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!

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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.