For years before I ever tried to have a baby, whenever I thought about being a mother in the future, I planned to breastfeed. I have quite a few friends who have done so successfully, and I had no reason to believe I couldn't do the same. Because everyone knows that "breast is best," right? And most educated people are aware of the various studies linking being breastfed to higher IQ, less obesity, and fewer illnesses. (If you're interested in reading one woman's very intelligent and well-reasoned post on the topic of "breast is best," go here. Lots of great information, much of which was new to me.)
Yes, I'd had some friends who didn't breastfeed for a few different reasons. Some found that their babies' demand outstripped their supply and had to supplement and eventually switched to just formula. Another friend needed to go back on medications that weren't safe for breastfeeding shortly after delivery in order to treat a serious medical condition. Still other friends just found the demands of breastfeeding to be too much, either in general or once they were back at work. But I had no reason to think that I couldn't make it work.
In fact, I wanted very much to finally do something natural vis a vis my children. While I am so very grateful at having had the option of using donor eggs to achieve pregnancy--because, without them, it's likely I would never have been pregnant at all--there is nothing natural about conceiving in that way. The union of MM's sperm and another woman's eggs (well, technically they were "mine" by that point, per our contract) took place in the sterile environment of the St. Mungo's lab. That moment of conception wasn't even natural in the sense of sperm-finding-eggs because we used ICSI. The embryos which became our sons were chosen by the embryologist and placed in my uterus by Dr. Dumbledore. The growth of my uterine lining and support of my developing placentas was supported by prescription medications.
My pregnancy itself was natural, I suppose, in that it took place in a real live human body. . . . but I was high risk from the start, being over 40 and having conceived via DE IVF. So I had a lot more monitoring than the norm, including a quick ultrasound at nearly every OB visit just to check heartbeats. I knew early on that it was more likely than not that I'd have a c-section, and that is, in fact, what came to pass, due to AJ's being breech. In short, my successful pregnancy and delivery could not have happened without the help of many modern medical interventions.
I'm not a crunch-granola-earth-mother type (not that there's anything wrong with that), and I was totally fine with using medicine science to conceive my children and to bring them safely into the world. At the same time, there was a significant appeal for me in doing something natural like breastfeeding, just as any mother would.
During my pregnancy, I'd done extensive reading on the logistics of nursing twins, on ways to increase milk supply and the like. I talked with friends who'd been there, done that to get the real low-down on what it would be like. I was ready, with my "My Brest Friend" twins pillow, nipple cream and nursing pads.
Then I ended up developing at preeclampsia at 32 weeks. And delivering our boys at 34 weeks as a result of its progression. And having major blood loss following my c-section. Prior to all this happening, the possibility of such complications had entered my mind. . . .but I'd never thought or learned much about how or if they might impact my ability to breastfeed.
I delivered around 9:45 at night and saw my sons for just a couple of hours after that. Neither of them could be put to the breast immediately: AJ had inhaled some fluid upon delivery and needed a little supplemental oxygen for the first few minutes of his life, followed by closer monitoring, and both boys needed their temperatures and blood sugars monitored (due to their prematurity and my gestational diabetes, respectively). Once it was clear that they were stable, they needed to go to the nursery for special care to learn to feed. Additionally, I was not stable and therefore would not have been allowed to have them "room in" with me even if they hadn't needed special care.
I knew I needed to start pumping right away to start my milk supply; I had learned this through reading I'd done during my pregnancy. So I asked that very first night to have a breast pump brought to me and to have a lactation consultant come see me. But between the interventions and closer monitoring needed due to my heavy post-operative bleeding that night and the instability of my blood pressures the following day, I didn't get one. (I guess being helped to establish your milk supply isn't considered a priority item when the nurses are in your room a couple of times an hour just trying to keep you alive and healthy.)
I saw my boys again briefly in the afternoon of the day after I delivered, but I was too weak to do more than hold them for a few minutes. I don't think it would have been physically possible for me to put either of them to the breast that day. Turning myself in the bed was almost more than I had the strength to do.
Early the following morning, my nurse finally brought me a breast pump. By the time I was finally able to pump for the first time, it had been about 30 hours since I delivered.
The boys came to see me again early that afternoon, and with the help of a lactation consultant, I finally put each of them to the breast. MJ was able to latch and suck for a little while but fairly quickly became frustrated that his efforts did not produce much (if any) milk. Poor AJ was not even able to latch; after several unsuccessful tries, he just looked up at me with sad eyes and rested his head on my breast.
At that time, I remained determined to make breastfeeding work, so I took the opportunity of talking with the lactation consultant about what I could do to facilitate it. After asking me some questions, she told me that she "didn't want to discourage [me]," but that I might not be able to establish an adequate milk supply.
I have to admit, this statement came as quite a surprise to me. So much of the information you get about breastfeeding says that any woman can do it. It's natural, and it's what our breasts are designed to do. The books I read, the websites I visited, were replete with stories of moms who successfully nursed twins to their first birthday, moms who gave birth even earlier than me and were successful in pumping enough to supply their babies. (One of the other lactation consultants at the hospital told me about a mom of quadruplets born at 28 weeks who established a full supply for all four of her babies solely by pumping.) Also, I'd often been told by people that LCs could be particularly militant about insisting all moms should breastfeed. And yet here was a LC who was telling me from the get-go that I might not be able to do it successfully.
She noted the shape of my breasts--set apart vs. touching one another--and the fact that they had not increased in size during my pregnancy--a fact which I had attributed to my relatively low weight gain--and explained that these were both "yellow flags" that I might have problems with supply. (I had never heard about either of these things before she told me this.) She also pointed out that I had had a significant blood loss and been on IV magnesium sulfate for a total of 96 hours, both of which are known to adversely affect milk supply.
Finally, she explained that the best way to build your supply is to let your baby nurse, because it stimulates the breast and hormone levels in ways that a pump cannot. Because both our boys would have challenges sucking due to their prematurity, it would be a while before my breasts would get much, if any, of this type of stimulation.
I don't want to leave the impression that the LC told me to give up or not to bother. Far from it. Having told me all this, she also showed me how to properly pump and hand express milk, gave me tips on ways to stimulate my hormones (mostly lots of skin-to-skin time with the babies), and encouraged me to stick to a regular every-3-hours-round-the-clock pumping schedule. She told me that it would likely take at least 4-5 days before I saw any significant production of milk and that I should stick with it.
Because by this time I had turned a corner healthwise, I was finally able to dedicate myself to pumping regularly. I set myself the recommended every-3-hours-round-the-clock pumping schedule and stuck to it, even when I would have much rather been sleeping, resting or holding the babies. I drank lots and lots of water. I did as much skin-to-skin time with the boys as I could.
I went home from the hospital on a Sunday evening, less than 72 hours after I delivered (at my request). Both boys remained in the hospital when I was discharged to "feed and grow." I visited them both every day, staying in the nursery with them for 8 hours (I'm sure the nurses loved having me there all day in cramped quarters), pumping at 3-hour intervals.
On Thursday, MJ came home while AJ remained in the hospital. (AJ was still being fed half his daily nutritional requirements through a small tube in his nose because he wasn't able to consistently bottle feed without tiring.) I now added caring for my premature son to my daily schedule of visiting his brother at the hospital, pumping for 20 minutes every 3 hours, monitoring my blood pressure and taking my medications.
On the plus side, I was able to put MJ to the breast for short periods by this point. I knew I was not producing enough milk to meet his needs, so I would have him nurse for 10-15 minutes--whatever he would tolerate--and then bottle feed him whatever volume he would drink for the remaining 30 minutes of his feeding time. (We had been instructed to feed him 45 cc--an ounce and a half--of formula every 3 hours around the clock and to not allow him to feed for more than 30 minutes a session to avoid overexpenditure of his energy.)
On the negative side, by the time MJ came home, I was on my sixth day of pumping with very little to show for my efforts. Despite doing everything "right," I was only getting about 10-15 cc of milk at each pumping session. (That's from both breasts combined, folks.) It would take me three pumping sessions just to get enough breast milk for ONE feeding for ONE baby.
Additionally, I had been to the doctor's office that morning and been told that I was overdoing it. My instructions, in no uncertain terms, were to take it easy. (In fact, my OB's NP said "you should be doing no more now than you did when you were on bedrest before you delivered." Hahaha. She did smile when I explained to her that I had two sons who were in the hospital, one of whom would be coming home that day, and that they needed me with them more than I needed to rest.) I was retaining a lot of fluid--more than before I delivered, actually--and was told my blood pressure would not come down until/unless I rested more.
Even though I was getting very little milk--not even a third of the requirements for one of my babies--and even though I knew the NP's advice was probably right--my feet/legs were grotesquely swollen, major cankles, and I was exhausted all the time--I wanted to continue pumping. Another LC at the hospital had told me that I could still improve my supply for up to a month after delivery, and I wanted to make breastfeeding work.
On Friday morning, after a particularly tiring night with an unsettled MJ and the continued every-3-hour pumping and feeding sessions, MM said to me "You know, it's OK if you want to give up on breastfeeding and just give them formula. I'll be OK with whatever you decide." That made me stop and think. We hoped AJ would also be coming home over the weekend (he did, in fact, come home that Sunday), and I just couldn't see how I was going to feed them both and pump for 20 minutes every three hours. By my math, that would mean that I would be busy with either baby care or pumping for 1.5-2 hours out of every 3 hours. When would I sleep? Even if someone would get up to feed the babies, I'd still have to wake up to pump. And truth be told, as little and fragile as they were, I didn't really want anyone else feeding them.
So I decided that I would continue pumping the rest of that day, but that if my supply hadn't increased to at least a full ounce per session (30 cc) by bedtime that night, I'd throw in the towel.
Predictably, I finally saw a tiny, incremental increase in supply at my last pumping session of the day: 20 cc, when I'd previously been getting 10-15 cc. That inspired me to continue through Friday night and into Saturday morning.
But when I woke up Saturday morning, I was still getting only 15-20 cc per pumping session. And we found out that it was likely that AJ would be coming home the following day. So I decided enough was enough.
I think it speaks to how little supply I had established that I felt only a very small amount of engorgement about 5 hours after my last pumping session. Excited at feeling something happening in my breasts for the first time, I had one last go at pumping. Even having waited 5 hours instead of my usual 3, I only got about 15 cc out of both breasts combined.
I gave up. I never pumped again, and Monday morning I called the medical supply company to pick up their hospital grade pump. (They thought there was a problem with their equipment, since I'd paid for a month's rental. Nope, it's my breasts that are defective, not your pump.)
Maybe part of the reason I still hold onto guilt about not breastfeeding the boys is, in part, because I wonder if I could have eventually built an adequate supply if I had just stuck with it a little longer. But after investing seven days into diligently doing everything I could for very little results, it just didn't seem to me like the best use of my time. I needed to devote my time and energy to getting myself healthy and to taking care of my boys. Continuing to pump did not fit in with that plan.
My husband mentioned to me the other day that his mom told him recently that, when the boys were brought to see me in the early afternoon the day after their birth, I cried because they were so small and helpless-looking and I felt responsible for their preterm birth. I had pretty much forgotten about it until he brought it up, but that's true. (To be fair, he introduced the topic only to tell me that he didn't blame me, or think I should blame myself, for their early arrival. But I do.)
There's no use in telling me I shouldn't feel guilty about not breastfeeding or because my sons were born early. I feel guilty about a lot of things: that my choice to transfer two blastocysts resulted in a twin pregnancy which greatly increased the odds of complications and preterm birth (both of which came to pass); that the fact of my gestational diabetes likely increased the risk that our sons will someday be obese; and that my crappy body was only able to do what it was supposed to do long enough to get them to 34 weeks, just to name a few.
I imagine as the years go on, I will find other things about my parenting to feel guilty about besides these things. Going back to work instead of staying home with them and who knows what else. I think that feeling guilty is an almost inevitable part of parenthood.
Today our boys seem to be healthy and thriving (apart from their reflux, now treated with medication). I try to take comfort in the fact that my sister and I were both exclusively formula-fed and turned out OK. (In fact, my mother never even tried to nurse us. She thought formula would be better for us because it was "more scientific.")
Still, I have sometimes worried that they will be fatter or sickly or less smart than they could have been if my weird body had done what it was supposed to and produced sufficient milk to nourish them. However, as there is nothing I can do about it, I have mostly let it go.