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.