A few of my friends have asked me this question when the topic has arisen.
Why indeed? That question shows up in several online forums too. Many people can not see any good reason why you might do this before your baby is born.
It was my obstetrician who first suggested it to me. Early on in my pregnancy I explained to him the struggles I had feeding my first child. By day 3 or 4 of her life, both obstetrician and pediatrician had suggested formula might be best for my little Grace. My Obstetrician at the time was far more blunt, saying “With your medical history, I’d be surprised if you could breastfeed at all.” That only added to the stress and insecurity I was feeling about breast feeding. Within 24 hours I had tearfully given up, allowing her to be totally formula fed.
That devastated me. I felt like a failure. I felt like it was yet another aspect of womanhood that PCOS had robbed from me. Every discussion of breast-feeding since brings tears to my eyes. I have endured six years of grief and guilt. Maybe I could have tried harder. I definitely could have seen a lactation consultant.
I was so overwhelmed with motherhood itself that I let it lapse for about 3 months. In that time, I spoke to my GP about it. She was a woman and tried to justify it to me. She explained that every woman has regrets about her birth, labour or nursing experience and this was mine. It didn’t help. I still felt guilty. I decided to see a lactation consultant and try to re-introduce my supply. I explained my whole sad story to her. She was very sympathetic and oohed and aahed at all the right places. She went on to explain that we could re-learn how to breast feed and we could re-introduce breast milk. It would take some effort, she said. Eight times a day I was required to massage both nipples for ten minutes each and see if any beads of milk appeared. We also worked on Grace’s latch as it would not really be a natural reflex anymore. She was used to a bottle.
It was hard work. I massaged for days and days without so much as a drop. Not a single drop. All efforts to have her latch at my breast failed. She turned her head away from the breast repeatedly,… just like I was told to do to Grace by the midwives when I told them I was giving up breastfeeding and put Grace on formula. I was heart broken much like I imagine she was when I turned her away from the breast. In those first few days in hospital none of us thought she was getting anything from me, but she must have been because she wanted to latch on and suck for hours – maybe for comfort more than anything.
The midwives told me if I wanted to switch her to formula, I needed to keep her away from my breasts. I watched, tearful, as a tiny 4 or 5 day old baby searched for my breast. I let her have a dummy from then on,… I felt like she deserved the right to comfort suck, even if I couldn’t give it to her.
What a failure I felt! I wonder how different things would have been if I had seen a lactation consultant at that point, rather than accepting the cursory remarks from busy obstetricians, pediatricians and midwifes. (Frankly, a new mother should be able to TRUST those people!!!!) why did no one sit me down and explain to me that it was a problem that could be solved? Why did none of these medical professionals bother to mention the issues surrounding PCOS and lactation???
An aside: Women are so vulnerable in maternity hospitals – it’s like we chose to submit to their expertise. It’s not always a good thing. I can completely understand why some choose to take the power back and homebirth instead. Midwives and doulas tend to be far more likely to take a team approach to the birth and the issues surrounding it.
The policy of the maternity ward where I had Grace was that mother and baby are not discharged until feeding is established. As my milk appeared slow to ‘come in’, both senior doctors recommended formula. They didn’t explain that I could start her on formula while I worked with a lactation consultant at home to bring in my milk supply. In fact, no one explained anything. If I had questions, the midwives sent me down the hall to watch a DVD. Those DVDs didn’t really apply to me. They applied to normal mums with healthy breasts – there was not a single mention of PCOS and what it does to a mum’s milk supply.
None of those DVDs explained what to do if your milk didn’t come it.
Nothing bothered to explain that delivery by emergency c-section could also delay milk production by a day or two, not to mention the impact of stress upon your milk supply.
Add to that the fact that our tiny Gracey was in special care and being fed formula from the nurses by gavage tube at the same time that I was ignorantly trying to get my milk to ‘come in’ by pumping at a breast-pump up the other end of the hospital! I remember begging the nurses to let me have my baby with me so I could at least try and breast feed. I understand that she was small and jaundiced but they were both problems that could have been helped by being with me and at least attempting to feed normally.
Oh the memories, they make me want to cry.
So why am I expressing colostrum? My Obstetrician this time around has a lot of widsom and a very supportive approach. He referred me on to a lactation consultant he works with to discuss expressing colostrum from week 34 onwards. I met with her and we discussed not only that, but several other strategies like the use of nursing supplementers and galactogues – teas, supplements and medications that can help bring in or support a woman’s milk supply.
We also discussed the worst case scenario of a baby being admitted to the special care nursery again. She has arranged for it to be noted on my hospital file that I need to be placed in one of the rooms beside the special care ward for better access to my baby – especially in the first 24-hours post caesar when I can not walk. If I’m right next door there will be more opportunities for the nurses to bring my baby to me or for Scott to be with our baby.
Also, by expressing colostrum for a month before baby is born, special care nurses can feed that to baby instead of formula.
Another benefit of expressing colostrum for a month is that my supply is gradually building day by day – from a drop or two three weeks ago to an average of 12 or 13 mls today. If my milk supply is slow to come in and it is necessary for me to use a nursing supplementer, I’ll at least be able to fill it with my expressed colostrum rather than formula.
Lactation Consultant Sue Cox says expressing gives a pre-natal mum confidence and I think she’s right. I now understand how my breasts work, how my supply works and more. When my hands became too sore and swollen to express properly around week 36, I began using an electric pump. That was hard too. It treated my breasts differently, but after a few days my supply had resumed and continued to increase. As I approach a planned caesarean this week, I am hopeful that breastfeeding will not be a problem – even if bub is placed in special care for days. I have done what I can to make up for my known deficiency.
I am convinced I could not have done it without a supportive team of medical professionals around me. Even if I had done all the research in the world on this stuff, if I had negative doctors around me it would be too hard to make these changes stick. I’m glad this was my Obstetrician’s idea. It gives me some faith in his approach as a doctor and I can see his positive influence on the midwives in the maternity ward where he works.
Since this is such a popular post on my blog, I thought I’d post a quick update. I posted this one before my baby was even born. He was born with zero blood sugars due to some kind of stuff up with the insulin pump during the night before he was born. I took around 20 small syringes of frozen colostrum with me to hospital. The entire supply of colostrum that I had produced over about a month or so was gone within 36 hours.
While in hospital I worked hard with a lactation consultant to get my milk supply to come in, which was difficult as bub was in the neo-natal intensive care unit and I had a caesar so I was bed-ridden for the first 24 hours. I expressed milk constantly and after about 5 days was producing approximately 20 millilitres of milk per feed. This had to be topped up with formula. We persevered trying to breastfeed and then follow up with top ups for a couple of weeks before I chucked a tantrum and put him solely onto bottles. I expressed milk several times a day so he was having a combination of breast and bottle milk.
Jacob had a lot of indigestion and reflux which the midwife felt was being caused by having one type of food at one feed and then another type of food at the next feed. He needed a constant and predictable food source, so I ended up transitioning him to formula after 3 or 4 weeks of expressing. It was hard work but as a woman with PCOS it was the best I could do for him. It still disappoints me that I couldn’t breastfeed him normally, but frankly, there are far more annoying PCOS symptoms than that. [sigh]
For more information:
Sue Cox is the author of several books on breast feeding. She has also written research papers for the industry on expressing colostrum.
Breastfeeding with confidence by Sue Cox
The web-site Low Millk Supply is full of information and resources about improving your milk supply. Diana West and Lisa Marasco’s book “The Breastfeeding Mother’s Guide to Making More Milk”, a very useful book for all nursing mums is available on this site.