Primary milk insufficiency

[@llli*evelyn.s.mum]

I understand this is rare, but I have experienced it, and there is a frustrating lack of support or information. I'm now pregnant with my second baby, and I'm after some practical information that might help prevent me going through this all over again.
Evie's birth was all natural, calm and beautiful, but she was sleepy and wouldn't latch straight off. My midwife and I tried expressing some of my colostrum, we managed about 0.5 mls. When I gave Evie these precious drops, she didn't swallow and they were wasted.

In the first few days, Evie didn't really wake, it would take me hours to wake her enough to latch.
although latching and feeding looked ok to my untrained eye, it turned out she wasn't getting anything. There were no wet nappies, she became badly jaundiced, and after 4 days had lost 12% of her body weight.

We called in consultants and took all the help we could find. I was pumping every 4 hours day and night (after giving E a good go) but nothing was coming. I took all the supplements, and the drugs, E and I took to our bed and just cuddled...but nothing bought the milk in. It just never came.

After all the pumping, and drugs etc. I was managing maybe 20mls per day (which is a pathetic amount at any time, but especially after 20m pumping at 1am!). I never got any engorgement, or any other signs that my boobs were up to much.

We managed to give Evie almost solely donated breast milk for the first 3mths (which was a mission, and milk is not regulated here in NEw Zealand, so we had to make our own contacts and do our own checks, it was quite nerve wracking).

I gave up pumping etc when Evie was 4 mths

I felt TERRIBLE the whole time. All the information out there tells me that breast feeding is possible if you try hard enough, and if its not working, it's essentially my fault.
I did everything I could possibly imagine to get this to work, but it did not.

Now that I'm pregnant again, I'm forewarned about what might happen. So I am again on the hunt for information, perhaps there's something I missed, perhaps I could express colostrum before birth so if this baby is sleepy, I at least have something in had to give it...any other thoughts?
All ideas are very gratefully received.
Thanks for listening!
Pam

[@llli*mommal]

First of all, I am so sorry you went through all of that! It is so unfair that a mom can do literally everything right, work her rear end off, and still not get rewarded with the birth she wants or the healthy baby or, as in your case, the milk she needs. I wish the information that is out there could encompass all the complexity and nuance, but with breastfeeding as with all other things, most information is written for the 99% (approximately) of people whose experiences are essentially "normal." For the 99%, the key to breastfeeding is patience, persistence, hard work, and the right tools. For the 1%, it doesn't really matter how hard they work, how patient they are, or what tools they have. So ditch the guilt for not being in the 99%. That's something you have no control over.

How has pregnancy been for you, this time around? Anything different going on with your breasts, that didn't happen the first time?

I don't honestly know that the's much you can do in addition to what you did the first time around, because it sounds like you pretty much tried everything. If you have a problem this time around, and you decide you want to go the herbs/drugs/pump route again, I would suggest pumping more frequently than every 4 hours. When you want to bring milk in, and you're using the pump, you have to pump in a way that mimics the nursing patterns of a newborn, who will typically nurse 10-12 times a day. And use a hospital-grade pump with correctly sized shields- I don't know if you did that or not, the first time?

WRT colostrum, you don't want to pump prior to the baby's birth. Pumping is a great way to induce labor, and you wouldn't want to get the colostrum but end up with a preterm baby or early term baby. You might want to try hand expressing once a day, and see if you can collect anything. If not, I think you'd do best to wait until the baby is born before attempting to collect the colostrum.

Let us know how things go! I really hope you have a great experience this time around, and if not, this is a place whee you can come and know that everyone will understand the magnitude of what you're going through.

[@llli*djs.mom]

The amount of colostrum you are talking about is normal. It takes very little. I would suggesting pumping much more often than every 4hours. Because the baby if drinking directly from your breast would drink MUCH MORE OFTEN than that. And by pumping to maintain supply you are supposed to be mimicking what the baby would do. Which honestly would most likely be every 1-2 hours on average with one 4hour stretch at night. So I would pump every 2hours during the day and give yourself a little longer at night. (Most women DO produce way less at 1am) So perhaps THAT would be the session to skip? Ensuring that when you wake at 4am or 5am to pump your yield is much better. Because the truth of the matter is if your were EBF and you were only bringing your baby to the breast every 4hours in the 1st 6-12 weeks, you WOULD in fact have supply issues. Because that is only 6times in a 24hour period and that is NOT ENOUGH to maintain supply. You MUST pump 10-12 times a day to establish and maintain supply.
Also I wouldn't ASSUME that you won't be able to make it work this time around. It truly is all supply and demand. You need to wrap your mind around the fact that in the 1st weeks it truly is an all consuming thing. We sit in our PJs the 1st weeks and just feed our babies. That's it. That's all we do. It is seemingly neverending in the beginning. And MOST people who don't make it with their 1st have bad information. The idea that you would be able to establish or maintain a supply by only pumping 6times in a 24hour period is BAD INFORMATION. So I would NOT rule out the possibility that you CAN DO THIS. But I think you also need to accept that it's going to be MORE time consuming than you thought previously. But trust me, mother nature designed it this way for a reason. In indigineous cultures when breastfeeding success rates are 99.99% mothers almost NEVER put their babies down for the 1st three months. Which increases their odds for survival exponetially and virtually always insures breastfeeding success. So I highly suggest a wrap for your new baby so that your child is on you nonstop but you are hands frees to take care of your older child.
And lastly since you are in New Zealand can you get a prescription for Domperidone? Because I have NEVER heard of that not helping with supply issues.

[@llli*mammi]

Wat you describe reminds me of some of my epxperience with my newborn boy. It was a peaceful jhomebirth and midwife was helpful etc etc and then I had no milk for about 10 days... etc etc. In my case however it did eventually end well and by 3 months it worked and by 6 months I had a great supply.

All this to say that there are some things I think I would do differnt if I had a second child. Number one I owuld not repeat was my nutrition during the last 6 weeks of pregnancy. YOu do not mention if that was a problem in the first pergnancy but then I was at that time also not ware this might cause a problem.
what happended was I lost weight during the last 6 weeks of pregnancy, about 2 pounds per week, due to an extreme low carb diet a doctor set me on. Looking back I think I was so starved that milk production did not kick in until I was eating normal again and put on some weight again, and eating properly.
Now this is anecdotal evidence I know, but I still feel if I had eatne properly I wouuld not have had such a severe issue with milk production to begin with.
The other thing I would do this is to look for a lactation consultation BEFORE birth. Once the baby was here I was in fact unable to phone around or surf the net and my husband was incapable in that respect (lactation issues are not his thing at all to put it mildly) so I went quite a while without profssional help. SO my advice is get that number now, to have ready when needed.
And then, everything might work out differnet this time, and this is what I hope for you, best wishes!

[@llli*manitobamommy]

The other thing I would do this is to look for a lactation consultation BEFORE birth.

This seems like a really good idea for your situation. Finding a good LC can take time, time that is not on your side if you are having trouble in the early days. You want someone that you have a good working relationship with, that you can trust, who is really knowledgeable, and who understands your situation well.

I think there is a good chance that things will just turn out differently this time around, but for peace of mind if I were in your situation, I would want that support already lined up.

And as DJsmom said, plan to spend the first little while just nursing all the time. Make sure you have the support you need to just stay home and not worry about cooking meals, cleaning house, etc. Do you have family/friends who can help out in those first weeks so you don't have to worry about that? Especially with an older sibling around, that can be challenging if you don't have good support at home.

[@llli*djs.mom]

Especially with an older sibling around, that can be challenging if you don't have good support at home.

And a wrap. It helps to have a wrap.

[@llli*evelyn.s.mum]

Thanks everyone for your thoughts and suggestions. In response to your questions...
Re frequency of pumping...ok, this is something to try. I was attempting to feed Evie for about an hour before I pumped. Often this involved a lactaid bottle with donated EBM, so prevented Evie from getting frustrated when she wasn't getting anything. So while I was pumping every 4hrs, I was getting stimulated every three or so on average. There were days when E was just on the boob all day. But it looks like I could increase that even more.
I was using a hospital grade pump my LC rented to us.

Evie and I were skin to skin much of the time, I wore her in a wrap often and we co slept for most of the night, except for when I was worried that I was so tired I'd roll on her or something. Again, this is something that we could increase to 'constantly', rather than 'most of the time'.

I started domperidone pretty early on in the piece, can't recall exactly when ( was pretty much an automaton, feed, pump, sleep, feed, pump, sleep). I was taking the max recommended dose for the first while, then on advice from my LC upped that again. Didn't seem to have much of an effect, my boobs got a little tingly which was apparently a good sign, but no more satisfaction from Evie, and no more volume at the pumps.

Not sure if boobs are doing anything differently this time, they are bigger than they were...but then so am I! So I'm unsure if it is fat or glands waking up and getting ready.

Will wait and see, and will do my damnedest to make it work. But I will also take Mommals suggestion and not buy into the guilt. I know I've done the best i can for my family, and that will be good enough for me.

Thanks again everyone