breastfeeding after reduction

Mothers who have had a breast reduction and want to nurse may be told they are likely to have poor milk production. They might even be discouraged from trying to nurse at all after hearing or reading stories about women who were not able to nurse to their satisfaction. This can be frustrating and confusing. I can only imagine that it might also cause some anguish if one is craving the experience of breastfeeding for either herself or her baby.

In addition to the women’s personal stories, this article will provide you with information, tip and go-to resources based on the experiences of two women who breastfeed after a reduction (BFAR).

I hope their narratives and insights will serve as a source of inspiration and support to women seeking to explore their breastfeeding possibilities.

ONE WOMAN’S STORY
I had a reduction more than 10 years before getting pregnant, and at that point I had no clue how much I would want to breastfeed. I was told I wouldn’t be able to, but I didn’t think it mattered to me that much at the time.

When I was pregnant with my first child, I decided I wanted to try anyway, so I did a little reading and took the hospital-based breastfeeding preparation class. Right after my son’s birth, I started pumping with a hospital grade pump. I pumped immediately after nursing in order to try to increase my milk supply.

I took all the recommended herbs and teas and I paid attention to my fluid intake and diet. Despite all of this, my supply was very low (about 1/4-1/2 oz per breast at my peak.) My son was frustrated and obviously not getting nearly enough to eat. I wasn’t aware of milk-sharing possibilities (such as donated breast milk) so I wasn’t doing that. We supplemented with formula and I kept at it for about six weeks. I was in tears several times a day, feeling like a failure, and exhausted from the normal new mom stuff, plus so much extra pumping.

I saw a lactation consultant around five weeks postpartum, but in retrospect, it was too little too late. I had already passed the point of my own tolerance. There were also latch issues that should have been addressed much earlier that had led to cracking, bleeding, vasospasms, etc. Though it was quite hard for me to stop breastfeeding, I simply didn’t feel like I could continue. Part of the lesson that I learned was that if you’re not prepared for the work it will take, it could sabotage your efforts.

A SECOND BABY; A SECOND CHANCE
When I got pregnant again, I was determined to have a better experience the second time around. First and foremost, I realized that I needed to change my expectations about the quantity of milk I was producing and to focus more on the quality of the breastfeeding. I also knew I needed to be better prepared.

RECOMMENDED READINGS
As part of my preparation I read two books by Diana West that were extremely helpful: Defining Your Own Success: Breastfeeding after Reduction and The Breastfeeding Mother’s Guide to Making More Milk.

I highly recommend reading these books before giving birth because they can help you plan mentally and emotionally for the breastfeeding experience. They can also help you practically by allowing you to explore your options for herbal supplements and medications prior to the birth. In this way you can get what you need in advance and have it on hand. Preparing for the breastfeeding experience in advance also allows you to have support in support in place (websites, lactation consultants) before you give birth.

Reading the books prior to birth also gives you enough familiarity that you can easily flip to relevant sections while in the midst of working through whatever nursing challenges you and your baby are facing. It can be hard to thoroughly read and absorb new and detailed information when you’re sleep deprived and have raging hormones postpartum!

ON-LINE FORUMS
There’s a web forum called BFAR that can serve as a resource for moms. You can sign up while you are pregnant and get advice from women who are currently breastfeeding after reduction.

THE IMPORTANCE OF A LACTATION CONSULTANT
I planned to see a lactation consultant pretty much immediately after the birth of my child so that I could work on everything I possibly could. I also had to “define my own success,” which for my particular medical circumstances still meant a pretty small supply. This time, however, I was able to work on latch issues right away, which helped with the comfort issues.

I would highly recommend a prenatal consultation with a lactation consultant who has experience working with women who have had breast reductions. It might even be worth interviewing a few lactation consultants before the birth of the child so you can find one with whom you will be comfortable working and who is familiar with BFAR.

USING A SUPPLEMENTAL NURSING SYSTEM (SNS)
In order to supplement a baby’s milk intake during breastfeeding while allowing the baby to latch on to the breast, a SNS is often recommended or desired by women who want to breastfeed but are not producing as much milk as the baby need. The SNS involves a small plastic bottle with tubes attached to it. The tubes are taped to the mother’s chest and the infant receives milk from this system while latching onto the breast. Through the SNS system you can supplement your own breast milk with donated milk or formula.

During my second pregnancy, the lactation consultant and I worked together to use the SNS which was a good way to get my daughter the quantity of milke she needed while nursing. Using the SNS system also provided the nipple stimulation needed for milk production which actual nursing provides so much better than a pump. I still needed to pump several times a day as well, but not quite as constantly as the first time.

A picture of the SNS from Medela website.

GALACTAGOGUES (MILK PRODUCING SUBSTANCES)
“The term “galactagogue” means any substance that is known to increase milk production or milk ejections.” This can include herbal teas, prescription medications, and herbal supplements, many of which have traditionally been used in other cultures for years.

Some herbs that can be used to increase milk supply include marshmallow root, nettle, fenugreek, blessed thistle, and goat’s rue.

Domperidone (DPD) is a prescription medication which is not available in the US; however, it is widely used in Europe and Australiafor low supply. With DPD, technically you can get it in the US, but only from compounding pharmacies (pharmacies that uniquely create drugs to individuals’ specific needs); however, it can be difficult or impossible to do it this way, and many doctors in the U.S. won’t write the prescription. Medications can also be obtained via on-line only pharmacies or through Canadian pharmacies with a physical location in Canada (in which case the pharmacy is regulated in Canada) which also offer sales on-line. Some companies will require a prescription which, again, your physician or OB may or may not choose to provide.

One option is to obtain the medication from the cheapest online pharmacy one can find. However, there is no assurance regarding the quality or safety of their products. A commonly used on-line pharmacy for obtaining DPD is http://www.inhousepharmacy.biz.

(Disclaimer: this blog is not endorsing or recommending any specific pharmacy for obtaining DPD. This is a discussion I would have with my physician.)

Remember, however, that each woman is different in her causes for low milk supply and the solution. Work with a doctor, lactation consultant, or herbalist to determine what is right for you!

According to www.lowmilksupply.org:

“There is no definitive recipe for making more milk. There are different causes of low milk production, so the techniques that work for one mother are not necessarily the best methods for another….the effectiveness of the techniques used to increase milk production depends on the actual cause, such breastfeeding management…or damage to your ducts and nerves, such as from breast surgery…Techniques to increase milk production are most effective when they specifically target the causes, which are not always a single factor.”

Be sure to determine what treatment is right for YOU.

DIETARY RECOMMENDATIONS
A healthy diet and adequate (but not excessive) water intake is important for lactating mothers. Foods which have been associated with higher levels of milk production include oatmeal, carrots, beets and leafy green vegetables. For more information on diet and lactation, here is an article on Foods That Increase Milk Production.

In addition, certain substances have been shown to decrease milk supply and should therefore be avoided. They include sage, caffeine, estrogen (birth control pills) and decongestants.

DEFINING SUCCESS: THERE’S NO RIGHT OR WRONG WAY
With this system of SNS, pumping, herbs, prescription medication, skin-to-skin contact and diet, we eventually got to a point where she would just nurse for awhile without using the SNS anymore, and then if she was still hungry, I’d supplement. My body generally was able to provide about a quarter to a half of her nutritional needs which was a big success.

But more than that, it was the nursing relationship that I feel the best about. It was good! After a lot of “blood, sweat and tears” I actually enjoyed it! She obviously did too. I will always cherish that experience with her. I loved it that we were co-sleeping and because I had persevered. There were times I could nurse her back to sleep at night without needing to supplement because she didn’t need much milk. I loved dozing in the wee hours of the morning with her nursing and both of us falling back asleep several times. It felt so right.

So I guess the wisdom I have to share is that breastfeeding after reduction can be truly beautiful and “successful” but one of the keys is preparation. You will need to work hard to educate yourself and to prepare for “success” in whatever way you end up defining it. You will also need to get some support in place ahead of time. It will likely take a lot of work and perseverance – and possibly some altered expectations – but with the right amount of knowledge and support, you will likely find your own route to “success” and it can become one of your most treasured experiences.

ACKNOWLEDGEMENTS:
Many thanks to Kimberly (kimberlyinmpls at yahoo.com) and Jeanine (jeaninedorfman at yahoo.com) for their contributions to this blog post and for sharing their stories, wisdom, experience, and advice for other moms!

ON-LINE RESOURCES:
www.bfar.org
http://increasemilksupply.org
www.lowmilksupply.org
http://www.ehow.com/list_5793267_foods-increase-breast-milk.html

DISCLAIMER: THE AUTHOR OF THIS BLOG AND THE CONTRIBUTORS TO THIS ARTICLE ARE NOT MEDICAL DOCTORS AND THE INFORMATION IN THIS ARTICLE IS NOT INTENDED AS MEDICAL ADVICE. PLEASE CONSULT YOUR PHYSICIAN, OB, OR ALTERNATIVE HEALTH PRACTITIONER TO DETERMINE THE BEST COURSE OF TREATMENT FOR YOU TO INCREASE YOUR MILK SUPPLY.

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Breastfeeding After a Reduction (BFAR): Two Stories of Hope and Inspiration

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