The Milk Maid Returneth

Milk supply. That magical and sometimes elusive key to nurishing and sustaining the life of a little baby. It’s amazing how the body works to create just the right kind of sustinence as a baby grows and changes. I knew from day-one that I wanted to breastfeed Joshua. Not only does it embue him with immune support and the right blend of nutrients, it’s also darned easy (in many ways) and far cheaper than formula.

I’m a big “Breast is Best” thinker… but don’t mistake that to mean that I think feeding an infant formula is a horrible-evil thing to do. Sometimes, formula is the right decision for a mother – either due to problems with milk production or pain while nursing or just a personal choice. I don’t look down on those folk. I just know that I feel a fundamental, powerful need to be the sole provider of nurishment for my child. I think it’s the best thing for him, I enjoy the nursing connection, I know it has health benefits for me, and I want to avoid the things in formulas at his young age (diary, soy, etc). Granted, I probably have a bit too much of my self-worth tied up in that belief, but it’s where I’m at.

So, with all this drive to nurse my son for as long as he’ll take it (I’m hoping for a year), imagine my dismay when I suddenly realized I was not producing enough milk to keep my little boy happy. Joshua was around three months old, and had become fussy at the breast, alternating between pulling at the nipple and burying his head against me. At that point, I was only pumping first thing in the morning after Joshua’s first meal of the day – trying to stock the freezer for my return to work. Also around this time, I started getting less than the typical amount of 5 ounces of milk at that morning pumping from the breast that Joshua didn’t nurse from. It wasn’t until I had actually returned to work and called the lacation consultants at our hospital (who are wonderful!) for help with Joshua’s fussiness, that the lacation consultant said “it sounds like you have a low milk supply.”

That hit me like a ton of bricks.

On top of that, I had a clogged duct in my right breast twice that week. It’s a pretty uncomfortable experience resulting from something having clogged the duct and then milk backing up behind the blockage. It meant that even a less-than-usual amount of milk was being able to be gleaned from that side. With massage and heat, we got the blockages to clear, but the breast has never really recovered. It’s now termed my “challenging” breast. Its supply doesn’t match the left side, and its rate of flow is much slower – something Joshua is NOT fond of. When he wants to eat, he wants to eat NOW!

I’d had such good milk… so much coming so fast that the poor guy had to gasp and struggle a bit to keep up with my let-down. How could I possibly no longer be producing enough for him?

Well… lots of factors. I’m sure that it didn’t help to have the stress of an impending return to work coupled with the fact that my mother-in-law (whom I love dearly) was going to be living with us 4 days a week while she provided childcare for Joshua. But looking back, my supply issues started a few weeks prior to my return date. So I don’t think those stresses were so big at that point. The thing that James and I both think has a huge portion of the blame is getting the Mirena IUD. Trouble with my milk started a couple weeks after the IUD was “installed.” I’d had this prior to being pregnant (thanks to my bilateral pulmonary embuli making it not possible to be on the Pill), so I didn’t think a thing of getting another one after the requisite healing period after childbirth. There were no warnings associated with the Mirena IUD regarding milk supply issues… however, James found several examples online of people saying they noticed milk supply decreases, as well as a host of other more general reactions… many of which seemed to get better upon removing the IUD. Since I had blood clots while on the Pill, it appears that I’m sensitive to hormones in my system – even though it’s really a pretty low dose of progesterone that’s in Mirena.

So, that’s what we think is predominately to blame.

But blaming something doesn’t get the milk back.

Given my passion (and self-worth) for nursing my child, I met with the lactation consultants multiple times to work on regaining my milk supply. I did research to see what essential oils might help. There were several things I could try. So I tried them all. I threw everything including the proverbial kitchen sink at this problem. Here’s what I did:

• Feeding Joshua every 2 hours when I was with him – granted, he tended to have a 2-hour window anyway, I just made sure not to try to push it to longer between feedings
• Pumping both breasts after every feeding
• “Double Pumping” (my term for pumping both breasts at once), it’s supposed to stimulate more prolactin (the lactation hormone) than pumping one at a time
• Pumping three times during the work day (about every 3 hours, which seems to be the pattern the other two women who were using the “Mother’s Room” had)
• Getting up at 1:30 to pump (Ironic, isn’t it? Joshua was sleeping for 8 hours, but I still had to get up! This was a suggestion by one of the lactaion consultants. When I spoke to another one, about a week later, she said she thought I could drop this one! Thank you Debbie!!!)
• Massaging the breasts while I pump (though this is hard to do when I’m double-pumping)
• Pumping for 5 extra minutes after the milk stops “flowing”, it’s supposed to continue to boost the prolactin
• Visualizing lots of milk – cascades of milk, rushing down and out…
• Using my breathing techniques to relax while nursing/pumping
• Looking at pictures of Joshua while pumping
• Eating Lactation Cookies (this one was not such a sacrifice) – they’re basically oatmeal chocolate chip cookies with Flax Seed and Brewer’s Yeast added. The recipe is on epicurious.com, I think
• Adding Brewer’s Yeast to my yogurt and granola for breakfast
• Drinking Ningxia Red (a juice from Young Living that has gobs of vitamins and minerals and is just really really good for you. James thinks the B-vitamins might be particularly helpful)
• Seriously upping my water intake
• Taking Fenugreek, three capsules three times a day
• Getting my Mirena IUD removed
• Using Fennel essential oil (Also from Young Living, which I know has a really high purity and is theraputic grade essential oil. I wouldn’t use essential oil from anywhere else.)
• “Power Pumping” every night – this is pumping for 15 minutes, taking a break for 15 minutes, pumping for 15 minutes, etc. for a recommended two hours. I pretty much managed to do it for an hour and a half each night before calling it quits for the evening
• Eating “Power Oatmeal” for breakfast – started this after the first two weeks. It’s 3/4 cup of oatmeal (thick-cut rolled oats, not the instant stuff!) with 1 Tbsp Brewer’s Yeast and 1 Tbsp ground Flax Seed. The Brewer’s Yeast makes it taste pretty nasty, so I add a fair amount of Stevia (a natural 0-cal sweetner) and a dozen-or-so chocolate chips. That makes it reasonable…

That’s… that’s about it.

It was brutal. Particularly the pumping after every feeding and the power pumping. But I was determined not to give up. And it paid off – I saw improvement. I could only sustain the maniac pumping schedule for a few weeks, but things like the Fenugreek and Power Oatmeal were things that I continued for months. Particularly with the addition of the Power Oatmeal, I saw a return to reasonable pumping quantities and a more-satisfied little boy.

At my lowest point, I was pumping 6-8 ounces a day, resulting from a pump before work and then three times during the work day. My son was consuming almost 15 ounces during the work day. We were operating in the red. Fortunately, we had enough milk frozen to bridge the gap. After the heroics listed above, I was getting more like 12-15 ounces a day. A much more sustainable amount when you factor in the fact that I’d do morning pumpings on the three days I didn’t work in order to cover the difference. On one day, after introducing the Power Oatmeal, I managed a record 18 ounces!

Life clicked on merrily for a month or two. (at which point I initially started to craft this blog entry in my head)

Then, when Joshua was nearly 6 months old, my supply started to decrease again. Not as low as it had been in the dark days, but still low enough to start stressing me out. I was starting to get only 10-11 ounces a day. James and Mary Anne counted the milk in the freezer, and determined that if I could pump 10 ounces a day, we had enough to get us through 12 full work-weeks. Not bad, but I wanted to make it until Joshua was a year old, not stopping at 8 or 9 months! Plus, Joshua was not a happy boy in the evenings when we’d nurse. It had become a nightly battle – with him fussing, unhappy at my breast, and me crying, feeling rejected and like a failure, not to mention more than a bit self-conscious as my mother-in-law was in the house, having to hear Joshua’s protests.

I was tired at this point. I knew I couldn’t put in the same effort I had done a couple months prior. James and I started talking alternatives. How long do we continue trying to find a way to get my milk supply back up, again? What’s the game plan if we start supplementing with formula? When should we introduce solids? James went to the store and read the ingredients on the containers of formula. He came home with renewed passion to support me in finding a way to continue breastfeeding.

In our earlier stint with the lactation consultants, the one we worked with the most (Debbie) mentioned a drug that could help. There are apparently a few drugs on the market to address milk supply issues, most of which have some pretty significant side effects. There is one drug, however, that has very few, if any, side effects but is quite effective. It is described by Dr. Hale in “Medications and Mother’s Milk” as “the ideal galactagogue” (that is, the ideal thing that makes you produce milk!). Obviously, at the outset of this venture we weren’t so keen on a pharmeceutical approach, preferring to find a more “natural” solution. By this point, however, “nature” didn’t have enough bang for her buck anymore. So, I looked into this wonder drug.

It’s called domeperidone. An increase in milk supply is actually a side effect. (The main purpose of the drug is something for your gut… digestion-related…) It is used in other countries to great success and many women have found it to significantly increase their milk production without causing any problems. Unfortunately, the FDA has not approved it. Yeah. So it’s not covered by insurance, it’s challenging to find a doctor who is willing to prescribe it, and, because it has to be compounded (rather than just counted out from a bottle) very few pharmacies could even fill a prescription if I had one. Fortunately, Debbie learned that a local Arrow Pharmacy would compound domeperidone, so all I had to find was someone to write me a script. I called my primary care physician, who was concerned by the lack of FDA approval and was unwilling to write me a prescription for it. I totally respect his decision – I don’t blame him for being nervous and cautioning me against it. However, I knew the risks and wanted to try it anyway. So, I asked my OB/GYN. Much to my surprise, she jumped into where to send the prescription to get it filled – I didn’t even have to try to persuade her to do it! Yippee!

I started taking 10 mg three times a day around Joshua’s 6 month birthday. Within a couple days, I saw an increase in the amount of milk I was pumping and less of a struggle as Joshua nursed in the evenings. In a week or two, I think I reached maximum effect – I was now consistently pumping *at least* 16 ounces a day! A few days, I reached my previous max, and once I even managed a whopping 20 ounces in one day! So, basically, with the introduction of domeperidone, I saw about a 50% increase in my milk production. After a couple weeks, I decreased and stopped taking Fenugreek, and have even stopped with the Power Oatmeal (though that’s partly out of laziness… it’s easier to pick up breakfast on the way in to work!). I haven’t had a single side effect besides the increase in milk production. It has been a beautiful thing. We’re even running out of room in the freezer for the extra milk!

After a solid month at 30 mg a day, James and I decided that it was worth trying to dial back the dosage. While I’m willing to take this medication and not overly concerned about it, I’d prefer not to be taking anything. Some people have had success with using domeperidone to boost their supply and then were able to get off the medication without losing the lactation benefits. We figured it’s worth a shot. If my supply goes down too much, we can always amp the dosage back up since we know it works!

I have now been taking 20 mg a day for a month and have seen a slight decrease in my milk supply, but not a huge one. I now typically get about 15 ounces a day. No longer do I get the massive surplus of milk, but I’m also not down to the lows before starting domeperidone. I find myself worried about meeting my quota, but I usually make it. I’m not sure yet if we’ll be able to pull off another decrease in medication without losing more ground… I wish we could, but I think I’m likely going to be taking this drug for another four months in order to meet my goal of nursing Joshua until his first birthday.

About a week ago, I started to see another little dip in supply, but I attribute that to stress over an upcoming surgery on my wrist and the pain in the wrist that prompted scheduling the surgery in the first place (a story for another blog entry).  We’ve decided to go back to 30 mg a day and reintroduce the Power Oatmeal.  My supply is back up to at least 15 ounces a day.  Because I think  it’s due to stress for a localized even, I’m hopeful that soon after Thanksgiving, I can go back down to 20 mg a day with more (and longer-term) success.

So, I’m happy that I have been able to regain my milk supply and continue to be the primary source of nutrition to my son.  We started introducing some solids around 6 months, but all the liquid he gets comes from me.  I feel good about what I’m doing and look forward to continuing this as long as he’s interested.  If I have any further tips or feedback about how the domeperidone is working (and particularly about my ability to step down off of it), I’ll be sure to post more!

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