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Our journey began in January 2001 when I decided to have breast reduction surgery at the age of 36 years old after suffering with a herniated disk. At the time I didn’t really consider the future implications and its effect on the potential to breastfeed as I didn’t believe that I would be able to have children. For a fleeting moment, I considered questioning the plastic surgeon about the possibility of breast feeding after the reduction surgery, but decided, at that moment, that relief from the back pain was more important that an answer to a what-if question. As I look back on that moment and consider the wisdom that I have gained since having my son in October of 2003, I realize that I would have handled the entire journey differently, although, at the time I had no idea how emotionally torn I would become after delivering my baby.

As I now know, no amount of reading or anecdotal information can adequately prepare a mother for the heart wrenching agony of not being able to breastfeed a child that she has brought into this world. Throughout my pregnancy at 39 years old, I was asked if I intended to breastfeed my baby. My answer was always the same, “I will if I can.” This was said without a lot of emotion as I didn’t know at the time the emotional avalanche that I was about to encounter. As an older mother, I was carefully monitored throughout the pregnancy. I was diagnosed with insulin dependant gestational diabetes and strictly followed doctor’s orders. Toward the end of my pregnancy, I was able to express a small amount of colostrum. That made me hopeful about being able to breastfeed. I should have met with a lactation consultant before the baby’s birth as I had so much that I needed to learn. My ob/gyn and I talked about breastfeeding. We knew that I would have to wait and see if I would be able to breastfeed, and I thought I was prepared. My ob/gyn also cautioned me that women with gestational diabetes often have a difficult time breastfeeding.

After being induced and encountering some complications, my son was born by cesarean section after a long labor and immediately rushed to the special care nursery for observation because of my diabetes. My baby wasn’t brought to me until 11 hours later. A nurse asked if she could give the baby formula. I agreed without knowing the consequences. My first attempts at breastfeeding were disastrous as I had inverted nipples, a debilitating spinal headache, and little support from the nursing staff. A hospital lactation consultant came about 8 hours later even though the pediatrician asked for help on my behalf early in the morning. She spent a mere five minutes with me, gave me a nipple shield, helped the baby to latch on once, and left. Once the baby came off the breast, I couldn’t get him to latch on again. I kept trying to get the baby to latch on, but had very little success.

It wasn’t until the third day after my son’s birth that I found a nurse who was willing to help me with breastfeeding. I had to have a meltdown to get the help that I needed. I kept telling the nurses before then that things weren’t going well. Their solution was to give the baby more formula. This one supportive nurse gave me the time and assistance that I needed. She spent an entire feeding with me in the middle of the night. From that point on, I insisted that the baby be brought to me each time he wanted to eat. I would be the one to decide if he needed formula. Even though I still had the spinal headache, I kept the baby with me as much as I could. My husband was a tremendous support. He completely took over the baby care as I wasn’t able to do much.

After five days in the hospital, the baby and I were sent home with a hospital grade breast pump, a nipple shield, and a haberman bottle. We were told to call the pediatrician if the baby seemed to become more jaundiced.

At home, things went from bad to worse. I still had the spinal headache and breastfeeding was not going well. I was pumping whenever I could. I pumped before a feeding to get the inverted nipples to protrude so that baby could latch onto something and I pumped every two to three hours to increase the milk production. I was supplementing with a minimal amount of formula using the haberman bottle.

After five days at home, we went to the pediatrician for a check up. When I told the pediatrician the amount of formula I was giving the baby and the yield of my pumping efforts (5-6 ccs each time), he was not hopeful about my ability to breastfeed. He was kind but not optimistic about my supply increasing. He told me that I had to supplement more. We made an appointment for the next week. I had to take the baby to the hospital for another Bilirubin test as his pediatrician was concerned that he was even more jaundiced than when he left the hospital.

Sometime during this week, I decided to give up breastfeeding. I wrote a letter to the baby apologizing for not being able to breastfeed him. I was devastated. I met with the ob/gyn for my two week post partum appointment and told her that I was giving up breastfeeding because I couldn’t do it. She told me how to dry up my milk supply. I tried for two days to give up. Each time I thought I was finished, I would put the baby to the breast and decide that I would attempt to breastfeed one last time. I was crying constantly at this point.

After two days and gallons of tears, I contacted the lactation consultant who had been working with me through email and phone calls and asked her for help as I realized that I couldn’t give up. I knew then that I had to do everything in my power to succeed. The LC suggested that I start taking Blessed Thistle and Fenugreek and start feeding the baby with a Hazelbaker finger feeder. She told me to order a Lact-Aid, and we made an appointment for her to help me with the latch. I used the LA for approximately two weeks. My husband and I carefully prepared each bag of supplement and grew increasingly frustrated with it. The baby was also very frustrated and was crying constantly because the tube kept slipping out of his mouth. We decided that we would give up the Lact-Aid and supplement with the finger feeder and with bottles only. We knew that we were taking a chance that the baby would have nipple preference and he might reject the breast, but it was the only way that it would work for us.

The lactation consultant also suggested that I get a prescription for Domperidone, but I was reluctant as I am not someone who likes to take medication. It wasn’t until my 6 week post partum checkup that I decided to ask my ob/gyn about it. She was familiar with it as she had prescribed it for an adoptive mother.

Through research on the BFAR webpage, I found a pharmacy in my state that would compound the medication. I began taking domperidone when the baby was 7 weeks old.

At eight weeks, with the suggestion of the lactation consultant, I decided to try to get a stronger breast pump. I had been working with the Lactina and was getting very little milk (15 cc's at most). My LC told me that many mothers were having great success with the Medela Symphony breast pump. After researching the pump, I realized that the cost was prohibitive and that it wasn’t typically covered by insurance except under extenuating circumstances. I asked my ob/gyn for a letter of medical necessity as I had so many problems. Because of the letter, the pump was covered. The first time I used the Symphony, I pumped over 2 ounces of milk. My milk was shooting out for the first time and got better over time. With the combination of the herbs, the domperidone, and the use of the Symphony Pump, my pumping yield increased to as much as four ounces.

My baby is now seven months old. We are still breastfeeding without the use of a lactation aid. We supplement with formula throughout the day as I returned to work full time when he was 10 weeks old. I am currently weaning off of the domperidone and am still taking the blessed thistle and the fenugreek.

I would like to say that I am completely confident about my abilities, but the truth is I continue to have my doubts and wonder if I am doing the right thing. I constantly think that my supply has dropped and often feel inadequate. I try to make it one more day, one more week, one more month. My original goal was to make it to six months. I did that and now I hope that I can continue to breastfeed for at least the first year.

As I reflect on this journey, I realize that I have had so many people who went out of their way to support my efforts. I have the most wonderful husband who partnered with me to give the baby every drop of mother’s milk that we could. He sacrificed a lot and never once suggested that I give up even though there were so many times that I think he should have. He was awake with me in the beginning during every feeding at night when the baby needed supplements each time following a breastfeeding session.

I found a fabulous lactation consultant who provided me with valuable advice through phone calls, emails, and home visits. She is a wealth of information and sent me lots of articles about breast feeding after reduction and often encouraged me when I felt so defeated. She provides a labor of love and is only paid a small fraction of her worth.

I have a wonderful ob/gyn who is more than a doctor. I have the utmost respect for this woman. She never hesitated when I asked about the domperidone. She understood my need to breastfeed my baby and provided the necessary medical support. The compounding pharmacy I found is top of the line. The service that I received at this small pharmacy can never be replicated by one of the chain store pharmacies that have put so many of these independently owned pharmacies out of business. The pharmacist has been very supportive and their on-site lactation consultant talked with my doctor to determine the appropriate dosage of domperidone. In addition, I joined a nursing mother’s group led by a lactation consultant who was very welcoming to me even though I often had to pull out a bottle of formula to supplement the baby once I was out of milk. In this group, I learned that lots of women have breastfeeding problems. Many of the problems I thought I was facing alone were common among breastfeeding women. My favorite phrase to people about breastfeeding is, “breastfeeding is natural, but it doesn’t come naturally.”

Of all the wonderful people who have helped to make this journey possible, the person who deserves the most credit is my son, Nathanial. He is a real trooper. He never gave up on me. He tries so hard to get milk from me and always has a smile on his face. The poor little guy doesn’t know that the breasts aren’t supposed to work that way. Every smile encourages me more. He eagerly takes milks from my breasts and then happily drinks from the bottle to fill his belly. He has worked very hard to stimulate the milk production. While I can not fully feed him with breast milk, I know that I am giving him all that I can. Every drop counts.

I have been very fortunate that I have had so much support. Each time I was about to give up, something would happen to give me a little more hope. Someone would come along and offer the encouragement that I needed to try for a little longer. Someone told me once that angels would come along just when I needed them to help me to breastfeed. I have had many angels who have given me the encouragement, support, and nudging that I needed to make breastfeeding a success. As my ob/gyn said to me, “Treasure every moment that you breastfeed your baby.” I think of this advice every single time I am breastfeeding Nathanial and I do treasure every moment as I have been truly blessed.

My suggestion to any BFAR mother is to seek help from the very beginning. Learn about breastfeeding after reduction early on in your pregnancy and seek the help of supportive people. Find a BFAR friendly obstetrician, learn about BFAR from the website and Diana’s book, find a BFAR knowledgeable lactation consultant, make sure that you let the hospital staff know your breastfeeding preference, and educate your family to the benefits of breastfeeding and the type of support that you will need. I know that I could not have done it without the support of all the people that I have mentioned. It requires a real commitment and will be a lot of work. It is, however, a labor of love.

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