Mirena and Low Milk Supply
My daughter had a lot of issues when she was born. We didn't know for some time that she had a reflux problem. That is pretty much squared away as she is five months now. I went from only producing 4-6 ounces total a day, to 3 ounces at a time from each breast. Then I had mirena put in. Everything seemed okay at first, but when I started to bleed into 3 weeks, my supply dropped massively. I was barely getting an ounce and a half from each breast each time I pumped. The bleeding stopped and I was still pumping and attempting to get my daughter to latch--she seems to really dislike breast feeding so I've mostly dealt with feeding her it through a bottle. I've tried nipple shields and supplementing... I'm still trying. This is my first experience breastfeeding and it has been horrible and difficult.
Anyway, the second time I started bleeding for three weeks again, my supply became almost nonexistent. I was told that this wouldn't affect my supply. I even researched it back in January right before I had my daughter. There was nothing on their site about it. Now there is something that in some cases a decreased supply was observed. My doctor didn't even know about this because she claimed there were absolutely no cases according to the information that the drug company had sent her from their tests.
So I have had extremely sore nipples, cracking, bleeding, lots of pumping, and for pretty much nothing. I am in discussion with my doctor to see about getting this removed but I am also looking into a lawyer. I don't think it's fair that they kept this information from people.
I am really confused as to what I should do. I haven't pumped in the last two weeks, but there are still very few drops that come out. Once in a while my nipple area gets wet when I bottle feed my daughter but not soaked. Just a couple specs here and there. Should I wait until I have the mirena removed before I begin relactation or should I start now. I should note I take 16-20 fenugreek a day without any maple syrup smell. I don't know if I built up a resistance while taking it so much when my supply was crashing. They also did not have blessed thistle available in any stores in my area until last month. I did purchase a bottle of that, alphalpha, steel cut oats, etc.
I am very upset and stressed. It feels like my baby hates my breast so getting her to latch is not working. Also, the lactation consultant here acts like I should know what I am doing. She just pushes my baby at me, gets her to latch for a few seconds, she cries like crazy, won't relatch, so she makes me bottle feed her a bit, and try again. Same scenario. She makes me feel very stupid and as if I am not trying enough. I can't even feed my baby in the middle of the night because she sleeps through it. She does not like it if I wake her up at night to feed her, even if I hold off some feedings--she will just cry bloody murder until I lay her back down. I saved whatever I was pumping in the freezer and supplemented with formula so I have maybe 3-4 weeks in there worth.
I have been working with skin to skin, but my daughter really dislikes it. She prefers to be clothed. She doesn't even like it if I try to put a blanket over us. She freaks out.
Does anyone have any advice. I've been reading the websites, but I feel so very alone and exhausted. Even my fiancé is upset about this and has tried to help getting our daughter to latch to no avail. The bleeding has stopped now so I don't know if that was affecting my supply. I still take my prenatal, dha, and extra iron due to a blood disorder (my platelets aren't very sticky so bleeding times run longer).
I am just very confused and in need of some advice. Do you think I should go to another hospital to find another lactation consultant? I really don't want to return to the one here and feel more miserable about myself. She also runs the local breast feeding support group so there is no way I am attending that either. I am just so frustrated, I have literally banged my head against the wall and cried. Now I am trying to sit down with a book and calm my nerves a bit. Does anyone know of some good one-on-one experts in Massachusetts--particularly the north central part?
Re: Mirena and Low Milk Supply
Hi rhaewyns mom! So sorry you are having this terrible struggle. You are not alone. Many mothers have low supply issues, and at least, anecdotally, even progesterone only products cause issues with production in SOME mothers. Why some and not others? I don’t know. Maybe no one knows. But breastmilk production is in large part a hormonally driven biological process. And all hormone based bc changes a mothers hormone balance, this is how they work. So if you are seeing a huge drop in production after the placement of mirena, then it is a good chance imo the iud has something to do with it. So, you are not crazy. I don’t know if you have a legal case or not, but lets leave that aside for the moment.
No. It was not for nothing. Even if you never produce another drop of milk or nurse your child for another second, it was not for nothing. Every drop of breastmilk and every moment a child spends nursing at the breast has value. I promise you!
So I have had extremely sore nipples, cracking, bleeding, lots of pumping, and for pretty much nothing.
Now, as far as approaching your issues-I have a few questions, sorry.
1)Did baby ever latch and nurse 'well?" Or at least, without resistance? Even if it was once. Was there ever a calm, relaxed, effective nursing session for baby? Ever a time nursing did not hurt you?
2) When was the mirena put in? before you had the mirena put in, how many times a 24 hour day was baby nursing at the breast and how many times a day was baby getting bottles and how much was formula and how much expressed milk was in each botttle? (per day)
3) Now, how many times a 24 hour day is baby nursing at the breast and how many times a day is baby getting bottles and how much formula or expressed milk is in each bottle?
4) Have you ever had your pump checked out? (troubleshooting, changed the membranes, connections, etc?) The flanges checked for proper fit? Is it a hospital grade rented pump (such as, a Lactina) or something else?
Ok lots of questions! But the answers may (I hope) help us give you information. Now some answers for you-
Assuming pumping is not painful or damaging you, I don't see why you would wait to have the mirena out. Pumping is certainly not going to hurt your milk production and it may well help, even before the mirena is removed. DON'T STRESS ABOUT HOW MUCH YOU MAKE EACH PUMP SESSION. Just pump, as frequently as you can. Not for long-15 minutes a session or so at most. (per side.) You can hand express instead or as well.
Should I wait until I have the mirena removed before I begin relactation or should I start now
I would say, do not go back to a breastfeeding helper of any kind who makes you feel stupid! Here is basically what a professional lactation consultation should involve: http://cwgenna.com/lconsult.html
She makes me feel very stupid and as if I am not trying enough.
Have you contacted you local LLL? You can look up professional lactation consultants here: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432 I always suggest, call at least 2 or 3 and chat a bit before hiring.
Ok, now lets talk about skin to skin. Sounds like it is not working for you. If baby prefers to be in a onesie or whatever, let baby be in a onesie. If you prefer to be lightly dressed, be lightly dressed. Just make sure baby has easy access so if baby starts to root around, you can get your breast out fast! Also, there is some evidence that the way a baby is positioned on mom and the way mom is positioned helps breastfeeding and reduces the 'pushing off" you are seeing. It is called laid back breastfeeding. You may have already tried it. I suggest, try again. If it feels like it is not working, adjust the amount of lean. You can be just very slightly leaning back. Baby can be in ANY position. The basic idea is mom is in a comfortable, supported position and baby is supported as well, by moms body, mom and baby are front to front. But you can adjust/play around with this any way you like. see http://www.llli.org/docs/00000000000...astfeeding.pdf and http://www.biologicalnurturing.com/video/bn3clip.html
Another totally opposite idea-try latching and nursing baby while standing, walking, bouncing etc. Or sidelying. Or in any different way than you are doing now! As much as possible, Offer the breast only when baby is calm and not frantic. At earliest cues or even, before there are cues.
Also try having baby so baby's head is above baby's tummy. This can be important especially for refluxy babies.
Re: Mirena and Low Milk Supply
:ita Don't wait. Start pumping, find a different LC, and try nursing as much as you possibly can.
I personally would not waste my time- or money- with a lawyer. As far as I know, the safety data on Mirena and other progestin-only contraceptives is pretty clear- they have not been shown, statistically speaking, to cause difficulties with milk supply. That does not mean that they don't cause problems. Just that the data don't show it.
Re: Mirena and Low Milk Supply
Yes for almost two months she was nursing great. For 6 weeks she was completely off formula supplement and only taking my breast. They were very soft after she would nurse and pumping right after wouldn't yield anything much but I started getting more each week. That definitely seemed to boost my supply in the beginning. I had to sit her upright because of the reflux and turn her inward toward my stomach or the other way--dependent on whether she was facing in or out. I tried to vary the positions but this was the only one she ever got comfortable in. I did try to move her slightly while she was feeding, but she would unlatch and cry until I started her back in the same position and didn't move her. I did get the cracked and bleeding nipples in the early stages. Nothing too terrible, but they were quite itchy when they were healing. Nothing a bit of lanolin didn't clear up.
The issue became clear the third week I was bleeding. When I had the mirena put in, I had light spotting after the insert for 3 days, and then no problem for 2 weeks. Then the bleeding started. My daughter became more and more fussy at the breast into the third week. I was mostly just breast feeding on demand which seemed constant throughout the day. I have a very small chest freezer, so I can't fit more than a month and a half in there due to space. She started sleeping through the night after she got her shots for a good 9 straight hours. She is also a big girl. She was born weighing 9lbs 6oz. She started losing weight the third week which we noted on our digital scale. She was refusing to latch. She would just push me away all the time then cry like crazy because she was hungry. When speaking to the lactation consultant she told me that I obviously wasn't producing enough and needed to supplement because I was starving my baby. (she made me feel absolutely horrid about this) I was to just pump at each of her feedings for 30 mins on each breast if she would not latch and bottlefeed her supplementing. I received the hygeia double pump from WIC to use. It was the only model they had available. The lactation consultant tells me that my insurance company will not pay for a double pump, but the insurance tells me they will if she files the paperwork. I have told her this and she refuses saying that they will just deny it so it's a waste of her time.
After the first week of the supply not picking up back up, the consultant told me to get on fenugreek. Which I did. I stopped bleeding for two weeks, and it started back up again decreasing my supply even more. The consultant said I needed to take enough to smell like maple syrup, but the dosage she told me to take 4 tabs 3x a day worked at first and then it started to fade.
Sometimes she would nurse just about every hour, or every hour and a half throughout the day from 7am-10pm at night. She was falling asleep at my breast and I was leaving her there at times to suck while she slept to increase supply as I was directed. There is an indent in my new couch from the two of us sitting there so much, lol.
My local LLL is about a 45 minute drive away. It's not very local which is upsetting. In fact the next hospital is much closer at 20 minutes away--which I why I am considering dropping in there. I have been by a few times, but the consultant was not in. She has very odd hours--only 3-4 different times during the week and it changes daily depending on her schedule.
Wow, I am checking out one of the links.... The consultant never looked at my daughter's tongue when we first met with her.
Currently my daughter wants to have 6-8oz at a time. She is also on baby food because of the decrease in weight. She has handled the baby food better than the formula and we take it slow. Half a small jar in the morning, half at night, if she is extra fussy we add a tablespoon of oatmeal to her bottle. She is on hypoallergenic formula as most formulas seem to make the reflux worse for whatever reason. We will be having her checked for allergies in 2 months (earliest appointment we could get).
Thank you for your advice. I am going to see about contacting some people and see if I can get transportation. I really wish they were closer which is one of the main reasons I haven't sought them out.
Re: Mirena and Low Milk Supply
You know, all the bleeding you describe makes me wonder if you have been tested for low iron. Anemia can cause poor milk production. Is the bleeding normal with a mirena?
LLL- Well, you do not have to go to an LLL meeting. I think it would be helpful, but you can also call any LLL Leader anywhere and talk with them on the phone. Maybe one lives nearer to you and does home visits (a few of us do) or you could visit her. you will have to call to see what they do locally.
Is there a Massachusettes Breastfeeing Coalition? They may be abel to help a low income mom see an IBCLC. Maybe. Some Breastfeeding Coalitions do this. Or they or LLL may know of a low cost or sliding scale IBCLC.
Does your WIC office offer IBCLC appointments? Does any WIC around you? many do these days.
Someone knows what lacation consultant resources there are for you. So I suggest, call around to LLL and IBCLCs. WIC and Coalitions to find the person in your area who knows these things.
Is the Hygeia pump the EnJoye or the EnDeare? Hygeia is a reputable company and they make good pumps. Typically, for low production issues, you want the hospital grade which would be the EnDeare. This does not mean if you only have the EnJoye that it is useless. It is not. Defintely, keep pumping. Add hand expression if it helps. But I do again suggest you make sure to troubleshoot your pump. Pump parts wear out. Pumps malfunction. If a pump flange does not fit correctly the pump will not perform correctly. If the folks at WIC cannot help you do that, try customer service at Hygeia. http://hygeiainc.com/contact-hygeia/
Your IBCLC may be entirely correct about the insurance. However, if you request that she file the paperwork for a pump, she should do it. She may not know how, this entire area is very much in flux and can be very difficult and confusing for many reasons. I suggest if you really want a different pump, call the insurance company, ask them exactly what the paperwork is that needs to be filed bring it to the IBCLC and ask her to fill it out right there and put it right in the mail or fax or whatever.
You could also look into what it would cost to rent a pump yourself. You can rent for a short time and see if it makes any difference.
So nursing was trouble free for 6 weeks? No supplementing at all? I am confused. I thought you had low production and were supplementing prior to the mirena. No?
I still don’t know how much baby is being supplemented each day or how many times a day baby nurses.
That is an enormous feed. Twice what is normal. How many times a day is she getting these huge bottles?
Currently my daughter wants to have 6-8oz at a time.
Baby is on solids? How old is baby? Early solids (before 6 months) is NOT the current medically acceptable protocol for slow weight gain. Formula or breastmilk under 6 months. Not solids.
A baby who is filling up entirely on large bottles of formula and solids is not going to be interested in nursing. Of course an overstuffed baby is going to refuse the breast. Yes baby has to be fed, but why so much at once?
A baby may take huge bottles because baby has a need to suckle, not becasue baby actually needs that much at once. Remember your baby's tummy is about the size of her fist.
here are tips on how to give bottles in a way that helps cut down on overfeeding with bottles. http://www.llli.org/docs/00000000000...astfedbaby.pdf
Re: Mirena and Low Milk Supply
I wonder if your LC is basing her assumption about insurance not covering pumps on her past experiences, because it is likely that requests for pumps have been denied in the past.
But as of this year, most insurance plans in the US are required to cover pumps under the Affordable Care Act. She may be working with outdated information.
Re: Mirena and Low Milk Supply
I had a VERY similar experience with Mirena. I drove myself half insane trying to get my supply back up. Even after I had it out I struggled and ultimately I decided that it was causing too much stress in our lives and I wasn't able to enjoy my baby (he was refusing to nurse at that point). I traced back everything I could...I was sick for a couple of days, and during a separate week I had to take some medication so I was only pumping...long story short, all the issues could have been overcome with my efforts. In the 2-3 weeks after having Mirena put in my supply went from decent to about 4-5 ounces PER DAY.
I'm sorry you've had to experience this. I wish I hadn't been swayed by the Doctor to get on BC (I hadn't taken it in years). I think I was scared of getting pregnant again so soon! It's unfortunate that it's a common opinion in the medical field that Mirena shouldn't have an impact on milk supply.
My baby is 7 months now and is ff. It still makes me sad, but I feel that I did everything I could do before I stopped trying. I've learned so much from this experience though, and I feel SOOOO much better equipped to be more successful at nursing my second one!
The best advice I was ever given was to talk to an IBCLC! I wish all the best for you and your babe!
Re: Mirena and Low Milk Supply
Just an update. Due to allergies and her weight dropping so much, we were referred to specialists for gastric and pediatric medicine. He believes she has reflux, but feels it is a food allergy or intolerance that is causing the food refusal... That and she started teething! She is now on hypoallergenic formula fully as of this week and still having trouble with it (really bad congestion). So we need to have it changed at her followup next week. We were using up what I had stocked into the freezer. I ended up in the hospital with severe cramping and have a severe uteran/cervical infection from the IUD (I have never had issues like that before). My family thinks there is really something wrong because I am not a pain medicine person and I allowed the ER to give me morphine for the cramping. The mirena was removed because of the infection. Today, my breasts are swollen, sore, and leaking milk. It seems like they are much more easily stimulated. I am going to check at her next appointment about relactation as an option since things suddenly picked up out of nowhere. Well... After the mirena was removed anyway.
Jennavee-- you are so right. I was very pressured by my OB. She said "You HAVE to pick a form of birth control and it can't interfere with your blood disorder." She recommended mirena to me because it helps with bleeding problems. Now the website lists issues with breastfeeding and the hormone is released into the breastmilk. In the old information from January it says it does not get into the breastmilk and it stays in the uterus. I am sooo upset that I was not given up-to-date information. Even the mirena website is different from back in January and now reflects the proper information. I will not take any hormones if I decide to have another child. I don't think the pressure of having to choose a birth control option is fair. They try to make you feel like you're an idiot if you refuse. I am not returning to my OB. I will find someone else.
Surprisingly, my iron has been fine. I have been taking supplements and my prenatals right along. I still take DHA as well as I find it helps with the momma-brain thing.