How I “Weaned” (Rated: TMI. Proceed with Caution)

I am a huge breastfeeding and breast milk advocate.  But there gets to a point in time when breast is not always best for mother and baby.  I reached that point when Baby E was seven months.  I never could imagine reaching to seven months on full breast milk.  But seriously, donor milk and domperidone kept us going.

When I had plugged ducts, I decided after that I was going to “wean” soon.  So, like most things in life, I turned to Dr Google. I googled and went on forums trying to find out the best way to cut my supply and to survive seriously engorged breasts.

I guess in my case it wasn’t really weaning the baby, but weaning my breasts from lactating.  I don’t really have experience in weaning a baby since my baby was bottle fed since he was a month old (sigh, the dreaded nipple confusion).

Turns out, there’s a lot of literature on how to breastfeed but not a lot on how to stop.  The breast specialist I went to when I had plugged ducts said I should wear tight bras and go cold turkey.  I actually think that is bad advice because it causes more plugged ducts and mastitis.  Wearing tight bras perpetuates the problem and doesn’t make it go away.  The only way to stop producing milk is to do it slowly and not do it suddenly.  Crazy.

So anyway, like most things in my life, weaning was a combination of trial and error.  So this is what I did.

1) I used cabbage leaves for relief throughout the first two days of major engorgement.  I’m still trying to find out why but they manage the pain and apparently cut down the supply.

2) I stopped using my electric pump.  I manually expressed, just enough to feel relief but not to completely empty the breasts.  I still got quite a lot though.

3) I cut down one express a day.

4) I continued this for about a month until my breasts did not hurt anymore.  Then stopped completely.

I was quite surprised at how fast my supply dropped.  It takes so long to build up a supply but it can drop so quickly.

I would be interested to find out how you weaned your child from breastfeeding or stopped lactating.  Do share with me!

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How to Increase Your Milk Supply

When I first came home from the hospital with Baby E, my parents, who are avid believers in breastfeeding, said, “There’s no such thing as low milk supply.  Supply always meets demand.”  My very limited research at the time seemed to suggest that as well.

I believed them.  But it came to a point when it really did seem as though my supply was lower than demand and I couldn’t keep up.  As I had shared in my earlier post on exclusive pumping, I cut out the middle of the night feeds – giving him expressed breast milk instead of direct latching.  Which caused two problems that lactation consultants warned would happened: 1) Nipple confusion 2) A drop in milk supply due to lack of stimulation.

But seriously, I just had a major abdominal operation and I had to wake up a few times a night to feed the little bugger?  Yes.  Who said motherhood was easy?

At the first month check-up, Baby E was at 3% on the growth chart.  It was highly embarrassing.  I dubbed him my little refugee.  Then after I started my crazy rigorous regiment he was more than 50% on the growth chart!  Incidentally, the same nurse weighed him and she was so surprised that he went from 95% breastfed to 100% breastfed AND gained so much weight!

I mentioned briefly in my previous post on exclusive pumping how I increased my milk supply.  Seriously, I am not an expert.  But I did a lot of research, spoke to a lot of people and made myself a guinea pig and trust me, my supply increased.  But this is really not for the faint-hearted and you really must believe in the benefits and goodness of breastmilk to want to do this.

I was first able to pump only about 50 ml per breast but after I made it my mission to increase my supply, I was able to do about 100 – 150 per breast.  When I woke up in the morning, I could get up to 250 ml on one side and about 150 ml on the other.   I have since decided to wean slowly and have voluntarily cut my supply dramatically. 

So here it is… How to Increase Your Milk Supply:

1) Feed on demand all the time, every time.  I failed at this because I was just too exhausted mentally and physically.  But if you can, don’t express or cut out a feed and replace it with formula.  Feed him yourself through the night.  Demand will stimulate supply.

2) Ask your doctor for a prescription of domperidone or buy fenugreek from the pharmacy.  It has proven to work for countless women.

Domperidone is not actually a medication for lactation, it is used for gut problems, but its indirect side effect is that it stimulates lactation.  Ironically, when I went to the GP for food poisoning he prescribed domperidone and I told him that I had way too many packets at home and  I was trying to reduce my supply and so rejected domperidone for its original purpose.

3) Breast massages and hot compresses before feeding / pumping – so important to stimulate milk supply

4) Pump after each feed until the milk stops flowing.  But don’t pump more than 20-30 minutes because it will damage your nipples and breast.

5) If you are exclusively pumping, you MUST MUST MUST pump every two to three hours.  If you are out in the shopping centre, you should still bring your pump with you.  I have found out that so many friends pump all over the place (at shopping centres, hotels, convention centers, offices, toilets, swimming pools etc…)  just like me! 🙂

6) Easy to say,  but nap when your newborn baby naps.  A good rest also stimulates supply.

Lactation Food — Fact or Fiction??:
Honestly, I have heard from so many people that the traditional Chinese confinement food of papaya soup is good for stimulating supply.  I think this is quite unsubstantiated and doesn’t make much sense to me.  I have also heard that oatmeal and leafy greens stimulate supply too.  I think these are just stories that people tell nursing mothers when they want them to eat healthily.   There’s also lactation cookies and tea in the market for nursing mothers… REALLY?  I don’t believe it.

I am curious if anyone really ate all these items and if they really stimulated their supply.  Please do let me know if it did!

Donor Milk / Milk Sharing

So I first heard about donor milk from my parents who said that during their time, they had two friends who donated regularly and were feeding another baby on top of their own.  This was when I had just given birth and had a low milk supply.

At first I was skeptical, who on earth would be so generous this day and age?  So I just dismissed this idea as myth.

One month in, and my relative who had a little girl just two weeks after me, offered me some milk.   I was over the moon.  It was as though someone had just offered me liquid gold.  I readily accepted.  The milk was so useful because it helped me along as I was on my way to increasing my supply.

When Baby E was about 3 months, I stumbled across Human Milk 4 Human Babies.   I read through the page and then found that they had country specific Facebook pages.  I found Singapore’s page and YAY it was as though I had found the mythical pot of liquid gold at the end of the rainbow.  There were so many kind and generous souls who were giving away 20-50 bags of pure precious milk.  Each bag typically had about 150-200 ml of milk.  It’s crazy.  The kindness, the generosity, the love that is poured into each bag cannot be repaid.  I am tearing up just thinking of how generous these ladies are.  Each bag takes time, energy and pain to create.  We all know that milk doesn’t just pour out of our bodies!!

At that time, I didn’t really need the milk because my supply had already increased and I was producing enough for Baby E and enough for my small growing stash I was keeping for when I went back to work.  However, before I went back to work, I decided to try.  I knew that I wouldn’t be able to pump as much and I would need the supply to get to six months.  I contacted at least four to five ladies and didn’t get a response before I found my current donor (whom I love and appreciate it).  It seems as though the milk is in such high demand!

If you are thinking of receiving or donating milk, it is important to note the following:

1) The milk is STRICTLY NOT FOR SALE. NO MONEY SHOULD CHANGE HANDS.

2) Both donor and recipient must be comfortable with each other.  The recipient should not feel shy to ask the donor if she has any pre-existing illness that renders her milk un-drinkable like if she has AIDS/HIV, untreated, active tuberculosis  smokes or takes drugs.  It really is based on trust, that is why you should meet your donor first and talk things through.  You can normally tell when you meet a person, mother’s instincts are (mostly) right.

3) It is recommended and expected that the recipient bring along milk bags to replace the bags that the donor is giving her.  I suggest checking with the donor first on her preference of brand.

4) Always find donors that have babies that are the same age as yours so that the milk content is similar.  As you know, milk varies according to the age of the baby (how marvelous is mother’s milk) so it is not advisable for a one month old baby to be drinking milk from a mother that has a six month old.

5) Always tell your donor how much you appreciate her.  Seriously calculate how much time it takes to produce 40 bags of milk and then feel the gratitude swell up in your heart.

If you do have excess milk, I STRONGLY urge you to donate it because it really could save lives.  Some babies have an allergy to cow’s milk and some are born pre-mature.  Breastmilk contains antibodies, proteins, vitamins, probiotics and scientists haven’t even scratched the surface yet.  To NICU babies, breastmilk is like medicine.

Donor milk may not be for everyone, and that’s ok.  But it is for Baby E and me.  My gratitude to my donors is immense.

Boy Milk or Girl Milk?

Just two weeks ago, findings from a new study by Katie Hinde of Harvard University took the media by storm.  Read articles found here, here and here.

It found that mothers of baby girls and baby boys produced milk that was different in content.  Apparently, mothers of boys produced milk that was richer in fat or protein presumably because boys are much more active and expend way more energy than girls.  It also found that mothers of girls produced 21% more milk than mothers of boys.  This is so that in accordance to evolutionary biology, girls, by drinking more milk, can reach sexual maturity faster so they can reproduce sooner since it takes so long for a woman to grow a child inside them.

By the way, one bag of milk is mine and one is from my donor.  Can you tell which?  Answer below.

It seems that this is just the beginning of a study that begets more questions than it answers.  The study concludes with a series of questions that it had yet to answer like how different the other constituents in the milk are, how do boys and girls utilize differently and what are some signals and mechanisms that the body uses to tell the mammary gland to produce a certain type of milk.

As a recipient of donor milk, both from mothers of baby girls who are roughly the same age, I am intrigued and I think I will continue to follow the progress of this research closely.

A few thoughts have crossed my mind:

1) In the past, some people used to feed their babies through a wet nurse — I don’t think people bothered what sort of milk she was producing and whether it was gendered.

2) What if a woman had twins? One boy and one girl?

3) Many women nurse their children of different ages and sexes simultaneously – what then? This has been going on for years. I don’t think it means you should stop tandem nursing.

4) I believe that breastmilk is always better than formula milk, especially for babies who are in the NICU, even if the milk is from a mother with a baby of another gender.

The one on the left in the Avent milk bag is mine!

Exclusive Pumping – Not for the Faint-Hearted

Before the baby was born, Nat and I signed up for the Mt Alvernia Childbirth Education Course. Well, 90% wasn’t very helpful since I had epidural and an emergency c-section (but again, another story for another time).  But what was useful were the breastfeeding classes.  Prior to delivering the baby, I knew absolutely nothing about breastfeeding.  People asked me, “Are you intending to breastfeed?”  To which I would answer, “Yes.  Of course.”  Thinking in my head it would be fun, relaxing, enjoyable…

Yes, that illusion was quickly shattered when I came home from hospital.  So the baby was a pretty normal nurser.  He latched on in the hospital and even when he came home.  But then, I did what they repeatedly told me NOT to do during the classes – introduce the milk bottle very early on.  I believe I introduced it on his 4th or 5th day of life.  Which was not a good idea.  It was introduced because I was just getting way too tired to do middle of the night feeds.  So my mother taught me how to manually express and so I expressed the milk I had into those Philips Avent VIA Cups and saved it for the night.

Well, after a week of breastfeeding and bottlefeeding, the baby started to wisen up.  He realised that he could get the same milk for less work using the bottle.  That’s when the drama happened.  He would cry and scream every time I put him to my breast.  It was so difficult.  I persevered until he was 4 weeks old and then my milk supply started to drop really low because he wasn’t latching.  It was hell.  Feedings would take 2 hours each time because he just refused to latch.  He was skinny and at 3 percentile body weight.  By that time I had bought a Medela Swing Maxi Double Breast Pump since I was pumping around the clock.

I started to supplement with formula.  I hung my head in shame when I walked into the supermarket to buy the milk powder Stage 1 because it clearly states on the tin that doctors do not recommend formula for babies under six months.  But what could I do?  My baby was starving!

I spoke to my doctor who said that exclusively pumping was not possible because you need the baby to suck to stimulate breast milk supply, but he did offer domperidone which helps to boost milk supply.

So I did research.  I found out also that my relative was successfully exclusively pumping, so it is not unheard of.  There’s also not a lot of literature out there.  There’s some, but not a lot.

So this is what I did to boost my supply and can I tell you, my supply tripled!  This regiment may seem brutal and not palatable to some, but it worked for me.

1) A prescription of domperidone – done strictly under supervision of your doctor.  Some people take fenugreek which apparently works too.

2) Pump EVERY 2-3 hours a day.  You can have a 4-5 hour rest in the middle of the night but you MUST pump in the middle of the night.  I pumped every day for 2 months at 3 am.

3) Breast massage prior to pumping.

4) Keep reminding yourself of the multiple benefits of breastmilk.

5) Bring your pump everywhere.  So pump EVERYWHERE.  Shopping centres, swimming pools, Christmas parties…

And yes, baby is almost 6 months and exclusively breastmilk fed which is my goal.   Exclusive pumping is difficult and a lot of time you face the pump more than your baby.  Which means you have to spend extra time and energy bonding with the baby through song, play and book reading.  It’s definitely not for the faint hearted and I’m not sure I have the tenacity to go through it again.

Also, to be honest, I have had ALOT of help with donor milk which really saved us!

Engorgement, Plugged Ducts, Mastitis and other Good Stuff

So I started this blog because I wanted to share my experience of engorgement and plugged ducts.  When I experienced it last week (17 – 19 February 2014) I did what most people do when they have a serious medical condition – turn to Google.  Upon Googling, it came to my attention that there were some helpful and meaningful articles found on nursing and breastfeeding websites, but nobody really shared anything first hand.

Since I have suffered through it and lived to tell the tale, I thought I now have enough experience to help other nursing / pumping mothers.

First of all, plugged ducts and engorgement are different ailments.  Some people use them interchangeably, but they are not. Engorgement refers to when your breasts suddenly have a huge amount of milk.  This happens commonly a few days after birth, when your milk comes in, or when your milk supply increases drastically through medication or stimulation (I think I will post about increasing milk supply next). Engorgement can be relieved through frequent nursing or pumping and will not last long if you do so.  If you do not express the milk out when engorged in time and properly, it can lead to plugged ducts.

Plugged ducts on the other hand are quite different.  It occurs when your milk ducts are filled with milk that cannot get out.  The milk is essentially stuck inside.  Plugged ducts occurs when milk has been stored inside the breast for a long time and hasn’t been expressed out properly.  You will know when you have plugged ducts when your breast is very hard, sore and unevenly shaped – as though you have literally something hard stuck inside.  And if you don’t do anything to your plugged ducts, it can lead to mastitis. 

And now the best of all, good ol’ mastitis.  Mastitis occurs when the plugged ducts aren’t cleared and solved and then the breast becomes even MORE swollen than before which then leads to a fever.

Now that we have all the definitions clear, back to my story…

I had several plugged ducts in my left breast last week.  It happened over night and when I awoke the next day, they just wouldn’t come out.  I was pumping and pumping and manually expressing and massaging and putting a hot compress and had a warm shower but nothing came out.  I was close to tears.  I went to work with an extremely engorged left breast and at work tried pumping and manually expressing again and nothing came out.  That’s when I just lost it.  I broke down in tears and cried my eyes out in my cubicle.  It was so frustrating, painful, stressful and scary all at the same time.  My quick thinking husband (whom I had lashed out at earlier in the morning saying that he didn’t have breasts and couldn’t understand my pain) rang the Mt Alvernia Parentcraft Centre and made an appointment with a Lactation Consultant ASAP.  My colleagues then bundled me into a cab and off I went.

The Lactation Consultant, Rita, was very experienced.  When I spoke with her, she said that plugged ducts were very common (she sees quite a few a week) and immediately knew what to do.  I had to, obviously, undress, and then she rolled up her sleeves and started massaging my breast.  Let me tell you now, IT WAS EXCRUCIATING.  I was crying my eyeballs out.  She said that normally she would advise patients to take some sort of pain relief before seeing her.  Then she said that she hoped I didn’t have to go back to work because of the subsequent pain.  Seriously.  I had never experienced so much pain in my life.  She told me she didn’t think my plugged ducts happened overnight, they were probably a build-up of inefficient clearance of milk.  I was literally wailing.  I felt like I was in labour!  She commented that some patients said that the clearance of plugged ducts WAS worse than labour.  I couldn’t comment because I had an epidural and an emergency c-section (perhaps another story for another time).  She had to use SO MUCH PRESSURE to press out the milk ducts.  It was insane. Every 5-10 minutes, she needed to stop so that I could just hold my head in my hands and sob uncontrollably.

Three lessons I learnt from her:

1) Pumping really doesn’t clear the milk as efficiently as the baby – but if you MUST pump, you must pump for five minutes, massage for five minutes then repeat the process for 20 minutes. Do NOT pump longer than 20 minutes as it ruins your breast tissues.

2) When you do have plugged ducts, do NOT use a hot compress.  This ran contrary to some other online articles I had read.  The reason, which totally makes sense is, that using a hot compress stimulates milk generation.  And why on earth would you want to stimulate milk generation when the current milk can’t get out?  It just perpetuates the blockage!

3) Breast milk is PERFECT for moisturizing and healing cracks, chips and broken skin on the breast.  Basically, my over-pumping caused cracks and bleeding so she moisturized the cracks with breast milk.  A few days later, they were completely healed.  Breast milk is filled with antibodies and all that good stuff, so don’t bother with manufactured balms because really breast milk is all you need.

After an hour or so of the massage, my ducts were finally free-er and I could see the milk squirting out.  She said that because I was in such tremendous pain, I need to go home, lie down and rest before pumping.  Just because it will be harder for the milk to come out if I was in pain and trauma.  So I did just that.  But after two and a half hours, I pumped and very little came out.  And I panicked. I pumped, poked, prodded and prayed and nothing came out.  I rang up the centre and left a message for her to call me back.  When she did she said that she had already rung up and made an emergency appointment with a breast doctor, also located at Mt Alvernia Hospital.

I jumped into the car and headed over there.  Lucky I didn’t have to wait long to see him.  He did an ultrasound of my breasts and then said reflectively, “The milk isn’t coming out because you have bacteria in your ducts.  Your ducts are all inflamed.”  Great.  Something else to consider – bacteria.   Bacteria he said happens when you put stuff on your breast like nipple cream and you don’t wash it off.   As I shared earlier, breast milk is enough.  Don’t buy nipple cream!  So he gave me antibiotics and I went home and hoped for the best that it wouldn’t develop into mastitis.

SO finally, after going to sleep in extreme pain, I woke up the next day and miracle of miracles, the wonderful sight of squirting milk greeted me.