Breastfeeding When Your First Time Did Not Go Well

QUESTION

Dear Lactation Consultant,
I have a question about chances for success at breastfeeding when your first time did not go well.I have a 20 month old son, and the day I had him, I got a fever in the hospital and was put on antibiotics. I was in the hospital a couple extra days hooked up to an IV. My milk did not come in until about the 7th day, and by that time my son had to be given formula to supplement, since he was not gaining weight. I was determined to breastfeed and make it work, and tried pumping and using a nursing supplementer.

But by week 3, I was still only getting 2 ounces total (both sides) when I would pump. I was so stressed, and my baby was not getting enough. I finally gave in and gave him formula with tears of both sadness and joy as he gulped it down happily. I never had the "let down" or the "engorgement" I hear other women talk about. I continued to pump for a few more days, just to give him some breastmilk, but could not manage pumping and feeding for more than a week, so I gave up. I felt inadequate as a mother, that I could not provide the best nourishment for my baby. I have felt guilty and sad about it ever since, even though my son is a happy, extremely healthy little boy.

My question comes as my husband and I are trying for another baby, and I am thinking ahead to how I can prepare myself best for a positive breastfeeding experience. I did not feel I got that from the Lactation Consultant in my hospital with my first baby. Do you have any advice for me? Are there ways to stimulate milk production during pregnancy? I want to head into this next situation with a relaxed and positive attitude about it.

Sincerely,
Jen Veum

ANSWER

Hi Jen,
I think it is wonderful that you are planning to breastfeed your second baby in spite of the problems you had nursing your first child. I'm sorry that you had a bad experience with your lactation consultant, too. Just like in any other profession, there are some people who are better at what they do than others.

First of all, let me assure you that nursing a second baby is usually much easier than nursing the first one. Part of the reason for this is that when you are pregnant for the first time, you really don't know what to expect, no matter how many books you read, how many classes you take, or how many friends with babies you hang out with or talk to. Being pregnant, giving birth, and breastfeeding are things that you just have to experience firsthand before you can really understand them. The medical problems that you experienced after the birth of your first child could certainly contribute to the difficulties you had with breastfeeding, and there is no reason to assume that you will have similar problems this time around. Hopefully you will have a normal delivery with no complications, and that may make all the difference in how breastfeeding goes for you.

In reply to your specific question: there is no way to predict whether you will have any breastfeeding problems at all with this new baby. Hopefully you won't, but the best way to prevent problems is to educate yourself beforehand about the basics of positioning and what to expect when the baby is born, and to have a good support system in place in the event that problems do develop. Establishing a support system is a very important component in having a successful breastfeeding experience, especially if you experience problems.Ask nursing mothers in your community for recommendations on "breastfeeding friendly" doctors in your area. See if any breastfeeding classes are available. Many WIC offices offer breastfeeding classes if you qualify for WIC.Read a good book on breastfeeding. I like Dr. William Sear's "The Breastfeeding Book" and La Leche League's "The Womanly Art of Breastfeeding".La Leche League is a great source of support for all expectant and nursing mothers. La Leche League Leaders are mothers who breastfed their babies and discovered that they loved nursing so much that they wanted to volunteer their time to help other mothers have the same satisfying experience. They undergo extensive training in order to have the information they need to effectively counsel nursing mothers. They aren't doctors or nurses, and they don't give medical advice, but they can listen, advise you on most basics aspects of breastfeeding management, and make a referral to a health care provider who is knowledgeable in lactation if needed.

Find out if there are any IBCLCs (International Board Certified Lactation Consultants) in your area. These are health care professionals who have received extensive training in lactation, above and beyond the training that doctors or RNs receive. They are the only members of your health care team whose focus is primarily breastfeeding. Most major hospitals have IBCLCs on staff, and some IBCLCs are in private practice. Lactation consultants in private practice often have more time to spend with you, but this is not always the case. Check around to find out what services are available and prices in your area. Insurance often covers lactation services, especially during hospital stays or in the case of hospitalized or premature infants.You can find an IBCLC in your area by contacting ILCA (International Lactation Consultant Association) at 312-541-1710 or by e-mail at ilca@erols.com. You can also find out what lactation resources are availalbe locally by calling Medela at 1-800-TELLYOU or my visiting their website at medela.com.You can find out how to locate your nearest La Leche League group by calling 1-800-LALECHE or going to their website. A low milk supply can be caused by problems with the mother (pituitary or thyroid imbalance, breast reduction surgery, congenital lack of glandular tissue, estrogen containing birth control pills, etc.) or with the baby (tongue tie, prematurity, improper latch, neurological dysfunction, etc). In the majority of cases, there is a medical problem that can be addressed, although it may take some time and some "detective work" to figure out what the problem is.

Did you use a good hospital grade double pump like Medela's Classic before to stimulate your production? The type of pump you use can make a huge difference in how successful you are in building your milk supply. There are also some prescription medications that increase prolactin levels, and these are options to try when other methods of increasing supply have not been successful.Since you know that the potential supply problem exists, You will need to track urine and stool output carefully, and start supplementing right away if it is obvious that you aren't producing enough milk. Make sure that you have expert advice from an IBCLC right from the beginning, so that if there is a problem that can be corrected, it can be addressed immediately.

Unfortunately, a tiny percentage of women are unable to produce an adequate supply of milk, and sometimes it just isn't possible to figure out a cause and a solution no matter how hard you try. It is unlikely that this is the case with you, but it's a possibility that you need to be prepared for.I would suggest that you get expert help from the beginning, track the baby's weight carefully, and be prepared to supplement early on if necessary. Remember that breastfeeding is much more than a milk delivery system, and you can still enjoy the closeness of nursing your baby even if you have to feed a combination of breastmilk and formula. Any amount of breastmilk is beneficial for your new baby, and many mothers nurse their babies even if they don't have enough milk to totally supply all their nutritional needs. Mothers who nurse adopted babies rarely are able to produce a full milk supply, but often continue because they feel that even a small amount of breastmilk is valuable for their babies and they enjoy the closeness of nursing, even if they use a supplementer or only offer the breast as a pacifier during the night.I certainly hope that things go more smoothly for you this time, but you need to be realistic and prepared for problems. Then you'll be pleasantly surprised if you do have enough milk, but ready to intervene quickly if you don't.

Many mothers can relate to the problems you had with nursing and your feelings of failure and disappointment. There is a website called mobi@egroups.com that is specifically for "Mothers Overcoming Breastfeeding Issues". There are lots of mothers on that site who have dealt with the frustration of trying to breastfeed unsuccessfully, as well as nursing mothers who have special situations such as cleft palate babies or preemies. They all have one thing in common: they really want to nurse, but all have had to deal with challenges like the ones you encountered and the resulting feelings of grief and fear of nursing again. You may want to check out that site sometime. There is a lot of support from other mothers who have 'been there, done that'. You are certainly not alone.

-- Anne, IBCLC

Kathleen Tackett

Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.

Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.

Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.