BFAR
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Making More Milk book


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Diana

In 1990, I decided to have breast reduction surgery.  I poignantly remember sitting in the surgeon's office when he brought up the issue of breastfeeding.  He looked me square in the eye and gently said, "You do know that you probably will not be able to breastfeed."  Certain of my decision and wary of anything that could threaten it, I brushed off his warning with the casual reassurance, "That's fine.  It doesn't really matter to me and besides, formula is just as good."  As you can imagine, that statement haunts me now because I have since learned just how inadequate formula is and how very much breastfeeding does matter to me.   But at that time I did not have a serious boyfriend and children were a far-off dream.  As luck would have it, though, only a year later I met my future husband, Brad.  We married and two years later I became pregnant with our first son, Alex. 

It was during my pregnancy that I first began to learn of the advantages of breastfeeding.  Each book that I read contained information about it, leaving little room for any belief that formula was an equivalent substitute for breastmilk.  When I came upon chapters describing how to breastfeed, I would deliberately skip them, not wanting to set myself up for guilt and disappointment.  I'm not sure when it was, but somewhere along the line, I decided that I would "try" to breastfeed, because who knows, maybe I would get lucky and I would have milk after all.  One night during my eighth month, I was reading a pregnancy book and tentatively ventured into a description of hand expression.  On a whim, I tried it and, to my astonishment, managed to express several drops of colostrum from each breast.  It was as if tension had been building within me and had suddenly been released.  I remember feeling proud of my breasts -- as if maybe they weren't going to let me down after all.  Strangely, I hadn't been aware that I felt that way until then. 

When Alex was born, I immediately put him to my breast and nursed him, feeling a sense of deep satisfaction.  We stayed at the hospital for only one day and I nursed him fairly often throughout it, not knowing if he was "getting much," but I was continually assured by the nurses that there was plenty of formula in the world if he wasn't.  Even on the tail end of the birth tape we made, I'm sitting in the room holding him and wondering out loud if nursing is going okay.  My father-in-law quickly reassured me on tape, saying "You're doing it, Mom!"  But a nagging uncertainty persisted. 

Once home, I asked my husband to run to the library and bring back anything he could find about breastfeeding.  He came home with "The Womanly Art of Breastfeeding," and "The Nursing Mother's Companion." I devoured both and absorbed all I could in every other book I owned that had any mention of breastfeeding.  It was as if I had finally earned the right to read all those chapters I had skipped before. 

On the fourth day, we began to think I might not have enough milk.  I had been increasingly aware that Alex was favoring the left breast over the right and he never seemed satisfied after nursing.  Alarmed about Alex's significant weight loss, the pediatrician said that we should supplement with formula and gave us the number of a lactation consultant.  I met with her and after hearing about my reduction surgery, she rejected any idea of pumping to increase my supply and provided me with an SNS (Medela's Supplemental Nursing System).  She showed me how to fill it with formula and wear it so that I could nurse Alex and supplement him simultaneously. 

The SNS seemed to be heaven-sent.  I became adept at managing it and even though we were using formula, I could still feed my baby at my breast.  After three days, he had gained ten ounces and we were vastly relieved.  By having me keep a record of three days' intake of formula, and knowing that he had gained ten ounces, the lactation consultant calculated that I was providing one third of his nutritional intake with my milk. 

When he was four weeks old, after having read in my books about the value of pumping to increase the milk supply, I called the lactation consultant and asked her whether she thought it would be worth trying in my case.  She was skeptical, but agreed to rent a Medela Lactina Select to me.  Interestingly, after a few pumping sessions, I discovered why Alex had shown a preference for my left breast over my right.  My left breast produced twice as much as my right breast did; an average of two ounces from the left for every ounce from the right. 

For the next two months, I established a routine of pumping after feedings, even at night, and filling the SNS with a combination of what I had pumped and formula.  We introduced the bottle for supplementation at around six weeks, because we had been told that at that age he would be past any danger of nipple confusion.  At first, we only used it when we were in a hurry (feedings with an SNS can take a very long time) and occasionally at night.  But about the third month we became much more lax about using the bottle and resorted to it for any excuse, many times giving it to him without bringing him to breast at all.  Alex then began to strongly prefer the bottle. 

I vividly remember the last time I breastfed him.  I had taken him into the nursery for a two o'clock am feeding and had put a bottle of formula in the warmer.  While it heated up, I sat in the rocker and nursed him, enjoying the freedom of doing so without the SNS, but feeling like I was depriving him because I was convinced that my milk couldn't possibly be as satisfying to him as the formula was.  In the emotionally vulnerable early morning hours, I thought about the thinness of my and then the thickness of the formula we prepared.  My milk seemed so inadequate by comparison.  I didn’t know then that the thickness of formula is from fillers and ingredients that are difficult to digest.  When the bottle was ready, I unlatched him, picked up the bottle and fed it to him.  He eagerly sucked it down and that was the last time I ever nursed my Alex.  From that point on, he screamed whenever I would try to latch him on.  I thought that he probably knew best and I gave in to bottle-feeding. 

I didn't throw in the hat, though.  I knew enough about the value of antibodies and immunities in my milk that I began to pump three times a day, feeding Alex the pumped milk in his bottles.  I continued this until he was fourteen months old, even taking the pump on vacations.  Interestingly, even though I was bottle-feeding Alex, I still thought of myself as a breastfeeding mother because I was lactating.  I encouraged others to enlarge their concept of nursing mothers.  It was at this time that I met other women online who were breastfeeding after reduction surgery and we began the BFAR email listserv. 

It was also at this time that I discovered La Leche League.  I had seen its praises sung all over the Internet, but it wasn't until Alex was six months old that I attended my first meeting.  I was so nervous!  I knew he might be fussy and I might need to calm him with a bottle during the meeting and I was a bundle of nerves thinking of how the other mothers and the Leaders would react.  Fortunately, they were tremendously supportive and encouraged me to nurture Alex in any way that was best for us.  They were impressed and touched by my story and soon became the source of my support network of breastfeeding mothers, as well as a fountain of information to quench my expanding thirst for knowledge about breastfeeding.  It was La Leche League that also helped me understand that I was grieving for the loss of the intimacy of the breastfeeding relationship I had had with Alex.  Many nights I had lain awake yearning to hold him to my breast and reconnect with him in that special way.  I resolved then that I would make every effort within my power to successfully breastfeed our next child.  I would take the information and support that I now had and work diligently so I would have every resource to make that dream a reality. 

When Alex was a year old, I became pregnant with Ben.  During my pregnancy, I renewed my quest for knowledge about lactation, reading and rereading every text I could find on the subject.  My husband and I took Bradley Method childbirth classes, which trained us in relaxation techniques to maximize our potential for drug-free birth so as to ensure the best circumstances for a good start for breastfeeding the new baby.  I obtained a Lact-Aid at-breast supplementer so that I would have both an SNS and a Lact-Aid handy should I need them.  I rented a Medela Lactina Classic (the most powerful rental pump available at the time), as well as a Medela BabyChecker Scale.  I purchased Blessed Thistle and Fenugreek herbs in dried form to make infusions.  And then I relaxed and waited for Ben's birth. 

Five days past my due date, Ben was born after only six hours of labor.  We arrived at the birthing center and I delivered him thirty minutes later.  He was put to my breast to nurse with the cord still attached and pulsing.  Brad, Ben, and I spent the next five hours in a blissful cocoon, enjoying the afterglow of our beautiful birth.  Then we went home and Ben and I began our breastfeeding relationship. 

After a long, deep sleep that evening, he began to nurse almost continuously for the next few days.  He seemed very contented and often alert.  My milk came in thirty-six hours after his birth and I went through twenty-four hours of profound engorgement.  I was miserable and used cabbage leaves to minimize the discomfort.  After a day, it did subside and Ben seemed to be very pleased with his new milk meals.  Weighing him once a day revealed that he was gaining an average of two ounces a day (one ounce per day is normal in the first months).  He regained any birth weight he had lost and it was not long before he grew into a chubby breastfed baby.  

Although I had been fully prepared to, I never had to supplement Ben at all.  This is not to say that there weren't moments when I doubted my milk supply and was only a hair breadth away from mixing formula.  Like many babies, Ben had a particularly fussy period in the early evening when he would latch on and off and cry inconsolably.  It was natural for me to doubt my milk supply at this time.  What kept me from supplementing at those times was the daily weighings that I had been taking on the rented scale.  I knew for certain what his weight gain rate was.  I was able to remind myself over and over that a baby who was gaining two ounces a day was not hungry. 

Ben and I went on to have that breastfeeding relationship I dreamed about.  We nursed anywhere and everywhere, I had an extensive nursing wardrobe, he was in the 85th percentile for weight, and he enjoyed the silky skin typical of breastfed babies.  We had an intimacy and connection that made me thank my lucky stars that the second time around I had the information and support that made it all possible.  I'm certain that my milk glands and ducts recanalized as a result of that year of pumping.  I am convinced that it was my thorough understanding of the issues involved in BFAR that maximized my potential.  But without the support of my family, my fellow BFAR mothers, and my friends in La Leche League, I would never have had the strength to persevere to reach the rewarding stages of breastfeeding.  Once I had experienced how wonderful a successful breastfeeding relationship could be, I knew that it was truly worth every bit of the effort.

My third son, Quinn, was born in May of 2001, just one week after the final proofs of my first book about breastfeeding after breast reduction surgery had been submitted to LLLI for publication.  I felt as if I had birthed twins – Quinn and the book!  Both were joyous births and yet I still experienced breastfeeding difficulties.  Quinn was three weeks overdue and his birth was very fast and intense.  At one point, I was so overwhelmed with pain that I asked the midwife to give me Nubain.  She agreed to a half dose, which did help somewhat. 

When Quinn was born, he had very little interest in latching and was very sleepy.  Over the next two days, I became increasingly concerned as he continued to refuse to nurse.  I contacted a Certified Nurse Practioner who specializes in lactation.  She discovered that Quinn had an obstructed nasal passage that made him unable to breathe easily through his nose.  She removed the obstruction and he immediately began to show normal interest in nursing.  Like his brother, Quinn gained very well and was in the 85th percentile for weight.  My fears about low milk supply finally receded.

I have thoroughly enjoyed nursing my boys.  It transformed me and inspired me to achievements I am certain I could never have conceived of otherwise.  I will be forever grateful to my La Leche League sisters for their never-ending support and wisdom to nurture my babies in the way that best meets our needs. I am grateful to my husband Brad for his constant encouragement and steadfast belief in the value of breastfeeding.  Most of all, though, I am deeply grateful to my sons Alex, Ben, and Quinn who have taught me all there is to know about true love through the experience of nursing each of them in turn.

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