Here are 2 of my favorite pictures from yesterday...
Oh... It is such hard work being a baby...
Thank you, Body, especially you, PCOS, for trying to take the one remaining, normal pregnancy/post-pregnancy thing from me.
So. Breast milk production has been the one thing that I've been kind of good at the last 6 weeks. This, of course, means that my body has decided to no longer play nice and cooperate. Bear with me as I try to articulate the issues.
Remember how I said that the babies would suckle so well and then we'd weigh them and they'd show a 0 transfer? I'm beginning to think it wasnt them- it was me. I started reading a book called "The Breastfeeding Mother's Guide to Making More Milk" and, as I was reading, I started noticing that our babies were displaying some of the behaviors they mentioned of babies who couldnt get enough milk from the breasts. I decided to pay close attention to them during our next breastfeeding time and, sure enough, they worked hard, finally started thrashing as though they were ticked off, would give the breast another chance, then just stop sucking altogether. Because they'd suck for a good 15-20 minutes, we weighed them and zero transfer. I even talked to the nurse afterwards about just giving them the bottle of pumped milk instead of breastfeeding because I didnt want to lower their daily percentages when it was obvious they could and wanted to suckle. But the nurse, a lactation consultant as well, said no, to put them to breast every time and that the issue was probably their immature sucking, not my breasts, since my production was good. So it must be them... Not me... Okay... We can work on this... Yet, every bottle, they do the same thing and transfer a good amount, but okay...
Over the last couple of days, though, I noticed my milk production starting to drop off. At first, it wasnt that noticeable. Instead of each breast filling at 60ml bottle at about 3 hours in between pumpings, it would only hit 50-55ml. My nighttime pump, if I got a good "long" sleep of 4.5-5 hours, went from being 200ml to 180ml (total). I didnt think much of it. But then, yesterday, my marathon pump only delivered 150ml. Strange, I thought... Then my next pump only gave me about 45ml per breast. So, I decided to pick up the book and keep reading.
- Around 6 weeks, apparently, drop off is normal in mother's of preemies who have to pump as their almost exclusive breastfeeding method.
- Women with thyroid issues tend to produce less milk.
- Women with PCOS tend to have issues with production and let down. They also, if they have larger breasts, may have breasts with a higher fat content and less mammary tissue.
- Women with PCOS may find that their breasts dont enlarge post pregnancy, which could be a sign of the lack of tissue.
I could go on, but suffice it to say, I was reading in horror. I'm using a galactogogue (MotherLove More Milk Special Blend) and I'm still seeing a reduction in milk. This isnt good... The MotherLove has the main herbs associated with improving milk production in women with PCOS (it is specially blended for that). I decided to buy saw palmetto to add to it, since the book notes some increases in women with PCOS who started to lose their milk. I figure I can try that this week and see if it works before talking with Dr Bailey on Friday. Another book suggestion was to pump very frequently to try and convince my body that the babies were eating all the time. Yesterday, I tried this by pumping 3 times in a 2 hour period. I didnt really notice a huge increase but you have to give this method some time. I pumped again 3 hours later and then again 3 hours later, and didnt notice an increase over my recent standard amounts. I'm plugged in now and wondering if this megapump will give me closer to 200 or closer to 150...
If the babies were home, this wouldnt be much of an issue. I am producing what they are eating ever 3 hours (40ml for him and 38ml for her), but because they fortify 200ml of breastmilk at once, they have to have larger quantities. Some of the nurses say I'm a great milk cow, others make it seem like they are running on empty. Which doesnt help emotionally. In the freezer at the hospital, they have about 300ml; as of last night, they had enough to get through the 8am/9am feedings in the fridge, without thawing anything. My pumping at home last night made only 75ml combined; I dont know what this pump will give, but assuming a minimum of 150ml, that at least gives a bottle to fortify, which will handle 2 feedings plus a bit.
The nurses told me yesterday I need to produce approximately 700ml to feed one baby and pump every 2 hours to try and get that up to the amount needed for twins. I'm not sure how I can manage this, although, I'm trying to figure it out. I desperately dont want to formula feed them. (Not that there is anything wrong with that... I was formula fed and so was Peter. This is just the last thing that I have really wanted to give our children and so far, it was the only thing that seemed to be working right with my body. The idea that I'm going to let them down (no pun intended) in this too is excruciating.) They also recommended keeping a list of when I pump and how much I get so that I can notice an increase/decrease, as well as see how I am doing getting in my 12 pumps a day (they put a minimum at 10 pumps a day, if I want to sleep more than 2 hours at night). They (like the book) also recommended "power pumping" (multiple pumps in a short span for 10 minutes each time or pumping a bit every hour) to try and trick my body into thinking the babies need to eat more frequently because I am emptying more frequently.
I am willing to do whatever it takes. I dont want to give up on the dream of having them at breast versus only breastmilk in a bottle, but if I am not having an ejection response that lets the milk flow right now, then that is something I will let go for the sake of having enough milk to bottlefeed them. We've pretty much made the decision that, until I get my production up, we shouldnt "hold them back" per say by trying to at-the-breast feed them and should give them their bottle and then have nipple time that isnt being scale measured. Last night, they were both so frustrated as they tried and tried to breastfeed and couldnt get enough to satisfy their hungry tummies. Their sucks are hard now and they are perfect little latchers, but no transfer. Not one drop. We ended up gavage feeding them while I kept them on the breast. I couldnt help but cry. I just wanted to give Bobby (who was the second fed) to Peter so I could go and pump and hope that I got a large amount. I didnt get a large amount, only a total of 75ml for both. Yep, I cried. That was after 45 minutes of pumping and hoping I'd have a second letdown.
So, this coming week, I'm going to live at the hospital. This is the only way that I can give them breastmilk instantly so that they wont run out, and it will also save me time so that I can pump well. I figure I can try the following schedule, but that only gives me 8 pumps in 24 hours.
5am-5:45am: pump at home
6:45am: leave for hospital
8am: Maya's care time
9am: Bobby's care time
10am-10:45am: pump at hospital
11am: Maya's care time
12pm: Bobby's care time
1pm-1:45pm: pump at hospital
2pm: Maya's care time
2:45pm-3:30pm Shift Change/ pump at hospital/grab a bite to eat
3:30pm: Bobby's care time
4:30pm-4:45pm: pump at hospital
5pm: Maya's care time
6pm: Bobby's care time
7pm-7:45pm: pump at hospital/ Peter arrives
8pm: Maya's care time
9pm: Bobby's care time
10pm-10:45pm: pump at hospital/grab a bite to eat/leave for home
Midnight-12:45am: arrive home/pump at home
To try and add in a ninth pump, I could try setting the alarm for 3am, but I'm thinking that I'm really going to struggle with a 3am-3:30am pump time, after going to bed at 1am and needing to get up by 5am to get pumped and on the road. But right now, I'm struggling to get 6-7 pumps in a day because of travel time. So, this will at least get me up to 8 regular pumps a day. And the time at the hospital flies by. I think there is no other way for it to be, since everything is divided into one hour per baby, and then I have an "off hour" which is filled with pumping. Even if I only get 50ml per breast, that is what they are eating, so being at the hospital allows me to keep up with them. And I'm hoping that the herbs along with the regular pumping sessions that arent interrupted by driving, etc, will help. The saw palmetto is reported to help with letdown. If that happens, then I could start putting them to the breast, which would help with the whole pump-every-2-hours thing. If I were breastfeeding one baby each hour (one per breast) and then pumping the third hour to try and empty whatever remained, that would be awesome. So, that is the goal I am shooting for. Send a prayer to Our Lady of La Leche for me.
(BTW, I just stopped my hour long pump and got 80ml per breast/160ml total. This is from my nightime stretch of 5 hours of sleep. I was so tired; I thought I'd actually be waking to alarm at 5am, which would have been only 4 hours in between pumping, but the arm wasnt set. So my body didnt wake up until 6:25. :( Not good. I'll do some power pumping this morning, since we wont leave until 9:30-9:45 to make the 11am/12pm care times, since we missed 8am/9am. Damn.)
Is it too much to ask that my breasts just work the way they are supposed to? I mean, really? Can I not even manage that? (While I know it is true, I'm not in the mood for hearing that it isnt my fault and that I cant control what the PCOS and Hashimoto's does, etc. I'm really just pissed off at the situation, saddened that exclusive breastfeeding up to a year and continued bf'ing through 2 years is most likely not going to be possible and that I will be really lucky if I can produce enough to breastfeed them through 6 months before introducing some solids. I feel like so much has happened and that I cant even give them this. I've already given them less-than-the-best start in life by not being able to carry them longer and now the idea that I will have to give them less-than-the-best to eat is killing me inside. Please just say a prayer that my diligent pumping at the hospital and the galactogogues will help. Please oh please oh please.)
Okay, so I've whined enough this morning. Time to do laundry so that we have clean clothes to wear to the hospital...
(Oh and some stats on the little ones... As of yesterday, 10/24, at 6w2d old...
Bobby weighed 4lb 9.2oz and nipple fed 39% of his daily intake
Maya weighed 4lb 2.1oz and nipple fed 30% of her daily intake.