Liquid Gold

This post makes me feel vulnerable and exposed, but I want to represent real life in hopes of helping mamas.

Birth day!  A few hours old

After 12 years of nursing (6 kids for 2 years each), I encountered something I never had to deal with before--trying to produce enough breast milk.  With my 7th, my water unexpectedly broke at 32 weeks.  I was able to keep the baby in for 6 days, before giving birth at 33 weeks to a healthy, yet underdeveloped 5 lb 1 oz baby girl.

First real snuggle
3 hours old

I never noticed that I do this to help my 
babies latch on, but once I was home from 
the hospital my 3 year old wisely observed 
while making a V with his fingers, 
"You have to help baby nurse like this." 

Too Tired

She could suck 5-10 times before needing to rest
11 hours old 

It was my first hospital birth, so I was dealing with major culture shock, in addition to the stress of a NICU experience. I was adamant that my baby be exclusively fed breastmilk.  I'm not judging anyone else's choices, but this was something that was important to me.  They insisted on IV antibiotics, an IV nutrition mix, and caffeine.  I couldn't avoid those, but I could avoid formula.  I wanted nothing else foreign in her body and I also wanted to build up her healthy gut flora after the antibiotics.  I was surrounded by babies who had constipation and reflux and I wanted to avoid that, if possible, and limit interventions. 

First gavage feeding at 12 hrs old with donor milk.
At the beginning, store milk in 1 oz increments because 
any thawed milk that isn't used within 24 hrs is thrown away.

She opened her eyes and was alert within a
minute of starting the milk via her feeding tube

Almost every day for the first two weeks I had to assert myself about no supplementation.  Once they put bottles of formula on my baby's pod cart and I asked, "Is that for my baby?"  When the nurse replied in the affirmative, I said, "I will beg, borrow, or steal, but I will find the milk.  So you can put those away."  And beg and borrow I did.   The donor bank was closed two times when we needed milk, so I asked a trusted friend if she had any trusted friends that were breastfeeding.  She found me two generous mamas that were willing to share.  Coordinating pick ups, drop offs and then claiming milk as my own, because the NICU would only allow donor milk from a bank, felt like I was dealing with an illicit drug!  

Definitely not how I envisioned cuddling my newborn

First time nursing while awake

3 days old

Unfortunately, unlike a full-term baby, a preemie is not equipped to wait 2-3 days for your milk to come in, so donor milk is a necessity if you don't want to supplement with formula.  Some might judge me for using untested milk, but I felt more confident in human milk than manufactured cow's milk.  I heard other's discharge talk several times during my baby's 3 week stay.  Did you know that you are supposed to boil water, even if the water is pure, to kill any possible impurities in the formula?  No, thank you.

Milk in at 2 days postpartum
I'd save every drop of colostrum
 to dab in her mouth

Milk at 5 days postpartum

The tangle of cords coming off my baby was a challenge to maneuver 

The head IVs were my least favorite.  
This side one really interfered with nursing and 
she was only able to nurse off one side.

This IV was in the middle so made 

breastfeeding off both sides possible.  

She looked like a sad, little unicorn.

6 days old

Three days of lights for bilirubin levels.
I could only hold her for 30 minutes every 3 hours. 
It was awful.  I agreed to the Vitamin K shot, 
because she was a preemie, but one of the 
side effects is hyperbilirubinemia (jaundice)

Living the dream

They were insisting I, at least, needed to give my baby vitamins, as if my milk wasn't perfectly made just for my baby.  I compromised and said yes to the Vitamin D, but no to iron.  I agreed to give her iron at discharge, just to keep them from harassing me about it.  They started her the day before we left and after one dose, she started being fussy, which was uncharacteristic for her and she began spitting up, which was also not normal for her.  Not only did she spit up, but it was foul smelling and iron colored, as was her poo.  The next day, the doctor confirmed that it can cause stomach upset so suggested we give her a 1/2 dose twice a day.  So my baby received a total of 1 1/2 doses, before we were discharged and I threw the iron mix in the garbage.   Instead of supplementing your baby consider supplementing yourself, if needed (more about that below).

I kept my baby undressed (diaper only) for the first week, until her IV was out.  
I preferred to use my own stuff--soft muslin swaddles and burp clothes, 
jojoba oil and Weleda diaper cream and body wash.  
Weleda also has a hand cream that saved my cracked, bleeding hands 
from all the hand washing while at the NICU.

First time wearing clothes (kimono top)

Super soft baby gowns

As long as I eat a healthy diet and am not deficient, I trust that if my milk is "deficient" in something, nature intended it that way.  I trust thousands of years of human evolution.  If breastmilk isn't the perfect food for babies how could we have survived as humans up to this point!

Such a good little nurser, even with all the tubes

13 days old

5 days postpartum
A treasured visit from my other kids
My 3 year old wanted to help me

Kisses

Most of the NICU team were great and I am grateful for the life-saving care they provided.  However, it was such a different environment than I was use to and I had to assert myself daily during her 3 week stay.  When she was hungry and a nurse wanted me to wait until her care time (every 3 hours) before feeding her, I would put my baby to my breast and insist over and over, "She is hungry now."  

 









I had a week of desperation when my body wasn't producing enough for the baby, but by the time we left the NICU I had a gallon of surplus milk!

By the end I had a nurse, to the chagrin of the doctor, suggest that I should donate my milk.  Each time she would get my pumped milk she would declare it looked richer than most breastmilk.  The doctors were amazed that my baby fattened up without supplementation.  They acted as if my milk was an anomaly, magical.  Well, I'm not an anomaly, but I was passionate and willing to do whatever was necessary. They were right about something though, breastmilk is magical! [1]

The first thing I did once getting home after showing the kids their sweet sister 
was to take a bath with my baby and climb in bed and nurse laying down.

These are the things I did to increase my milk supply:

• Drink water

• Drink 1 quart of electrolyte daily
     My favorite electrolyte is Vitalyte, a natural electrolyte without artificial colorings or artificial flavorings.  When my son went to Philmont, a high adventure camp where they do extensive hiking (40-50 miles), they were told that for true dehydration those with Gatorade would need to water it down by half!  Vitalyte is also my go-to recovery drink when we (not including baby) have been plagued with diarrhea or vomiting.  Please, don't use Pedialyte EVER! [2]  It has artificial coloring, artificial flavoring, and artificial sugar. 

We like all the flavors, except orange, 
but don't let our preference keep you from trying them all

• Drink 1 quart Mother's Milk tea daily until your milk supply is sufficient and whenever you want thereafter, because it is so delicious.




• Take an herbal supplement like Motherlove More Milk Plus.  I took the maximum dose until my milk supply was sufficient.












• Take Floradix to increase iron, at least until no longer bleeding
     Anemia can reduce milk supply.  Floradix is my favorite iron supplement; it causes no stomach upset or constipation.  It is German-made, came highly recommended by my midwife, and I have used it for years after blood loss (births and miscarriages) and during physiological anemia in pregnancy.  I can tell it's working by my increase in energy, but this last pregnancy I actually had a blood test confirm that my hemoglobin (Hb) went up two points in less than a month after starting the Floradix!

Take it with Vitamin C to increase absorption--glass of orange juice or supplement.  
Do not take it with calcium, because it interferes with absorption.

There are several sizes, but you have to use it within 3 or 4 weeks of opening it.  

I recommend the liquid version, but there is a tablet version.

Floravital is the yeast and gluten free version of Floradix, but is a little more expensive

• Pump 15 minutes every 3 hours, preferably near your baby
     I would produce more if my baby was near and especially if she nursed/nuzzled first.  Some nights we were separated about 6 hours and when I would pump in the hotel I would get less than 10 mL.  When I would see her in the morning my body would release the flood gates.  Once I pumped 258mL (30mL=1 oz so almost 9 oz).  It was incredible to me the physcological/biological connection!

I loved when I had to switch bottles 
mid-pumping because my milk was pouring out

    

   Consider an occasional Power Pump session.  Pump 15 minutes and then wait 10 minutes and pump again for 5-10 minutes.  This mimics a baby and can trigger your body to increase supply.  Massaging your breasts while pumping can also help.

     To make pumping more bearable, I got a cheap bra and cut slits at the nipple area.  I would pop it over my clothes (I don't wear a bra regularly, thus over the clothes) to pump hands-free.

Hands-free!  I could stroke my baby, read, or 
rest my head on her crib while pumping

Felt soul-crushing to pump again and again,
especially in the early morning hours.
This gem was taken around 2 am.

 I would feed her and then pump, but as she got stronger
I sometimes would be in the middle of pumping
when she would want more milk.  Super encouraging!

• Kangaroo care

    Hold your baby skin to skin as much as possible.  I got lots of these type of shirts and I would wear my baby inside.  You're supposed to wear a shirt under these, but I wore nothing, not even a bra.  I did get a pretty brooch to close it up whenever I left the NICU, but I'm sure I flashed my breasts to countless people and I didn't care.  My only concern was my baby.  Not only did it help my milk supply, but it was best for both my baby and me.  
     
               
                              

     Once I started to make enough milk that I would leak, I used breast pads and a light, loose undershirt with a swooping neckline to help keep the pads in place.  I don't use bras while breastfeeding for easier, more comfortable access.

• Talk to the lactation consultants
     They are a great resource for support and trouble-shooting and an advocate for ridiculous hospital "policy" issues you might need help with.  I had a nurse tell me I couldn't sleep bedside (as if you can sleep well in a recliner!).  I talked to the lactation consultant and she confirmed that there was no policy and that I could.

• Eat at least 4 lactation cookies a day 
     When I saw one of the lovely Labor & Delivery nurses that I met the day I was admitted into the hospital she asked how breastfeeding was going and I began to cry and told her I was too stressed and not producing enough!  She told me when she had milk supply issues she bought lactation cookies online and that she had her milk tested afterwards and rather than the usual 20 calories per ounce, it was closer to 30!  I wanted those cookies immediately and didn't want to wait for shipping, so I made up my own recipe.
     These were often my meal, because I was too stressed to eat and I didn't like to leave the NICU.

Florence's Lactation Cookies                                                                                    

Includes ingredients that help with milk supply and increase calorie content.            
          Cream:

½ c. butter, softened

½ c. coconut oil

¾ c. sugar

¾ c. brown sugar

            Beat in:

2 eggs

1 t. vanilla

¼ c. almond butter

            Mix in:

1 c. flour

½ c. almond flour

2 c. oats

4 T. Brewer’s yeast

3 T. flaxseed meal

3/4 t. baking soda (high altitude ½ t.)

3/4 t. baking powder (high altitude ½ t.)

1 t. salt

2 t. cinnamon

            Add:

1 c. dark chocolate chips *

1 c. semi-chocolate chips

¾ c. unsweetened shredded coconut

½ c. raisins

½ c. dried cherries
     Scoop small balls (ping-pong size) and place 12 per cookie sheet.  Bake at 350º for 10 minutes.  Cool 5 minutes, then transfer to cooling rack.  I prefer these fresh, so I make 1-2 dozen and then wrap the remaining dough in plastic wrap and refrigerate.  If won't be using the dough within 1 week, freeze.  If working with chilled dough, increase baking time to 12 minutes.

            Yields: ~3 dozen cookies

*I like using the Ghirardelli 60% cocoa.  I read somewhere that dark chocolate can stimulate milk production.  However, I couldn't easily find it again, so maybe I just wished it.  While breastfeeding you should avoid caffeine, but my babies have never reacted to the amount of caffeine in chocolate.  If your baby does, eliminate it from the recipe and have a good cry.

Food/Herbs that boost milk supply:

• Fenugreek—tea (more effective if taken with Blessed Thistle)

• Oats—cookies, oatmeal, granola

• Brewer’s yeast—cookies

• Alfalfa—pills, sprouts

• Garlic—pills, food

• Sesame seeds—food, Tahini paste

• Dandelion—tea or pills

• Fennel—tea

• Nuts—almond is best

• Barley—soup, salad

• Carrots

• Ginger—pills, ginger snaps, juicing

• Shatavari (wild asparagus), stinging nettle, raspberry leaf, spirulina

• Flaxseed and Chia seeds

         

Supplementing

I feel as long as I'm not deficient, my breastmilk will be exactly what my baby needs.

Iron
Although breastmilk is naturally low in iron, the vitamin C and high lactose in breastmilk make it more easily absorbed. [3]

https://kellymom.com/nutrition/vitamins/iron/

Delaying cord-clamping is a fantastic way to get your baby some extra iron.  Waiting at least 2 minutes after birth to clamp the cord increases the baby's body iron content by over 30%! [4, 5]

Healthy, full-term babies have enough iron stores in their bodies to last at least six months.  My baby was not full-term, but I had healthy iron levels during the pregnancy and decided that I could supplement with iron later if she ever tested for low levels.  Ultimately, I wanted to limit interventions at this tender, sensitive age.

One possible reason breast milk is low in iron is that bacteria require iron for growth. [6]  It could be that breast milk has evolved to have low iron to protect infants from infection.  Most iron that is present in breast milk is bound to an iron-binding protein (lactoferrin), which limits the amount of free iron in the baby's GI tract, which might limit the growth of harmful bacteria. [7]  A study showed an increase in diarrhea in kids given iron supplements. [8]  Another study found that iron supplementation helped infants that were anemic at birth, but when given to infants that were not anemic it caused diarrhea.  They concluded "that routine iron supplementation for breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb." [9] I believe low iron in breast milk is meant to protect infants from infection.

Vitamin D
A study showed that a breastfeeding mother taking 6400 IU/day of Vitamin D will provide sufficient Vitamin D to her nursling. [10] My pediatrician was supportive of me not supplementing and shared the study with me.  This is the Vitamin D  I took while pregnant (I was my midwife's only client that was not Vitamin D deficient--before using this I had been) and have continued using it successfully in combination with my prenatal.

Solgar Vitamin D3 5,000 IU soft gels
Also have a 10,000 & 1,000 IU, but
 I didn't like the 1,000 IU as much

Probiotics
Normally, I don't supplement my baby, but due to her receiving antibiotics, I wanted to supplement with probiotics to help improve her gut flora.  I used these because they were more convenient then mixing up the powdered form, but if you give bottles of either formula or breastmilk the powdered versions would be much cheaper.

My pediatrician recommended these and they also contain Vitamin D. 

More Breastfeeding Tips

• Remember it takes time to make your baby in your body and it takes just as long or longer to grow the baby out of your body

• Nurse on demand and let the baby pull off on her own.  Offer both sides, but it is fine if she only takes one side.

• Use pillows, recliner, bed—whatever to be comfortable
     Use enough pillows so you can bring the baby to your breast, not your breast to the baby.  I was declared a "breastfeeding goddess" by the nurses, because I looked like I was on a throne with all my pillows.

• Use a co-sleeper and as long as you aren't using drugs/alcohol sleep with your baby

I bought a heavy, solid end table at the thrift store for $10
and my sweet husband transformed it into a co-sleeper.

• Avoid pacifiers, formula, and nipple shields (also decreases direct nipple stimulation), bottles—anything that will effect latch or milk supply.
    During our NICU stay I had a doctor repeatedly tell me, "Nipple confusion is a myth," and I would smile, but in my head I was screaming.  After the first few bottles, it took up to 30 minutes of her frantically trying to latch on, but failing to do it correctly.  If I hadn't been experienced I might have given up.  

First bottle of breast milk at 1 week old

I have never been bitten so much by my other babies.  Thankfully, within ~5 months of not having a bottle or pacifier she went from biting me every single day up to 10 times a day to not biting me at all.  If your baby does bite, push their face into your breast rather than your instinct to pull out.  If they do it often, pay attention during the the nursing session so you can anticipate it and break the latch with your finger.  I have never had a baby go on a nursing strike due to my reaction to being bit and I scream every time, because I can't help it.  But I am a sample of one, so take it for what it's worth.  

• Use wet diapers as a gauge for if your baby is hydrated.  Exclusively breastfed babies can go very long periods without pooping, because breastmilk is so perfect for them and they are able to absorb and use almost all of it.

• Fish scale & baby sling for weighing, if needed.  However, better than weighing is how they act.  If they are overly lethargic or extremely fussy something might be wrong.

Best if done with only a a clean diaper & you can tare it
We popped her in here to demonstrate,
because I stopped weighing her a month after we left the NICU.

17 lb 11 oz at 11 months (9 months adjusted)

  

• No decongestants/antihistamines—can dry your milk

• No Birth control (especially Estrogen based)
     Usually, breastfeeding can delay ovulation, as long as you are nursing at least every 4 hours during the day and every 6 hours at night. [11]

• Illness (sore throat, stuffy nose) can affect latch.  If baby has a stuffy nose, express a few drops of milk into a small cup (shot glass works great, then use a dropper to put some in both nostrils.  After ~ 1 minute, use a nasal aspirator to suck out the now softened mucus.  Bloom is my favorite.

  Not only is breastmilk great for helping with congestion, it is also great for any eye related issues.  I spray a little in their eye and massage to help with clogged ducts, etc.

• Please, continue nursing your baby when you are sick.  This great article explains why. [12]

• Mastitis-- I have had mastitis several times in over a decade of nursing. Mastitis often follows a clogged duct from missing a feeding, doing too much, or a poor latch.  You'll have red streaking on your breast, which indicates an infection, a fever, killer headache, and boob-feels-like-it-is-going-to-fall-off pain.  Mastitis can be a serious issue, so follow your gut, but I have never gotten treatment for it or taken antibiotics and have always been able to resolve it within 2-4 days.  This is what has worked for me:
- Stay hydrated with water, electrolytes, tea, and bone broth
- Nurse as often as the baby will allow (even if there is puss, the baby will be fine)--it feels like glass going through your nipple when they first start sucking, but the pain subsides
- Hot showers while massaging your breasts with oil--it hurts, but helps
- Hot/cold compresses
- Supplement with Garlic (food or pill, but not odorless), Vitamin C, Probiotics
- REST, REST, REST

• Circumcision [13] & vaccines [14] can affect breastfeeding temporarily. Please, research both before making a decision.  If you do decide to circumcise or vaccinate, pump to keep your supply, if needed.  Please, consider declining or delaying Hep B and circumcision until breastfeeding is well-established. 
For more on circumcision, go to my post Genital Cutting
For more on vaccination, go to my site about vaccines 

• Breastfeed anywhere and anytime.  I love these historical images of women breastfeeding in public.  Enjoy the hilarious commentary.

Want more...my pregnancy, her birth and NICU experience--coming soon.

For more about my family, go to http://parkerfreerangekids.blogspot.com

You probably thought I'd never end... me, too.  

References

1. Garbes, Angela, "The More I Learn About Breastmilk, the More Amazed I Am"

August 26, 2015; Article about how breastmilk adjusts to baby's needs due to the baby's saliva
"breast milk adjusts its immunological composition. If the mammary gland receptors detect the presence of pathogens, they compel the mother's body to produce antibodies to fight it, and those antibodies travel through breast milk back into the baby's body, where they target the infection."

2. Pedialyte ingredients:

3. Bonyata,Kelly, IBCLC.  Is Iron Supplementation Necessary?   Jan 15, 2018

4. Chaparro, C.M., L.M. Neufeld, G. Tena Alavez, R. Eguia-Liz Cedillo, and K.G. Dewey. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 367(9527): p. 1997-2004. 2006.

5.  Dewey, K.G. and C.M. Chaparro. Session 4: Mineral metabolism and body composition iron status of breast-fed infants. Proc Nutr Soc. 66(3): p. 412-22. 2007.

6. Woolridge, KG, Williams PH.  "Iron uptake mechanisms of pathogenic bacteria" FEMS Microbial Rev. 1993 Nov; 12 (4); 325:48.

7. Bullen, J.J., H.J. Rogers, and L. Leigh. Iron-binding proteins in milk and resistance to Escherichia coli infection in infants. Br Med J. 1(5792): p. 69-75. 1972.

8.  Gera, T. and H.P. Sachdev. Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ. 325(7373): p. 1142. 2002.

9. Dewey, K.G., M. Domellof, R.J. Cohen, L. Landa Rivera, O. Hernell, and B. Lonnerdal. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. J Nutr. 132(11): p. 3249-55. 2002.

10. "How Much Vitamin D Does a Mother Need to Pass It Onto Her Breastfeeding Infants?"  Grassroots Health

11. Weschler, Toni. "Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement"  1995

12. a. Newman, Jack.  "Breastfeeding and Maternal Illness Part 1"  Sep 2017
      b. "Photo of Breast Milk Repelling Harmful Bacteria", Feb 10, 2017

13. a. La Leche League International (LLLI) "Circumcision and Breastfeeding" LEAVEN, Vol. 36 No. 5, October-November 2000, pp. 94-95
       b. McAllister, Ryan, PhD, "FAQs about Circumcision", #8 
       c. Circumcision and Breastfeeding Resources, Feb 8 2018, Kellymom
       d.  "Position Statement: The Effects of Circumcision on Breastfeeding", Sep 2002; an  extensive reference list with links to studies and journal articles.
       e.  "Circumcision vs Child Health, Breastfeeding and Maternal Bonding", Dec 2007;index page with links to studies and journal articles.
       f.  Babycenter community forum "Does circumcision effect nursing?" 2009

14.  a. Medic8, "Baby refusing to breastfeed" Vaccines are on the list of reasons a baby might refuse breastfeeding
      b. Breastfeedingproblems.org forum, "Breastfeeding problems after immunizations", 2012
     c. LLLI Breastfeeding Support Community, "Fussy at breast after vaccines", 2014

     d. What to Expect Forum Discussion, "Not eating well after 2 months shots", 2015

     e.  Babycenter Community forum, "My baby is not feeding properly after administrating her first vaccination".  2010

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