#MomTalk: A Birth Doula Shares How She Navigated Milk Supply Issues
Today's #MomTalk comes from Connie Carringer, Nourisher's Community Manager and the mother of two little girls. Connie has her Masters degree in Clinical Mental Health Counseling and a Post-Masters Certificate in Expressive Arts Therapy. She is a DONA trained birth doula (2010), CAPPA trained postpartum doula (2016), Lamaze Certified Childbirth Educator (LCCE), and Certified Lactation Educator (CLE). Interested in sharing your breastfeeding journey on the Nourisher blog? Email your story to firstname.lastname@example.org.
An Easy Birth - A Not So Easy Breastfeeding Experience
I thought I knew A LOT going into my first pregnancy. I felt prepared for birth, breastfeeding, and parenting. I had already been a doula for several years and watched my sister and many friends breastfeed successfully. My first pregnancy was healthy and the birth was everything I could have hoped for - I felt powerful, strong, supported and loved. I got the undisturbed birth center birth I had planned with a healthy 10 lb baby! (This story isn’t about birth, so I won’t go into the details here, but pushing out a 10 lb baby is possibly the most badass thing I have ever done! I honestly still don’t really know how I managed to do that...).
Holding my new (not so) little baby was amazing. She latched on well from the beginning and I really had no reason to think we would have any difficulties. Most families go home from the birth center 4-6 hours after giving birth. After the initial euphoria of birth wore off, the reality of taking home this tiny human really sunk in and I realized that I had no idea what I was doing. It was around the 8-hour mark after birth that the nurse practically pushed us out the door! We were on our own.
Those early days are a blur. I remember nursing SO MUCH. I remember the home visit nurse coming two days after birth to check on me and baby. She had lost weight, but in the normal range - 7%. “She is probably on the upswing,” the nurse told us. We were tracking diapers and not getting any poops after the initial meconium poops of the first day. I was concerned. The nurse called to check in and she suggested continuing to nurse, and that my milk was likely still coming in. And it was, at least for sure on one side, which was way bigger than the other. I was nursing on both sides every feeding, alternating which I started with, just like you are supposed to. But by day four we were still not getting poops, so I made an appointment to see a lactation consultant at the birth center where I gave birth for the following day.
The Dreaded Triple Feeding
That night, she finally pooped (It was what we call a POOPSPLOSION)! I thought we were in the clear. Thankfully I kept my appointment and the next day we saw the IBCLC. At first, she seemed unconcerned. My baby looked healthy (she was 10 lbs to start, so she was still a chubby baby) and was alert. When they took her weight I remember the mood shifting - she had lost 13% of her birth weight. It took a while for me to take in what was happening. Over 10% weight loss is not normal and very concerning. We needed to supplement. I needed to nurse, then bottle feed and pump after nursing - what I know now as the dreaded triple feeding. The other message I got was that this was probably just a “bump in the road” and my milk would come in as it needed to. We needed to come back tomorrow to weigh-in.
We went home with some (very expensive) donor milk and I called a couple friends who had babies to see if they had extra milk (and they did!). I called my sister. I called my mom. I cried and cried and cried.
Emotions During the Early Days
I felt so GUILTY - I had been starving my baby! No wonder she nursed so much and so often and got frustrated at the breast. I also felt ASHAMED - what was wrong with ME that I couldn’t make enough to feed my baby? Was my body broken? Did I do something wrong? I felt very OVERWHELMED - how was I going to nurse, pump, bottle feed, change diapers, eat, sleep (ha!), or shower (lol!)? I had never used a pump before, so I had to figure that out - It was THE WORST. Pumping took me away from my baby, made me feel broken, resulted in mere drops of milk, and was weird and uncomfortable.
My husband was amazing through all of this. He rocked paced bottle feeding and took charge of visitors, food, and all the other things that go along with having a new baby. He encouraged me to do what I could, but try to find balance with sleep and self-care. He sat with me while I cried.
Finding Answers by Learning About Mammary Hypoplasia
I can’t even remember how many times we went to the lactation consultants in those first few weeks. It was almost every day at first. There was a turning point for me with one lactation consultant, maybe the third one we saw from the group practice. She started out by actually taking a look at my breasts! “Oh! You have breasts like mine. See, they are far apart and they are very different in size.” She helped me feel where I had glandular tissue and where there were big gaps and invited me to feel her breasts as well (kind of weird, but actually super helpful!). She taught me about mammary hypoplasia, which is sometimes indicative of insufficient glandular tissue (IGT). I asked if I would ever be able to make enough milk for my baby. She was a little reluctant to say for sure but indicated that it was unlikely. Some women with the markers of mammary hypoplasia - wide set breasts, different sized breasts, tubular shape, puffy nipples - are still able to produce enough milk, but most are not. For the first time, I had some answers! It was oddly comforting to know that I wasn’t alone.
After that appointment I had direction. I learned everything I could about IGT and low supply. I found a local low supply support group and I join low supply groups online. I read or re-read breastfeeding books. Side note: most books back then said that IGT or the inability to produce sufficient milk were very rare and almost everyone can exclusively breastfeed. I may have thrown one of those books across a room... I know now that the study used to support those statements has been basically debunked and chronic low supply is way more common than previously thought, though there is very little actual research on it. So, if anyone tries to tell you that everyone can breastfeeding or only 1-5% of women aren’t able to, feel free to send them my way and I’ll set them straight!
Dealing with Low Milk Supply
I tried just about ALL THE THINGS to make as much milk as I could - pumping, power pumping, supplements, cookies, medication (domperidone), and so on. I made my own low-sugar granola full of galactogogues (if only I had Milkful Nursing Bars back then!). Ultimately I made about 50% of what my baby needed and we combo fed with donated milk for a year. We got milk from my sister (who lived in another state), my friends, friends of friends, and through online milk sharing groups like Human Milk for Human Babies and Triangle Milk Share.
I was eventually able to find a peaceful place with low-supply. I was really grateful that I could give her some milk from me and even more grateful for the dozens of mamas who generously donated to us. I had a couple mantras that really helped me:
- Your worth as a mother is not measured in ounces.
- The way you feed your baby in the first year is only a small part of how you will parent them for the rest of your life.
When our breastfeeding journey came to an end, I was a little sad, but also I was also relieved. It had been hard. It was emotionally hard, physically demanding, logistically difficult at times (sourcing, picking up and storing SO MUCH donor milk), but it was also sweet and snuggly and so worth it.
What I Did Differently Breastfeeding My Second Child
When we decided to have another baby, I dreaded navigating breastfeeding again. At least I was going into it with more information and preparation. I found a lactation consultant that did home visits (I didn’t want to have to drive 40 minutes multiple times again). We did a prenatal meeting to talk about my previous challenges (during which I cried and cried and cried), come up with a plan for feeding this baby, and map out postpartum visits and support. Here is how I prepared for feeding a baby when anticipating low supply:
I sourced donor milk from moms with newborns to have on hand when our baby was born.
I started hand-expressing colostrum and freezing it to give to baby around 37 week.
I tried a couple of supplements that were safe in pregnancy, but they had unpleasant side-effects, so I decided not to take them.
I got little syringes for feeding if needed, but decided to spoon feed in the first few days, then use an SNS (supplemental nursing system - basically a tube taped to the nipple area that is attached to a bottle of supplemental milk or formula so that baby gets milk from mom, stimulates her supply, and gets needed supplement all at the same time) once we got the hang of things.
I decided that I would wait until around 4-5 weeks to see what I could make on my own with just some herbal supplements before taking medication again.
I also decided that I would pump when it was feasible, but I would prioritize sleep and self-care first.
- My IBCLC would do a visit on day 3 before we went to the pediatrician and then again at 1 week, 2 weeks and as needed after that (I got 6 visits completely covered by insurance - THIS SHOULD BE THE NORM!).
My second birth didn’t go as smoothly as the first (little stinker didn’t want to come out and I was induced at 42+1 weeks), but was overall good and without complication. I feel really lucky to have had two great birth experiences. Being in the hospital was a new experience and I had to do a lot of education around low supply and IGT with the nurses and lactation consultants there. Thankfully, no one gave us any trouble with using donor milk and we started supplementing in the first hour. Once we got home we used the SNS. It was around day 3 that breastfeeding started to REALLY HURT. What the heck! I knew this wasn’t normal, it hadn’t hurt like that with my first and I was having nipple damage. I’m so glad I had already established support before birth. My lactation consultant was able to help us identify the problem (a posterior tongue tie) and work on solutions (in our case chiropractic was enough to make breastfeeding comfortable again).
Finding Out About Low Prolactin Levels
My supply wasn’t up to where it had been with my first by week 4, so I decided to see my general practitioner to get some blood work done. My lactation consultant helped me determine what blood work to ask for: thyroid panel, A1C, prolactin, and some other things. That blood work was extremely illuminating! It showed that my prolactin levels were very low, nearly at non-lactating levels. Prolactin is the hormone that tells the body to make milk. It also showed that my A1C was on the higher end of normal, indicating that I probably have some insulin resistance (IR). There is some new research out that suggests IR can contribute to low supply. My doctor and I decided that taking domperidone (to increase prolactin) and metformin (to reduce IR) could help me make more milk. I’m so grateful that I have a low-supply literate doctor - they are SO RARE. I think it’s really important to note that any medications you are considering should be discussed with your healthcare provider. In my case, those medications, along with a low-carb, nutritious diet and lots of self-care, helped and I got back up to around 50% of a full supply.
Finding Gratitude in My Breastfeeding Journey
On the whole, our feeding journey was a lot easier the second time around. I was really lucky that I was teaching childbirth education at the time and knew a ton of lactating women. One of my students donated THOUSANDS of ounces of milk to us and our babies were only a couple weeks apart in age. I still feel overwhelmed with gratitude when I think about all the mamas who shared milk with us - it blows my mind. We ultimately switched to combo feeding with a bottle instead of using the SNS. I still had to use my mantras. I still cried and cried at times. The end of breastfeeding was still bittersweet. I was relieved to be done, but knew I would miss the sweetness of those quiet middle of the night feedings. Like the rest of motherhood, it was hard, but worth it.
So, if you made it through all of that, thank you for reading. I’m not going to lie, I shed some tears writing it. I think I will always feel some grief for the breastfeeding relationship I expected but wasn’t able to have. In a lot of ways that grief helps fuel my work now. I know, deeply, the pain of low supply. I want to help others who are struggling know that they aren’t alone. Whatever your journey looks like and whatever choices you and your family make along the way (even if they are different than the choices I made), know that you are not alone in facing challenges. Remember that your worth as a mother is not measured in ounces. No matter what, YOU ARE ENOUGH.
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