really hoping to BF baby #4...any advice? (kinda long)

[pomegranate]

hi there i am PG with baby #4 (due in november) and i would love to be able to have a more successful BF experience this time.

my BF background: i had breast surgery when i was 19 years old (13 years ago). i was very hopeful that BF would work out with my other 3 children. however, i had low-supply with all of them.

with baby #1 i rented a hospital pump and tried pumping after nursing. i found this physically and mentally exhuasting. he was supplemented very early on. i *think* i used domperidone/herbs as well, but ultimately gave up on nursing after about a month.

baby #2 i tried a SNS and i used domperidone/herbs as well. results were the same as the baby #1. supplemented very early. quite BF after a month. i found the SNS very tricky to use (tube wouldn't cooperate and end up being outside the baby's mouth after latching MANY times )

baby #3 i did some pumping with a manual pump, but didn't bother renting one nor did i use the SNS. i DID use domperidone/herbs again. i supplemented early again. i don't think i lasted a full month before giving up. i was mentally drained and my DD was having some health challenges that made daily life harder; never mind adding dismal BF success to the mix.

so, THIS time i will again do domperidone/herbs and try nursing teas too. i don't recall the dose of domperidone used before, but i would certainly go to the max. dose. would there be any point to the nursing teas? or would that be herb "overdose"?

i should add that i had midwife and doula support for BF with the other 3 and will again this time. it was great having them work on the latch over and over and over. i also have the dr. jack newman DVD guide to BF.

i am really debating on whether i should rent a pump again or try the SNS again. part of me wants to try harder than ever before, but i also wonder if that is a realistic idea given the fact that i have 3 other kids, 2 of whom will need school transportation.

one other thing that i am hoping to do is "rooming in" after birth. staying skin-to-skin as much as possible and in bed with baby as much as possible as well. i'm very lucky that my mom and my husband will both be taking some time off after this baby is born, so i hope that rooming in will help with BF.

i crave the seemingly impossible (for me it seems) ideal of exclusively BF. any tips on helping me get closer to this goal? (the link in the resources for BF after breast surgery didn't work)

thanks so much!

[Chloe 777]

It seems like you've done everything right with the other three babies.

I would suggest all the things you 've already tried, but if pumping is going to make you feel drained and make you give up, then I guess it's not a good idea.

I would suggest taking the herbs and domperidone right from the start, and pumping with a hospital grade electric pump after every nursing session. The sns is great for supplementing and still increasing the supply while having baby at the breast. But if that's too much (I've used and I didn't like it either),then you can supplement with an eye dropper or cup, and have someone else like hubby do that for you, while you pump.

Make pumping fun for you, think of it as some time you can spend reading a book, or watching tv, or talking on the phone, and those are little breaks that you can take lots of times during the day.
Of course having another three kids, that won't be easy at all, unless you have lots of help, from hubby, or someone else, or all the people you can get to help out.

If you really want this, you can do it. Even if it means having to supplement, it's ok. Baby will still be getting lots of breastmilk from you.
Just make sure you don't miss meals, and always put baby on the breast before supplementing, and pump every time after feedings, especially when you supplement. Sleep with the baby, let him/her nurse while you sleep, wear him on a sling, let him nurse while you do chores, play with the other kids, or while you go for a walk. Nurse on the first signs of hunger, like biting hands etc, and don't wait for the baby to cry, as that is the last sign of hunger.
Nurse nurse nurse, and you can do this.

I'm wishing lots of luck! May you have a wonderful birth and a beautiful healthy baby!

[blessedwithboys]

Whatever you decide, just remember that your baby will benefit sooo much from even just a month of bm! The colostrum is especially important. It sounds like you have a truly unique situation and aren't looking for an out, that is sooo awesome! For sure do whatever you can, but don't let the thought of stopping at one month keep you from at least initiating. You rock!

[pomegranate]

thanks soooo much for your replies!!

[emilysmama]

I suggest that you interview several lactation consultants, including but not limited to, the lactation consultants that are in the hospital. I suggest that you interview them now, before you give birth, instead of after the baby is born. Not all lactation consultants are created equally.

In my personal experience, all except one of the lactation consultants I ran into the hospital had no experience with babies older than a few days. Almost all of the hospital lactation consultants just spent their time with the easy babies in the labor delivery floor and just had to point the baby in the correct direction. One lactation consultant kept remarking that it was so weird to her to see such a large baby (my baby was only 3 months old!) because she only saw babies that were just a few hours old. Another lactation consultant kept recommending olive oil for every single problem I presented to her (and I came to her with many very different problems on different occasions).

On the other hand, just by random trial and error, I found a hospital lactation consultant who was worth her weight in gold. She had experience with all kinds of breast feeding challenges that are not run of the mill. She continually read up on the literature. She also happened to be an RN as well, which I found to be very helpful. She even came to my home after work on several critical occasions!

You want someone like that. You also want someone who has experience with "older" babies, which means babies that are more than just a couple weeks old. You want someone who has experience with working with low supply mothers, beyond just suggesting that they offer the breast more often.

It should be easy to figure out whether you've got that when you interview the lactation consultant. Just tell them your experience like you did in your original post, and ask them what thoughts they have. Ask them if what experience they have had working with mothers that have had breast surgery. If they don't have any experience, it will be obvious to you and you can continue looking.

I found the fantastic lactation consultant that I needed, but I found her the hard way, while I had a brand new baby and couldn't leave the house. I wish that I had done the vetting before the baby had come because life would have been so much less stressful.

If your interviews blow through all of the lactation consultants in your hospital, try those in another hospital, and also ask you local LLL leaders for recommendations of local lactation consultants. (Pediatricians too, maybe.)

[emilysmama]

I, too, used the SNS on my dd and I disliked it intensely because it was so tricky. For me, however, pumping and SNS did help me in the end. (Also a few other implements.) My situtation was different from yours. I have never had breast surgery, and I only had/have the one child. However, I had a low supply, and a child who refused to latch on (even once) for the first 3 months of her life. In two weeks, I was able to build the supply up from zero by just pumping. (I was too chicken to try the medication. I dabbled with some herbal teas but for me I didn't find them helpful.) But even then I had to spend the rest of the three months trying to figure out how to get dd to latch on. But she did eventually.

My point, however, is that it was a scary time. What helped me succeed and gave me the will to persevere was that the lactation consultant said that I could do it. It wasn't just that she said I could do it. She outlined a game plan of exactly what I should do. Once I saw the plan, I just implemented it.

But to get that game plan, you need to find a knowledgeable lactation consultant that is experienced with tricky low supply problems, and those are too rare to find by trial and error.

My dd was a strong nurser until she self-weaned cold turkey at the age of 3 years old. I don't have enough experience to be able to tell you that you can too. However, I was able to do it with the help of a very good lactation consultant and without her, I would have surely given up. With the right help, just imagine what YOU can accomplish.

[emilysmama]

If you are willing to pump (and believe me, I have a little idea how hard the pumping is because every drop of breast milk that my dd got during her first three months of life came from the pump), then I suggest some things that will make the pumping more of a "me time" or productive time, instead of a draining chore. Once you figure out how to pump hands free, there is a lot that you can do while pumping. I set up a pumping station.

When I pumped, I used to march in place. It was only ten or fifteen minutes per pumping session, but it must have added up because I lost weight quite rapidly.

I later started reading all kinds of books and magazines while pumping, which made it more enjoyable, but didn't get as much exercise, unfortunately

I learned to nap while sitting up and pumping in the middle of the night.

There were times when I pumped milk while feeding the baby. Now that was an ironic sight to see!

My baby was born before I could do this, but now that wireless internet is so common, it would be great to be able to pump while surfing the internet. My dh set up a wireless network using a router so that it would now be possible, but he is 6 years too late! But not you! You still have time to set something like that up.

I didn't try this, but I bet it wouldn't be hard to pump while, say, chopping vegetables or doing some kind of meal prep.

[SubliminalDarkness]

Wow, OP! You are really determined! That's great!

I'm curious about a few things.... What kind of breast surgery did you have? And with your previous babies, what caused you to feel the need to supplement, and how did you go about doing it? All of these things can make a difference.

fwiw, I do have a bit of background.... I EBF my DS2 after having a breast reduction. I had very low supply and he had some oral issues that complicated matters, so I walked a tenuous line of whether or not EBF was sufficient, and there were a lot of things I watched to make that call.

[justKate]

I had a breast augmentation on one side at 14, but no work on the other, so I totally see both sides of it.

It took six months for the augmented side to match the natural side, but eventually, the augmented side made as much milk (in fact more, around 12 months), than the natural one. Not sure when yours was done, but I don't think they gave a lot of attention to breastfeeding futures when they did mine. It sucks. I get mastitis on that side exclusively. Pumping is harder on that side--the right side would make three times as much as the left.

I guess the point is, ANY breastmilk that you can give your LO is great. Yeah, EBF is great. But it's not all or nothing. Give your LO what you can, do your best, and don't stress the rest. A lot of post-augmentation mamas successfully breastfeed for a very long time, even if not exclusively. You can do it!

[nicky85]

Something that might maximize your success is getting your newborn to a pediatric chiropractor ASAP. Even gentle births are hard on a baby can push the jaw out of alignment making it difficult to open the mouth all the way and establish a proper latch. Some babies won't be able to trigger the milk ejection reflex or will move their mouths in a side-to-side sawing motion to trigger milk ejection (painful for mom!) I suspect this is what happened with me when I was a baby. My mom thinks she couldn't make enough milk even though it was coming out all over shirt at night. 25 years later, I am being treated for TMJ and can't open my mouth all the way. My jaw actually only moves side to side and not up and down. My whole life I've had clicking and popping sounds when I open my mouth.

Go to www.icpa4kids.org to find a pediatric chiropractor. My baby is adjusted by a chiropractor on a regular basis and adjustments for babies are very gentle. You wouldn't know it's a chiropractic adjustment if you didn't know what was going on. It will look like the chiropractor is just feeling with her fingertips along the baby's spine, cranium, and jaw.

[pomegranate]

hello again i'm glad i checked back as there are more replies (i forgot to subscribe to the thread; oops )

thank-you all so much for the support and new ideas, i really, truly appreciate it.

@emilysmama - i think i will pursue some LC support, probably via LLL. it makes sense to do this NOW so all the ducks are in a row. my doula is a wealth of information as well i like the idea of an official "gameplan"; then everything will seem more concrete for plans of action in the mind-bending post-partum time i am totally impressed about what you were able to do while pumping! if it's "me time" it most definitely would seem less chore-like.

@subliminal darkness - i had bilateral augmentation and maxopexy (lift) on one side when i was 19. my breasts were vastly different in their size and appearance. i probably caved and supplemented too early with the other babies. they did show some signs of dehydration and weight loss. i know that weight loss is to be expected after birth and while BF is getting established, but there was never a plateau that was reached, just further loss. i didn't feel comfy letting it go on and on like that, so i supplemented.

@justkate - i wonder how breast surgery techniques with relation to BF has (hopefully) improved. i did ask my surgeon if/how BF would be affected after my surgery. i recall him saying that it should be fine; but in an offhand manner. i wonder if he took my question seriously, as i was only 19 and not close to having babies i agree that some BM is certainly better than none! all my babies had some, so i take solace in that (specifically the colostrum).

@nicky85 - thanks for the chiro suggestion! i do have a wonderful chiro and he has children of his own so i would be happy to have him help. i wonder if it would have helped with the other 3. too bad it didn't occur to me with each of them

thanks again - the tips and morale boosting are wonderful!