It never rains, but pours

Wow. Previous blog post in 2013! I guess with increasing popularity of facebook, I didn't feel the need to write blogposts to vent anymore. I mean, like, instant gratification with LIKES, yo!

 So, new on the frontier is a yummy newborn and I have unexpectedly come to face with one of the greatest problems I have had to date. I've always believed that with hardwork and perseverance, there is little I couldn't overcome. But now there's the one thing that, despite all my best attempts, I'm unable to correct. Something I never even THOUGHT existed, prior to this. 

LOW MILK SUPPLY.

With all the hoo-hah about 'Breast is Best' and myself being a OBGYN resident, why WOULDNT I breastfeed? So, armed with flowery thoughts of comfortable nursing with the new baby and me stocking up freezers full of breastmilk (BM) for the rainy day, I went ahead and bought tons of breastmilk storage bags! breastpads! pumps! medela bottles! and braced myself for the nasty future of painful engorgements, leaky breasts and an episode or two or mastitis (ouch!).

But then none of the above happened.

My baby came early at 36+6 weeks, when my waters broke while on-call (yes, convenient, isn't it?), and I was given a myriad of drugs to prevent post-partum hemorrhage. Emergency C-section brought him into the world, frank breech with two loops of cord around the neck, no less. He was put into the sick baby room to monitor for any possible platelet problems, and I wasn't allowed to nurse on demand. He was whisked away soon after and we didn't get to do skin-to-skin.

The next day I was given (or did I request for it?) a couple of syringes and taught to start hand expressing colostrum. I happily did so and was elated to see white stuff coming out of my nipples! I expressed around the clock at 3-4 hour intervals (and slept for 6 hours straight the first night), without knowing that I had to express/pump WAY more frequently than THAT, all the while being pleased at my progress of 1ml - 3ml - 5ml. Sadly Chris was already given the bottle and eating little meals of 20ml - 30ml at that time, and my colostrum sufficient only for a snack. I remember making only barely 10ml of milk upon discharge.

On postpartum day 3, while they were teaching me to nurse, my milk came in and there was a slight, mildly tender lump on my right breast. 'You're starting to engorge', said the nurse. That was the most engorgement I've ever had. EVER.

I quickly went into a state of panic when I realized that I wasn't producing enough for my baby and spent the next few days feverishly reading up on everything milk supply related. Every thing I read was reassuring => with frequent breast-emptying, more fluids, sufficient calories, sufficient rest/quelling stress, your milk WILL increase! So I wolfed down every single confinement meal (you need an extra 500kcal a day! make sure you are eating enough!), drank copious amount of lactating soups, drinks, milks.. I massaged my breasts till they were bruised and battered, I put Chris to breast whenever he was hungry and then pumped to empty around the clock. I was exhausted and baby blues sank in.

Then I came across the issue of tongue-tie and lip-tie, and that got me suspiciously inspecting Chris' mouth, and his latch. I became well-versed in the symptoms of TT/LT. It appeared that Chris had latch issues, which result in poor transfer of milk, which might affect my supply, I thought. So I brought him back to my hospital to have it checked out by the senior nurses there, at day 2 post-discharge. We learned to improve our latch and also learned that Chris' bilirubin levels were through the roof. He had neonatal jaundice and required hospitalization for phototherapy.

So with little Chris out of action again and back on the bottle, I had 3 days where my sole job was to PUMP PUMP PUMP milk for him during visiting hours. I was getting increasingly frantic. He was eating more and more. 45ml now and still I was stuck at 20ml every 3 hours. I crawled through every blogpost telling stories with happy endings - of mothers with low supply and doggedly pushing through with pumping and soup-drinking (it was always soup drinking...) and eventually reaching a supply balance at a month postpartum. But then there were other posts with people having oversupply and those whose supplies increased faster than mine, which made me nervous. I started to look at what supplements I could take: I started with lecithin, herbal teas, and even chinese medicine which I loathed.

No increase. 3 days came and went. He was drinking too little, it seemed. All they did was to increase his milk intake and he improved. I was suspected of underfeeding my bub, and the nurses had to make sure I was capable of feeding him properly before they would discharge him. Great confidence booster, because clearly I wasnt producing enough.

Maybe Fenugreek was what I needed. Maybe Domperidone? Despite keeping up with my crazy pumping schedule, I wasnt seeing much of an increase. Still I suspected poor transfer because even after 30 minutes nursing, Chris would maybe manage only 20ml and he would click like crazy, indicated a loss in vaccuum. Also, the MIL found it troublesome for us to nurse every session and was not very supportive. She had the best intentions in mind but that is another story to tell..

As the days rolled by, I hired masseuses to clear my ducts, I suspected that I had retained placental fragments, I tried pressure point massage.. and I even had my blood tests taken to check my hormone levels. TSH is borderline for lactation, normal otherwise, while Cortisol rather on the low end, with everything else normal.

I joined a low supply group and read vociferously about the subject. I considered insufficient glandular tissue to be possible. I examined my breasts and compared them to pictures of IGT breasts. They said that IGT people don't experience obvious breast enlargement during pregnancy (I had some increase), no postpartum engorgement (mine was very, very slight). I matched myself with other markers of IGT and found some similarities, while I didn't fit others. Suddenly, all I wanted to do was to be overflowing with milk and I began to jealously read about other mothers with oversupply, and resented those with freezer stashes enough to feed a dozen kids.

Some days I would dream of more milk. Some days I would wake up suddenly at night, and rush to pump, only to realize it wasn't time yet. Other days I would cry in my sleep because I felt so helpless, so betrayed by my own body. And it didn't help that no one I knew had the same problem I did. Most of the previous generation didn't breastfeed, so no help there. My husband tried to help, and consoled me by saying it is alright to supplement, which actually made me feel worse, because it made it seem as though I was silly to try all these things for something as inconsequential as BM.

I don't know why this became an all-consuming affair... I don't know why I persist when I know there is nothing wrong with formula, because so many of us were brought up on it and turned out fine. But I wanted it so bad. It was one thing I couldn't have, despite all my attempts and hard work. I still don't know why I have low supply - maybe I do have hypothyroid? Maybe my cortisol is out of whack? Maybe I just don't respond well to the pump and had Chris' latch be better I might not have this problem? Maybe (and this I really wish I didn't) have IGT?

There are good days and bad days. On good days I think, well at least I am making some (I've actually increased to 75ml per 2 hours), but on bad days I worry about my supply when work starts, on what it could have been, and how I still wish it didn't turn out like this.

I spent my maternity leave in a milk haze. How I wish for a better breastfeeding relationship with Chris (crying? no problem! here's mummy's milkies!) Instead I spent it attached to my pump, dry pumping... I have never hated myself so much. Now, nearing the end of my maternity leave, I'm slowly coming into terms that I will never be a normal producer.. and despite my best attempts, it still hurts.

I'm sure all of these wouldn't matter very much in the grand scheme of things, but this is the painful truth of how I tried my best, but yet, best is not enough.