March for Babies

Monday, June 19, 2006

Boobs Again

So I am now on my third yeast infection in as many months. Azure has not once shown signs of thrush, but, it seems I continue to get it over and over again. It hurts, my supply is shit. (1-1/2oz this morning when I used to get 8-12oz first of the morning pump). I spent the weekend trying to come up with a way to pose the question to T about whether I should continue to pump or not. Azure is not allowed to exclusively breastfeed. She requires extra calories and nutrients so she is getting breastmilk fortified with formula. That is to say the formula powder is mixed into the breastmilk. (Some people have confused the fortification with thinking that she is getting some breast milk and some formula, this is not the case.) The Ped told me specifically not to nurse her exclusively yet and at this point, with the yeast infection again I have not been nursing her at all the past few days.

Here is my issue. I know that for a preemie with a heart defect she needs all the immune boosting help she can get. I know it is better for her and for me to breastfeed for the first year. While she was in the hospital and I was running out of freezer space for all the uber lactating I was doing this did not seem like a difficult task at all. However, now that she is home and drinking as much fresh squeezed boob juice as I can muster and I am still raiding the freezer on a regular basis and my supply is dwindling... I am entertaining thoughts of giving up.

Following is my thought process:

1) I just ordered a one month supply of Domperidone. Our Ped/LC was not only un-opposed to my taking it, she is very interested to see how it works for me as I will be her first patient to try it. So, I have decided to commit myself to at least one month on Dom to see how it goes. If things improve, then I may continue with no other concerns...except these blasted yeast infections. (Yes, I sterilize my pump equipment and change my bra every day.)

2) If I were to quit pumping at the end of my Domperidone trial period the question of how to go about feeding Azure comes into play. Do I feed her out of the freezer stash until it is gone so that she gets exclusively breastmilk (fortified) as long as possible and then switch over to formula?
Do I feed her some breastmilk and some formula every day to make the freezer stash last longer and therefore stretch out the time period of nutritional benefit from breastmilk? (Did I read somewhere that freezing the milk kills off some of the antibodies in the breastmilk so it might not matter anyway? I can't remember and am too lazy at this point to look it up.)

So, where does that leave us? I will pump for at least the next month and a half (7-10 days shipping then 30 days on the pills) and see where we stand then. That would put us into August when I plan on returning to work, adding more stress to our busy schedule. Also, she would be almost 6 months old.

If it looks like I will need to stop (for my own health and sanity) then I will take up the nutritional questions with our dietitian assigned by the county health department and our Ped.

NOTE: I am drinking lots of water and pumping about 4 times per day, (although the minute I turn on the damn pump is Azure's cue to start crying/coughing/alarming/etc.) and rest is something I heard about once in another life but I think it is actually just a rumor. My boobs have gone soft where once they were full and firm and it takes so much breast compression to get the milk out T is afraid I will actually hurt myself.

I find myself looking for that bar with the mechanical bull.


suzanne said...

I have no idea what to tell you. I never exclusively BF and despised pumping at work so my kids generally always got a mix. My son only nursed for 8 weeks, but my daughter nursed for 10 months.
Good luck with whatever you decide. I hope the thrush clears up quickly. It's miserable.
And welcome home Azure.
Your mommy was so waiting for you.

EJW said...

The mechanical bull comment made me spray my keyboard. Nicely done.

Also a question: you say Azure will be six months in August. What is that adjusted? Not that it should affect your decision, I just wonder.

DD said...

I was wondering if you read that article...

I supplemented with breast milk, also. My son never latched so I was pumping and they say pumping will not get your breasts producing the quantity of milk that nursing does. Somehow the boobs know the diff between a machine and a baby. Go figure.

No advice. It will be all work out in the end no matter what choice you make.

Catherine said...

(delurking) You might try looking here for answers to breastfeeding questions. I found it a valuable resource while I was nursing. And I see there are some items directed specifically at caring for premature babies.

Well-heeled mom said... that anything like the champagne????


Miss W said...

Oh, Blue.

I've been there. (Except of course I never got the amount you did) Except my doctor refused on the domperidone front -- I used reglan which is NOT as good.

What we did is to switch almost exclusively to Neosure. I nurse him at every feeding (now only 5-6 times a day and NONE at night -- it does happen!) and supplement with a bottle of formula. I pump after every feeding with him in the bouncy beside me. Once my reglan is gone (tomorrow) I will continue to nurse until he stops on his own and will stop the pumping at the end of my rental period. At that point, I'll give him a bottle of breast milk a day until my freezer supply is gone.

Like you, I am just getting weary of this fight. I've done all that I could do and more than most would have in my situation. So why does that damned mechanical bull make me feel like a bad mother?

kaybeedee said...

Delurking to suggest eating yogurt. That was a recommendation from a doctor to ward off the yeast. Don't know if it works, but I eat it everyday and have not had a yeast infection, ever, in 8 months (almost exclusively pumping).

Good luck, and welcome home!

Puppermom said...

I pumped exclusively for my twins from 3 months to 13.5 months thanks to domperidone. I also pumped every 3-4 hours, but that was for twins.

My twins were born at 33 weeks, but I was on bedrest at 25 weeks when I fell and my daughter started to come out of my cervix. I had discordant twins (she was 3 lbs at birth), my son came home on a monitor because he couldn't breathe and eat at the same time, and they both had reflux.

Hang in there. They are 16 months now and have caught up completely. My ped thinks it is because of the breastmilk but I can't take that credit. They just caught up for whatever reason.

Whatever you do, they need a functional you more than anything else.


Anonymous said...

Good job trying so hard! Do what you need to do and your baby will do well and impress you with her beauty. I suspect that things will get easier with the domperidone and with having her able to go on the boob, as soon as you get over your infection. I'm rooting for you!


Erica said...

The breastmilk game is a WEARY one. I don't have any tips for you at all. I'm in the process of weaning my eight-month-old right now because I just can't stand my pump for another day. I've been working and pumping full-time since she was about ten weeks old.

From everything I've heard and read, it's VERY hard to keep the supply going with just the pump and not the baby there to stimulate. Like one of the others said, somehow our boobs know the difference between a baby and an appliance. You have an actual documented medical reason why you can't nurse exclusively. If you just can't keep it going, you can't. At least you tried. A lot of people don't even try. I have numerous friends who didn't nurse because they were just too tired to try it in the hospital, didn't want to invest the time into trying to get a good latch, or (this is my favorite excuse) they just found it strange. Whatever. You have given Azure a wonderful gift. Try to keep it going as long as you can, and then when you can't, pat yourself on the back and go on.

You're doing a really good job, Blue...hang in there. I hope your thrush clears up fast.

amy said...

Blue, I have been in your same position. It is the one, you know, between a rock and a hard place. You want to do what is best for your baby, you want to be a functional mom, you know you have a medically fragile baby and don't know how to weigh the risk/benefits. It sucks. You have to decide what is going to work for you and ignore the jerks who make stupid ads.

For me, I decided to try and pump exclusively until he was one. He also ate breastmilk mixed with neosure. I just took it day by day and kept telling myself I was doing all I could. I only made it until he was a year actual, not a year corrected, and by that point he was half my milk and half straight formula. I have to remind myself to not feel guilty. It is hard when he gets sick because I think, if I had only pumped longer he would have had my antibodies. But the reality is that we do the best we can and that is good enough. You have enough love for your daughter that what ever you deicde is the right decision.

I hope your thursh clears up quickly.

Heels said...

I am so sorry you're having such a time with the boob stuff. Here are my thoughts:

1. Your milk is "made" to correlate with your infant's age, so the nutrients of the frozen milk age-appropriate for when you froze it--use it sooner rather than later, if that makes sense. For example, I would begin to use it a bit every day right now.

2. With my first child, I had to pump many times a day (I think 6) to get enough for two or three full bottles for daycare. I had to wake up to pump in the middle of the night, even. It was the only way I could keep any kind of supply.

3. If you're not already using a hospital-grade pump, check into renting a Lactina. The difference in output, for me, betw the Lactina and the PIS was worth it.

4. I took Feungreek (pills from the health food store) this go round for several months. I found it helpful. Some people think beer is helpful, but I'm not sure about that.

5. I also made pumping sessions longer at least once a day--I went past the initial letdown, cranked the speed down a bit for a "rest" (that's so laughable) and then turned it back up to full speed again for a second letdown. Not fun at all and it doubles pumping time, but it helped output, too.

6. I think if you can nurse the baby more, your output will increase and that doing so is probably the single easiest way to increase output.

7. Do the best you can and be very, very damned proud of what you've done so far. It's a big deal. After that, just feed your girl however you can.

lagiulia said...

I'm sorry you're having to deal with all this! It sounds like you have a plan going forward, though, and that is good.
I think my situation is pretty different from yours, but I'll share anyway just in case it's at all helpful. My twins were in the NICU for a month. They had breastmilk exclusively... like you, I was a pumping fool while they were in there, and I had so much frozen milk at the hospital and at home that there was pretty much no place to put it. When they came home, I nursed them, and I was fortunate enough to not have any infections, etc. I still pumped sometimes, but not as regularly because they were nursing. After a while, though, I noticed that my breasts just weren't seeming as full as before - it's like my body learned to make less milk when I started nursing them all the time and stopped pumping as much. I think my body "thought" that I was weaning, because they were drinking a lesser amount than what I used to pump in one sitting. As they grew and demanded more, it was like my body didn't want to make more. I was running through my frozen supply really quickly and getting nervous. I decided to pump more and get up at night to pump, and a lac consultant also told me to eat a lot of calories, especially a big protein-rich breakfast. Don't know if those things did the trick or if maybe my body just kicked into high gear, but it's been okay ever since (they're 7 mo. old now).
I really hope that wasn't too assvicey. Like I said, I know your current situation is unique. And I think it's amazing that you've done as much as you already have to give her a good start. Good luck!

Rachel A said...

Blue, sounds like a miserable situation. What if you just stop pumping altogether, and just focus on direct breastfeeding? If she nurses frequently, that should build up your supply. Then, if after a nursing she still seems hungry then give her an ounce or two of formula. The pump is really a PITA, isn't it?

ethanbsmommy said...

btdt for 13 months, and battled supply problems from the time I brought him home. The only assvice I can think of is to pump more often- I read you have to pump as often as you would nurse if Azure were exclusively b/f- 8-10x a day. It is nearly impossible without losing your mind! I did it (and lost my mind) only because my mom was here for 3 months doing 50% of the 'baby shifts' and still had to give whole bottles of 27 cal formula by the time he was 3 months adjusted because I just couldn't keep up. Pumping for my preemie was the hardest thing I've ever done, and although he did get at least some mbm until he was 10 mos. adj. he suffered from having an exhausted, depressed mother the entire time. I wasn't a good mom and wouldn't make the same choice again. I hope the drugs work and all this worry is for nothing. I read somewhere else that a year of b/f is better for baby than a month, a month is better than a week, a week is better than a day, and a day is better than not at all, and if you can get Azure to 3 mos you've done a great thing for her, and a healthly happy mommy is really probably more important than anything a few more months of mbm.
Sorry if this is too assvicey- I remember too well the agony of wanting to b/f and the reality of trying to get through the day with a preemie. My heart goes out to you.

Rivka said...

Congrats on making it this far! Six months, adjusted or not, is awesome.

About the freezing: frozen breast milk does lose some of it's "live cell" qualities, but it's still got more antibodies than formula, so keep that in mind.

I'll be wondering what formula you decide on! There are so many choices...

Murray, mom to Maggie said...

I had supply issues due to a breast reduction. I started Domperidone about 8 weeks into breastfeeding and wish I had started much earlier. It really helped my supply. I think you'll be pleasantly surprised at how your supply increases. I had to supplement with formula from the very beginning, so I always had that, but was able to go from half formula, half bm to more like 30/70 formula/bm.

As far as your yeast infections, have you tried taking a pro-biotic - i.e. acidophilus? You can get them at Whole Foods or similar.

If you have any questions about Domperidone, I am happy to help.

Uberimma said...

I can't remember if I already said this in a comment--have you tried gentian violet? I had two nasty rounds of yeast infections and after all the gangbusters pills that was the only thing that worked. It makes a huge mess, but who cares, really? You can get it at a regular pharmacy--maybe ask your LC what she thinks.