Breastfeeding: Lessons Learned

I had a lot of trouble breastfeeding Eliza, and it was an enormous source of emotional and physical stress for me. I was 99% pumping, and ended up weaning entirely and stopping pumping around five months after she was born. I have babbled endlessly about this in the past, but the take home is: I had inadequate supply (I was pumping about 75% of what Eliza was drinking, at best), Eliza wasn’t a great nurser, nursing was extremely painful (partially because I have Raynaud’s), and I felt like an awful failure at life for a while.

It’s been a completely different ballgame with Hazel, for a variety of [likely interrelated] reasons – girlfriend doesn’t like bottles or formula, she was born during the summer so Raynaud’s wasn’t as much of an issue at first, my supply is better, and importantly, I am so, so secure in my understanding of breastfeeding and all the surrounding BS. I know formula is a wonderful invention. I have access to lots of things to help support breastfeeding. I can weed out the bullshit messaging that comes along with a lot of breastfeeding info and advocacy.

I have a few friends who are dealing with breastfeeding for the first time, and I’ve found myself repeating some of the same suggestions and recommendations, so I figured I’d compile them here.

First of all, a lot of the literature on nursing, as well as many nursing advocates, will say that breastfeeding shouldn’t hurt. I want to burn all of them in a fire. At first? That shit hurts. Like, toe curling, tears streaming down my face, even crying at the THOUGHT of nursing the baby. Who, of course, wants to eat all the time, those first few weeks. I think of the considerable number of women I have talked to about this, perhaps 5%, at most, have claimed that it never hurt at all, not even in the beginning. Which is great for them! And I would say for most people, once nursing is well established, it doesn’t hurt. But the first few weeks? HURT OMG. Based on my informal polling, it sounds like it is very painful for most women for about a week. For many women, two weeks. For some, three or longer. The pain seems to be a combination of needing to toughen up a body part that is usually handled gently and infrequently, and of poor latching. The latter can sometimes be fixed easily and immediately, just by learning better ways to hold the baby and facilitate the baby latching correctly – from an LC, or the internet, or more experienced friends – but sometimes there is a mechanical issue. Like a tongue tie, that might require a minor surgical intervention (super easy when caught early!). Or, very commonly, the baby might have a teeny tiny mouth, and might be physically incapable of taking the nipple deeply enough to get latch the areola rather than the nipple, causing pain – especially over time. This last one seems to be a big factor when pain continues for two, three or more weeks – you’re basically waiting for the baby to GROW. Bigger mouth means better latch means less discomfort. Also better stimulation of milk supply!

For me, based on my statistically insignificant n of 2, the timeline seems to be: the first three weeks are lots-o-pain, accompanied by emotional turmoil and sleep deprivation, especially after the initial new baby high wears off in the first few days. Then, the next three weeks, the pain has improved but the mounting sleep deprivation almost nullifies that improvement. Then magically, around six weeks, things get a lot better all around.

That said, there are a lot of things I felt helped me during those first six weeks, as well as subsequently, with both nursing and pumping.

Stuff worth buying for Nursing:
My Brestfriend nursing pillow – I am EVANGELICAL about this thing, despite the absolutely wretched product name. And at less than $40, this thing is WELL WORTH IT. I would pay twice as much for this, without batting an eye. It is more supportive than a boppy, but lighter – it has structured foam, rather than … stuffing? The angular rather than rounded form means baby – especially tiny floppy baby – doesn’t roll into your belly too much. It keeps me from hunching over when I’m nursing. There is enough extra space to rest my phone on the pillow so I can read. There is a silly little pocket, that I can keep chapstick or a snack or some boob stuff in. It straps on, so when Hazel was cluster feeding like a crazy baby in the beginning, I didn’t have to bother readjusting everything when I went to refill my water really fast (yes, I walked around with a baby shelf attached to me. Whatever, it saved me minutes of fiddling!). Kevin actually used it a lot at first, too, to rest the baby on so he could have his hands free to play video games or whatever else. Tiny babies are adorable but boring and floppy.

Medela soft shells – these allow your nips to hang out in air, protected from any kind of friction. Super helpful for the first three-ish weeks, when there can be some serious trauma. Three weeks doesn’t sound like long, but it IS. And even the softest nursing pad can be AWFUL.

Lansinoh Gel Soothies – these feel good on traumatized boobs in the first few weeks. I tried some other brands that were a bit cheaper, but these ones are a much better product. However, if you find yourself running through them like mad, Medela’s are a bit cheaper, or you can get hydrogel pads marketed for burns.

Ocalette nursing cups – Ok, these are awesome. They are a hard plastic cup that, like the soft shells, let your nips recover in an air bath, and more importantly, collect and save any milk that leaks out. (I still recommend the soft shells, because the hole is larger in those, and the material against the breast is softer/more comfortable at first.) These work because they exert light pressure on the areola, but not the nipple, kind of like how a well-latched baby is actually nursing on the areola. When you nurse on one side, and have just a nursing pad/bra on the other, the pressure on the nipple keeps too much milk from coming out. With these, there isn’t any pressure on the nipple, so a bit more milk comes out. I was curious, so I weighed a nursing pad to compare the leaking to the volume I get in a cup, and found I only leaked about 5 mL tops in a nursing pad, versus 15-45 mL in the cup, depending on time of day, how long since I’d last nursed, etc. I wore these a LOT right after Hazel was born – on both sides to catch the random let downs before things regulated, and certainly when I was nursing. I managed to save up about a liter of milk this way, without having to pump after nursing, which is a soul crushing and terrible way to spend time those first few weeks. I actually wonder if these might have contributed to my better supply this time around, just encouraging a little extra production. I also have a Milkies milk saver, but much prefer the Ocalettes – the Milkies is much bigger, so I couldn’t wear it in my bra under my shirt. It’s also completely open on top, and I spilled it a few times in the middle of the night, or forgot to remove it before putting the baby down, so all the milk spilled out in her crib. (The Ocalettes have a little air vent, so if I leaned over before removing it, a few mL might leak out, but not the whole thing.)

All Purpose Nipple Ointment (APNO) – a combo of topical antifungal, corticosteroid, and antibiotic that you can get at a compounding pharmacy by prescription. Very helpful in the first few weeks of trauma – feels soothing like lanolin, with bonus healing properties. Totally safe for baby.

Domperidone – if you are having supply issues, this is what you should do, hands down. I mean, pumping and nursing like crazy will help, yes, but depending on the level of inadequacy, might drive you bananas before they work. Fenugreek and Blessed Thistle are herbs that have been scientifically shown to help a little bit – but in addition to not working that well, you have to take so much of them that you reek of maple syrup. That is how you know you are taking enough, seriously. When your spouse starts calling you Pancake Pits. And that just means it MIGHT work. Mother’s Milk Tea is vile, and you have to drink LITERS per day for it to help, generally. Domperidone, on the other hand, works incredibly well. It isn’t FDA approved for use as a lactation inducer in the US, so I did a good bit of research on it before deciding it was safe for my own use. My OB prescribed it for me, but I ended up getting it online because it was much, much cheaper. Some doctors won’t prescribe it because it is an off label use, so then you’d need to get it online as well. I had a bunch of this on hand when Hazel was born, expecting supply issues again, and being completely unwilling to just deal with them. I didn’t end up needing it, but did take some for a week a few months ago, after a bad stomach bug and cold leveled my supply, and I wanted to see if it worked. It helped quickly. I could write like 18 blog posts about this specifically, but won’t – ask me if you have any more questions about it.

Stuff to buy for pumping:
Hands free pumping bra – I have a Pumpease brand, which I like fine. You can also make one out of an old bra, though I prefer the bandeau design so I don’t have to put it on over my clothes, or remove my shirt completely. Anyway, it lets me do other stuff while I’m pumping, worry less about accidentally spilling, or losing suction (which drags out the process), or I am free to massage the ladies to work out any clogs or speed up milk collection.

Pumpin Pals flanges – I love these. I have two sets in my size, to complement the two sets of regular Medela flanges, and I get more milk on the days I use these. Also they are a bit more comfortable, and I don’t have to sit up as straight, and I lose less when taking everything off. Worth it to me, since I had to buy extra flanges anyways.

Extra parts – ok this might be my biggest suggestion for pumping. I have four sets of flanges, valves, and bottles now. I use one set per day at work, where I pump three times. I refrigerate the parts in between pumping (actually in the cooler I keep the milk in, because I’m too self conscious about putting boob stuff in the office fridge), and then wash all four sets once I run through them. This is HUGE. I nearly lost my mind when I was pumping exclusively with Eliza, because washing all that shit was such a process. Every time I pumped – get all set up, pump for 10-20 min, get the milk put away, wash all the parts. The whole process took a minimum of half an hour, once I was good at it, and that was at home where the sink was close and there weren’t any coworkers making me feel awkward, and even then it made me RAGEY. I mean, it takes me half an hour to nurse Hazel in the middle of the night, but she is a LOT warmer and snugglier and cuter than my breast pump, and I don’t have to wash her off afterwards. So – definitely have extra parts.

Other tips and info:
For pumping, having the right size flange is important – if you can, get an LC to take a look and fit flanges. The right size will be more comfortable and more efficient. There are a wider variety of sizes available on the internet than in stores. Also, Pumpin’ Pals will suggest getting the variety pack and trying them all, because their sizing/design works a bit differently than traditional flanges.

Using something to lube the flanges – I use coconut oil. This makes pumping more comfortable/less painful, as well as more efficient. I get a lot more clogged ducts if I don’t do this. I used to use olive oil, at the suggestion of my original LC, but switched to coconut this time and much prefer it. You don’t want to use lotion – edible, food grade oils are better, because a little might end up in the milk.

Introduce bottles ASAP, if you are going to go back to work. When I was first nursing Eliza, I had heard a LOT more about nipple confusion, and babies refusing the breast after even a single experience with a bottle or pacifier, than I had about babies refusing bottles. I think nipple confusion CAN be a thing, but from the research I have done at this point, it is very rare that a baby will develop a preference in the first few weeks of life – they will suck on just about anything, then. Some babies eat better from bottles than boobs, that is certainly true (as is the reverse), but most newborns won’t refuse a boob just because they tried a bottle once or twice. BUT – many WILL refuse a bottle, quite vociferously, if you wait too long to introduce them. From my research when we were trying to get Hazel to accept bottles, it sounds like you should use a bottle regularly – say, a few times a week – starting in the first few weeks of life, so the baby is familiar with it from the get go. Babies will suck on anything at first, and then are much less inclined to readily accept something new after the first several weeks. This isn’t to say they won’t – hunger is an impressive motivator – but it might be an enormous headache/source of stress.

So, with Eliza, I pumped a LOT – almost exclusively – those first few weeks to manage pain, and she got used to bottles and was impatient with my subsequent clumsy attempts at breastfeeding. With Hazel, we tried a bottle a couple times the first week or so, but breastfeeding was simpler so we abandoned the bottle until she was a couple months old – and by that point, she didn’t know what the hell we were trying to pull on her, seriously, please stop with that nonsense. Balancing the two approaches is hard, and who knows if I’ll get it right next time. (And, of course, the individual baby plays a significant role in all of this!)

There are a number of common medicines that can negatively affect supply – certain oral contraceptives and pseudoephedrine are the most commonly encountered. For the former, this is why a lot of nursing mothers choose the mini-pill, IUDs, NFP, or some other method of birth control (or none, choosing to hope that nursing will keep ovulation at bay – aieee!). For pseudoephedrine, I’ve had a few colds bad enough that I’ve needed to take some or risk death by snot, and here is what I’ve personally found: I can take it at night for about three consecutive days without any effect on my supply, assuming I’m also drinking lots of fluids, etc. I take diphenhydramine (benadryl) during the day, even though it makes me incredibly sleepy, rather than just drowning in snot. I also alternate with a nasal spray decongestant, which doesn’t affect milk supply. You aren’t supposed to use that for more than three consecutive days either, because they can cause rebound congestion. So. Lame, but it works.

A note on supply changes in general – I have been pretty hyper about this, because my supply was inadequate with Eliza. BUT. In my experience, it takes days of some change in behavior, diet, medicine, etc. to have a measurable impact on supply. That is, it takes a few days before anything changes it – when Hazel sleeps longer stretches, it takes days for me to regulate. When I skip a pumping session at work for a single day, it’s no big deal – I don’t have less milk the next day. But if I do it for a week, I might have to work to get things back up. When I AM trying to get it back up, Hazel will nurse a whole lot for a few days and then go back to normal. The only thing that has effected a drastic, noticeable change in my milk supply was a very bad stomach bug, where I was so dehydrated I was dizzy. And it came back easily even then, once I started drinking more water, etc.

This jives with my experience weaning Eliza/stopping pumping – it took time to turn off the faucet, especially completely. This revelation has eased the mental game of pumping at work, or leaving my kid to go hang out with friends. I don’t feel as married to a schedule – nothing bad will happen if I wait four hours instead of three, except I might hope I’m wearing nursing pads.

Amazon links are affiliate. I will use any tiny proceeds to buy myself kindle books to read while nursing, probably, or maybe to fund my evangelical distribution of Brest Friends to all the pregnant women I know.

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18 Responses to Breastfeeding: Lessons Learned

  1. Roberta says:

    This is so awesome. SO AWESOME. I was just ranting on Twitter about how women need to seek out good breastfeeding info because OBs won’t give it to you, by god. I also heartily SECOND the bullshit call on “nursing shouldn’t hurt!” Bull. Shit. I had everything going right with baby #1 – plenty of milk, no latch issues, no tongue tie, but I was SORE for about a month. Let’s liken it to breaking in a pair of shoes. Lots of them aren’t great right off the bat – they have to get soft & flexible & break in before they stop hurting your feet. If your nipples have never been sucked on for 20 hours out of 24, guess what! They might get sore until they get used to it! Not rocket science. And yes, APNO (or Triple Nipple Cream) is THE BEST. Saved my nursing life.

  2. Katie says:

    This is AWESOME and I plan to encourage all of my new mom friends to read it. It would have helped me tremendously when I struggled with my first. And don’t get me started on the “bf’ing shouldn’t hurt” crowd. I once got into a heated argument about this subject on an my local AP listserv (I am slightly AP, mostly mainstream, and am mainly on the listserv for comic relief at this point). It is just cruel (and setting women up to fail, IMO) to not be honest with them about the PAIN. I cried daily for three weeks with each of my babies over the pain and, just as you said, it was anatomical! Big breasts and two tiny babies = pain. Am so happy I managed to get past that point, but I felt like I was doing something wrong and I wasn’t!! Anyway, great post for those of us in the reality based nursing camp.

    • admin says:

      Oh, thank you. I agree that it is setting women up to fail. Even with an improved perspective this time around, had my daughter not refused to drink from bottles, I might have given up – I had at that point anticipated a couple of weeks of pain, and when I exceeded that timeline, I was yet again convinced it would never ease up. And I love the phrase “reality based nursing” – I’m using that!

  3. Dawn says:

    We introduced bottles at 2 weeks, because I flat out needed more sleep and my husband was happy to take the midnightish feeding. You’re right – babies at that age will take anything, and it didn’t destroy her latch (although I got lucky in that she latched pretty well early on). It’s a PITA to remember to pump during the day so a bottle is available, but everyone is way happier if I do.

    Also, I wished I’d known about those Ocalettes weeks ago, when contralateral letdown was totally soaking the poor kid’s side.

    • admin says:

      Ahhh I’m sorry I waited so long to post this! It’s been floating around in my head for awhile now, but I guess I’m just starting to come out of the haze of the newborn period.

      I hope things are going well for you – it sounds like y’all are figuring it out!

  4. Elizabeth Hartman says:

    Yes, Yes, ALL OF THIS. I was just talking to a coworker this morning (whose wife had their first baby 9 days ago and is struggling to breastfeed) about how it’s so difficult at first, but so incredibly worth it. Toby had tongue-tie (which we got clipped when he was 3 days old) and I had to wear a nipple shield for the first month and a half. It wasn’t until we hit the two month mark where I felt adequate in breastfeeding, and it took until three months when I actually felt comfortable with it. Now he’s a year old and I’m a pro, but we still have hiccups on occasion. I think a lot of women give up on breastfeeding because they don’t realize that you can overcome the hurdles and it will get significantly easier over time. A good support system is key – especially in those early weeks when you’re so sleep deprived.

    • admin says:

      I tried nipple shields with Hazel, and she was like “WHAT IS THIS PLASTIC CRAP”. I will say I was completely amazed at how (relatively) quickly Hazel and I figured out the mechanics – how to hold, how to latch, etc – versus with Eliza, where I felt clumsy and inept all the way till we quit at five months. Obviously, because I was pumping so much, because it hurt so badly, we didn’t get to practice that much – but even still, it seems like Hazel was just naturally better. So, I think maybe it COULD have worked out differently with Eliza, but I would have needed very specific support – pain management and help with the mechanics, with the right tone – and I didn’t know how to ask for it or where to find it. I think MAYBE I could overcome that stuff now, by myself, knowing more, but it’s also possible I just WOULDN’T, because sleep deprivation and struggle combined with only six weeks of leave to get it all established might just make it too much. So yes, SUPPORT, kind of important. And honestly, other than online, I just haven’t found anything sufficient!

  5. K says:

    I had one side that was hurty with Ezra until things got roughened up a bit, and then it was fine. I don’t think a different latch or position would’ve done a damn thing to change it, so I really dislike the “Nursing shouldn’t hurt!” statement. Because really? Someone is CHOMPING ON MY BIZNASS.

  6. Erin Jaffe says:

    Man, this was SUCH great info. I was nodding my head along a ton as I was reading.

    I am totally ditching my Boppy for a My Brest Friend next time. The Boppy worked fine for me, but BABY SHELF THAT IS GENIUS. Also I like the back support thinger and the pocket.

    I pumped at work for about 9 months and the idea to get extra parts is so smart. I was super self conscious about putting the milk and parts in the department fridge, too, but then I got the idea to put them all in a nondescript paper gift bag and fold the top down. Then it just looked like somebody’s lunch, and if some nosy-pants went poking in there, well, enjoy your peek at the workings of the milk factory, turd-face.

    I think next time I may buy a reusable (non-insulated- I assume insulated wouldn’t be good if I’m sticking it in the fridge, since then it would insulate it FROM the cold temps, right? Correct me if I’m wrong!) lunch bag.

    • admin says:

      Yesssss get on the Brest Friend train. The back support thinger is so-so for me, like I still can’t LOUNGE and nurse – I think I am destined to hunch a bit no matter what? But I’m pretty sure that’s just a me thing. I know other people can lounge! I’m keeping hope alive for a Future Me who is less hunchy.

      Re: work pumping – I am SO self conscious about it. I *should* put it in the fridge, like you are saying, in a non-insulated bag (I think you are right), but I keep mine in a cooler on my desk instead. Like I am so ridiculous, I don’t want anyone to know that I am doing boob related things at all, ever, even though any idiot can tell by the thrice daily locked door and suspicious pumpy noises. I should really adopt your attitude about all the nosy pants turd faces. That exist only in my imagination, I think, because I don’t think any my coworkers actually care or even think about it. Maybe. AHHHH.

  7. Purdy Bird says:

    This is great. I have 3 kids and have had 3 totally different experiences BFing them. The worst experience being with my youngest. Its so hard to find good support when your tired, hurting and getting conflicting advice but your explanations of why you liked something is great (so people can tell if its applicable to them.) I also loooooove the Brest Friend and the nipple cream. Total game changers.

    • admin says:

      Ooooh I worry about having a HARDER time with a subsequent baby – like, I think I have it all figured out, because it was easier the second time, but what if it’s just Hazel making me THINK I know what’s up? EEEK. What was harder about your youngest? Do you feel like it was something specific to the baby, or something you had control over..?

  8. HereWeGoAJen says:

    This is the best post ever!!! I have been nursing for more than three years now and this had info that I didn’t even know. And now I feel guilty that I have had my nursing tops post in my drafts folder for so long and haven’t finished it yet.

    I would cook dinner and nurse with the My Brest Friend pillow. (Terrible name! Terrible!) And I am one of those 5% too, but I make up for it by being extremely prone to thrush and also being thrush treatment resistant. Nursing just flat out hurts, at least some of the time. I’ve had to do labor breathing at times.

    • snoozical says:

      Oooooh thrush! That might be worse! Especially with the resistance to treatment – does your doc prescribe fluconazole or anything? Mine put me on a TON when I was first having so much pain with Eliza, when we weren’t sure if it was Raynaud’s or thrush. UGH.

      I need you to finish your nursing tops post. I have not managed I find anything I like for nursing bras or tops. I just use camis from target, and they are fine, but now that I’m exiting the newborn haze, I feel super frumpy.

  9. Awesome post! I have so many friends who’ve had luck with Domperidone, especially those with PCOS. I haven’t had as much luck with ‘My Breast Friend’, but that’s in large part due to big boobs. Softer nursing pillows have worked really well for me and some of my big-boobed friends.

    I have had three very different nursing experiences – exclusive pumping/hand-expressing with tongue-tied Teddy, then nursing with Veronica and Susannah. Susannah was 1.5 lbs smaller than Veronica at birth and HOLY CRAP, what a difference a much smaller mouth makes. YEEEOUCH! I mean, it wasn’t the same as the awful pain of trying to nurse a tongue-tied baby, but it was still crappy for a few weeks until, as you said, her mouth was big enough.

    I’ve also found that my body has reacted differently each time. I had a huge oversupply with Teddy because of the expressing schedule. I had a reasonable supply with Veronica. And I am back to an oversupply with a really painful letdown with Susannah. The same body, totally different reactions. It’s a n of 3, but it’s still fascinating to me.

  10. phancymama says:

    Such great info. I wish I had known about the Ocalette cups. The Breast Friend pillow is the best thing ever, I love it so much. My two BF experiences have gone fairly similarly. I always feel arrogant admitting that I am one of the 5% who never really had pain at all. But the price for that seems to be a lack of general sensitivity in the nipple region–I think I seriously have more nerve endings in my elbow.

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