Exclusive pumping feeling discouraged

[@llli*pumpingatwork]

Hi everyone, first I will start with a background. My baby is almost 3 months old. He spent the first 3 weeks in the NICU due to pneumonia. I started pumping right away and breastfeeding when possible. He started to refuse the breast at around 7 weeks of age. We found out he had tongue tie which the ENT thought was too risky to clip at that age in the office, and that the reason he was not nursing was probably multifactorial. I have had help from several lactation consultants and have reconciled with the fact that he really won't nurse. On a rare occasion( every 2 weeks or so) he will briefly comfort nurse, but I have been exclusively pumping with one 4-6 ounce formula bottle per day to keep up. I went back to work two days ago, got mastitis due to waiting too long to pump and missed a day and half of work.I have had problems with recurrent clogs,and in retrospect several bouts of mild mastitis even though pumpin pal flanges have reduced the frequency of this. I am a doctor in training and have high demands at work during the day and several large projects, presentations, and papers to work on at home. My mom helps to care for him while I am at work and the early evenings. Because of almost exclusively pumping I spend So much time pumping and cleaning parts that I barely have any time to spend with the baby. Frequently someone else will be caring for him while I am dealing with pumping. Also because of exclusively pumping I barely get any sleep, because I take care of him also at night. My original plan was to BF and pump until 12 months of age, now my goal is to get to 6 months. And recently, after the last mastitis, I am wondering if the pumping is worth it, as I feel it is affecting my work, health, and relationship with my baby and spouse who frequently will spend hours helping me get rid of a clog, and not getting any sleep himself. I am wondering what is more important, spending quality time with the baby and transitioning to formula over the next month or so, or continuing to pump until he starts solids and me not sleeping, feeling stressed, and not spending as much of my limited free time with him. Any thoughts? What is more important in the long run, spending time with the baby or the nutritional aspects of breastmilk? Iam planning to work part time starting September, and if I have another baby I really want to try breastfeeding again, with less work demands and hopefully no NICU stay.

[@llli*mommal]

I am wondering what is more important, spending quality time with the baby and transitioning to formula over the next month or so, or continuing to pump until he starts solids and me not sleeping, feeling stressed, and not spending as much of my limited free time with him. Any thoughts?

This is a question that no-one can answer but you. Every mom is going to assign different values to the variables you are working with- for some moms, producing and providing breastmilk would be the primary goal, with sleep/stress/spending time with the baby being secondary. Other moms would put sleep/stress/baby time ahead of producing/providing breastmilk.

What is more important in the long run, spending time with the baby or the nutritional aspects of breastmilk?

I do not think anyone has done a study comparing these two variables. (Maybe that can be your next research project? Hello, Cochrane reviews!)

I will say that breastmilk is more than just nutrition. It's also immune system support against diarrhea, respiratory infections, and ear infections during infancy, it is protective against SIDS, and it's the only food that you can feed a baby that is associated with lifelong normal outcomes in terms of things like obesity, diabetes, heart disease, and intelligence. And producing milk carries health benefits for you: lowered lifetime risk of diabetes, obesity, heart disease, and breast and ovarian cancers. I'm not mentioning these things to guilt trip you, of course. How you want to weight these factors is, of course, up to you!!! I just know that if I personally had a family history of some of the conditions mentioned above, I would probably weight producing/providing breastmilk more highly than if everyone in my family died at age 99 after being run over by a bus.

I am planning to work part time starting September, and if I have another baby I really want to try breastfeeding again, with less work demands and hopefully no NICU stay.

I hope all goes as planned! Meanwhile, here are some things which may help you in terms of nursing and in terms of workload:
- This link covers getting a baby to the breast: http://kellymom.com/bf/concerns/child/back-to-breast/. It may be possible even at this relatively advanced stage.
- Use a hospital-grade rental pump, if you are not already. Hospital-grade pumps are usually a marked step up from consumer models in terms of how fast you can remove milk.
- Make sure your pump has correctly sized breast shields. This can also improve pump efficiency.
- Have 2 or more sets of pump parts, so that you don't have to wash everything as often.
- Keep a large basin by the sink and throw used bottles and pump parts in as necessary. When I was exclusively pumping, I found that it was less stressful and less time-consuming to do 1-2 large wash-ups per day than a zillion small ones.
- Instead of washing your pump parts every time you use them, just leave the pump attached to the bottle and pop the whole thing in the fridge in between sessions. When it's time to pump again, simply re-use the same pump parts. You can pump new milk on top of old, or just use a new bottle.
- It's really easy to overfeed a baby from a bottle, so if you find that your baby is routinely taking more than 30 oz per day, you want to look into paced feeding techniques: http://kellymom.com/bf/pumpingmoms/f...ottle-feeding/. That way the pressure to provide won't be on you to such a large degree.
- Remember that breastfeeding doesn't have to be all or nothing. Right now you are providing most of your child's nutrition, and that's really stressful and time-consuming. If you're really agonizing over quit/don't quit decision, maybe it would make sense for you to think about providing as much milk as you reasonably can, but not striving to make your milk your baby's only or primary source of nutrition.

[@llli*mamawin]

I have lurked on this forum for many, many months and finally felt compelled to join when I saw your post.

I exclusively pumped for my son (now 3) and it was SO SO HARD. I commend you for having done it for 3 months. Even if your baby got not one more ounce of breast milk, you've given him an amazing gift.

As Mommal said, only you can answer the question as to what's more important breastmilk or your stress level/sleep/time with baby. When I look back on my experience, I personally wish I would have tried to balance the two. I focused entirely on breast milk and, as a result, he had exclusively my milk for nearly 9 months. While I am proud of that, I can also honestly say that I look back on that time as one of the worst on my life. I was sleep deprived to the point that I blew up at colleagues at work in a totally inappropriate way, I was so depressed and, the worst, I did not feel bonded to my baby. I felt like a cow off to the side while others got to bond with him. It's really awful to look back on your child's first year of life and feel such sadness, regret and negativity.

Because of those feelings, I wish I would have chosen to provide some breastmilk and some formula. You're already doing that to some extent so maybe a little more formula and a little less pumping would allow you more sleep, less stress and some time with your baby. If that were the case, then I'd do it.

Breast milk is important. More importantly, in my opinion, is a healthy, happy mama. Truly, your baby needs YOU more than he needs your milk. If you can find a way to provide a good mix of both, then great.

If you do decide to keep pumping, a couple of tips:
- Rent a hospital grade pump.
- Allow yourself a decent break somewhere in a 24-hour period so you can get some sleep. Consider giving yourself at least a 6-hour stretch.
- take some herbs or drink Mother's Milk tea to help with your output

To give you hope...I now have a 7-month old daughter and have been able to exclusively breastfeed her. We've had major challenges along the way, but I was able to battle through them with a lot of support. Even with all of the challenges, it's been a million times better than exclusively pumping.

I hear the sadness in your post and I sincerely hope you're able to find a way to regain some balance in your life and enjoy your baby. Good luck to you.

[@llli*filmmommy]

Is there any way the tongue tie could be remedied at this point and possibly getting baby back to breast? Since you said he comfort nurses sometimes, there may be hope for getting him to breast. It's nothing I've dealt with, but I'm sure some moms on here have.

[@llli*bsua65]

In addition to the great advice/comments above... As a doctor you have probably already looked into these but a friend of mine who had recurrent mastitis ended up taking lecithins and a low dose of antibiotic over a long period of time, it stopped her mastitis... I wonder if the whole picture would look less bad if you weren't in so much discomfort :/

I wish you all the best whatever you decide to do!

[@llli*pumpingatwork]

Thanks bsua65, I am going to look into lecithin. If I have to, I could consider a low dose antibiotic, but I'm not sure if that would be The best over the long run, because at least some of it would end up in breastmilk. I definitely would feel better about the whole situation if i didn't have to deal with clogs and mastitis. What will happen is I will feel satisfied with pumping for a while, and then a bout of clogs and mastitis really brings me down reminding me that I have to be really careful how long I go between pumping. Thanks for your support.

[@llli*pumpingatwork]

thank you so much mamal for your response and advice. It would be a great study to compare the outcomes of bonding time with baby vs. pumping for breastmilk. Since your response I have started applying several of your tips. Putting the pump parts in the refrigerator at lesast for a couple sessions will lessen the burden of washing parts overnight. The comment " breastfeeding doesn't have to be all or nothing" makes me feel so much better. I agree that it's better to get some breastmilk and also give formula, than not giving any breastmilk at all. I feel better about the situation and am going to continue to pump as long as I can. I really hope to at least get to 6 months. I am using the medela Classic, which seems to work better for the clogs than the medela symphony.

[@llli*pumpingatwork]

Thank you for your reply filmmommy, I looked into fixing the tongue tie, but the ENT doctor said that it would have to be fixed using conscious sedation or general anesthesia because of the thickness of it, and we decided that the risks outweighed the benefits, especially if we weren't guaranteed he would nurse successfully after. I am going to try some of the tips for getting him back to breastfeeding.

[@llli*pumpingatwork]

Mama win, thank you for sharing your experience and advice. It was very eloquently written. I really identify with what you have said about feeling so tired that you got upset with colleagues,etc. It is hard to feel patient when you are so sleep deprived. I am going to adjust my pumping schedule and do the most that I can realistically to help balance things out, so it's not so stressful and I get to spend more time with the baby. I hope to have another baby in the future, and am glad that things worked out with breastfeeding your daughter rather than having to pump.

[@llli*greatestjoy]

First of all, MANY big hugs. It sounds like you have put an unfathomable amount of work into providing breastmilk for your child. I truly understand the demands on your time at work, as I am an ER attending. I also pumped at work through half of residency. As you can imagine, it is difficult to schedule pumping in the ER, as you kind of can't stop CPR because you have to pump.

However, I cannot imagine having to pump at work, come home and wash bottles, and on top of that, pump all day at home then wash those bottles too, then spend time with your baby, then be on call in the hospital, study for hours a day so you can pass your shelf exams, and actually learn medicine so you don't kill people when you become a resident/attending. Unfortunately, our job is not one where mistakes are an "oops." At least I got to run away from the pump when I got home, and simply nurse my child.

Here's what I would tell you: if you can continue pumping as you are while maintaining your grades and actually understand what is going on with your patients, then keep on keeping on. No reason to give more formula. If not, something has to give. Either the job (which may be an option for you, but i doubt it) or pumping as you currently are. This is not an office job where a report may have some spelling errors or even thousands of dollars may be at stake. I have seen people injure or kill people from lack of knowledge or sleep.

I don't think I have ever said this in real life to a single person who has chosen formula, but: YOU ARE NO PUNK and you could not try any harder than you are. Who could possibly have put in more effort into BFing than you, despite the multitude of hurdles in your way? Pneumonia, NICU, mastitis, tongue tie, nursing strike...

That being said, there is zero reason to completely stop providing your child with breastmilk for at least 1 year. Choosing to give just enough formula so that you are not dangerous at work does not mean you should not pump and BF the rest of the time. You can and you should. As others have said, BF does not have to be all or nothing.

The onlyyyyy other thing that I feel obligated to mention to you is revisiting the option of nursing your child at your breast. I know you have beat your head against the wall trying to do this. I just can't help but think that if your child still comfort nurses here and there, there is hope! The fact that you still put him to your breast after all this time tells me that you still think that maybe, just maybe one day he will start nursing on his own. Have you tried nursing in motion, while baby is in the tub, or getting your letdown first with the pump then nursing your child so he gets an immediate reward? Have you talked to a lactation consultant or LLL leader who has successfully helped to get an older baby back to breast? I certainly would not want a doctor who has never placed a chest tube to put one in me, know what I mean? If you have tried everything to nurse your child, forgive me, I just felt I would do you a disservice if I didn't at least mention this, as this would literally solve all of your problems.

PM me. I would love to help out a fellow doc who is trying to BF their child. I really haven't met any other docs who don't just throw in the towel either at the first sign of trouble or predictably, a couple weeks after returning to work. They exist, but I personally have never known any to BF at all to 6 months. It's a lonely club, lol. Good luck, your child is very lucky to have you as his mother.