Our Breastfeeding Journey Part 2

I wish I had some better news at this point. All I have to report is a lot more time, energy, and emotion wrapped up in this heartbreaking struggle. I'll pick up where I left off with my last post. 

I met once again with my lactation consultant on May 25. 

We ended up getting AJ's lip and tongue ties lasered at the dentist on May 26. We were much better about the oral exercises/stretches we needed to do with this go around. 

I've continued to take Legendairy supplements because once I transitioned from one to the other, there was a day in between that my small supply took a hit. So I know it works! I have also added in sunflower lecithin, not because I get clogged ducts obviously, but to help with flow. 

We have tried many times to latch without the shield. He does a good job, then he switches to a shallow and painful latch and gives me lipstick nip. Just this past week or two as I've gone back to work, he's decided my milk flow is not good enough for him, so he gets frustrated and pulls off and fusses at me. It's been heartbreaking. 

As I mentioned in my other post, starting on May 12, and all the way through June 20, I woke up at 3am to pump each night. This wasn't an easy 15 minute pump session. Each one was 30 minutes, with hands on compression. It wouldn't be worth it to do less than that. I only ever got 2oz at the most from that session and didn't see a difference in supply. I took a break after June 20. Then I did another week long challenge of getting up at 3am from Legendairy July 2-8. 

Overlapping with those overnight pump sessions, I did an hour long power pumping session every day from May 27 to June 9. Two weeks. No change. 

From May 12 to May 26 I was removing milk by nursing plus a pump at least 8x a day. 

Thanks to some posts on Legendairy's page, I've gotten more adept with my Spectra, switching back and forth from expression mode to regular mode, slowly increasing the suction over the duration. 

I got officially sized for flanges through Legendairy. They suggested 17-19, saying 19mm looked like it wasn't right based on my videos. When I use 17mm (just a silicone insert), it hurts. I've been using 18, so it looks like that's what I'll continue to do. But I may try the Pumpables silicone insert, recommended by the lady I discuss below. Just trying to figure out the money for that. 

I have had oatmeal with flax and brewer's yeast every day. Maybe one or two days the last couple months I have had something else for breakfast. But mostly it's been oatmeal. Every day. Even as I've gone back to work, I've made a baked oatmeal for easy reheating. 

On June 25, my friend Kelsey sent me a reel from an IBCLC saying that triple feeding is nuts, and that a consultant should always provide an exit plan. Triple feeding is nursing, bottle feeding, and pumping all in one session. I never was given an exit plan. And I also wasn't really told to start with that the pumping after nursing wasn't meant to collect milk but to create demand. So I got discouraged early on when I collected next to nothing. (But I also wasn't good at using my pump.) Regardless, I gave it a good go. 

Somewhere along the way, maybe in early June, I decided to see if my Haakaa could collect the same amount after nursing as my Spectra pump could. Turns out they both got the same amount. And in my mind, if the goal was to make sure I was empty, then the Haakaa was just a much more convenient way to do that. I'm still not sure if the continuous suction of the Haakaa makes the same demand as an electric pump, since it doesn't simulate the sucking motion, but again, if they collected the same amount, and the Haakaa emptied me better, then I didn't see a problem with using it. From what I could tell, all the pumping post-feeding wasn't making a difference for my supply anyway. 

I got blood work done again, and my doctor emailed me on June 23 to tell me my dose was still too high. So I was still on the wrong levothyroxine dose for over two months. 

And so:

- Overnight pumping
- Emptying 8x or more a day
- Emptying after each feeding (using real pump and Haakaa)
- Power pumping
- Proper flange size
- Hands-on compressions during pumping and feeding
- Hand expression after pumping
- Galactagogues (oatmeal, flax, brewer's yeast)
- Hydrating (especially with electrolytes)
- Skin to skin
- Supplements (early on: Moringa, goat's rue, blessed thistle, then Legendairy Pump Princess and Liquid Gold)

I've done it all.

It's hard not to play the "what if?" game. I have obsessively gone back through my app and my tracked data to see where I went wrong. 

In the first two weeks, though it's painful to admit, I probably took too many nights letting other people care for my baby so I could sleep, when constant contact and frequent feedings were vital to supply. I was sick, and when I expressed concerns about my supply, I was told that I needed the sleep. My milk came in on 4/20. I did have midnight nursing sessions with him on 4/21, 4/22, 4/26, 4/27, 4/28, 4/29, 5/1, 5/2, and not again until 5/9 (unless I just forgot to log it, which is possible). I'm sure that week of sleeping hurt me. On 4/23-4/24 I didn't log very well. I now know these are pivotal weeks for establishing supply, and I probably just didn't do enough nursing or didn't empty well enough, without the right size flange and without being savvy with my pump. I'd like to think that supply could still be recovered from those early errors, but what do I know?

I also stressed way too soon - day four I had nothing to worry about. But I was exhausted and sick and couldn't get my baby to latch, plus his ties--everything put together was a perfect storm for me. 

I also tried too hard to make him stick to a feeding schedule, and didn't understand his hunger cues early on, mistaking them for gas. I now know trying to impose a feeding schedule hurts supply, although I was trying to make sure it was every 2-3 hours and no more spaced apart than that. I had good intentions of making sure he ate often enough; we often had to wake him to feed him. 

Last week I spoke with a woman online who said she had only been pumping 1oz per session at 16 weeks, and managed to turn her supply around to exclusively breastfeed her baby for 18 months. I was optimistic going into the conversation--there was hope for me! She recommended looking into oral restrictions (we did this early), using proper flange sizes, emptying 8x a day around the clock via pump (this means twice overnight, like 1am and 4am for example), and doing two power pumps a day. When she got close to his intake, she dropped one power pump, but continued to keep power pumping until she surpassed his needs. While exclusively pumping, she dropped to one nursing session a day (with a pump after) as she implemented this schedule to save her supply and make nursing successful moving forward. After a month of that intensity, her supply was up enough to exclusively breastfeed. After stressing and obsessing and reviewing everything I had tried, I felt incredibly inadequate and emotional after this conversation. 

The next day, I learned that prior to 16 weeks, this woman had adequate supply for her baby. Restoring a pre-existing supply feels very different from trying to build a supply that never existed. When I mentioned this, she said, "I still think it's possible though because women relactate all the time after not nursing for months." And I agree, but again, they're RE-lactating when they previously had a supply. And while I have felt empowered about switching to mostly pumping at this point, as it's more efficient than nursing and bottle feeding and doing the Haakaa, I don't know if I can do the 3am wake ups or two a day power pumps. And it's hard not to feel bad about that, even though I've worked so hard. Like after everything I've done, maybe her suggestions really would be the key for me. Maybe I should give it one more hard push. 

I've talked with my therapist about this whole saga, and what it would be like to give my early postpartum self some grace. I didn't know what I was doing, even though I took a class and saw an IBCLC (5x) and tried so hard. Hindsight is always 20/20. Except it's not in this case, as I haven't kept a meticulous record of my efforts and when I switched strategies. It's hard not to want to go through it all with a fine tooth comb and figure out where I went wrong. 

I posted on July 19 on Facebook to see if other women with hypothyroidism had successfully breastfed their babies. Many women commented saying yes. I asked for NO advice on the post because my mental health cannot take any more. But still two women couldn't help themselves, mentioning hydration, knowing your optimal thyroid level, and of course "oatmeal, Body Armor, and flaxseed" (insert eyeroll emoji here). From what I've read about hydration, they say to drink to thirst and that it is possible for over hydrating to negatively affect supply. My urine is always almost totally clear, even if my intake isn't super high. But I can definitely push up my hydration level; it wouldn't hurt. One commenter I messaged was able to turn her supply around at 8 weeks with "more hydration than you think you need, the right thyroid dose, and a hospital grade breast pump." 

I've talked extensively with my good friend Kelsey who wants me to be satisfied with my efforts. She says anyone else who had gone to the lengths I have gone to would have run themselves into the ground, or had an intense oversupply by now. She sent me this amazing text:

And I've been reading this comment from an IBCLC over and over again:

Since I started writing this post, I've tried a few things. 

July 11-13 I nursed AJ before and after work, pumping 3-5 times at work.
July 14 and 15 I nursed all day, plus bottle and Haakaa while I worked at home.
July 16 I solely pumped.  
July 17-20 I dropped to a single nursing session just in the morning. 
July 21-25 I strictly pumped. I did have a random nursing session with him on July 24 that was so special; I just wanted to practice latching and figured he wouldn't get much. But he smiled up at me like he had missed nursing. 

I've worked up to 8 pumps a day today and the last couple days, and was 6x a day prior to that. I've also been pumping at 3am the last several nights, counting that as one of my 8 sessions. I'm already feeling worn out.  

So what now? I'm seeing if I can build up supply by just pumping. I feel good about this, as I think doing the triple thing (even with a Haakaa) was just too time consuming because he does not empty me and falls asleep (and more recently gets frustrated and fussy).
- I may still try a hospital grade pump, rented from my IBCLC; we don't really have the funds right now though.
- I am trying to drink more water, just for general health as well.
- I may try to continue the 3am pump sessions as I can. 
- I want to do the Thompson Method courses (but again, money).

It's so hard to know if I should throw more at this. Wiping myself out to have it not amount to anything is so frustrating. Will pumping 7x instead of 8x, and just once overnight help? If I go at this, should I just go all in so I know I tried it all? 8x/day, power pump, overnight pump? It's hard to know. Anyone who has pumped knows how restrictive and time consuming it is. It's taxing on Matthew as he has to be the primary feeder and caregiver while I pump. It's just a lot. And all the effort could amount to nothing if my thyroid is preventing me from succeeding. 

But I hesitate to pull back because we have a long term milk donor, and she obviously has the freedom to stop pumping or stop donating any time she wants. She also is looking to move. If she does stop or move far, and we have to go to formula, I want to make sure he always has SOME breast milk, even if it's just the small amount I make. 

So, there's no conclusion to this saga as of now. I love my boy and have done everything I could with what I had. It's very hard for me to accept that I did the best I could with what I had, and that when I knew better, I did better. This isn't the end, clearly. But I have to keep navigating what more I can give to this, and figure out how to give myself some grace, rest, and find peace.