time.
• At 10:30 PM, he breastfed 15 minutes + 13 minutes and took 20 ml formula via the tube.

August 30, 2014 – Todd using the SNS tube while breastfeeding

Sunday, August 31st–

• At 1:30 AM, he breastfed 15 minutes + 15 minutes, but he would pop off the breast every time I tried to administer the tube.  Eric finger fed 10 ml breast milk + 10 ml formula with the tube.
• At 5:00 AM, he breastfed 13 minutes + 11 minutes.  Eric finger fed 10 ml breast milk + 12 ml formula with the tube.
• At 7:30 AM, he breastfed 19 minutes + 12 minutes.  Eric finger fed and bottle fed 8 ml breast milk + 20 ml formula.
• At 9:30 AM, he was too sleepy to breastfeed.

To summarize the details above–

On average, we were only able to administer 5-10 ml per feed using the tube.  We weren’t even close to the 20-25 ml that were recommended.  On top of that, Todd was more sleepy than before and not nursing nearly as well.  I was getting more and more frustrated with the tube because it made breastfeeding sessions take longer (because Todd would pop off my breast frequently with the tube in place.)  It took several tries to get it in place correctly, and then sometimes it would still leak.  Out of desperation, I ended up having to wake up Eric in the night to help me because I couldn’t do it by myself.  The whole process was taking forever and then I still had to pump afterward.  It was beyond frustrating.

At 11:00 AM on that Sunday, we had our 3rd lactation appointment.  Todd weighed 6 pounds, 3.5 ounces.  He was still 11% below birth weight.  After all our dedicated hard work, he’d gained just 0.2 ounces since our last visit…ugh!  During the clinic visit, Todd only took 6 ml of breast milk when he breastfed on my left breast for 17 minutes.  The nurse said he needed 480 ml of milk per day to gain weight.  We clearly needed a better plan.

The lactation nurse recommended breastfeeding no more than 20 minutes per session, 3 hours apart, in order to conserve Todd’s energy.  I’d give 60 ml of supplement (pumped milk and/or formula) after each breastfeeding, via bottle.  I’d keep pumping after each feed.

So that’s what I did.

August 31, 2014 – To lighten the mood, Eric pretends that the breast pump is a bong.

On Monday, September 1st, I was encouraged by getting a bit more milk per pump.  I got 38 ml in one session and 47 ml in another session.

On Tuesday, September 2nd, we returned to the pediatrician’s office for Todd’s 2 week follow-up.  Todd weighed 6 pounds, 9.5 ounces…good news!

I also received my new breast pump from my insurance company.  Before I got it, I was using an older model pump that belonged to my sister’s friend.  I was hopeful that I’d have better output with my new pump.

September 2, 2014 – Medela Pump in Style Advanced arrived at my door

On Wednesday, September 3rd, I had a really emotional day.  A nurse case manager from my insurance company called to check on me in the morning and I cried as I spoke with her.  Then I went to our 4th and final lactation appointment.  Afterward, I had a follow up appointment at the birth center and I cried again there.

At lactation, Todd only took in 14 ml while I breastfed him in clinic.  The nurse at this visit assessed Todd’s suck and she said it was uncoordinated.  That’s why he doesn’t transfer milk very well from my breasts.  My baby sucks at sucking.  She didn’t think it would improve.  We just had to keep doing what we were doing.  I left there feeling defeated.

As this week progressed, it became clear that, as Todd was getting more of what he needed from the bottle, he was doing less and less well at the breast.  He wouldn’t stay latched on very long.  He’d fight me when I’d try to get him on, pushing with his arms.  He’d seem agitated and shake his head. And yet, sometimes he did have a good feed.  When that would happen I’d try to enjoy the moment.

By Thursday, September 4th, I was lucky if Todd would breastfeed for 10 minutes per side.  I focused my energy on pumping.  I was getting 30-45 ml per pump session.  This meant that Todd’s diet was approximately 1/2 to 2/3 breast milk and the rest formula.  I was grateful for all the breast milk I could feed him.

By Sunday, September 7th, I was at another low point.  Even though I was pumping religiously, my output seemed to be declining.  It was taking longer to pump less volume.  My breasts seemed more full, but the milk wasn’t releasing.  I tried warm compresses.  I massaged my breasts like crazy while I pumped.  At 4:30 AM, I broke down when I pumped only 27 ml in over 20 minutes.  Then I sobbed when I accidentally spilled it because I was so distracted and upset.

My mood was becoming dependent on how much I could pump.  I felt okay when I pumped 44 ml at 7 AM and then I felt awful when I only got 12 ml at 9 AM.  I was at my bottom.  I knew I couldn’t live like this anymore.  The never ending routine of breastfeed, bottle feed, pump, wash pump parts, wash bottles was making me crazy.  I felt like everything I did revolved around feeding.  It was taking away from my ability to simply enjoy spending time with my baby.  I felt like I was having to choose spending time with the pump over spending time with Todd.

On Monday, September 8th, I started the week with a new attitude.  I’d pretty much accepted that it was only a matter of time before I switched to exclusive formula feeding.  I just didn’t know when that would be.  I would take it day by day and week by week.

That week, I decided to do my own thing.  I no longer stuck to a strict schedule.  I kept trying to breastfeed, but I didn’t stress out if Todd wasn’t into it.  I pumped when I could, but not if it meant choosing the pump over Todd.  The pressure was off.  And that felt good.  It also helped to have Eric’s mom over to visit 4 days that week.  I needed the company.

On Tuesday, September 9th, we returned to the pediatrician’s office for another weight check.  Todd weighed 7 pounds, 2.5 oz.  He was over birth weight and then some.  The doctor asked how the feedings were going and I told her what was up.  She said if I needed to switch to formula then I had her support.  She was a formula fed baby and she turned out okay.  For that matter, I was a formula fed baby, and I turned out okay, too!

September 10, 2014

Todd was 3 weeks old on Thursday, September 11th, and that was our best day yet!

September 11, 2014

Interestingly, I felt a lot more engorged that week.  Yet, neither the baby nor the pump seemed to release the milk.  I still wasn’t pumping more than 18-73 ml per session.  My all time high was 86 ml on Saturday, September 13th.  That time, I actually felt my breast soften.  It was cool when I’d actually see milk spraying out of my nipples.

Occasionally, Todd would still have what I considered to be a “good” (i.e. vigorous sucking) breastfeeding session.  On Friday, September 12th, I tried a lot of breastfeeding and I didn’t pump at all.  This picture is how I like to remember my sweet baby at my breast:

September 12, 2014

Starting the week of Sunday, September 14th, Todd’s bottle intake increased significantly.  He was no longer satiated with ~2 ounces or 60 ml per feeding.  He was now taking up to double that amount at a time.  Because of this, it seemed like the right time to officially start weaning.  No matter what I did at this point, Todd would be getting a very small % of breast milk.  It didn’t seem worth the effort anymore.

September 14, 2014

I stopped consuming all the things that were supposed to increase my milk:  Mother’s Milk tea, fenugreek tea, fenugreek capsules, lactation support herbal supplements, oatmeal, non alcoholic beer, extra water, etc.

I half-heartedly attempted breastfeeding this week, but Todd wasn’t really into it.  Our last “good” session was on Monday, September 15th.  The very last time was briefly on Wednesday, September 17th.  (If I tried after that, then it wasn’t successful because I didn’t write it down.)  I pumped for the last time on Monday the 15th.  I got 9 ml.

Gradually this week, my engorged, uncomfortable breasts started to soften. Once, I easily hand expressed lots of milk all over my shirt to relieve some of the soreness.  I felt bad when I did that, like I was wasting something precious.  That night, I had a dream that I squeezed my breast and filled up an entire bottle with milk.

I guess part of me still doubts whether I’ve done the right thing by drying up my milk.  The decision is so permanent.  I don’t really think that Todd misses my breast, and that makes me feel a little better.  He seems to like the formula, and he’s tolerating it well.  At this point, I’m the one still feeling like I’m missing out on something.  And, of course I still wish Todd could have a diet of my breast milk instead of formula.  I have to let go.  I did my best.

For now, I’m trying to focus on the positives of being a bottle- and formula feeder.  It’s all I can do.  The main benefit is that Eric and I can both bond with Todd over feedings.  I like that Todd stares at me when I feed him with the bottle.

My bottle baby – September 19, 2014

Todd is now 1 month old, and he appears to be thriving. That’s all that matters, right?

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Our formula of choice is:  Earth’s Best Organic Soy Formula.

A blog I found helpful is:  Fearless Formula Feeder

A book I found helpful is:  “Bottled Up,” by Suzanne Barston (of the FFF blog)