Weaning

With my return to work date looming, one of the things I have to do is start weaning Savanna.  Ever since she quit drinking from the bottle at 3 months of age, she has been exclusively breastfed.  For the past 6 months, we’ve been in a very comfortable routine of nursing 4 times a day, while I take the maximum dosage of domperidone.

This week, I stopped taking domperidone, and reduced the feeding to 3 times a day. Later this week will be 2 times a day, then next week onward just keeping one feed a day. Savanna is a pretty good eater, so I’m not worried about her missing vital nutrients.  I can tell right away that my milk production has reduced greatly once I stopped the medication.  Thank goodness for the meds, or I would never be able to breastfeed exclusively!

This afternoon while I was nursing her, I had her cradled in my arm, with a warm fuzzy blanket covering both of us.  The afternoon sunlight was streaming in from our window, shining beautifully projected streaks on Savanna’s face.  She looked up at me with her bright eyes, while scratching my neck with one hand.  It made me a little sad to think that 10 days from now I’ll be sitting in my office, churning out tax work, rather than being with my baby.  I’ve had a much better experience with breastfeeding this time around, and I am really going to miss all this bonding time I’ve had with her.

A year is a long time, and a short time.  It’s long because you sleep little, you’re chasing after a toddler while trying to care for a baby, and you’re cranky because your toddler is growing a personality.  A year is short because your baby is still just a baby, barely taking a few steps, and barely saying a few words.

Weaning Savanna is harder for me than it is for her.  I feel like I need to be weaned off my attachment to her, and all the sweet and luxurious amount of time I got to spend with her.

Sharing milk

Burnaby-20130330-00025It has been an amazing journey with breastfeeding Savanna.  We started off with me crying like a mad woman in the hospital because I wasn’t producing any, progressed to breastfeeding and supplementing with formula for 3 months, and then eventually Savanna decided she no longer needed to be supplemented.  She has been exclusively breastfed for the last 2 months.  Oh, the freedom from bottles is so sweet!

Not only that, she has been sleeping longer at night.  We put her down around 7 or 7:30 pm, and she wakes up around 3 am to feed.  Before I go to bed (usually around midnight), I would pump out the milk that has been accumulating since 7 pm.  I freeze the milk, thinking that we might need it one day.  But our use of the frozen milk is very limited, because even though Savanna will drink it from a cup, she doesn’t drink very much from it.  She just really prefers the boob, and would rather wait for me to get home.  I had about a litre of frozen milk just accumulating in our freezer.

I didn’t want the milk to go to waste, so I talked to a friend who could use it.  A few nights ago, I delivered the little bags of frozen milk in a cooler bag to her.  I snapped a picture of the cooler bag content, and I’m saving the photo for Savanna.  I want her to know one day that she was sharing at a very young age.

p.s. I struggled a bit on whether I should have written this post.  Sharing breast milk may sound weird to you.  The first time I heard of donor breast milk I was weirded out too.  But I think if you are in good health, free of diseases and infections, why not donate extra milk to others who can use it?

Who says having a girl is more expensive?

It has been almost exactly a month since Savanna last ingested baby formula.  At her 4-month check-up this week, we learned that she is still on her growth curve at the exact same percentile.  That means she has been putting on just the right amount of weight.

Thanks to her refusal of a bottle, we no longer have to buy any baby formula.  That translates to over $50 a month we no longer have to spend.  Savanna is saving us money!

On a more serious note, I cannot get over how fast she is growing.  I try so hard to savour every moment with her, try to remember how little she was, try to memorize the feel of her little hands and feet, but she still keeps on growing like weeds.  I am so afraid that tomorrow I’m going to wake up and realize her baby phase is already over.

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So a cup is the answer

Woah, how did an entire week fly by without a blog post?  I am just tired. I get little chunks of sleep here and there.  Some nights I fall asleep while sitting in the nursing chair holding Savanna.  Some nights I fall flat on my face tripping over Sam in the dark.  Some nights I tell myself that this frequent feeding phase is very short and one day I will miss it.

On Friday night my Street Photography class had a “field trip” to a professional full service print lab.  I really wanted to go, but the downside was I had to leave Savanna at home for about 3 hours.  Since she still wouldn’t take a bottle, she would go hungry while I’m gone.  Oh I was so torn.  At the end I decided to go on this field trip, and asked Cliff to try giving her formula in a cup while I was gone.  If things went sideways, he could text me and I would rush home in 10 minutes.

While doing the tour at the print lab, I kept checking my phone and Cliff never texted me.  When I got home at the end of the night, he proudly told me that Savanna drank formula from a cup and she was already asleep.  She wouldn’t drink much, but enough to tie her over till I got home.  I couldn’t believe with all the different bottles and nipples we tried, the cup is the answer!  I was overjoyed with relief that if I had to be away for a few hours, Cliff can manage feeding Savanna with a cup.

Now I really need to go to bed because I have some shooting to do tomorrow.  Here is one of my favorite pictures from this week.  It looks like Cliff and Savanna are having a conversation, and Savanna isn’t quite agreeing with what daddy has to say.  I can just imagine her arguing about her curfew or something.

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Introducing: The exclusively breastfed baby!

Since I last wrote about Savanna rejecting most of the bottles we offer her, she has now further rejected the last bottle at night too.  So for about a week now, she has not taken an ounce of formula.  She couldn’t be tricked into even taking one sip from the bottle.  To make up for the lack of milk production, she feeds 11 or 12 times a day (compared to most babies this age feeding 6 or 7 times a day).

I was worried because she went from taking 350 ml of formula a day to taking none.  What if she is not getting enough?  I certainly did not feel that I was making that much more milk to make up for the shortfall.  So the public health nurse came last week to weigh Savanna.  It turned out that she had been putting on weight within the healthy range.  There was really nothing for me to worry about.  The nurse said I probably produce more milk than the past even if I didn’t feel the difference.

I went from being worried to being totally ecstatic.  From the time I had Joshua, I’ve always wished I could exclusively breastfeed my baby.  That never happened with Joshua for whatever reason, possibly because he just had a bigger appetite and I couldn’t catch up to his demands even with all the nursing and pumping.  When it didn’t happen with Savanna for the first 3 months, I settled for breastfeeding and supplementing.  But there was always that innate desire to exclusively breastfeed.  It’s probably not a big deal to someone if she has always been able to exclusively breastfeed, but I’ve always been a bit envious of the moms who could.

Now I truly got what I wished for.  It’s a huge deal to me!

The frequent feedings result in less sleep for me at night, but I wouldn’t trade what I have now for sleep.  Before I know it, Savanna would be starting solid food and the time to sleep more will come with that.  It’s all too soon these little beings grow big and grow up.

I got what I wished for

You know how I’ve always lamented about the fact that I can’t produce enough breast milk, and have to supplement with formula for my babies?  Well, now that Savanna is dead set against the bottle, in a way I got what I wished for.  I no longer really have to give her bottles.  Ha.

Since my whiny post about her rejecting the bottle, the situation has not improved.  During the day, she would reject all the bottles I offer her.  The little stinker.  We’ve thrown out so much formula lately (ka-ching!).  I tried using an eye dropper to drop formula into her mouth, and she just spits it all out.

At night, she would reject most of the bottles.  The exception is the one right before bed.  Around 9:30 or 10 pm, she is generally so tired that she’ll nurse with her eyes closed.  That’s usually a good time for me to sneak a bottle in there.  She can be tricked to drink anywhere from 10 to 30 ml.  It’s very little, but I think it helps her feel fuller and she sleep better.

Night time feeding is a bit of a nightmare.  When she was taking more formula, she would have a 4 1/2-hour stretch of sleep, then a 3-hour stretch.  Now it’s anywhere between 2 to 3 hours.  So all that means is I’m up a lot more often at night to feed her.  She also feeds more frequently during the day.  Some days it feels like I have a baby permanently attached to me.

For the first 2 1/2 months we had a comfortable routine we established and followed.  It stressed me out the most when this new pattern first emerged and I didn’t know she was changing things up for us.  I’ve now come to terms with it is what it is.  Besides, for my baby to prefer the breast over the bottle is a much better problem than the other way around.

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Research on domperidone

I thought I’d write this post in case someone else is taking domperidone for breastfeeding, and have concerns about the safety of the drug.

I was spending some time this week doing research on Domperidone, the prescription drug that helps me produce more milk to breastfeed my baby.  Dr. Livingstone at the Vancouver Breastfeeding Centre is dead set against the drug.  My own doctor is a bit on the fence.  And my public health nurse thinks I should just keep taking it if it is helping me breastfeed.  With all the conflicting advice, basically I need to make up my own mind about it.

If you were to do any research on breastfeeding, Dr. Jack Newman is a name that will come up everywhere.  He has a lot of very useful information and videos on his website about breastfeeding.  He is the authority in this area.  I would certainly consider whatever he has to say about the drug.  When Health Canada issued the black box warning about the drug, Dr. Newman issued the following statement:

Based on a study that was published in Belgium which looked at over 1000 cases of sudden death and found that some of the people who died suddenly were taking domperidone, Health Canada has put out a warning about possible concerns about treating with domperidone. This is a bit of an overreaction on the part of Health Canada. Well, a big overreaction given the data.

Note that in the study, the youngest person who died was 55 and the average age of those who died was 75 years. What has this to do with breastfeeding mothers who are rarely older than 45 years and are usually in reasonably good health? Furthermore, this information came from a data base with no clinical information. It simply has information that so and so died  suddenly and was taking such and such a drug. The thing is that domperidone in these patients was used for reflux and we know that heart disease is frequently misdiagnosed as reflux; severe pain at the top of the abdomen or lower part of the chest is typical of both reflux and cardiac pain.

Misdiagnosis is particularly possible in Europe where domperidone is available in countries like the United Kingdom, Belgium and the Netherlands without a prescription and it is likely that many people are self-diagnosing and self-medicating.

So that’s it and it does not mean that domperidone kills. I will continue to prescribe domperidone at our doses which are based on many years of clinical experience. I have treated many thousands of women with it with only minor side effects. I believe this article from Belgium proves nothing and does not require us to stop prescribing it.

It would be a pity that mothers and babies not benefit from domperidone when used in conjunction with our Protocol to manage breastmilk intake.

Dr. Newman is also a part of the consensus statement issued by a number of breastfeeding doctors.  It is a very good read, giving a lot more information on the articles/studies that Health Canada based its warning on.

I know Health Canada has to issue these warnings when there is a possibility that a drug could have harmful effects.  But it would seem to me that it has over reacted here, especially the statistics came with no clinical information.  I have yet to find any articles or research on the harmful effects of the drug, other than potentially giving you an upset stomach.

I still haven’t decided if I am going to decrease the domperidone dosage and track Savanna’s formula intake, based on Dr. Livingstone’s advice.  But either way, at least I feel more at ease about taking the drug if I need it.

Does domperidone make a difference?

A few weeks ago at the Vancouver Breastfeeding Clinic, Dr. Livingstone advised me to cut my domperidone dosage in half (from 80 mg to 40 mg a day) because she doesn’t believe the lack of prolactin is my problem for the lack of milk supply.  I did take her advice, and then 3 days later I believe that my milk supply dropped because I was pumping out less than what I normally would.  I had put myself back on 80 mg a day, and cursed Dr. Livingstone under my breath. 

The interesting thing is, when I went back for the follow-up appointment, I was ready to tell her she was wrong to give me that advice.  When I told her that dropping the domperidone dosage also dropped my milk supply, she was pretty quick to tell me that my method of measurement is not accurate.  She said just because I pumped less it doesn’t mean my supply dropped.  And just when I was about to argue with her, she gave me a chart to use for a month.  This chart basically tracks my domperidone dosage and the amount of formula Savanna takes in over a month’s time.  If dropping the domperidone dosage has no impact on the amount of formula she takes, then it means the drug has no effect on me and I should stop taking it.  She went on and on about the scary things domperidone can do to me and baby, and strongly encouraged me to get rid of it if I can.  So now I’m supposed to slowly cut my domperidone dosage and keep track of Savanna’s formula intake for the next month.

Even though I went in to the appointment ready to tell her she was very wrong, I came out thinking maybe I should try this tracking chart, slowly drop my dosage, and just see what happens.  If I don’t have to be on medication, I’m all for that, as long as I can still breastfeed Savanna the same way.  I already use an iPhone app to keep track of Savanna’s feeds anyway, so it really isn’t any more work than I usually have to do to complete this chart.  And if Savanna really takes more formula because my milk supply dropped due to the dropped domperidone dosage, I’ll just get back on the high dosage without being any worse off.  It’ll be a bit of an experiment, but I don’t see the harm in it.

I am feeling a lot more at peace with the breastfeeding issues now.  It makes my life so much easier when I just accept my limitations and move on.  I find that it gives me more energy and freedom to enjoy my very precious time with Savanna and Joshua.  I am still doing the best I can to breastfeed and give Savanna the best possible start in life.  Whatever the outcome is with this experiment, I have decided that not to waste anymore time fretting over everything.

The never ending battle of breastfeeding

I wrote a number of posts on breastfeeding during Joshua’s first year of life.  Most of the posts were about the stress of trying to figure out how to produce an extra ounce of milk to feed my baby.  I took the maximum dosage of domperidone, and was also taking fenugreek seed and blessed thistle.  But for whatever reason, I physically cannot produce enough to exclusively breastfeed, so I’ve always had to supplement with formula.  It was something I really struggled with, because there was no correlation between my efforts and the result.

Domperidone

Now, the battle continues.  This time around with Savanna, I expected that I wouldn’t produce enough.  What I did not expect was that while I was still in the hospital, my doctor told me she would no longer prescribe domperidone because of a Health Canada black box warning.  For certain demographic, it raises the risks of cardiac arrest.

No domperidone?  Are you kidding me?  If I can’t be on that drug, I would have no hope of breastfeeding.

Domperidone is a drug often prescribed to women to help increase lactation, although the original intend of the drug was for something else.  I had taken the maximum dosage of domperidone when I was breastfeeding Joshua during his first year, but that was before the black box warning came out.

Luckily for me, the obstetrician on rotation that night at Women’s had no problem giving me the prescription for a 2-month supply of domperidone.  I filled the prescription, against my doctor’s advice.  I felt that I do not fit in the demographic of the people having issues with domperidone, and that I had no problems with it when I was on the drug the last time.  I’ve decided to take the medication.

Vancouver Breastfeeding Clinic

Still, even with the medication, I do not produce enough milk, just like the last time around. And even though I already knew this was going to happen, it does not make me feel any better about it happening again.

My doctor referred me to the Vancouver Breastfeeding Clinic. I was a little reluctant to go, because I felt that I’ve seen my fair share of lactation consultants and nurses specialize in lactation issues.  I remember going to numerous appointments and putting Joshua on scale after scale to figure out how much milk he was getting.  At the end I wasn’t really sure how much those appointments really helped.  I don’t really want to waste time going to another appointment when I can enjoy some time at home with Savanna.  But at the end, I agreed to go, in the hopes of learning something new that may help me.

Last week we had our first appointment to see Dr. Stringer.  She came across very clinical, straight forward, and no none-sense.  She gave me some tips on how to help Savanna latch on better for more efficient drinking, and gave me a plan of reducing nursing time but include pumping after each feed.  The plan is supposed to make my body produce milk more efficiently without being tied to a nursing chair 24/7.  But that also means pumping and washing all the pump parts 8 or 9 times a day.

I followed the “plan” for an entire week, and went to the follow-up appointment today with Dr. LIvingstone.  She’s apparently the authority figure on breastfeeding in Vancouver.  Anyway, she’s another interesting character.  She told me to stop the pumping because it’s not really helping much, and actually told me to cut my domperidone dosage by half because she doesn’t think the drug is actually helping me much.  She felt that I was just born physically incapable of producing enough milk.  I have no idea how she came to that conclusion, but I would tend to agree.  My mom didn’t produce enough milk to breastfeed me, so it seems like it’s partly genetics that I just don’t produce enough for my kiddos.

Now what?

So we’re sort of back to sqaure one.  I don’t produce enough milk, and there’s not a heck of a lot we can do about that.  I can still breastfeed, but would just need to supplement with formula so that my baby will put on weight properly.  I am frustrated.  I’ve spent so much energy and effort into this issue with Joshua, but I’m no further ahead with Savanna.  I don’t know why I can just accept this as a fact of life and move on.  There’s just something about this issue that I struggle with, and I couldn’t quite put my finger on it.

I am slowly working through how I feel about all this.  I think at the end of the day, I need to come to terms with my physical limitations and focus my energy on other more important things.  It’s probably easy to say that than to really achieve it.  I’m defintely not there yet, but I’m working on it.

I won and you lost!

With all the issues I’ve had with breastfeeding Joshua, our doctor and I both felt that weaning Joshua off at 3 or 4 months is good enough.  Then somehow I found the energy to continue with breastfeeding.  I figured, ok, I’ll stop at 6 months.  So when Joshua was 6 months old, I stopped taking domperidone.  But without the medication, I was still producing some milk, so I kept feeding Joshua twice a day.  It became a comfortable routine, and I didn’t really feel the need to stop.  This continued for the next 5 1/2 months.

Now I only have 2 weeks left of maternity leave, I definitely need to wean Joshua off before I go back to work.  I started skipping a feed each day last week, so now I only breastfeed him just before bed.  In a few more days I’ll start skipping the evening feed too.

I keep expecting this major emotional turmoil for me, but so far I’m feeling quite relaxed about the whole thing.  Maybe it’s because I know that I’ve already done the best I can, even exceeding our doctor’s expectations.

Actually, I’m quite proud of myself.  I remember how stressed out I was about producing one extra ounce of milk, and how desperate I felt for not being able to exclusively breastfeed.  Looking back at the battles I’ve fought in order to keep breastfeeding, I feel a sense of pride and victory.

It makes me want to say to my breasts: I won and you lost!