SSC

Adoption and Breast Milk

mom baby on beachCasey Brown is a wife, Paramedic-turned-stay-at-home mom, and adoptive mom of one princess. She is passionate about adoption and breast milk and her journey to make sure her baby could have breastmilk in the NICU hit the national stage in social media.  She encourages other adoptive mamas to fight for the liquid gold, to not back down, and stand up for what they believe in. Ending discrimination against adoptive mamas has become a passion of Casey’s.  She is co-founder of the company Quiver Full Adoptions, an adoption consultation service based out of Greenville, SC.  You can also follow her on Twitter and Facebook.

When I was little, I had one million baby dolls. Almost. I played “house” every single day and ever since I can remember, I have wanted to be a mama. Not a teacher, not a doctor, but a mom. Maybe that desire came from seeing my mom making it look like the best “job” in the world. I won’t bore you with the details or make you feel inferior by telling you about how awesome my mother is, instead, I’ll tell you about the day I found out I was going to be a mom. Let’s rewind. My husband and I had been married four years and had been trying to conceive since the day we were married. Hey! I told you I wanted to be a mom! The stars weren’t aligning and the doctors were saying I would need science to help our dreams come true. Science. That’s something I was familiar with, being a Paramedic for three years and being in the health field for seven. After much prayer, Josh and I decided to forgo the science and medicine and pursue adoption. Adoption had always been in our hearts and on our minds, but something that we imagined doing when our biological children were older.

Three weeks after announcing that we were adopting, we were matched with our birth mom. Now if that wasn’t a sign from the good Lord, I don’t know what is. Crystal, our birth mom, asked me to attend her doctor’s appointments with her, and of course I said, “Yes!” I was going to be a mom and she was allowing me to experience as much of the process as I could. During the second or third doctor appointment, I was sitting in the room with Crystal, and she sat up on the exam table and said, “Have you thought about breastfeeding your baby?” Wait. What? Our birthmom has to be the coolest birthmom on earth to be asking me this question. I replied, “No,” although I had actually been thinking about it. I had been in contact with Krista Gray from Nursing Nurture and had already started the Newman-Goldfarb protocol – that’s how much I had thought about adoption and breast milk. I’m not sure why my immediate response was “No,” it wasn’t meant to deceive her, it was just a knee jerk reaction. I later told her the truth and she was very supportive. Crystal was already sixteen weeks pregnant when I began the protocol. Ila Mae, my princess, was born six weeks early and had a two week stay in the NICU. I had no time to stop the birth control and begin pumping, as the protocol needs eight weeks of pumping to start producing milk. Ila Mae was on a ventilator, had a chest tube due to a collapsed lung, and was on TPN. Seeing her fragile, tiny four pound, thirteen ounce body lying in the isolette, I knew I had to do something to get her that liquid gold. I did what any mama would do. I fought. Then I took on the hospital.  Below, you will find my Facebook post that went viral just a few days after Ila Mae was born.

“Baby Ila Mae was born July 23. The adoption papers were completed today. Through this group [Breast Friends] and Adoptive Breastfeeding group, I have begun the Newman Goldfarb Protocol. I haven’t started

NICU battle for adoption and breast milk

NICU battle for adoption and breast milk

pumping yet to induce lactation. I have a ton of donor milk that I was planning to use with my Lact-aid. Today, I experienced bullying for the first time that I can remember. It was so real. I said to the nurse, ‘When Ila Mae gets off the ventilator, we have breast milk that we want her to have instead of formula.’ She looked at me like I had three heads, turned around and went and got the lactation consultant. This lady comes over and says, ‘So, I hear you have breast milk. Where did you get it?’ This breast milk comes from my best friend. I told her this and she looked at me like I was disgusting and said, ‘you cannot use that unless you get it from a milk bank.’ I said ok, and asked how to go about doing that and if I could see the protocol they have set in place that says I cannot use donor milk. They could NEVER produce one and then finally admitted that they had never had this happen ‘because adoptive moms just don’t do this kind of thing. Mam, if you want to give this baby donated milk, then you’ll have to do it when she is actually yours in your own home.’ Ummmm, I about lost it at this point. This baby is MINE. Then, I leave and come back three hours later in hopes that she has left, only to get cornered by her and the neonatologist. While I was gone, they decided that I wouldn’t be able to use milk from a milk bank ‘because there isn’t one close enough’ and 4pounds 13 ounces isn’t a low enough birth weight and adoption isn’t a special circumstance that they could write a prescription for.’ They went on to tell me about all of the “risks” of donor milk and I politely informed them of how misinformed they are. My question is, would y’all be willing to write a letter to this hospital informing them of the benefits of breast milk, donated whether through a milk bank or not, and the non benefits of formula? They also told me that in order for me to use the Lact-aid, I’d have to have blood work done!! WTH?! Seriously? Ok, what’s the difference then? Why can’t my milk donor go have blood work done to show she isn’t infectious and then allow me to use her milk? I’m so aggravated that I can’t make an informed decision and I have been bullied into using formula. It will still be a few days before she is off the ventilator and able to nurse, but this is a big deal to me!”

Adopted yet thriving on breast milk!

Adopted yet thriving on breast milk!

Six months later, here I am reading what I posted on Facebook, and all I can see is how stressed I sounded. I could hardly form complete sentences. The group Breast Friends has approximately 5,000 members. About 300 of them wrote the hospital handwritten letters, fighting on behalf of me and my princess. Four of the members called the hospital, and one of the members spoke directly with the President of the hospital. After some threatening of getting the news involved and threatening to picket on the sidewalk while mothers nursed their babies, the hospital finally caved. They finally agreed to get me the donor milk from a milk bank. I compromised since they were getting me breast milk, to agree to not use the Lact-aid and to not use my personal stash of donor milk. Ila Mae is now six months old and has never had a drop of formula. We have had a total of eighteen milk donors (plus how many ever donors from the milk bank), all friends or friends of friends. (And due to Casey’s battle with the hospital, the policy has officially been changed regarding donor milk.  Here is more information on Spartanburg Memorial in SC.)

You have a choice, mamas! You don’t have to settle for fourth best, according to the World Health Organization, you can have that liquid gold. Fight if you have it in you, settle if you don’t. Either way, I won’t judge you, but I will stand behind you if you decide to fight!

You may also be interested in reading more about Adoptive Breastfeeding, Induced Lactation, 5 Challenges of Adoptive Breastfeeding, and Tube Feeding Devices.


What To Do When Baby Won’t Latch

Cindy and Jana

Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.  You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana.  You can also connect with Cindy and Jana on TwitterFacebook and Pinterest.

Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit  for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn.  A month later, we received a phone message from Noella: “You aren’t going to believe it.  Nathan is now breastfeeding! I just decided to try it one day and it worked!”

Why babies may not latch at birth

Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:

  • Baby may be recovering from a difficult birth.
  • Baby may have a tongue tie.
  • Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
  • The shape of mom’s nipples may make it difficult to grasp the breast.
  • Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.

If baby will not latch in the first 24 hours after birth:

  • Keep your baby skin to skin as much as possible.
  • “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
  • Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
  • Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
  • Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.

If baby continues to not latch after 24 hours:

  • Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
  • Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
  • In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
  • Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
  • You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
  • Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
  • Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
  • Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
  • A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
  • Search out a mother-to-mother support group such a La Leche League.

In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.


Nursing Twins

Grace & Leo 10-2-12 (133)

Elizabeth lives in Nebraska with her husband and 2 kids, twins Grace and Leo. Her days are spent being a referee, cleaning never ending messes, making delicious meals, and trying not to wish the moments away.  Elizabeth blogs about raising twins, being married to a farmer, and living in the country over at My Glad Heart.

I am still currently breastfeeding and plan to do so until they choose to wean. For me, breastfeeding wasn’t really something I thought about. I just knew that God made my body the way he did for a reason. My boobs were meant to feed my babies. It just made sense. I found out I was pregnant with twins and I started reading anything and everything I could get my hands on about twins and breastfeeding. I thought I was prepared for nursing twins. But I was wrong.

The babies were born on Sept 12, 2012 at 36 weeks via cesarean. While that’s not ridiculously early, they were both on the smaller side. Grace was 4 lbs 7 oz and Leo was 6 lbs 3 oz. They were both jaundiced and everything put together made for 2 very tired and very lazy babies. I think Leo would have been able to breastfeed somewhat from the beginning if he had had more time on the breast and if I had known what I was doing. But it’s hard to give your undivided attention when you have 2 babies to take care of.

Grace on the other hand wouldn’t even open her mouth to eat. When we bottle fed, we had to force the nipple in her mouth or catch her in the middle of a yawn. In the beginning she latched, but she got tired really fast and she just needed to gain strength. So I pumped and bottle fed them. We still worked on latch though, and by 5 weeks Leo finally figured out latching. So I would bottle feed Grace on my lap and I would breastfeed Leo. But Leo mostly hung out at the breast and after awhile I would take him off and he would still be hungry. So I would have to bottle feed him.

gleditedIt would have been easier in the beginning if I had been able to feed them separately, but they always woke up at the same time to eat. I couldn’t give Leo the attention he needed to get more efficient. Grace finally figured out latching at 8 weeks, but then 2 weeks later we all got sick and when she started to get better, she had forgotten everything we had learned. We started over from square one. First she learned to open her mouth, then she learned to take more of the breast into her mouth, then she learned how to suck, and then finally she got it all working together.

They started breastfeeding better, but they never took a complete meal in one sitting. I used to breastfeed them until they pulled off, and then I would immediately get bottles and start pumping. But that never gave them the opportunity to try and get more from the breast. So around month 4 my lactation consultant suggested I get a scale, feed them each session until they pull off and then let them play for 20 min to 1/2 an hour, put them back on, and repeat. Weigh them in between and keep track of how much they’re taking and keep feeding them until they get enough, which for us is usually around 3 1/2 to 4 oz. It worked for us, most of the time. Sometimes they got too frustrated and hungry to eat like that so I would bottle feed them the rest of their meal and pump. Anytime I had to supplement them I pumped, that way I could keep my supply up.

This worked great for a while, but I just go so sick of pumping and supplementing them at each meal. They were both capable of getting a full meal, they just weren’t doing it. So I just quit supplementing them. We basically had to redefine what eating was. I always assumed I needed to get them to a specific number each time they ate. But they didn’t. They were also in the habit of having the same amount each time they ate, so anything less than their usual resulted in screaming for more. I returned the scale and I quit pumping during the day.

Around 6 months I felt confident breastfeeding. We made it past lazy eating, flow preference, and milk supply issues. We had so many frustrating feeding sessions and lots of tears, but when they started eating better, it was so worth it. And honestly? Breastfeeding is so much easier than bottle feeding. No more washing and sterilizing. All I had to do was lift my shirt up and put it back down when we were done. So easy.

I’m so glad I stuck with breastfeeding. I don’t regret the effort I put into this. I have always kind of halfway done stuff. I am constantly starting projects but never finishing them. This is something that I have given 110% and I will never regret that. But I am sad that it was my main focus for 6 months. I was so focused on making this work that I missed out on spending quality time with my babies. But I know that if I hadn’t given this my all, I would have regretted that forever. I want people to know that you CAN breastfeed, even if you get off to a rocky start. You just have to be patient and you just have to stick with it. I go into more detail on my blog about our journey. I want to be honest about our struggles and I just want to be a beacon of hope for those who want to breastfeed but got off to a rocky start like we did.

  • Some advice I have is find a good lactation consultant. Find someone that listens to you and works with you. We went to ours 5 times.
  • Rent a hospital grade pump, especially if you’re building a supply.
  • Don’t overfeed your baby when you bottlefeed. This was something huge to overcome for us. The other thing I can say about this is vary the amount you give them each bottle. We always gave them exactly 4 oz. When they got just under 4 oz, they screamed for more and more. You don’t eat the same thing and same amount for every meal, don’t expect your baby to either.
  • Unless you have an overactive let down, invest in slow flow nipples. We love playtex VentAire bottles. We dealt with flow preference and that was tough to overcome. It’s easier for babies to drink from a bottle than it is from the boob, so you want to make them work for it when they’re bottlefeeding. You know it’s a good bottle when you tip it upside down and nothing drips out of it.
  • Just be patient. If you stick with it, they will get better. It took us 6 months.
  • Understand that breastfeeding isn’t all or nothing. If you feed them 5 out of their 8 meals from the breast, you’re still breastfeeding. If you breastfeed and then have to supplement, you’re still breastfeeding. I don’t think it has to be something that moms feel like if they can’t do it all, they shouldn’t do it at all.

The Journey Continues

Brittnei HeadshotBrittnei is the wife of Harroll Washington and mom to one beautiful baby boy and 3 amazing step-children. She loves Jesus Christ, homemaking, healthy living, football and bowling in leagues with her husband. Writing is a hobby and she enjoys doing it in between caring for the ones she loves and taking care of her home. Brittnei blogs at Homemaking with Style.

When Krista asked me to write a guest post for her blog about my breastfeeding experience, I have to say I was completely ecstatic!  We have only interacted briefly via Twitter recently, but from reading her credentials and about her experience, I was completely honored.

Then I had to think about what I would say.  I mean, my son is 20 months old on December 15th and we just found out that we are pregnant with our 2nd.  I’m currently 7 weeks and due a week before my birthday on July 27th.  I wasn’t sure if I should go into my experience with breastfeeding my son or if I should solely talk about what breastfeeding has been like so far during my pregnancy.  Then I figured, if I tell you all about the beginning, then you will be able to understand my feelings and decisions I have made about breastfeeding up until this point.

So, before I was pregnant with my first son, Harroll Jr., better known as J.R., I read everything and I mean EVERYTHING that I could get my hands on about babies, child birth and most importantly, breastfeeding.  Breastfeeding was the one thing that people around me couldn’t really teach me because many of them had not experienced it.  I had one aunt who has breastfed, but she lived several states away so I wasn’t going to get the in person help that I thought I needed from her or any other family member.  I decided that I was going to try with everything in my being to breastfeed no matter how difficult it could get.

Let’s fast forward to my 3rd day postpartum.  The day that I thought my nipples would fall off.  Mind you, I had been doing great, according to the nurses and lactation consultant in the hospital.  The latch was fine, yet it was still hurting when my son would initially latch onto my breast!  Day 3 that he was here, I just knew I would have to resort to solely pumping because the pain was just too unbearable.

And then, the next day (after we had given him a few small bottles of formula from the hospital), we saw his doctor.  I owe her so much because of what she said to me that day.  You see, my husband was very supportive, but he wanted me to do whatever I thought I could do.  He didn’t want to pressure me either way.  In this moment, if we decided to continue to give J.R. formula, he would have been fine with it.  But his doctor, she told me what I needed to hear.  I explained my frustration with the initial latch and how bad it hurt and she said: “do you know how many women before you have done this?  This is something that has been proven to be the best thing for your baby.  You will get through it.  Countless women before you did!”  And then I felt like a baby.  Some people perceived this story, when I told them about it, to be critical of her or judgmental, but no, she was telling me the truth.  I value truth so much even when it hurts or it’s not what I want to hear, so, I put my son back to my breast and he gravitated to it and suckled like it was what he wanted to do so much all along.  My supply didn’t suffer.  I had breastfed him on demand so much except for about 3-4 feedings.

So let’s fast forward to the other night, the night that I screamed at the top of my lungs because my son clamped down on my right breast because he had fallen into a deep sleep with the breast in his mouth.  When I was finally able to get him to unlatch, while he still slept, I had immediate thoughts to wean him.  And then, my emotions settled and I remembered the words of his doctor back in New Jersey.  I remembered how many infants that I knew who had been sick with ear infections, who needed nebulizers and the like.  So many different issues they were having during the first year and beyond.  I knew breastfeeding didn’t cure or prevent everything, but I did know all of these infants had been breastfed for a very short time or not at all.  I looked down at my little angel and I smiled.  He and I both haven’t been sick since he was born.  I knew this was a credit to our wonderful breastfeeding relationship, for sure.  I knew I couldn’t allow this temporary pain cause me to make a life-changing decision for our relationship.  Not now.  It wasn’t time.  No, sir.  So here we are, as I’m writing this post, cuddling, while he nurses on Mommy’s breast.  And so, the journey continues…


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Perseverance at the Pump

Mary Straits HeadshotMary Straits resides in North Carolina with her husband of ten years and two energetic boys, ages six and three.  She earned a B.A. in English and music from Columbia College and a Masters of Education from Liberty University.  In her spare time, Mary teaches 8th-grade English and somehow finds time to blog at www.marystraits.blogspot.com.

When our ob gave us the list of classes the hospital was offering for soon-to-be parents, we actually said, “Nah.  We don’t need the breastfeeding class.  I mean, how hard could it be?  It’s natural, right?”

Out loud.  To each other.

It took about two hours of mommy-hood for me to realize that breastfeeding, albeit natural, is an art form.  It takes coaching and practice and patience and sometimes a trip to the ER at 2 am.

When my first son was freshly born, we started nursing about two hours later. I came to the hospital ready.  I didn’t just have a Boppy—I had a “My Breast Friend.”  I had my own pump and all the parts.  I thought breast-feeding was going rather well until the nurse came in and started saying things like, “Nope.  He’s not latched.  Let’s try it again.”  And, “It’s not supposed to hurt.  You’re wincing.”

Then, when they called in the lactation specialists, things got real.  I learned about all sorts of positions that involved stacks of pillows.  They gave me something called a nipple shield.  Then came a syringe with a tube to connect to the shield.  In the tube, we put formula.  The idea was to make baby associate my breast with his food source.  But we couldn’t use the shield too long or he would become dependent on it.  And then we’d REALLY have problems.  I was to feed baby with the system and then pump to get my milk to come in faster.

Two days later, we went home with a shield and a syringe feeding system, which I promptly abandoned once my milk came in the next day.  In fear, I used the shield off and on, and pumped after each feeding.

When our pediatrician’s lactation specialist called me at home to see how nursing was going, I stupidly said it was going fine.  And no, I didn’t need to see her.  She didn’t let me off the hook, though.  When she found out we were bringing baby in for his weight check, she said, “Great!  I’ll check in with you then!”

The next day, however, I came down with a high fever and chills that would not go away.  Being that our baby was five days old at this point, we ended up in the emergency room at midnight and I endured all sorts of trauma I hope I never relive.   I was discharged hours later with a heavy dose of Tylenol and a label of “Fever of Unknown Origin.”

When we showed up at the pediatrician the next day, I looked like a mess.  But not your average mess.  A HOT mess.

The lactation nurse took one look at me and said, “Oh, you poor thing.”  Then, when we showed off our breast-feeding ritual, she knew we were really in bad shape.  My nipples were raw and cracked in several places.  She said I had a touch of thrush as well and gave me a concoction of creams to put on my nipples after every feeding:  Neosporin, Monistat, and Lanolin.  We were to use only the shield until my nipples healed and continue pumping in between.  And see her again in two days.

A few days later we checked back in, and my skin was on the mend finally.  Baby, however, was not latching properly.  Come to find out, his frenulum was tight, which prevented him from latching properly.  We had to drive across town to the pediatrician who could clip his frenulum and then continue on with the work of breast feeding.  With the shield, pumping after a feed.

At this point, my milk supply was very profound, as I was pumping off 4-5 ounces after baby was done with a feed.

A few days later, the fever came back with a vengeance.  It hit me almost instantly, and I struggled to even pick up the baby to feed.  I somehow loaded up the baby, lifted the car seat, and headed to the ob-gyn, who said I had a bladder and sinus infection.  They gave me a z-pack and sent me on my way, and I felt remarkably better in about 6 hours.

At this point, I tried abandoning the nipple shield, but it didn’t take long for me  to get a little crack and then have shooting pains during a feeding.  I promptly used the compound the lactation nurse told me about.  A few days later, we found out both baby and I had thrush.  At this point, I didn’t try to feed him straight from my breast, but just pumped and bottle fed until we both were cured.

The next week or so, the fever came back AGAIN on a Saturday.  This time I had a red patch on one my breasts, which really freaked me out, but I took ibuprofen and waited for my primary care doctor to open on Monday.   All the while, I continued to pump for feedings, as I was too weak to try and latch baby.

On Monday, all mysteries were answered.  My primary care doctor finally figured out what was causing the fever:  Mastitis.  There is a specific antibiotic that treats it, and he advised me not to feed the baby the milk I was expressing but to be sure that I completely emptied my breasts often.

At this point, my milk supply reached epic proportions, as I was pumping for a long time every two hours or so.

After I finished the antibiotic, my husband and I decided that we had enough drama with this breastfeeding journey.  But, it was so important to me that my baby had breast milk.  For one, I knew it was the best for him.  For two, formula feeding would have cost us $30 a week (at least).  For three, we had a great pump and my supply was ample, to say the least.

I ended up pumping on a schedule of 5:45 am, 8:30 am, 11:15 am, 3:15 pm, 6:30 pm, 10:30 pm, and maybe during the night if baby woke up.  It took me about 10 minutes to totally empty both breasts, which was a lot easier/ faster for me than before.  After a while, I was able to drop a pumping session and still maintain my milk supply very well.  In the end, in fact, I ended up giving my sister bags and bags of frozen milk and using the other bags of frozen milk in baby food purees.

I found pumping much less stressful than our previous experience, which I learned later was pretty extreme.  When I ran into the lactation nurse on a routine pediatrician visit when Noah turned one, she congratulated me on making it a full year and assured me that pumping “counted.”  For some reason, I had it in my head that I wasn’t really breastfeeding by pumping full-time, but I couldn’t bring myself to give up and quit.  And I knew it was best for my baby.

When our second son was born, as soon as we started having latch problems and I started getting cracked nipples, I broke out the pump and began pumping full time.  With a very energetic almost three-year-old, I did not have the stamina and the time for any semblance of our first go round.  I brought out my trusty pump (Medela, if you’re wondering!), and once again, had a solid supply in about 5 days time.

The second time around, though, I worked on pumping a bottle right before baby would eat so that he could have fresh milk more often than not.  I ended up having an epic milk supply the second time around, all from the pump.  At one point, I had so many bags of milk in the freezer, that our freezer actually broke.  Ha!

The point of my story is this:  If you’re passionate about breast feeding and struggling to find peace from any challenges you may be facing, consider pumping full time.  Don’t listen to the masses, who tend to view a breast pump as a ball and chain.  It was an awesome avenue for us to be able to give our boys the most optimal start. And saved us hundreds of dollars!

{Note from Nursing Nurture: Mary’s determination allowed her to give her babies breast milk even when the medical system really failed her.  Though every issue she had could have been remedied with good, qualified lactation support this mother – like so many – did everything she knew to do.  If you are experiencing breastfeeding issues and your lactation support is not helping solve the problems at hand, find someone else!  Look for an IBCLC – which is the only certification showing a lactation consultant is a specialist.  And, if your IBCLC is not helpful, find another (just like you would any medical doctor you weren’t pleased with).}


Induced Lactation

What is induced lactation?

Induced lactation is when a mother who has never had her own biological children stimulates lactation in her breasts.  The term is also used when a mother, who is not currently breastfeeding, adopts a child and goes on to nurse the infant (adoptive breastfeeding).  It is different than relactation, which occurs when a mother’s milk supply is stimulated to nurse a baby she gave birth to but has been weaned.

How do you induce lactation?

There are many techniques that women use to help induce lactation, however the most important is frequent and effective breast stimulation (and milk removal once milk begins to flow).  Many women around the world have effectively induced lactation solely by regularly nursing a baby and/or through pumping/hand expression.1 Conversely, no amount of additional tools (galactagogues, hormonal stimulation, skin-to-skin, etc.) will effectively induce a milk supply without this first step.

Strategies for inducing milk supply

  1. Breast stimulation on both sides for at least 100+ minutes every 24 hours.  A woman may start with shorter sessions, say 5 minutes or so, and build up to expressing 15-20 on each side 8-12 times a day, including at least once at night.  The more frequently the breasts are stimulated, the quicker the milk supply will build. A newborn eats approximately every 2 hours, 10-12 times per day so expressing this often would be ideal.
  2. It is not essential to express on both sides at once, though this is a great way to save time.
  3. The milk ejection reflex can be trained so thinking of your baby, nursing or pumping in the same place, listening to relaxing music, hearing a baby cry, etc. can help to stimulate it.  Conversely, stress can inhibit hormones involved with milk ejection.
  4. If you already have your baby, and if he is willing to nurse at the breast, try nursing with an at-breast tube feeding device. This allows your milk supply to be stimulated by your child rather than pumping or hand expressing to stimulate your supply.  It reduces a step because while you are “pumping” you are also feeding your baby.  As you begin to develop a milk supply you can reduce the amount supplemented in the tube feeding device.  It is important to make sure your baby has a good latch in order to effectively stimulate your milk supply.
  5. When nursing at the breast (and at other times throughout the day and night as well) make sure to spend time skin-to-skin with your baby.  There are many tremendous benefits for both mother and baby, but this time together will help you bond and help maximize a mother’s breastfeeding hormones.
  6. Taking pharmacological and/or herbal galactagogues while expressing/breastfeeding can increase breast milk supply.  Domperidone is generally considered the safest pharmacological option and fenugreek and blessed thistle are common herbal options.  Eating oatmeal several times a week or even daily may also increase milk supply.
  7. Acupuncture may also increase a mother’s milk supply through enhancing the secretion of the hormone prolactin, which is necessary for milk production.2
  8. Having a support system around you cannot be overestimated!  Having family and friends that can support and encourage you as well as getting involved in a local mother-to-mother breastfeeding support group are essential.  There will be challenges you face with adoptive breastfeeding.  Having others to encourage you and share their experiences will help you tremendously.

If you have several months before getting your baby

If you are in the process of adopting but will have to wait weeks to months, there are medications you can take that mimic pregnancy hormones in your body.  By taking an oral birth control pill with estrogen and progesterone, and skipping the week of “sugar pills” each month, your body’s hormones will mimic those in pregnancy.

In addition to the oral birth control pill, a mother would take Domperidone which is used in lactation to increase breast milk supply.  After at least 30 days on this protocol, but longer (6 months) if possible, a mother would stop the birth control pill and begin pumping or breastfeeding.  She could also take Fenugreek and Blessed Thistle – 2 herbal galactagogues known to help increase milk supply.  Please read here for further details on how to implement the Newman Goldfarb Protocols for Induced Lactation.  Though the treatment protocols for inducing lactation have not been tested in clinical trials, women from around the world have successful adoptive breastfeeding stories by using these strategies.

There are many challenges that adoptive breastfeeding mothers may face.  Arming yourself with knowledge is half of the battle!

You may also be interested in reading adoptive breastfeeding and how to encourage your adopted baby to latch.


Megan Church Blog 2 Featured

How I Succeeded: My Breastfeeding Journey

Megan Church HeadshotMeagan Church is a writer, children’s book author and the brainpower behind Unexpectant.com, which explores the realities of birth, babies and beyond. She lives in the Midwest with her high school sweetheart, three children, two cats and one dog. Her passions include running, black coffee, and simple, yet intentional living. Connect with her on Twitter @unexpectant or Facebook/unexpectant.

As I discussed in a previous post, I was prepared for cracked nipples and poor latching. But I wasn’t prepared for the mental fortitude that was necessary to reach my breastfeeding goal.

Even though breastfeeding my first two children was more mentally exhausting and demanding of my time than I could’ve predicted, the mechanics of it went smoothly. From the start, both were great nursers with a naturally good latch. I never experienced soreness or difficulties with them. I credit that to a few factors:

Megan Church

Pre-birth education

Knowing I was absolutely clueless about how to breastfeed a baby, I signed up for a class at my local hospital. I took the class, while I was pregnant. This helped me understand what to look for in a proper latch, positioning and more. Sure, it was odd practicing with dolls, but when it came time for the real thing, I at least had some idea of what to do.

Immediate skin-to-skin contact

After my babies were born, they were immediately placed on my chest for skin-to-skin contact. We enjoyed an hour or two together, just getting to know one another without a lot of intrusive examinations getting in the way of the most precious bonding moments. This allowed both babies to root and follow their natural instincts for nourishment and comfort right after birth. I still remember how amazed I was after all three of my babies began to nurse on their own within the first hour of their lives. That wouldn’t have been possible without that skin-to-skin time.

Lactation consultants

Before having a baby, I was a pretty modest person. I wasn’t sure how I would respond to people seeing all sides of my body. But, in the throes of labor, discretion sort of goes out the window. And, I found that to be true, while nursing as well. Our hospital had great lactation consultants on staff who answered any and all questions. They would come watch me breastfeed to make sure the latch was good and that baby was feeding well. As a newbie with no expertise in breastfeeding, this feedback was a beautiful thing.

Supportive husband

I am blessed to have a supportive husband who also believes in the benefits of breastfeeding. After doing our research during pregnancy, we knew we wanted to not only give our babies the most natural entries into the world as possible, but we also wanted them to be nourished by the most natural food possible. He was always a great supporter and, while he might not have gotten to spend time bonding with the babies during feeding sessions, he bonded in many other ways instead (such as middle-of-the-night diaper changes, rocking to sleep, baby wearing and more). He respected the importance of breastfeeding and he’s an encourager for other moms to breastfeed as well.

Examples of others

By the time I had my first child, I had watched both of my sisters-in-law nurse their babies. While I wasn’t eyeing their latch and getting an up-close-and-personal view, their example still showed me that it was possible and that, while struggles might occur, patience and dedication can get you through.

The will to not give up

Natural birth taught me that I’m a lot stronger than I realized. Before giving birth, I did my homework. I knew the benefits of breastfeeding and I knew I did not want to give my babies formula. So even during those moments of exhaustion and times when I struggled with always having to be the one to feed the babies (my first two rejected any sort of bottle), I still knew that I didn’t want to give up. I knew it was a season of life and that weaning would eventually occur some day. I knew that my top goal was to get them through their first year without formula. And, we made it. With each of my three babies, we made it that first year…and even a few months beyond.


Pros & Cons of Breastfeeding Twins

Probably no woman is completely prepared to hear the words, “You are pregnant with twins” even if it isn’t a complete surprise.  Once the reality sets in, there is a lot to do to get ready for these new little blessings.  One of the many decisions a mother of multiples will need to make as she is preparing for their arrival is how to feed them.

Advantages of Breastfeeding

There are many benefits to breastfeeding for both a mother and baby.  However, there are some advantages specific to nursing twins and higher order multiples (HOMs) as well.

  1. High chance of premature delivery
    The majority of mothers carrying multiples will deliver early.  The March of Dimes Perinatal Data Center statistics show that in 2010, nearly 60% of mothers in the US carrying twins or HOMs delivered their babies prematurely and another 34% had late preterm deliveries (before 38 weeks). 1 Breast milk is completely unique and unlike any other mammalian milk, and breast milk has even added benefits for preemies.  Though nursing a preterm baby presents its own set of challenges – such as separation while your babies are in the NICU and trying to build your milk supply – breast milk can mean the difference between life and death with a premature baby.  Many mothers of premature babies will give their babies breast milk while they are premature and later decide if they will continue with breastfeeding.  (Just a note of encouragement though…it is completely possible to transition your babies to the breast if they were born prematurely and you had to start off pumping and giving your milk by different methods; kangaroo mother care can also help make this transition happen more smoothly.)
  2. Immunological protection of breast milk
    Breast milk as immunological antibodies that are made specifically for the germs and bacteria your baby confronts each day.  Since multiples have a higher risk of prematurity – and therefore illness – giving breast milk can significantly boost their immune system and protect them from illness.  But not only if they are premature; with multiples, if one baby gets sick the chance of having all of them catch the illness is high.  Breastfeeding can save time and money from visiting the doctor both while they are young and over the course of their lifetimes.
  3. Promotes bonding
    Twins and HOMs will keep a new mother extremely busy.  Sometimes it is harder to bond when you have multiples because of time constraints – there is just more that must be done since there are more babies.  However, breastfeeding allows a mother built-in time all throughout the day and night to stop and relax and just hold and feed her babies.
  4. Easier to feed two at the same time
    Whether you have twins or more, you still only have two hands.  It is much easier to use your hands to hold/support your babies at the breast than it is to sit them down and hold the bottles.   Your babies will have more times of physical touch and cuddling which is beneficial to their mental, physical, and social development as well.

Disadvantages of Breastfeeding

There are also many disadvantages – or perceived disadvantages – to nursing twins.

  1. More Work for Mother
    It is true that with breastfeeding, only the mother has the equipment to feed her babies.  Many mothers of multiples have extra help and support from family and if they give bottles would be able to have others feed their babies as well.  However, this must be weighed against several factors:  the time of mixing formula and cleaning/sterilizing bottles as well as whether or not this extra help will be around for the entire first year or two.  It may be easier in the beginning, but if this extra help is gone after a month or two, bottle-feeding may be more cumbersome than breastfeeding.  Also, if a new mother does have extra help and support (and please try to have extra help and support – you will need it!) they can do many other things while a new mother is breastfeeding – cook, clean, change diapers, burp babies, rock babies, etc. It is common for new moms, especially mothers of multiples, to wonder when life will ever return to normal!
  2. Concerns of sleep deprivation
    This is also related to the first reason.  If a mother is not breastfeeding then when her babies wake to feed at night someone else could feed them.  Again, this must to be weighed though: will the help be around for the first year or two?  Will they be the ones to do night feeds? If not, breastfeeding would allow a mother to get more sleep than her formula-feeding counterparts.  A breastfeeding mother does not have to arouse as fully to scoop up her babies and latch them to her breast as a mother who must mix formula, give the bottles, clean the bottles, and get her babies back to sleep. Even while feeding two, a breastfeeding mother can nurse lying down for added sleep/rest. And breastfeeding produces oxytocin which has a relaxing effect on a nursing mother, thus making it easier to fall back to sleep.
  3. Concern over pumping/transitioning to the breast
    Many moms are concerned that they will spend the time pumping and building a strong milk supply only to find that later their babies do not transition to the breast.  While this occurs (rarely) the vast majority of babies will transition to the breast once they are full-term. Even if your baby doesn’t transition to the breast, pumping and expressing is not only healthier for your babies’ bodies but much less of a financial burden than buying formula.

How can I prepare to breastfeed my babies?

There are many things a mother can do while she is pregnant to prepare for breastfeeding her babies!

  1. Find a qualified lactation consultant
    You are going to be nursing twins or more and having qualified, hands-on support to make sure you get breastfeeding off to a great start is critical.  Find an International Board Certified Lactation Consultant in your area and meet with her prenatally.  Many lactation consultants have prenatal workshops and then will offer a discount for breastfeeding support once your babies arrive.  This will be money well spent – and much, much less than the cost of bottles and formula if you didn’t breastfeed.
  2. Meet with a lactation consultant to discuss maximizing your milk production
    While it is completely possible for your body to make enough milk to exclusively breastfeed twins, triplets, or more, having a plan in place that involves lactation practices to maximize your milk supply is critical.  During the first few weeks after giving birth your body is laying down the prolactin receptors that will regulate the amount of milk you will make for the duration of breastfeeding. You want to make sure you maximize what your body will make and the importance of having a plan in place so you know the best way to initiate breastfeeding in the early days cannot be understated.
  3. Begin attending a mother-to-mother support group
    Find a La Leche League or other breastfeeding support group in your area.  There may even be a group specifically for nursing multiples!  Knowing other mothers who have successfully nursed their twins or HOMs will be a great help and encouragement to you – trust me!

Tubing can be run to both breasts for tandem nursing or twin nursing.
Photo courtesy of http://www.joyfulabode.com

Tube Feeding Devices

There are a variety of tube feeding systems that allow mothers to supplement their babies while nursing at the breast.

Who Should Use an At-Breast Tube Feeding Device?

Tubing can be run to both breasts for tandem nursing or twin nursing. Photo courtesy of http://www.joyfulabode.com

Tubing can be run to both breasts for tandem nursing or twin nursing.
Photo courtesy of JoyfulAbode.com

These devices work well for babies who are able to latch effectively to the breast.  They are an excellent choice when a mother is attempting to increase her milk supply while breastfeeding her baby. They are also valuable when a mother must supplement but wants her baby to have the benefits of nursing – cuddling, bonding, skin-to-skin contact, proper oro-facial development, etc. Examples of situations where mothers have successfully used at-breast tube feeding systems include relactation, induced lactation, adoptive breastfeeding, nursing after breast surgery, in place of pumping to help increase low milk supply, when a baby is breastfeeding but must also have a supplement such as with PKU, in place of giving a supplement in a bottle, and more.

How Does a Tube Feeding Device Work?

This type of supplementation system consists of a container to hold the supplement (whether expressed milk, donor milk, or formula) and then thin tubing protruding from the container to the mother’s nipple. The tube is held in place by a nursing bra, nipple shield, band-aid, or hypoallergenic tape. Many moms prefer a band-aid as they can slip the tubing on and off and just leave the band-aid on their skin.  Care should be taken to ensure tube does not extend past the mother’s nipple so baby does not learn to suckle only the tube. The tube can be secured to the top, bottom, or either side of the areola – whatever garners the best result for baby. The tubing is typically inserted under the upper lip and enters the baby’s mouth along the roof of his mouth/palate.  However, some baby’s prefer the tubing to lie on the lower lip or along the tongue. Experimenting with what works best for you and your baby is key.

Baby Using Tube Feeding Device

Tubing can be secured to the breast with tape, if necessary.
Photo courtesy JoyfulAbode.com

The supplement can be initiated as soon as a baby begins to suckle at the breast, or the supplement could begin to flow after the breast has been drained. The tubing can be used in conjunction with a nipple shield.  For a baby with a weak suck, it is even possible to put the tubing from both sides on one breast so baby can receive an even larger quantity of supplementation while suckling at the breast. The flow of the supplement can be controlled by blocking and unblocking the flow of the tubing.

How Do You Clean the Tubing?

After each feeding, the tubing should be rinsed with cold water, then filled with warm, soapy water that is squeezed thoroughly throughout the tubing. This soapy water should then be rinsed well.  Once every day (24 hours) the tubing should be boiled for 20 minutes. 1

What are the Benefits of Supplementing with this Method?

As baby latches to breast, the tubing gently enters his mouth.

As baby latches to breast, the tubing gently enters his mouth.
Photo courtesy JoyfulAbode.com

At-breast tube feeding devices have many benefits:

  • Allows baby to continue nursing at the breast, rather than switching between bottle or other device which may lead to nipple confusion or breast refusal
  • Allows mother to breastfeed while supplementing with the added benefit of baby stimulating a mother’s milk supply while nursing
  • It is temporary aid to allow a mother to increase her milk supply while continuing to provide adequate nutrition to baby in a natural way
  • Mother can control rate of flow of supplement as well as starting the supplement later in the feed once breast has been emptied, or vice versa
  • A great option for mothers whose ultimate goal is to have baby nursing at breast
  • A great solution for mother’s who do not have enough breast milk to exclusively nurse but want their baby to experience full breastfeeding

When Should At-Breast Tube Feeding NOT be Used?

When a baby is not able to latch effectively to the breast, this type of nursing system is not very effective.  (In this case, working with a lactation consultant, it may be preferable to initially use finger feeding with the tube.) Babies can learn to suck the tubing, rather than the breast, in which case it does not help to stimulate a mother’s milk supply.  And when a baby is not able to generate sufficient suction at the breast, he will not be able to suck effectively enough to gain the nutritional benefit he needs.  If feeds take greater than 30 minutes, baby falls asleep during a feed, or if baby fails to gain adequate weight this type of feeding system is probably not the best option.2

Where Can You Obtain a Tube Feeding Device?

The supplement hangs in a pouch around mother's neck as baby nurses. Photo courtesy JoyfulAbode.com

The supplement hangs in a pouch around mother’s neck as baby nurses.
Photo courtesy JoyfulAbode.com

Two commercial tube feeding devices are sold in the US: SNS (Supplemental Nursing System) by Medela and Lact-Aid. Both can be purchased on-line and through many local doctors, hospitals, and lactation consultant offices.

The SNS by Medela has a firm feeding bottle, whereas the Lact-Aid has a soft plastic bag for the milk supplement.  The Lact-Aid requires a baby to suck against the flow of gravity as the tube exits from the top of the pouch. This may help to strengthen a baby’s suck, or it may be challenging for a baby with an already weak suck. 3

It is also possible to make your own at-breast tube feeding system. A gavage setup with a No. 5 feeding-tube or tubing from a butterfly needle can be used. 4


Breastfeeding

Increasing Milk Supply

Concern over low milk supply is a very real issue for many breastfeeding moms.  While not having enough milk is the most common reason given by mothers for early weaning and supplementation, actual low milk production is very rare. 1 Whether it is real or perceived, understanding how your milk supply is established and knowing what to do to optimize your breast milk supply can relieve stress, worry, and ensure your body has the opportunity to make enough milk for your baby.

Strategies to increase breast milk supply

Once you realize there is a milk supply issue, diligence is extremely important to help build your supply.

  1. Ensure you are feeding your baby with a deep latch and effective milk transfer at his early feeding cues, without limiting access to the breast, at least 8-10 times (or more!) every 24 hours.
  2. Increase the amount of times your baby is nursing at the breast.  Babies with an effective suck are usually more effective at milk removal than pumping or expression.  Offer each breast more than once at a feeding and offer to nurse your baby often!
  3. Use breast massage/compression.  Think of this as “pumping” into your baby.  Breast compressions while breastfeeding (or pumping) help your breasts drain even more milk.  And an empty breast makes more milk.
  4. If your baby doesn’t completely drain your breasts, you can express following a feeding to help build your supply.  Alternatively, if your baby does empty your breasts, waiting 30 minutes (while your breasts are busy at work making milk) and then expressing will help increase your supply.  Remember, an empty breast makes more milk, whereas milk stasis in your breasts slows milk production.
  5. Don’t allow more than 5 hours to go between a feed, and only allow this much time once every 24 hours.  If your baby goes this long between a feed, make sure he is still nursing at least 8-10 times in a 24 hour period.
  6. Spend as much time skin-to-skin with your baby as possible.
  7. Consider safe bed sharing or co-sleeping with your baby.
  8. Avoid pacifiers (dummies) and anything else that would keep him from suckling at the breast.
  9. Consider taking a galactagogue.  Herbal galactagogues include fenugreek and blessed thistle.  There are also prescription medications that can help (though all galactagogues can have side effects and inherent risks) so other measures should be tried first.  Also, a galactagogue will only be effective if you are frequently and effectively removing milk from your breasts.
  10. If a supplement must be given, consider giving it through an at-breast tube feeding device.  This has the benefits of continued breastfeeding and breast stimulation while at the same time giving your baby a supplement (which could be formula or breast milk), skin-to-skin time holding your baby, and no chance of nipple confusion! But, be aware that formula takes nearly twice as long to digest as breast milk (78 minutes vs. 48 minutes) so if you give a supplement with formula (as opposed to expressed or donor breast milk) then your baby may sleep longer between feeds than he should.  You may need to express twice during this time to actually mimic how your breastfeeding baby would have nursed.
  11. If any bottles are given, make sure you pump or hand express on both sides so your body knows that your baby just ate.  If using a pump, make sure the flange is the correct size.
  12. Use caution with bottles. Babies must suck at the breast before there is a let-down of milk.  This makes it easier to self-regulate how much milk he actually needs.  With a bottle, some babies continue to eat even when they are full because it is an “effortless flow” and they can do nothing but gulp and swallow.  Taking care in how you give a bottle can ensure this doesn’t happen.

Other things to consider:

  • Make sure you are not using any hormonal medications (estrogen suppresses lactation and progesterone may also) or other known anti-galactagogues (such as decongestants).
  • Is it possible you are pregnant?  Hormonal changes in pregnancy can also decrease your milk supply.
  • Have your doctor check your endocrine levels. Perhaps there is a thyroid issue or some other hormonal imbalance that could be corrected with medication.