I NEED to start off this article by pointing out that a true breast milk supply issue is extremely rare.  Most experts estimate that around 1% of women have true low milk supply.  Having said this for those in the 1% this issue is serious, and can be devastating.

Best Intentions

When I became pregnant with my first baby I knew I was going to breastfeed.  This wasn’t even a question for me.  My mother had breastfed me, and I grew up thinking it was normal to breastfeed.  I looked down on mother’s who used formula, and assumed there was never a good enough reason to not breastfeed.  I also knew I was going to have a natural birth.  Birth to me also seemed normal.  I had the right ideas in general, and was a very well intentioned mother, but I was woefully ignorant about the challenges I was going to face in motherhood.

Disappointing Circumstances

I planned a home birth, but due to circumstances beyond my control had to transport to the hospital and ended up with a birth far from what I wanted.  I took my sweet newborn baby home from the hospital tired beyond belief, in lots of pain, and had little help.

I thought the breastfeeding was going well.  He nursed 24 hours a day around the clock, but I had heard newborns could be like this and wasn’t concerned.  He didn’t cry almost at all, and seemed perfect.  My mom called me on the 3^rd day and asked if my milk had come in yet.  I told her no, and that it still looked like colostrum to me.  She said not to worry, that it would come soon, and I really wasn’t worried.

Worrying Something’s Wrong

On the 5^th day I realized that things seemed odd to me.  My breasts didn’t feel full, he was still nursing 24/7, and I had no signs that my milk had, “come in”.  His check up revealed that he had lost a considerable amount of birth weight, and my pediatrician was urging me at this point to supplement with formula.  Convinced that we didn’t have a problem I left very frustrated, and didn’t give him any formula.

My pro breastfeeding pediatrician agreed to watch and see for a while, but urged me to come in every other day to weigh him.  2 days later I took my sweet baby in.  He had lost even more weight.  He also hadn’t had a bowel movement in 3 days, and his diapers were barely ever wet.  It was clear to my pediatrician he wasn’t getting enough.  I was still stubborn though.  He hardly cried, and he looked healthy to me, and I was set in my ways.

Realizing There’s a Real Problem

Again I ignored her, and didn’t supplement him with formula, but I did consult several lactations consultants, and began taking measures to increase my milk supply.   A few days later it was clear to me there was a problem.

My little baby seemed lethargic, and was starting to look sickly.  He still hadn’t had a bowel movement, and I had that sinking feeling that we really did have a big problem.  I took him back to his pediatrician.  I was hoping I was wrong and just overreacting, but the scale said otherwise.  Again he’d lost weight.  An initial weight drop in a newborn is not at all uncommon, but he should have been gaining by now [most babies lose about 10% of their birth weight, but begin gaining it back by the 10^th day].

The First Formula Feed

The pediatrician wanted to admit him to the hospital, he was so dehydrated.  I couldn’t bear the thought of seeing my baby hooked up to an IV, and I begged her to wait and see first.  She agreed to let me wait in her office for a couple of hours of observation while I gave him a bottle of formula.  I had been nursing him for several hours non stop.  He guzzled down 3 ounces of formula (a lot for a newborn), and fell into a deep and peaceful sleep.  I couldn’t believe it, for the first time since he was born he wasn’t latched onto me.

No More Breast Milk

I continued to seek help from lactation consultants, and was using a breast pump and herbs in an attempt to increase my milk supply.  Unfortunately though by about 2 months my milk had dried up entirely and that was the end of our breastfeeding relationship.  I felt horrible.  I had tons of guilt over not giving him my own milk.

Pregnant Again

When my son was 14 months old I discovered I was pregnant again.  I was so excited to have another baby, but this time was so nervous about the birth and breastfeeding.  I planned another home birth, and this time began preparing much earlier to see if I couldn’t have a full milk supply this time.  I bought some books on breastfeeding (The Womanly Art of Breastfeeding is my favorite), and began attending La Leche League meetings regularly.  I was confident this time could be different.

A Better Birth

My daughter’s birth went perfectly!  I couldn’t have asked for a more perfect, peaceful, beautiful home birth then the one I had.  I was elated.  She latched on and nursed like a champ, and I thought this time we wouldn’t have a problem.

Like her brother she nursed around the clock, but this didn’t alarm me, as I know babies like to nurse.  Around day five, I realized that I didn’t feel like my milk had come in, but she seemed fine, and though she had lost some birth weight it was still on the lower end of normal.  She wasn’t passing as much stool as I had hoped, but I still kept hoping my milk would come in that night.

Recurring Problem

On the 6^th night my daughter was restless.  She nursed, then cried, then nursed, then cried.  My midwife came a few hours earlier and was concerned about the weight loss, and lack of soiled diapers.  She left me with a syringe to give her formula milk with (just in case).  My daughter’s crying continued for hours, and at 3 am my husband asked me what was wrong.  I said I really don’t think there’s enough milk.  He went to the drug store and bought a can of formula, and I cried as I dribbled it into her mouth.  I felt like a huge failure.

Trying to Increase Breast Milk

In the morning I was on the phone with my local La Leche League leader, my midwife, and IBCLC lactation consultant.  I began my routine of pumping, herbs, and even tried heavier prescription meds (reglan) to increase my milk supply.  Nothing worked.  I was making about 4-6 ounces of breast milk a day.  Enough for about 2 of my newborns feeds.

Our daily routine went like this.  My daughter would nurse for a long time, about 30 minutes, and then pull off frustrated; I would give her any milk that I had pumped, then give her formula until she was full; then I’d rest for an hour and go pump breast milk for about 30 minutes.  My daughter was usually ready for her next nursing session about an hour after I’d pumped and the cycle continued.

Diagnosing the Problem

I had more milk for my daughter then I did my son.  I was so determined, but I never got anywhere near a full supply.  Finally, my midwife and lactation consultant told me that I had Insufficient Glandular Tissue.  Around puberty my breasts just didn’t develop enough glandular tissue to feed my baby.  There was nothing I could do other then what I’d already done.

Alternative Feeding

Once I had realized that I did everything I could, my guilt went away.  I knew before God that I had done everything in my power to give my baby the best.  I had a friend and doula client that knew about my supply issues. She offered to pump breast milk for me when her baby came, and let me tell you she had lots of milk!  I was so relieved to be giving my daughter breast milk instead of formula!

Then I found out about a local Facebook based group, Human Milk for Human Babies, which seeks to match moms in need of milk with moms that have plenty of extra frozen expressed breast milk.  I began to get donations from other mom’s, and my daughter was getting about 90% breast milk and 10% formula.  I was so happy, and am still so grateful for all the moms that worked hard to feed my daughter.

Supplemental Nursing System

Since my daughter’s birth my knowledge about breastfeeding has grown even more.  I honestly think I did a really good job with keeping the supply I did have with my daughter.  There is only one other thing I wish I had tried.  Something called an SNS (Supplemental Nursing System).  It’s basically a bottle that goes around your neck with a tube that attaches to your breast so the baby can still get the supplement at your breast rather than from a bottle.

Here is my advice:  If you think you have an insufficient milk supply talk to a lactation consultant ASAP!  Don’t wait, call immediately!  I have TONS of advice to give, but each situation is different, and it’s important that you get first-hand expert advice.  Please keep in mind that not all lactation consultants are equal in their education, and you need to seek out the best of the best.  I highly recommend that you consult an IBCLC (International Board Certified Lactation Consultant).  These lactation consultants are highly trained and are able to distinguish the difference between a low milk supply that can be easily corrected, and a mother who is truly medically unable to obtain a full supply of breast milk.  If you are unaware of an IBCLC in your area turn to the internet, and find one from elsewhere.   If you truly need to supplement your baby, consider using breast milk from another mother.  I would ask close friends and family first, but if no one is able, consider asking for help through a local branch of the Human Milk for Human Babies Global Network.  (Read the article Human Milk for Human Babies on Saudi Life for more information about the Saudi branch.)

I thought about just writing a research based article rather than giving you my full breastfeeding history, but I remember how alone I felt when I really and truly was not making enough breast milk.  You probably can’t even imagine how hard I worked to give my babies the best.

Helpful Resources

Al Bidayah Center offers breastfeeding support in Jeddah and has plans to open an office in Riyadh as well.

If you are in the Americas, search IBLCE in the Americas.

For general support, consider attending a La Leche League meeting.  The Al Bidayah Center hosts La Leche League meetings in Jeddah and there is an also an online Yahoo group for mothers in the Middle East called La Leche League in the Middle East.

In Riyadh, there is an informal group, Circle of Nurturing, comprised of several breastfeeding counselors.  They host monthly breastfeeding support and social meetings and are available to meet with mothers in need.  You can contact the Motherhood Column Editor, Aisha Al Hajjar, for more information.

Rare Problem

Although many mothers have difficulty with breastfeeding at first, it really is rare to have a problem that cannot be overcome with determination and diligence.  I hope there aren’t many out there who go through what I went through, but if your story is similar to mine know you are not alone.

All the best!

Dayle Student Midwife and Doula