Breastfeeding: where we've been, where we are, where we're going (plus some nitty gritty)

Since I need something to do to feel productive while I sit here and eat salt & vinegar chips on our brand new couch avoid the stack of Christmas cards in the dining room relax for a few minutes in front of the tv, I figured I'd write the breastfeeding post I keep writing in my head lately.

Where we've been:


I exclusively breastfed Julia until we introduced solids about a week shy of six months. She had about two ounces of formula the first night home from the hospital when she was starving and my milk hadn't come in yet, but otherwise, it was all me. She did not nurse exclusively, though. Around week two or three, we introduced a bottle, which she took just fine. We ended up doing about a bottle a day and she never had any trouble switching back and forth.

We had two trips away from the baby during those six months, so I pumped like a crazy person and went to these extreme measures to make sure she still had breastmilk while we were apart. In retrospect, it would have been better to have just given her formula, but I was hell-bent on exclusively breastfeeding, and didn't really understand how to incorporate an alternative, so that's what I did.

Everything went smoothly, for the most part. I got mastitis once, which ended up drastically reducing my supply on one side, but I was still able to produce enough for the babe. After awhile, we got into the habit of giving Julia a bottle before bedtime, then I would pump later in the evening for the next night's bottle. That ever so slowly decreased my evening supply to the point where I wasn't pumping enough for the next night's bottle. After my freezer stash was used up - built up for and during those trips - we ended up adding in formula around eight months. I agonized over this, but despite being attached to the pump for hours in the evenings I was coming up shy, and the sanest choice was clearly to supplement with formula.

Then, we went on vacation and I decided to stop pumping in the evenings altogether. This was AWESOME for my personal life but bad for my supply. I was going from about 3:00 in the afternoon to the next morning without feeding or pumping, and my body couldn't seem to balance that with the rigorous feeding Julia was doing from morning to afternoon. In retrospect, it would have been better to have spaced out the nursing sessions more evenly throughout the day - maybe give a formula bottle in the afternoon and nurse again at night.

Right about this time, my supply started to really tank. I remember worrying to Robert the week I stopped pumping about whether I was making the right choice, since it looked like it was a slippery slope for me - a little drop in demand seemed to be rapidly snowballing.

Turns out, I was also newly pregnant...

Breastfeeding while pregnant (nitty gritty):

My supply started to decline right away. Some women don't seem to notice a change until much later, but I definitely noticed - even before I knew I was pregnant. In all the reading I've done on breastfeeding while pregnant, the one conclusion I can draw is that it's totally different for everyone. Some people are affected more than others, but the range of normal is huge and varied.

For me, I noticed the initial supply dip, then another much stronger dip around 14 weeks. After the initial dip, Julia mostly lost interest in all the nursing sessions except the morning one. She would usually just get up and leave after only a minute or two. I'd give her a cracker or something and she'd happily munch on that instead. So, we weaned down to just the morning session painlessly and fairly quickly (over two weeks or so). I did supplement with formula (she was only 10 months at this point) in bottles. I know some women choose to power through it but for the life of me I don't know how - I was so exhausted with first-trimester fatigue that I felt all my life force draining out of me when she nursed. I just couldn't imagine keeping my body running and sustaining three people. Plus, it's not like formula is evil - she's done just fine and she's doing just fine and it's so much nicer to have a well-nourished baby.

I also called the lactation consultants at the hospital at which I gave birth. Their opinion was that there wasn't much I could do to increase supply while pregnant because the pregnancy hormones supersede pretty much anything you can try. The usual galactagogues aren't safe to take during pregnancy so my only potential option was to pump more to increase the demand on my body, which may or may not work for a little while. Um, no.

(Dad, if you're still reading this, skip this paragraph:) It sounds like many women (i.e. those that post on online message boards) experience nipple soreness in the first trimester that gets better around week 14. I had the opposite - almost none the first trimester, then weeks 14-16 it really peaked. It was toe-curling when Julia latched on. No worse than the toe-curling of the initial week or two of breastfeeding, but kind of a shock nonetheless. It's eased off a bit by now but it still makes me flinch for a second or two when she latches.

Where we are:

So, now I'm at 19 weeks pregnant and she's still nursing once in the morning. I think she's getting very little actual nutrition, though: if we give her a bottle or a cup of milk right after the session, she pounds it away, so I think it's mainly for comfort and just-waking-up cuddles. I can still hand-express a very little amount so I know I'm still making something, but I just can't believe it's very much. (And I'm not digging out the pump to see how much is in there.) I feel no let-down at all and even right before nursing, I don't feel full at all like I used to either. They say colostrum production starts anytime between now and the end of pregnancy, so I'm curious whether either Julia or I will be able to tell when that happens.

It feels like uncharted territory now. Like I said, there's not a whole lot of information out there on what's normal in similar situations. I'm so used to researching the heck out of every single parenting step I take (can I blame law school for this?), so it feels really weird to be truly winging it. It's also kind of nice and freeing - whatever happens, it'll be the right choice for our family and that's really all that's important.

It IS clear, however, that breastfeeding while pregnant is perfectly fine as long as the pregnancy is normal and healthy, and there are no indicators of premature labor. So far so good. My OB knew I was breastfeeding at the beginning of the pregnancy and didn't seem incredibly supportive, but she's apparently forgotten by now and I haven't seen any reason to bring it up again so far. My body will make milk tailored primarily for the new baby - hence the imminent colostrum production - so New Baby won't be missing out on anything, and anything Julia gets is just bonus good nutrition for her.

Where we're going:

I don't know.

I certainly never imagined I'd be in this position. It feels like such a hippie thing to do - be pregnant and breastfeed, but it's truly been a very natural progression for us. I've cut back here and there for my sanity but we both overall enjoy breastfeeding and there just hasn't been a compelling reason to stop. Julia is 13 months and she is still such a baby to me. That morning session clearly brings her comfort (and I die every morning for the chance to just lay in bed with my eyes shut for another 20 minutes) so it's really working for us now.

Maybe she'll lose interest down the line as it becomes clear there's a cup full of chocolate milk available immediately afterwards. Maybe she'll dislike the taste of colostrum when that change happens, and decide to stop then.

Maybe she'll keep at it for the whole pregnancy and I'll end up nursing both my newborn and my toddler. I have no desire to nurse my toddler the same amount as my newborn, but if Julia wants to pick up an extra session or two during the day, I can understand. I have no idea how she's going to react when she sees another baby partaking of "her" buffet, so if tandem nursing minimizes conflict during the tough transition, I'm okay with it.

Basically, I'm going to wing it. And not be afraid to set boundaries with Julia if I start to feel completely overwhelmed or too much like a milk factory for sanity. My goal is to nurse the newborn for six months, and then re-evaluate and see what I feel like doing. But if I don't hit that, I'm okay with it. (Well, not 100% okay, but mostly okay. It is my goal, after all, and I prefer to achieve them.)

And I kind of like that we're doing something unique. Not in a "I'm a better hippie momma than you" or "GOGOGOGOBREASTFEEDING!" way (you moms know exactly what I mean), but I've enjoyed navigating these (fairly) uncharted waters - and the uncharacteristic chilling I've been doing exactly because they're uncharted. And I like knowing I'm doing what works best for my family right now even if it's a little unconventional.

Which is why I'm blogging about it in such detail. I'll update as it becomes relevant but for now, we're going to just keep on keeping on. The human body can be such an amazing thing.

Traveling and flying with "nursing milk"

So, I know over half of this blog's followers are not moms, but I've got another mom-directed post to get off my chest. I searched the web high and low for this information when I was trying to prepare for our trips, and couldn't find it anywhere, so I'm hoping this helps out a few random Googlers in the same boat I was in.

R and I had two trips this spring that we were taking without the baby. But, since I was all gung-ho to keep nursing her, I basically went to some crazy measures to make sure she had breastmilk while we were away from each other. The easy part was pumping and freezing about 200 ounces of extra milk: I used the Lansinoh storage bags and froze the milk in 4 ounce increments. (As an aside, I liked the bags - of the couple hundred I've gone through, only a handful have broken.) The tough part was getting this frozen milk, which needs to be used within 24 hours of thawing and cannot be refrozen if thawed, from our place in the midwest to my parents' house in Dallas, where Julia was staying for this trip. The other tough part was transporting the milk that I pumped while away back to our house to restock that freezer stash. If you think I'm going to spend hours pumping in a hotel room while I'm on vacation just to dump that hard-earned baby food down the drain, you crazy.

The key for both those objectives was dry ice. We debated overnighting the milk to Dallas, but in the end opted to carry it down with me during my flight. I bought an insulated box from Control Temp Packaging and R.N.C. Industries via their Amazon store, and planned to check it just like another piece of luggage (thank goodness for Southwest and their baggage policy!). Even checking the  milk as a third bag on Southwest was way cheaper than overnighting it using FedEx or UPS ($50 vs $100+), and checking it involved much less travel time from freezer to freezer. It was a little risky because the airlines can always lose a bag, but we had a direct flight and I felt comfortable enough.

Anyways, our flight was at 1:00, so I bought the dry ice the day before. I ended up at some warehouse that did mostly ice carvings and shaved ice machine rentals, but it worked out just fine. You can only carry on 5 lbs of dry ice in a package (which is the same limit imposed by FedEx and UPS by the way), but I bought 15 lbs because it was so cheap ($0.80/lb). That 15 lb block was about 10 lbs by the next morning after sitting overnight in my insulated box. Don't put dry ice in your freezer - they say it won't last any longer than if you store it in a cooler, and it'll mess with the temperature settings of your machine and make you sorry. A few hours before the flight, I broke that 10 lb block into pieces by dropping it on our garage floor, and got a few chunks that made up approximately 5 lbs. Wrapped those up in newspaper and put them on top of the frozen milk inside that insulated box. Packed it carefully, used newspaper to fill the holes, taped it up and away we went. (Don't make the seals airtight because you need somewhere for that CO2 to go when the ice sublimates, but you also don't need to like, poke holes in it to vent. A regular cardboard box should vent fine as long as you don't tape every single edge.) When I checked the bag with the airline, I just told the guy there was dry ice in it, yes the ice was less than five pounds, and all it required was an additional sticker. He did ask what the contents of the box were, and got totally flustered when I told him "breastmilk." He wrote "nursing milk" on the label instead, which made me giggle.

TSA did not open the box, which might have just been lucky on my part. But everything arrived frozen solid when we got to Dallas! There was still a decent-sized chunk of ice in the box when we got there. So, all in all, my 15 lb block turned into a 10 lb block after about 12 or 13 hours, and my 5 lb block was plenty sufficient to keep the milk frozen for about seven hours of travel time. Success!

To get milk back home safely, I've used gel packs to keep milk chilled in my checked luggage. I've also used gel packs to keep milk frozen in checked luggage, but they definitely only barely kept things frozen during travel time. The thinner parts of the frozen bags were thawed, so I wouldn't recommend that or do that again. You hate to throw out a 4 oz bag because one little end of it started to thaw.

What we did this trip, since it was five days long and the milk needs to be frozen within a few days of pumping, was overnight the first few days' worth of milk - chilled but not frozen - back to Midwest, where some relatives were kind enough to receive the package and put the milk into the freezer for us. I bought a cheap, hard-sided cooler at WalMart, and two 3 lb bricks of dry ice from a local grocery store (call around but I guess it's not that uncommon for a grocery store to sell dry ice - who knew?). I put the dry ice in the cooler, put the chilled milk on top, boxed it up, and the hotel overnighted it out for me. Turned out the dry ice froze most - but not all - of the milk in transit, but since there was still dry ice in the cooler when the package arrived at its destination, I'm assuming the temperature never fluctuated back up and the non-frozen milk didn't go through a freeze/thaw cycle in transit. If I were to do this again, I'd distribute the milk more evenly around the dry ice so that everything would freeze and stay frozen, instead of the bags furthest away from the ice remaining liquid, which is what happened this time. My fault though, since I put the ice on the bottom of the cooler rather than the milk (the cold air from the ice sinks - duh Jess).

Anyways, the milk I pumped for the second half of the trip got chilled, then put into two soft-sided coolers (one inside the other) with a big frozen gel pack wrapped up in a washcloth. Then it got carried on - I declared it ahead of time at security and TSA was totally cool with it; honestly they didn't even look inside the cooler to check it out. I brought extra baggies in case I needed to dump the gel pack - thinking I could fill them up with ice on the other side of security - but (go figure) a frozen gel pack is fine to get through security as long as it's completely frozen solid. This kept the milk chilled for my travel time (another seven hours or so). I've also checked chilled milk before using the same set-up, and it also went fine; I just prefer to carry it on in case the airline loses my bag.

I asked our hotels to provide mini-fridges in our rooms, which wasn't a problem at all. The mini-fridges all had little bitty freezer compartments to freeze the gel packs. The shipping department at the Ritz was also very accommodating in helping me overnight my package. (By contrast, the Bellagio, while ultimately coming through for me, was all, "Well maybe we'll have a fridge for your room when you get here, maybe not. Can't guarantee it. Just have to see when you get here.") The key things to remember are storage bags and cleaning materials for the pump parts and bottles (if you pump into bottles like I do instead of directly into bags). I brought my electric pump for use in the hotel room, and a manual pump for pumping on the plane, which was WAY more discreet and convenient. (Remember to pack a nursing cover so you're not trying to hide awkwardly behind your husband's jacket.) Also remember to pack some extra ziploc baggies for ice in case you end up having to toss a gel pack (I used these on the flight out when I didn't pack a gel pack in my carry-on but pumped on the plane). Most airports have a family restroom or an itty bitty space in the women's restroom where you can pump discreetly.

It's tough, and honestly looking back, I kind of wish I had just decided to supplement with formula instead of go through all this trouble, but it's doable. Dry ice and preparation... and you too can go through an inordinate amount of hassle to keep your baby exclusively on breastmilk while traveling without her!