Conclusion: 'There's no use being a damn fool about it'

I started writing this journal just over a year ago, to work through my feelings about breastfeeding as I contemplated the possibility of feeding a second baby.  As the arrival of that second child draws nearer, I am finally able to bring these musings to a close.  And at this point I must confess that, in embarking on the process of writing, I thought I knew how it would end.  I had the final paragraph composed in my head, and I reproduce it here now:

‘I’, ‘could’, ‘not’, ‘breastfeed’.  Four little words that it took me a long time to allow myself to say together. Was I one of the estimated one in fifty who are physically unable to do so?  I have no idea – maybe, maybe not.  There are so many ‘what if?s’, so many unknowns.  As I contemplate the thought of feeding another baby, I know that next time I will be so much better prepared.  Those things I now wish I’d done differently, I will be able to do differently.  If it’s physically possible for me to breastfeed successfully, then I’m confident that I will manage it. I have a mountain of knowledge about breastfeeding, and it would be wonderful to complete that with the one piece of knowledge I still don’t have, a piece of knowledge that can’t be found in any books: to know what it feels like to nourish a child with one’s own body, to give suck and to know ‘How tender ‘tis to love the babe who milks me’.  But despite all this, despite all my efforts to succeed, if I’m honest with myself I must acknowledge that, deep down underneath it all I yearn, not to succeed, but to fail again.  Why?  Because if I go through it all again, doing all the things I wish I’d done first time around, knowing all that I now know, and still do not succeed, only then will I know that there was nothing I could have done first time around either.  And only then will I be able to look at myself in the mirror and say four more little words that I long to be able to tell myself: ‘It’, ‘wasn’t’, ‘my’, ‘fault’.

Thank goodness I no longer feel this way.  If there’s one thing I’ve learned in the process of writing this journal, it’s that none of this was my fault, and that the technical question of whether exclusive breastfeeding was ever going to be physically possible for me is entirely irrelevant to that fact.  True, breastfeeding is physically possible for all but 1-2% of mothers.  But I of all people should know that that physical possibility is not the only kind of possibility, or even the most important kind.  Aside from what’s physically possible, that is, what’s consistent with the facts about the physical world, there are (amongst others) the questions of what’s practically possible, of what’s rationally possible, and of what’s emotionally possible.  Even if breastfeeding is physically possible for all but 1-2%, it will not be practically possible for nearly so many. For many more it may be both physically and practically possible, but still not rational, to pursue a goal of exclusive breastfeeding at all costs.  Yes, all things being equal, breast is best, but all things are rarely equal and there are many other issues that may reasonably, on a purely rational cost benefit analysis, tip the balance of reason against breastfeeding in certain cases.  And perhaps what’s most important to remember, but easiest to set aside, is the bounds of the emotionally possible.  At the point I threw in the towel, continued breastfeeding certainly wasn’t consistent with the emotional state I found myself in.  We all have our limits, points at which we simply cannot take any more.  So I am finally able to say to myself what I will readily say to anyone who has faced that point where they just can’t see any way of going on: it wasn’t your fault.

And as to my thoughts about what happens next time?  Well, what I now realize is that I have absolutely nothing to prove.  So I will not go on at all costs.  I will not torture myself testing the bounds of the physically possible.  Instead, I will approach things with an eye to what’s practical, to what’s reasonable, and to what’s emotionally acceptable for me to do.  I choose to define my own success, and this time my success will be measured not by the amount of milk I produce, or the amount of hardship I endure to get it.  My goal is simply that I, and my family, emerge from the experience relatively unscathed, and with my sanity relatively intact.  And if we do, I won’t have failed.

One of the MOBI mothers has, as her email signature, a motto that I once thought of as encapsulating my approach to breastfeeding this new baby.  It’s from C.S. Lewis, The Voyage of the Dawn Treader.

‘My own plans are made.  While I can, I sail east in the Dawn Treader. When she fails me, I paddle east in my coracle.  When she sinks, I shall swim east with my four paws.  And when I can swim no longer, if I have not reached Aslan’s country, or shot over the edge of the world in some vast cataract, I shall sink with my nose to the sunrise’

A noble sentiment, perhaps, but this world’s no place for noble failures, and I have no intention of sinking in the single minded pursuit of this one little goal.  So I set it aside and turn instead to W. C. Fields for the motto I will try to keep with me this time around:

‘If at first you don’t succeed, try, try, again.  Then quit.  There’s no use being a damn fool about it.’

Part 12: '98 and 3/4 per cent guaranteed'

But there is a positive side to my obsession.  I read everything and anything I can find about breastfeeding in the hope of answering the burning question, what could I have done differently?  And in doing so I discover, in amongst the many myths and misinformation that goes around about what counts as ‘normal’ breastfeeding behaviour, myths that lead many to fall at needless hurdles when, with the right advice and information they could have carried on, what is perhaps the biggest myth of all – the myth that ‘anyone can breastfeed’.  Because when I really look into it I discover that what I thought I knew is wrong. For an estimated 1-2% of mother/baby pairs – perhaps as many as one in fifty of us - breastfeeding is simply impossible, for a variety of reasons.  Some of these are obvious ones: breast surgeries, infant palate problems, incompatible medications.  Some are less obvious: retained placenta, for example, can stop the appropriate hormones kicking in to get lactation going, so that the milk never comes in. But setting these cases aside, according to The Breastfeeding Answer Book an estimated one in a thousand women will be unable to breastfeed exclusively simply due to primary lactation failure.  That is, for no other reason than that their breasts can’t produce enough milk. One in a thousand women.  A small proportion, yes, but certainly not vanishingly small.  Not so small that it should be completely unheard of, unspoken of by breastfeeding counsellors, and unmentioned when things don’t go to plan.

Lactation, like almost any bodily function, is a complicated business. Not only does the machinery have to be there in the first place – the milk making glandular tissue – there needs to be something – in the form of hormones – to switch that machinery on.  Primary lactation failure is not very well understood, but in some cases there may be a problem with the switches (as, for example, in some thyroid disorders), in other cases a problem with the milk making machinery itself.   The causes of insufficient glandular tissue are various and not well understood, though the condition is often noticed in women with PCOS, and those with high testosterone levels.  For some women the lack of tissue is visually recognizable, in the form of hypoplastic breasts, which tend to be widely spaced and tubular, often asymmetric, with large areolas.  But breast hypoplasia does not always mean insufficient glandular tissue, and insufficient glandular tissue does not always present as hypoplasia. A woman’s breasts may appear quite full, but if this fullness is due to fat cells, rather than glandular tissue, it may still not be able to produce sufficient milk. Women with IGT experience little or no breast changes during pregnancy, will tend not to notice their milk come in, or experience any let down sensation, but again, in some women all of these things can be absent and still be no indication of a problem with milk supply.  But if lack of breast changes, sensations of milk coming in, or let downs in the mother are accompanied with dehydration and weightloss in a nursing infant, that’s some indication, however fallible, that the problem may be one of IGT.

As I learn about all this I of course wonder about my own case.  It’s complicated, given the tongue tie and the mismanagement in the early days.  But something I’d never understood is why I never felt my milk coming in.  At first I had thought this too was the tongue tie, as my son just wasn’t stimulating my breasts enough to produce milk.  But milk coming in is meant to occur as a result of giving birth, not of breastfeeding.  Even women who never once put their babies to their breasts will feel it happening. So why not me?  And why no letdowns, no sensations of filling or emptying, no changes in breast size during my pregnancy?  My breasts are not hypoplastic to look at – they are, you might say, quite buxom. But then I remember my teenage years and their first appearance, and how, conscious of their straight sided rather than nice rounded shape I used to joke with my friends about my ‘triangular tits’.  So is this my answer?  Is this why even with all that feeding and pumping my milk supply never increased.  ‘Do all this’, said the LC who’d cut the tongue tie, ‘and you will see your breasts producing more milk.’  I should have read my Dr Seuss: ‘And will you succeed? Yes! You will, indeed! (98 and ¾ per cent guaranteed.)’

I can’t know that it was IGT.  There are just too many variables.  But in preparation for the new arrival I join the mailing list of MOBI: Mothers Overcoming Breastfeeding Issues, and through that I am introduced to a world of mothers living with IGT and other severe breastfeeding challenges.  Some with diagnoses of IGT, some without.  But mothers who have gone through the heartbreak of insufficient milk with baby after baby, doing everything right and still not producing a full supply. Many of these women manage to continue to breastfeed, using supplemental nursers for long term at breast supplementation using formula or donor milk.  Most are on a cocktail of lactogenic herbs and drugs, spending all of their spare money on high doses of over the counter domperidone for the sake of increasing a pump yield, if only from 15 to 30mls a session.  Some are virtually housebound for the first six months of their baby’s life, not wishing to feed their child in public from a tube taped to their breasts.  These are some determined women (and I have to remind myself, never compare).  And from them I learn, not how to guarantee myself a full milk supply next time around, but how to make the most of what I may have, and how to prepare for the possibility that a full milk supply may not be possible. And just as I resign myself to IGT being the root of our problems, an LC posts on the list about upper lip ties and breastfeeding problems and I, together with many other MOBI mums, take a look at our babies’ top teeth and gums and discover yet another potential cause of our woes.  Undiagnosed abnormal maxillary frenum attachment – could it have been that all along?

So I don’t have any easy answers, but forewarned is forearmed, as they say, and the challenges I faced last time around mean I have plenty of warning of a myriad of potential problems.  In case of IGT, for my pregnancy I follow the MOBI regime of herbs to take in pregnancy to increase glandular tissue, to the extent that I am comfortable with doing so.  I am stocked up with galactagogues for after the birth too, together with lactogenic foods such as oatmeal and barley malt.  I have family in place to help with my toddler while I babymoon for the early days, knowing so much more about normal newborn nursing behaviour and the importance of skin to skin contact in stimulating prolactin receptors.  Through another UK-based MOBI mum I have the number of a private ENT consultant who knows about lip ties as well as tongue ties, and I’m ready to go straight to him if I suspect any problem.  And I have the number to call if I need to rent a hospital grade double breast pump (with a variety of flange sizes to try!), and a pumping halterneck at the ready so that I can pump hands free.  And knowing that one’s mental state too can affect one’s milk, I’ve even submitted to breastfeeding hypnosis – lying back with the headphones on and letting myself be told, despite my reservations, that, yes, my breasts will make exactly the amount of milk my baby needs.  Of course, I don’t know what challenges I’ll face this time around, but I’ll go in all guns blazing.

Part 11: 'It's not our fault if you feel guilty'

But that’s how I feel now, after a long time of wondering what should I, what could I, have done differently.  There’s an awful lot of ‘what ifs?’, and I don’t know whether following a different path would have made any difference to the ultimate outcome.  But I do know that much of what I was told to do was unhelpful, and I can allow myself a little anger at that. Two years ago, though, things felt very different.  As far as I knew, the advice I had been given on around the clock triple feeding was the right advice to get me back on the road to a full supply and my goal of exclusive breastfeeding.  And, as far as I knew, anyone could breastfeed if they just tried hard enough.  And yet there I was, formula feeding despite it all.  So the only conclusion I could draw from it all was that I had failed.  I hadn’t tried hard enough.

And if that’s what I thought about myself, I naturally assumed that that would be what any successful breastfeeder who saw me formula feeding my baby would think of me.  My first foray into the world of postnatal socializing did not help with this assumption.  I’d signed up for a baby massage course and our first session was when my son was 6 weeks old.  There were only two other mums in the class, one breastfeeding and one formula feeding.  As we sat and chatted at the start, the breastfeeding mum discretely nursing her baby girl, and me cuddling my son close to my breast as he sucked on his dummy (we’d introduced one the day I’d stopped breastfeeding), the third mum confessed what a failure she felt she was, because her daughter had never latched properly and consequently she was formula feeding her baby.  ‘Look at the two of you, with your calm babies happily breastfeeding.  That’s how it’s meant to be’.  I turned and showed her the dummy, explained how it hadn’t worked for me either, and was glad to be able to show this woman that she wasn’t alone in her grief. Later, as we all swap phone numbers while talking about our birth experiences, it turns out that the breastfeeding mum had a similar long drawn out birth story to myself, also ending with an induction drip and ventouse delivery.  ‘Gosh,’ I say, ‘well done you for establishing breastfeeding after all that.  I sometimes wonder if the difficult birth contributed to the hard time we had with it.’  ‘Thanks,’ she responds. ‘I suppose I was just determined’.  The words hit like bullets and I want to scream right back at her, ‘But I was determined.’  Instead, I just mumble a response, and accidentally forget to save her number to my phone.  Back home, as I sit licking my wounds, my husband reminds me that it’s all very well being determined when the milk is spilling out of your breasts.  But I’ve not yet learned the crucial lesson: Never compare. No one else has had to walk your path in your shoes.

As it is, my experiences colour the friendships I am able to make. When I meet other new mums I’m relieved when I discover them bottle feeding, and wary – and insanely jealous – if they put their baby to their breast.  I’m convinced that, on some level at least, the successful breastfeeders must see me with my bottles of formula and think to themselves, ‘There’s an intelligent woman.  She must have known breast is best.  She just couldn’t have cared enough for her baby to keep going with it.’  So I preemptively try to explain to all who will listen.  ‘I did want to breastfeed.  We tried really hard with it.  We just couldn’t get a milk supply established.’  I know what you’re thinking, but it’s not like that. You don’t understand. I do love my baby.  Just as much as you love yours.

At home, when left alone and to my own devices, I beat myself up incessantly.  And when I finally tire of beating myself up I go online and discover no end of people who are ready, willing, and able to do it for me.  At first I lurk the bf/ff debates silently, tears streaming down my face from behind the anonymity of the computer screen.  I hear people saying again and again what I’m assuming everyone who successfully breastfeeds is really thinking: ‘Anyone can breastfeed if only they try hard enough’.  I discover a league of women for whom ‘failure was not an option’.  A league of women who profess themselves to be sick of all the excuses they hear from formula feeders. ‘Why can’t they just admit to themselves that they weren’t willing to put the effort in?’ ‘Of course they feel guilty about their choices – so they should.’  And a league of women who, admitting that there are indeed some women (perhaps those who have suffered the misfortune of a double mastectomy) will genuinely not be able to breastfeed, will say, ‘Well if I was in that position I’d hire a wet nurse.’  They’ve read The Politicsand they think they know it all.  ‘Human milk for human babies; devil’s milk is not for me.’

After a while I can’t stop myself from answering back: ‘How can you say these things?  I went through this hell.  What more could I have done?’.  But my emotional outbursts, my endless attempts to explain myself, fall on deaf ears.  Some are ignored completely; others find themselves consigned to the dustbin of deleted posts.  Those that do merit a response are answered with ‘It’s not our fault if you feel guilty about your choices’, or, somewhat better in intention at least, a well meant variation on a Rooseveltian theme: ‘No one can make you feel inferior/guilty/shitty/judged without your consent’.  Well maybe so, Eleanor dear, but here I am feeling all those things nonetheless, and it helps me not one iota to know that, not only is it all my own fault that I didn’t succeed with breastfeeding my son, it’s also all my fault that I’ve allowed myself to feel this way when I read these things.  I’ll just add it to the list of things to beat myself up about.  It’s a compulsion, I readily admit.  As though I’m picking at a scar to make it bleed again and again.  I’m wounded, but I’m not ready to let myself heal. 

Part 10: 'We'll support you whatever you choose to do'

In fact, I now realize, there are lots of things that could have been done differently that might have made those early days go better.  For starters, the advice I was given in the first week or so was not only unhelpful, it was actually counterproductive.  Whereas I’d been happy to feed continuously to help my milk come in, there was the breastfeeding counsellor telling me I shouldn’t need to feed again once I’d offered both sides, and that any more would just make me sore, so when my son was desperate for milk the following nights I didn’t understand and interpreted his breast refusal as meaning he wasn’t actually hungry.  Whereas, if the state of my son’s nappies (hard pellets and urate stained urine) had been taken as they should have been, as a warning sign of a supply/transfer problem, we might have been able to up the feeding/skin to skin and move more quickly with the tongue tie referral, as it was I was simply reassured that everything I was experiencing was ‘Normal in breastfed babies’, and left to keep going as I was right until the moment of truth of weighing, and the desperate need to top up. 

As for the top up advice itself – while I understand the importance of making sure a baby isn’t dangerously undernourished, and making sure that they have the energy to be able to feed, I’m convinced that 30mls after every feed is much more than necessary for a baby whose blood sugar is still at safe levels.  I could tell, the first time I woke my baby to feed him after he’d had a formula top up, that he just wasn’t that interested in nursing – why would he be?  He’d had a whole ounce of formula only a couple of hours before, and was happily sleeping it off.  All that happened was that my breasts lost their chance of having any association with food, and for him were just an annoying thing to be woken for to nibble on, long before he was really hungry and ready for his bottle of milk.  In the meantime, I became more and more stressed about catching up with all the formula, losing all confidence in my milk supply.   If I had to top up again I’d use the SNS from the start to keep the breast/food association, would not top up every feed, and would allow my baby to wake naturally after any top up.  I also wish they’d suggested a babymoon as soon as the weight loss issue had become clear – far more chance of success then, rather than three weeks in with dwindling supplies and in the middle of a nursing strike.  And I wish the breastfeeding clinic had had more understanding of the realities of pumping.  The fact is that many women have difficulty letting down to the pump even if there is plenty of milk there in their breasts, but there are ways of increasing pump yields, e.g., through combining pumping with compression and hand expression, not to mention getting the flange size right.  Instead all I got was ‘Something’s wrong’, and another big knock to my confidence, with next to no guidance as to how to put things right.

Yes, there’s plenty I could have done differently had the advice been better, and it’s frustrating to say the least to know that I worked so hard following suboptimal advice, much of which might actually have been counterproductive rather than helping things.  I would like to complain, or at least to sit down with some of the people whose job it was to advise me and talk about where they could have supported me better. I have learned a lot about how breastfeeding works, how to avoid or overcome some of the problems I faced, and to be honest I’m angry at the amount of quite basic information I’ve been able to pick up from a few books and an internet connection, that was seemingly unknown to those people being paid by the NHS who I trusted to support me with this.  It’s not right that, to stand a chance of overcoming what are some fairly standard hurdles with establishing breastfeeding, you have to know more than the professionals do, and be willing to ignore much of what they tell you.  My hospital was awarded its stage 1 Baby friendly accreditation (policies and procedures) in November 2008, the month my son was born.  Its stage 2 assessment (staff education programme) is due this month, when I’ll be having my second baby there.  I hope that this means that in the meantime they’ve made some improvement, but to be honest I don’t hold my breath.  I hope I will one day sit down and write that letter of complaint – but it’s taken me two years to write even this, so realistically I don’t know if it will ever happen  Instead, when my midwife asks me what my plans are for feeding my next baby, I give her the potted version of my story and of why, while I’ll try my best to breastfeed, I don’t honestly have a clue what we’ll end up doing, and just bite my tongue and smile sweetly when she responds, ‘Oh well, you know we’ll support you whatever you choose to do’. 

Part 9: 'Today's the day I've given up breastfeeding'

It’s Sunday night, day 27, and the longest night of the year.  We’ve been at my parents’ house for dinner, and when we get home I feed Tommy and then get out the pump.  For once, though, I stay in bed rather than retiring to my pumping chair, propped up with pillows, and my husband stays with me while Tommy dozes between us.  We chat and I pump, and the time goes by, and before I know it I have about 25mls – my best yield ever.  Maybe it’s working? Maybe we’ve turned a corner?  It’s not been a bad day – Tommy has latched, he’s stayed on the breast, and though he’s had top ups it’s felt like he’s been feeding too.  Perhaps we’ll do it?  I go to bed feeling positive, and though we pump and feed through the night as usual, I think, ‘Perhaps tomorrow we’ll babymoon again?  Maybe it’s time?’  

Monday morning comes and I’m ready to go.  I let Tommy wake with hunger and put him hopefully to my bare breast.  But there’s nothing for him; he thrashes and screams and refuses.  ‘Shall I get the SNS?’ my husband asks gently.  ‘It’s not ready.  He’s desperate.  Just get the bottles.’  Tommy downs them both: the good and the bad.  And finally something snaps.  I can’t do it any more.  We can’t go on like this.  My son is four weeks old that day, and the thought suddenly strikes me: I only have six months of maternity leave before I have to go back to work, and one whole month of my six has gone by already.  Instead of enjoying my baby and treasuring our precious time together, I’ve spent most of this time chained to a breast pump, dreading the moment that he wakes and I have to struggle to feed him.  I’ll never get that time back, and I don’t want to waste a minute more in this nightmare.  It’s Christmas day in a few days, and I want to be able to enjoy our first Christmas together rather than worrying about how I can fit my pumping sessions around Christmas dinner.  So that’s it. I pack up the pump, the SNS, breast pads, and nursing bras, and become a formula feeder.

I’d like to say that I never looked back, but of course I did look back, a lot.  The day I decide to stop I initially feel liberated.  Tommy sleeps contentedly between feeds, falling immediately into a textbook 4-hourly routine, and I can finally start taking control of my life – and house – again.  The Christmas decorations come out at last, and I’m able to focus my attention on something other than breasts, that damn pump, and the measly bottle slowly filling in the fridge.   A funny thing happens from going cold turkey on the breastfeeding – some time in the afternoon my breasts feel for the first time a bit firm, and I’m shocked to discover (for the first and last time) a wet patch maybe the size of a 20p piece on my t-shirt over my left breast.  But that’s it for ‘engorgement’.  By the next day my breasts are back to their normal selves.    I finally have the time to phone friends and chat, and tell them it’s been hard work, but all feels a lot better since we finally decided to give up on breastfeeding.  But my oldest friend, who’s over from Australia, comes over for a visit, and when I tell her, ‘Today’s the day I’ve given up breastfeeding’, I break down.

And that’s how it is, for some time.  On the surface I feel great.  I have a gorgeous baby boy and I’m totally in love with him.  But then it hits and I’m in floods of tears again.  Christmas day is a disaster, and instead of our happy first Christmas together, as I sit at the dinner table the tears roll down my cheeks and onto my turkey.  Occasionally I wonder whether I should start all over again – try to relactate – and I unpack the pump or try in vain to put my son to my breast.  But although I continue to be able to squeeze out a single bead of milk from each breast (something that remains with me, it turns out, until I fall pregnant again eighteen months later), actually pumping is of course entirely unproductive and simply depressing, and my son is just bemused by my offering my breasts now he’s used to his bottles.

When the health visitor visits next and I tell her we’ve stopped breastfeeding she sees the tears in my eyes and makes me fill out the PND questionnaire – but the truth is that apart from those moments where I let myself think about it, I really do feel just fine.   She asks if there is anything they could have done differently to support me better, and to be honest, at that moment I really don’t know.  I feel as though there must have been things that could have been done differently, but I really don’t know what.  All that I know is that I did what they told me to as best I could, and in the end I just couldn’t keep going with it. What more is there to say? I failed.

Part 8: 'Why should you be different?'

Friday comes around, and I decide it’s time to babymoon.  My breasts have had the stimulation of my son’s nursing (with the SNS), plus regular pumping.  Tommy’s now used to latching again.  So for the first feed of the day, I decide, I’ll ditch the SNS and top ups, strip down to skin to skin with my son, and let him stay there feeding as long as he wishes.  My husband has to go to work, so he leaves us wishing us a lovely day in bed together, and for once instead of dreading it I am excited about my son waking for his next feed. 

Alas, the babymoon is a disaster.  Without the SNS Tommy won’t contemplate latching, and just screams and fusses.  Instead of some wonderful, bonding, skin to skin time, we’re both crying, frustrated, and distressed.  Eventually I admit defeat, run downstairs and get the two bottles: expressed (I’ve only managed about 10mls) and formula.  I don’t even have time to fiddle with the SNS as my son is desperate and the parts are all still in the sterilizer.  So I let him down the two bottles one after the other, and he finally falls asleep on my chest. 

A thought strikes me – I’m due my last community midwife visit before they discharge me.  I carefully ease Tommy off my chest and onto my bed, so that I can go and get a shower.  After all the screaming, and alone in the house with no one to take over while I wash, I don’t want to wake him, so I leave him in the same position, on his chest, in the middle of the bed, pulling up the duvet just to cover his back.  I rush off and shower, and manage to get into my dressing gown as the doorbell goes.  I run down and open the door and sit down with the midwife to talk about how I’m getting on. ‘Where’s the baby?’ ‘Oh, he’s upstairs sleeping – come on up.’  As I lead her up the stairs I suddenly realize what I’ve done – my son is asleep, stark naked apart from his nappy, on an adult bed, on his front, covered with a duvet, and surrounded with empty bottles of formula.  The midwife’s face drops when we go in - I must look like the worst mum in the world.  I try to explain what we’ve been doing and that he’s not always left like this, and she seems to buy it (or she just wants to sign me off and move on anyway). 

I tell her my newest plan for breastfeeding, hatched in the shower after the clearly failed babymoon.  I’ll continue to feed using the SNS, and just ditch the breastpump (I strongly feel the need to simplify one way or another, and all the time at the breastpump for mere drops is just getting me down).  ‘Oh no – you’ll have to keep pumping if you ever want to get back to exclusive breastfeeding’, she tells me.  ‘Even if you’re not getting much from the pump, your breasts are still getting the stimulation and the signals to produce milk.’ So much for that plan then – back to the round the clock triple feeding, even though I’ve been doing it for 16 days now non-stop, with no sign of my milk supply increasing.

So I keep going, trying to make sure my breasts are stimulated either with the pump or by feeding (with or without SNS) 12 times in every 24 hour period.  I find that Tommy will latch on without the SNS now, so more often than not I feed him like that (for an hour or so), before offering a top up bottle afterwards.  It’s the run up to Christmas, and the family are gathering, who all of course want to see the new baby.  I sit and feed feed feed, as they gather around and helpfully say things like, ‘Is he actually feeding?  He looks like he’s fallen asleep.’  ‘Oh look, he’s really woken up now he’s getting his bottle.  He’s enjoying that, isn’t he?’.  ‘What that boy needs is a dummy.’ On one occasion I’ve switch fed for a couple of hours while chatting with my aunt. ‘I’d better get his bottle’, I say. ‘Does he need one? I think he’s full up on you.’ God bless her for saying so, but still he cries and roots, and in comes my mum with the 90 mls which, sure enough, he downs with enthusiasm.

I’m an emotional wreck, and I change my mind from feed to feed about what to do and whether to keep going.  Why am I so bothered about this?  I obsess about the practicalities.  ‘I don’t want the hassle of having to make up formula all the time.  And how on earth are you meant to manage when you’re out and about? If I could even have enough milk that I could feed if I needed to when out, I wouldn’t mind doing some formula feeds at home.’  I tell myself I’m being practically minded, but the truth is that I’m filled with shame at the thought of formula feeding in public.  After all, a carton and a sterilized bottle, or an icepack with some premade milk – what’s so hard about that? What’s really preying on me is the thought of what people will think of me, whipping out a bottle to feed formula to a tiny little baby.  To be honest, thinking back on it, I’d never myself really paid any attention to how anyone around me has fed their babies.  It’s not something I generally registered, and I certainly didn’t give it any thought.  But for that time I’m sure that breastfeeding is the norm, and that getting out a bottle will guarantee me looks of icy disapproval.  (How wrong I was on that one!) 

My husband, I know, will support me in whatever I decide to do, but he finds it hard. I’m usually the stable one in our relationship, keeping him on an even keel, so he is freaked out by seeing his wife reduced to an emotional wreck, eyes red with tears and flip flopping every hour from optimism to despair.  He wants me to stop putting myself through it all, and tries to take the pressure off.  After every phone call with his mum, it seems, he comes along to tell me of yet another family friend or relative who couldn’t breastfeed.  ‘Plenty of women can’t breastfeed.  There’s no shame in it.  Why should you be different?’  ‘But I am different,’ I want to say.  ‘I’m tough.  I’m determined. They were weak.  They didn’t try hard enough.’ It brings me no comfort to hear yet another story of someone who tried and failed; I don’t want to be just another one of their number. After all, I know that anyone can breastfeed.  It’s just a matter of toughing it out.  So I keep on and on, setting alarms, feeding, pumping, strapping on the SNS, sterilizing, sterilizing, sterilizing, through night and day until something improves.

Part 7: 'I thought breastfeeding was meant to be a natural thing'

We get home on Wednesday afternoon and I start pumping.   Although I’d never actually stopped breastfeeding since my baby was born, I’m basically on a relactation schedule – trying to stimulate my supply as if from scratch, as though I’d never nursed at all.  My husband does Tommy’s bottle feeds so that I can stay at the pump.  By Friday morning, after sticking to my strict 2 hourly pumping schedule around the clock, I have a single bottle with about 55mls of blood, sweat, tears, and Lansinoh cream mixed in with my expressed breastmilk. The Health Visitor comes to see me for the first time, and I tell her what we’ve been doing to build up my supply.  I proudly let her know that I’ve almost got a full feed’s worth, and that after my next pumping session I should have enough to give Tommy breastmilk rather than formula at his next feed.  ‘I’m sorry, but you really can’t do that – some of that milk has been in the fridge for longer than 24 hours – it isn’t safe.’  Then she helpfully informs me that if I find I have too much milk I can freeze it and it’ll keep for longer (WTF!).  She leaves, and the product of approximately 16 hours of pumping over a 32 hour period is poured (needlessly, I later discover) down the drain.

So I keep going, but never keep my fridge bottle for more than 24 hours.  I never see such a full bottle again – a 24 hour period can get me 30-40mls on a good day, so Tommy gets that at one feed a day, followed by a formula top up.  My nipples improve, and I’m eager to get Tommy back on the breast, but when I try this he’s not playing ball – he screams and thumps and pulls away, or he’ll latch for a few seconds and then pull away in distress.  I keep notes of every feed: what time, how long fed for, how much pumped, how much top up drank.  More and more often it reads ‘Feed: refused; Pumped: trace; Top up: 90mls’.  How am I ever going to catch up with all that formula? I try to get him to latch at every feed, wrapping him in a muslin straightjacket the way that the first breastfeeding counsellor showed me, so that he cannot punch or pull away.  The muslin I use for this is covered in blue stars, and wrapped around him he looks like a little superhero.  We try and we try and it breaks my heart.

Tuesday comes around again, day 22, and I return to the hospital feeding clinic.  Tommy’s barely latching for more than a few minutes if at all, and my 2 hourly pumping is still unproductive (if I’m lucky, I can produce around 5-15mls in a session; sometimes I can barely cover the bottom of a Medela bottle).  We try to get Tommy to latch while we’re there, but he’s having none of it.  The feeding support midwife feels my breasts and tells me, ‘Yes they do feel pretty empty, don’t they?’  I ask if they can prescribe me any drugs to increase my supply – I’ve looked online and heard that there are some things available, such as domperidone, but she tells me no, that they don’t prescribe anything, that all they can suggest is plenty of skin to skin and a babymoon (‘cancel everything’ - as if I was otherwise keeping up a hectic social schedule – ‘go to bed with your baby and just feed and feed and feed’).  But if that doesn’t work, she says, there’s really nothing left you can do – he won’t latch on and feed himself, you can’t get anywhere near enough to feed him by expressing, so what can you do except throw in the towel?  ‘11 out of 10 for effort’, she tells me, ‘but for some reason it just hasn’t worked for you’.

I disagree – I’d done a bit of research online and had ordered myself a Supplemental Nursing System (SNS) from Medela.  This is basically a feeding bottle on a string that you hang around your neck, with two lengths of tubing that you stick to each breast with scotch tape.  It’s meant to enable you to feed formula without causing nipple confusion, and while still stimulating your breasts to produce milk.  Surely this would work?  The SNS was initially invented for the use of adoptive parents who wanted to breastfeed, to enable them to get enough of the right kind of stimulation to build up a milk supply despite having never even given birth.  I had the advantage of having some supply already – if others could get to a full supply from nothing using the SNS, surely I’d be able to build up my partial supply this way?

The SNS arrived the next day, and excitedly I fiddled about with it, taped myself up, and put Tommy to my breast.  Success!  With the milk coming down the feeding tube he stayed latched for a full feed, taking his top up milk from the SNS, but also (I presume) taking breastmilk alongside it.  Over the next couple of days I use the SNS at each feed, four-hourly, and keep up with pumping at 2 hourly intervals. My sterilizer goes into overdrive with all the new bits to sterilize, to the extent that I break the microwave with overuse and have to send my husband out in a panicked search for a new one.  I’m so pleased with the success of the SNS (the fact that my son will stay latched on for a feed at all), but it’s not always easy to get him to latch, and it’s an incredibly fiddly business – we both get quite covered in formula in the process of latching him on.  My husband is quite freaked out by the sight of me feeding my son with tubes strapped to my breast (‘I thought breastfeeding was meant to be a natural thing.’)  I’m also, as he kindly points out, behaving rather like a rather desperate breastfeeding addict – bags under my eyes, surrounded by milk paraphernalia, and always fretting about where the next feed is coming from.  I’m keen to move on from the SNS as soon as possible.

Part 6: 'If you keep at it you'll soon find the bottle filling up'

On day 15, the hospital feeding clinic comes around again, so I go along to let them know how I’m getting on.  By this point my breasts are in quite a state from all the tongue-tied feeding, and the blisters from pumping, and I’m disappointed in myself that I’m using nipple shields, stretching out the time between feeds, and not always managing to feed on the most painful side.  The usual feeding support midwife is away, so I see a different one who is shocked to discover what I’ve been putting myself through – she actually has tears in her eyes when she sees the state my nipples are in, and when I confess my slips in the feeding schedule, she tells me that no one would expect me to have continued with around the clock feeding and pumping as I had done given the trauma to my breasts.  She thankfully gets straight on the phone to the tongue tie clinic to recommend that they go straight for the snip (they apparently usually have one appointment to assess the baby and talk over the operation, and then a later one a week later if you decide to go ahead).  I’m so pleased – I just have to make it through one more day of painful feeding, expressing and top ups, and then things will start to improve.  My son will be able to feed more efficiently and without chewing my nipples off, and I’ll at last be able to build up my supply.

We’re lucky that there’s a midwife in Chester who’s trained to do tongue tie operations for babies who are having trouble with breastfeeding.  A lot of people have to fight for this operation and travel far to get it.  (And even though Chester is just down the road from us, we still have to pay £50 for the consultation, as we are outside the catchment area for the hospital.)  It used to be that midwives would cut tongue ties routinely just after a baby was born (sometimes, apparently, just with a sharpened fingernail!), but when breastfeeding rates went down so did this practice, and nowadays there are still many doctors who see it as unnecessary mutilation.  It’s true, tongue ties don’t always interfere with breastfeeding, but many women with tongue tied babies do have problems with constant feeding, painful feeds, mastitis, or low milk supply due to inefficient suckling, and it’s ridiculous that in most places people have to wait until feeding has become a clear problem before they can even be considered for the snip. 

The midwife – a trained lactation consultant – talks us through the ‘operation’ – in fact, just a quick snip of the frenulum with sterile scissors, without even using anaesthetic (when it happens, Tommy cries less than he did for his heel prick test).  But mostly she talks us through the hard bit – what we’ll need to do to get breastfeeding back on track and build up my supply once the operation has been done. We tell her the schedule we’ve been on so far, and I confess to having slipped so that we’re often going four hours between feeds rather than three.  I tell her about the long pumping sessions and how I never manage more than 15mls, and she says that that’s probably as much as my breasts are holding at the moment.   I’ll need to do some serious work to build my milk supply up, and she gives me some expert latching tips, explains how to use breast compressions, together with switch and ‘super switch’ nursing.  She reminds me of the importance of skin to skin, and shows me how to hand express properly (she’s appalled when I maul at my sore nipples the way they showed me in the hospital).  I’m so excited when she manages to get a single spurt of milk to come out of my left breast – having only ever experienced tiny drips myself.  ‘That’s your let down happening all over my desk!’ I love this woman – she makes me believe that yes, the milk is really in there, and now the tongue tie is dealt with it’ll at last start coming out.

As well as finally understanding hand expression, at long last I finally get given some helpful pumping tips, such as switching breasts when the supply slows from one and then switching back again when it’s ready to ‘let down’ again.  Unfortunately at the moment this is purely theoretical for me – pumping has only ever produced droplets very slowly, and I’ve never experienced any feeling of let down.  But I take it all in because I’m convinced that once Tommy is able to suckle properly my supply will begin to improve and I will start getting more milk.  We talk about feeding schedules and, given the state of my nipples, she suggests that I give them a rest from feeding for a couple of days and just pump pump pump to build up the supply.  She says that I’ll need to keep up at least 12 sessions in each 24 hour period to start seeing improvement in my supply, but that if I do this (even if for some of those I just pump for 10 minutes on each side) I will see myself producing more milk.  And she points out that it’ll be a long slog – that it can take as long as the supply has been in jeopardy to build it up again, so if we assume that my son never really managed to transfer milk well, with a 16 day old baby that could mean another 16 days of hard work before we’re back to exclusive breastfeeding. 

I understand all this, but I’m happy – I’ll pump and pump around the clock for as long as I need to, as long as there’s an end in sight, and the thought that in another couple of weeks I could have enough milk to feed my baby and ditch the formula completely is enough to keep me going.  16 days will take me just past Christmas – if we could be back to exclusive breastfeeding by then, that would indeed be the best Christmas present I could give him.  So I agree that we’ll feed Tommy formula four hourly (60-90mls), and I’ll pump 2 hourly around the clock to build my supply while my nipples recover.  And to save me a little bit of sterilizing she suggests another trick – collect my expressed milk from each pumping session and keep it in a single bottle in the fridge. When I’ve got enough for a single feed, I can give it to Tommy at his next feed instead of formula. ‘You may find at first it takes a while to get enough, but if you keep at it you’ll soon find the bottle filling up more quickly, as your supply starts to increase from all the stimulation.’  After a couple of days I will go back to feeding Tommy at my breast before topping him up, and as my supply builds up I will cut down on the top ups, and eventually eliminate them.

Part 5: 'Don't begrudge him his little drink of milk'

I ask a visiting midwife about the pumping blisters I’m getting, but she doesn’t know why this should be happening.  I ask what I can do to get more from the pump and she can’t tell me, though she does manage to reduce me to tears by helpfully letting me know that some women never get their babies back to the breast, and end up pumping exclusively to feed their babies.  Aside from the fact that I’m only getting drops, I really don’t want to be an exclusive pumper.  I hate pumping with a passion, stuck in my chair on my own, chained to my breastpump while someone else enjoys cuddling and comforting my baby.  This isn’t, for me, about providing breastmilk for my son; it’s about breastfeeding, and if I thought that after all this I wouldn’t be able to get my son back to my breast I’d stop right now.  My three states during all this time are: feeding, pumping, and sleeping. For the hours on end I spend attached to the pump I come to hate the rhythmic sound of the sucking action.  I think I sound like Darth Vader, and shudder at the thought of my son coming to associate this noise with his mother.  ‘But you won’t have to pump all the time’, my husband reassures me.  ‘The difference between you and those other women is that you’re determined. If you want to breastfeed you’ll breastfeed.’ 

I later discover that a different flange size might have sorted the pumping blisters at least, and may even have helped with the amount I could pump.  I also find out that using compressions when pumping, and hand expressing at the end of each pumping session, can make a big difference to the amount of milk removed, and can thus increase supply more than pumping alone.  I kick myself, when I look back, for not getting hold of a pumping bra so that I could at least do it hands free and have some semblance of freedom when I was pumping, but as it is I am pinned to whatever chair I’ve landed in, holding the pump to my breast and staring at the results as the drips make their way into the bottle.  In my ignorance, then, I just smother myself in Lansinoh cream and try my best to feed, feed, feed, and pump, pump, pump, through the pain.  For some feeds, alas, I simply have to skip my worst, right breast, and just feed from the left – it’s the only way I can face latching at all, and even then I’m dreading the moment my son wakes up.  On occasions, I even resort to the dreaded nipple shields – I know I shouldn’t, but with the blisters and chewed nipples it’s sometimes the only way I can manage a latch. 

During this period it feels like one step forward, two steps back: one feed I’m happy because when my son is finished there are signs of some milk in the nipple shield; another I have to stop in pain after a few seconds, only to find the nipple shield completely filled with blood.  On Thursday evening (day 10) I’m delighted to feel some changes in my breasts, the first time since giving birth that I’ve really noticed any sensation in them at all (apart from pain).  But there it is, as I sit pumping and watching a DVD, a momentary flicker of something happening under the surface, as though they may be finally starting to fill.  But continued pumping sessions still fail to produce more than about 15mls, and they soon go back to feeling like empty sacks. 

During this whole time I am convinced that it is Tommy’s tongue-tie that is the problem, and that his inefficient sucking has meant my breasts haven’t been stimulated enough to produce milk, so I assume that the feelings of filling up on Thursday are the result of all the pumping, and this makes me determined to pump even more. (Looking back, though, I wonder if those feelings were my milk finally coming in – I now know that, despite what the breastfeeding counsellor told me, this can take up to ten days to happen.  If I had stopped the top ups and pumping then, would my supply have become established, I wonder?)

In fact, on day 11 (Friday) I did try giving up the formula top ups.  The breastfeeding counsellor visited that morning and noted that Tommy had been putting on weight and was now getting wet and dirty nappies (his first soiled nappy since Saturday morning had come on the Wednesday, the day after his first top up bottles), and that he appeared to be latched well and contented.  So why not ditch the formula?  (I did point out that I’d been told at the feeding clinic to keep on with the formula until I could get 30mls through expressing, but she dismissed that idea, to my delight, so for the next couple of feeds I just breastfed and pumped.)  While the feeding counsellor was with me, one of the community midwives visited too and they chatted amongst themselves about all the feeding problems they’d experienced. ‘I could write a book, given all the things I’ve seen’, the feeding counsellor announces, though what she’d say in it I still don’t know.  ‘Just the other day I attended a terrible case.  The baby had stopped having soiled nappies and was passing urates – I sent the husband out myself to buy formula.’  Passing over the fact that this was exactly the situation I had been in just a few days before, when I’d been told by the hospital that ‘That’s normal in breastfed babies’, I just smile and say, ‘Tell her it does get better.’  After all, I’d just been told I could ditch the formula – we’d passed the danger zone and could get back to breastfeeding normality.  I was delighted.

The trouble was, though, that later that day Tommy was weighed again he had actually lost weight since Wednesday’s weigh-in.  My husband begged me to go back to formula top-ups, just until we could get Tommy’s tongue-tie sorted out – he’d gone from the 40^th centile to below the 9^th; we knew that the tongue-tie could be stopping him from getting milk; and to be honest neither of us had that much confidence in the breastfeeding counsellor by this point anyway – she said he was latched well and appeared contented on her previous visit too, but in fact he was becoming dehydrated and losing serious amounts of weight, so why should we think that anything had improved this time? My mum took me aside: ‘Don’t begrudge him his little drink of milk.’ How could I? At any rate, our appointment had come in to have Tommy’s tongue tie assessed the following Wednesday (day 16), and so I clung to that as the target I had to aim for, and agreed to stick to the triple-feeding (breastfeeding/pumping/top-up) regime until then.

Part 4: 'Oh dear, something's wrong'

The weekly hospital feeding clinic was thankfully held on Tuesday mornings, so that morning we dragged ourselves back to the hospital, together with the newly purchased Medela Swing breast pump, for advice on feeding and pumping.  The feeding consultant looked at Tommy’s tongue tie, observed a feed (lying down, as I still could not sit comfortably), and then set to work showing me how to use the pump. For this, she insisted, I had to sit up in a chair, so I made myself as comfortable as I could, stitches permitting, and she showed me how to massage my breast and begin to hand express to start things off. Then I pumped – and pumped – and pumped – for about 40 minutes while we chatted, and while she sorted out a referral to another hospital where they would be able to look at Tommy’s tongue.  (At this point I was convinced it was the tongue tie that was causing all of our problems.  Although he seemed to latch well, he just couldn’t be sucking efficiently enough, so I assumed.)  Finally, we looked at the pump and the fruits of my pumping – 5mls – about a teaspoonful.  ‘Oh dear, something’s wrong – you should be able to manage more than that.  I’m afraid you’re going to have to give him some formula, at least until you can pump some more.  Feed him three-hourly, then give him whatever you can pump, and then make that up to 30-60mls with a top up bottle of formula.  You’ve got to let this poor lad know what a full stomach feels like.’  ‘How long do I have to do that for?’ ‘For as long as it takes – until you’re producing enough milk that you don’t need to make up the top ups with formula, and until he’s gaining weight.’

So that was that.  We went home. I gave Tommy a breastfeed, then the teat-full of milk that I had expressed at the hospital, and then finally my mother (who had answered the call and rushed over with some ready made cartons of formula) brought over the dreaded top-up bottle of 60mls of SMA Gold.  ‘Perhaps you’d better give it to him?’, I tentatively suggested. ‘I’ve heard that babies sometimes won’t take to a bottle if they can smell their mother’s breast milk.’  (As if he could smell anything from my woefully dry breasts! – The truth was I just didn’t want anything to do with feeding him that horrible stuff.)  ‘I think it would be better coming from you’, she gently urged.  People say that reaching for formula is the easy option, but that first formula feed was one of the hardest things I’ve had to do as a mother.  I held him virtually at arm’s length, and could barely look at him as he glugged down the bottle and looked full for the first time.  Finally left alone, I found myself kneeling at the side of Tommy’s Moses basket as he slept a deep, full bellied sleep.  ‘I’m sorry.  I’m sorry.  I’m so, so, sorry.’ I repeated as the tears streamed down my face.  I felt as though I’d failed him utterly.

That was Tuesday afternoon.  From then on, until further notice, I was on a strict schedule:  Wake Tommy.  Change nappy so he’s no longer sleepy. Breastfeed for 40-45 minutes.  Get husband to collect the bottles of good (expressed) and bad (formula) milk from the fridge, and to bring up the breast pump pieces from the microwave steriliser. Hand Tommy over to husband who offers first the good and then the bad milk, winds him, and puts him back down to sleep.  Attach breast pump and pump for at least 20 minutes on each side (longer if I can bear it).  Take bottle of freshly expressed milk (5-15mls), breast pump pieces, and the two used bottles down to the kitchen.  Put expressed milk in the fridge and wash and sterilize the used bottles and breast pump pieces.  Set my alarm for three hours since the start of the previous breastfeed.  Sleep for the hour or so that remains (or, if it’s daytime, do such essentials as washing, eating, receiving guests, ...). Start over.  When I can, I read up on whatever I can find online about milk supply, and send my husband out for galactagogues.  I start popping fenugreek capsules and eating porridge, plus (as recommended by the NHS breastfeeding consultant, who says ‘someone told her’ it was good for increasing milk), shedloads of papaya.

I manage to keep to this strict feed/top-up/pump schedule for 48 hours, after which time I start slipping.  Sometimes I let Tommy go for four hours between feeds.  Sometimes my pumping sessions are curtailed or missed completely due to such requirements as eating meals (my husband vetoes my request to be allowed to continue to pump at the dinner table), a visit to my parents (I take the pump, but a 20 minute car journey means the schedule starts slipping and the sessions are not so long as they should be), or a walk to the shops (my husband insists I leave the house for this purpose one day, just to get some air, but all I can think about is the pumping time I’m missing).  Worse than this, the state of my nipples goes from bad to worse – the breast pump leaves blisters around my areolas, and Tommy’s tongue-tied latch means they’re chewed and bleeding badly. My flat nipples have, it seems, been pulled out from all the feeding and pumping, but my right nipple emerges from each nursing session squashed and flat with a horizontal line splitting it across the middle, and eventually the bottom half of my newly formed nipple simply gives up the ghost and falls off.  The up side, if there is one, is that I finally have a use for all those breast pads – they help to keep the blood stains off my bras.  

Part 3: 'perfectly normal in breastfed babies'

And so I continued, oblivious to any problems with feeding.  Friday night was a struggle – my son screamed continuously from about midnight to 3am.  I tried to latch him and feed as I had the night before, but he was fretting and wouldn’t latch on, or would latch for a few moments and then pull away. At any rate, given that he’d had a full feed from one side before all this had started, I didn’t really think it could be hunger, given my discussion with the breastfeeding counsellor that day, so I paced up and down the stairs, sang to him, patted and comforted him, and he eventually fell asleep on my husband’s chest as he had done the night before. 

Tommy had only the tiniest pellet of (still dark) poo in his nappy on Saturday morning, and nothing since, and by Saturday evening we noticed what looked like brick dust in his nappy.  Concerned, I phoned the labour ward, and was told ‘That’ll be the urates in his urine.  Don’t worry, that’s perfectly normal with breastfed babies.’  Nevertheless, they offered to send a midwife out the next day to set my mind at ease.  Saturday night was a similar affair to Friday, despite my having turned down the spinach and broccoli on offer for dinner in case my son with his night time screaming was already suffering from colic (!). When the midwife arrived on Sunday and I showed her his last, stained, nappy and single hard pellet of dark poo, she reassured me, ‘Don’t worry, that’s urates alright – perfectly normal in breastfed babies’. I pointed out that he had vomited what looked like blood – was there something wrong with his stomach?  (He’d never, of course, brought up any milk.)  ‘Not at all – most likely you’ve bled a bit when you’ve fed him and it’s that that he’s bringing up.’  Of course – my nipples were a bit sore, but I hadn’t given it much thought as I knew that was to be expected, and when I checked I saw that there had indeed been some bleeding. Finally I told her of Tommy’s late night crying sessions and, in desperation, asked whether it would be alright to give him a dummy – of course she answered that it wasn’t, not if I wanted to breastfeed.   But at no point did she suggest that the crying was hunger, or that I should be feeding any more than I currently was. So on Sunday night, none the wiser, we went through the same thing again – a distressed newborn screaming from midnight until about 3am.  This time, though, my husband and I had agreed (under advice from my parents, who had after all brought up three breastfed children successfully) that once Tommy did get to sleep we’d let him sleep rather than waking him for a feed that night – perhaps, they thought, all he needed was to be left to establish his own rhythms, rather than this constant waking for regular feeds.  He went 5 hours between feeds that night, something I still feel terrible about given what was to come.

Monday came around. My son was one week old, and the midwife came to weigh him for the first time.  Before he was weighed we went through the usual questions – ‘Plenty of wet and dirty nappies?’ – ‘Well, no soiled ones since Saturday morning, but he is passing urine – we can tell because of the urate stains.’, I breezily responded.  Then she put him on the scales, got out her calculator, and my universe shattered: he had lost 12.3% of his birthweight.  ‘I knew this was going to happen as soon as you told me about his nappies.  Didn’t you notice him losing all that weight?’  Failure to thrive – how couldn’t I have noticed?  I crumbled. 

Out came a chart, with instructions for what to do if the weight loss is 10-12%, and for 12%+.  As Tommy was on the border of these, the midwife went through the 10-12% regime with me: feed three-hourly and top up after every feed with 30mls of expressed milk or formula. 'Do you have a breast pump?' 'No, but I’ll get one.  But what if I can’t express 30mls?’  ‘Of course you’ll manage 30mls.  It’s really not that much’.  And the procedure for weight loss over 12%?  ‘You’d need to go back in to hospital to have your baby assessed for dehydration – I’ll have to check whether that applies in your case, as you’re just on the border.’  The call came through a couple of hours later – ‘Come in, as soon as you can, to children’s A&E – they want to do some blood tests.’ 

So we dragged ourselves in for what turned out to be a stressful and fairly pointless evening in A&E.  On the journey there I looked out of the window to see a bright bright star next to the crescent moon, just a sliver, like I’d never seen it before. I later discover that this astronomical event is a conjunction of the moon, Venus, and Jupiter, but in my distress I fancy that the star is waiting for Tommy, my perfect little fighter, who I’ve somehow allowed to waste away. On some level, I’m convinced I’ve lost him, that I’ve messed up on my one chance with this special gift, and that I’m going to have to send him back.  At the hospital, we wait and wait for the tests, and then again for them to be re-done as the nurse hadn’t managed to collect enough blood from Tommy’s heel prick first time around.  My stitches are throbbing and I can’t sit on the uncomfortable plastic chair in the room they’ve left us in to feed Tommy (who’s not yet had any top ups as I haven’t had a chance to open the breast pump my parents have helpfully rushed out and bought for me).  In the end I hoist myself on to the bed in the room we’re in, and feed him lying down while we wait. Eventually the tests for dehydration come back thankfully OK, and I am sent away with the 10-12% top up instructions, and information about the hospital’s feeding clinic.  When we get home we’re exhausted, so I decide just to feed as best I can overnight without starting the expressed milk top-ups, and to leave the pumping for the next day (Tuesday).

Part 2: 'Has your milk come in yet?'

At home, my son remained sleepy and I continued to wake him for feeds, 3-4 hourly (despite protestations from helpful family members telling me it was cruel to wake a sleeping baby).  My mother had breastfed all three of her children back in the 1970s in the heyday of 4-hourly schedules, and of hospitals feeding sugared water in the night to give the mothers a break.  She must have been a Jersey cow – she used to struggle to keep my older brother feeding for the requisite 5 minutes on each side, and by the time she brought him home from hospital at ten days old he was a bouncing baby who was sleeping through, having realised it wasn’t worth his while waking up at night just for sugared water.  (I think I must have inherited my breasts from my dad!)  So she was rather dismissive of my own insistence on waking my son to feed every 3 hours.  When a visiting midwife pointed out that Tommy had jaundice, though, I became all the stricter about waking him for his feeds 3 hourly during the day (4 hourly at night), despite all the tut tuts from the grandparents.  Once he was awake he seemed to latch on well, although it was painful at first, and though I did get the inevitable sore and cracked nipples, I continued to feed happily knowing that they would improve with time.   

I had enthusiastically agreed to a visit from the local NHS breastfeeding counsellor, who came the day after I’d arrived home (Wednesday).  Tommy was asleep so we just had a nice chat about breastfeeding – its benefits, of course; some techniques and tips; and its history, during which time she told me that, while I’d hear people of my parents’ generation saying ‘I could not breastfeed, I didn’t have enough milk’, that’s just because breastfeeding wasn’t so well understood back then, and people didn’t realise that it was all about supply and demand, so they didn’t feed enough to get their milk supplies up.  In fact, she said, we now know that anyone can breastfeed – it’s just about allowing the baby to feed enough to stimulate the milk supply.  I ask her about my son’s tongue-tie – this hadn’t been noticed in the hospital, but I’d noticed it since, and I wondered whether anything should be done about it.  ‘Well, I think there are places you can get it cut if it causes a problem with feeding – but there’s no reason to think that it will, if he’s latching on OK.’ He seemed to be latched well, so anyone who’d checked said, so that was that.  As my milk hadn’t yet come in, she told me all about the engorgement I may feel in the next couple of days and how to ease engorged breasts with cabbage leaves, and promised to return later in the week to see how I was getting on.

By Thursday morning I was a little surprised that there were still no signs of my milk coming in (Tommy was born on the Monday of that week), but I continued to feed confidently.  He was still getting dirty nappies, but his stools had become more solid and hadn’t really changed colour from the black meconium he’d passed in the hospital. However, the visiting midwife didn’t seem to see any problem with this, so I thought nothing of it.  Thursday night was a bit of a shock, though, as instead of his usual routine of feeding for 45 minutes then dropping off to sleep, my son fed continuously from 11pm until 3am (he’d drop off from the breast he was on having dosed off after about 40 minutes feeding, then would wake up crying and rooting, so I’d just shift sides and start again on the other side).  Although I was taken aback to be feeding for so long, I actually really enjoyed the time I spent that night just gazing at my perfect new baby as he made adorable little faces for only me to see.  At 3am, though, he was still wakeful and crying, so my husband took him and was able to get him off to sleep on his chest without any further feeds.  He couldn’t possibly still be hungry, I naïvely thought – perhaps he was just tired and needed some help to drop off. 

Friday saw the return of the breastfeeding counsellor, who asked if my milk had come in yet.  When I said that it hadn’t, she helpfully told me that it must have come in by now, and that it could come in without any feelings of engorgement.  I told her about my marathon feeding session the night before, and how I’d gone with the flow as I thought if nothing else it would help my milk come in, and she said ‘Well I can tell that you’ll have no problem with breastfeeding, if you’re willing to take your baby’s lead that way’.  But in the very next breath – ‘Still, he shouldn’t really be hungry if he’s had a full feed from both breasts – and if you keep feeding him continuously like that, you’ll just get sore’.  She helpfully explained to me how to break the suction to bring an end to a feed if I thought my son had stopped feeding and was just sucking for comfort.  Then, ‘How about nappies?’, she asked, ‘are you getting plenty of wet and dirty nappies, and are his stools changing colour?’  ‘Well we’re not having so many dirty ones now, and his stools haven’t really changed colour, though they’re getting much more solid, but we are getting wet nappies.’  Naïvely, as a first time mum I add, ‘It’s so hard to tell with disposables whether they’re wet though, isn’t it, because they absorb the moisture so well?  But I can tell they’ve been wet as I can see that they’re stained.’   Looking back at this exchange I can’t believe that alarm bells weren’t ringing – no feelings of milk coming in; previous mention of tongue-tie; solid dark poos; and stained but otherwise dry, nappies – surely a trained breastfeeding counsellor should have picked up on a problem at that point? 

As it was, later that day when my mum asked (for the umpteenth time) ‘Has your milk come in yet?’, I answered ‘Well I don’t feel any different, but apparently you don’t have to feel anything for it to have come in, and the breastfeeding lady says it must be there by now’, and as far as I was concerned, that was that.  We chatted, as I fed Tommy, about the interesting things the breastfeeding counsellor had told me about the history of breastfeeding, about supply and demand and how anyone can breastfeed.  ‘That is interesting’, my mum responds, ‘You know M?  She always says she didn’t have enough milk, but can you imagine her sitting down patiently enough like you are now spending all of that time feeding?  She just wouldn’t have the temperament.’  I tell her of my friend, S, who gave up on breastfeeding early on because her nipples were so sore that her daughter was getting mouthfuls of blood with her breastmilk.  ‘Of course, they say to keep feeding, and that there’s nothing wrong with them taking in a bit of blood,’ I say, ‘but it must be hard to see that happening and to keep going.’ On to my mother-in-law who, my mother has noticed, keeps repeating that ‘The problem with breastfeeding is that you don’t know how much they’re getting.’ ‘She can’t have breastfed, can she?’, my mother asks.  ‘No one who’s breastfed a child would think that way – of course you can tell that they’re getting plenty from you.  You only have to look at Tommy there and see he’s feeding contentedly.’  In fact my mother in law did breastfeed my husband, though the details of how long for are lost to history – she’s very vague about it and I don’t wish to probe.  At any rate, sharing a few more stories of people who didn’t make it with breastfeeding, my mother and I sympathise and agree that it must be a very emotional thing not being able to provide nourishment for your own child.  But looking at Tommy suckling away happily I sit back smugly and congratulate myself on having made it into the sisterhood of successful breastfeeders.