Tag Archives: low milk supply

breastfeeding failure: the emotional fallout

26 Jul

Have you noticed that all of the information about low milk supply available on the web (and in books, for that matter) says the same thing? “This is not your fault. You are not a failure. Any breastfeeding is better than none. Your child will thrive on formula too.”

It so happens that I believe all of these things.

And yet–none of this addresses the emotional reality of breastfeeding failure.

Part of the problem is just that: while you may call it low milk supply, it feels like failure. Many PCOS women have struggled with their bodies forever–to maintain or reach a healthy weight, to get pregnant, to control blood sugar or acne or hair loss or whatever. And then, when you reach this lovely milestone of having a sweet baby to nurse, you discover that you can’t. Add postpartum hormones washing around your bloodstream and you have the makings of some pretty major grief.

I’m not going to pretend I have answers for this problem. I don’t. I think it’s a struggle that every woman will end up having on her own. But I do want to acknowledge that there are lots of PCOS women in this boat, and give you a heads-up that you are NOT alone in hurting. Especially when:

* …a lactivist says, “Any woman can breastfeed.” This, along with “lack of education is the reason for breastfeeding failure,” “mothers who say they can’t nurse just don’t want to,” and “nursing is natural–any mom can do it if she tries hard enough,” is one of the most hurtful things that can be said to a mama with IGT or other low supply problems. And yet it is said, all the time. An OB said it to me after I had spent $500 on LCs and pumps, plus hours and hours and hours of my life with my sweet new baby, just to produce 6 oz or less per day. I would say, just let it go and ignore it–except that even lactation consultants, doctors, and midwives are often misinformed about this. You don’t have to let it slide. Direct them to material about IGT if you have to, and point out that these statements only undermine your attempts to have a breastfeeding relationship anyway.

* Your baby refuses the breast or cries at the breast. This might be the worst. I didn’t get the hang of the at-breast supplementer; I know that many women find them a godsend, but for me it made achieving a decent latch nearly impossible. I used bottles. My daughter was completely unwilling to nurse by the time she was 6 weeks old (and mostly unwilling long before that). I pumped exclusively for her for months. And every time I sat down to pump, saw another baby nursing, or filled her bottle, it hurt. (My son, on the other hand, nursed enthusiastically for 10 months even though he also got most of his nourishment from bottles. Babies just differ on this.)

* You get a judgmental look (or even what you feel MIGHT be a judgmental look) from another mom, or dad, or whoever, while you’re bottle-feeding. This one was really hard for me, because I am very pro-breastfeeding and it was a big adjustment to be part of the bottle brigade. I had no choice, though, and that’s the reality. Your job is to feed your baby, and if that means bottles, it means bottles. Do not let anyone intimidate you–you’re doing exactly what you must do to keep your baby healthy.

* You confront your own preconceived ideas of what your breastfeeding relationship should have been like. For a long time, it made me very sad to see my nursing pillow sitting there, because during my pregnancy I had imagined, so many times, using it and nursing my baby. And that just did not become reality.

* People tell you to get over it because you have a healthy baby. You can be thankful for your baby and in love with your baby and still feel sad. Grieving for the nursing relationship you’d expected is totally normal.

In a nutshell, being unable to breastfeed exclusively hurts. My daughter is almost 4 and thinking about it still hurts–enough to make me feel a little ill. But facts are facts: there is nothing more I could have done. I tried it all. Formula fed my babies and grew them into the amazing people they are today, and I’m grateful for it even though I am sad that I needed it.

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Metformin for low milk supply in PCOS mothers

3 Jul

Lisa Marasco–the ICBLC who is possibly the first researcher to examine the role of PCOS in low milk supply–has found evidence that Metformin can help with low milk supply in mothers with PCOS. The La Leche League has an excellent article by Marasco available on their web site (Marasco is an LLLI leader, as well as a lactation consultant).

Marasco suggests that anecdotal evidence shows a boost in milk production for low-supply moms with PCOS. She acknowledges that large-scale studies and high-quality research on this do not yet exist; however, in the absence of other good options, it may be worth trying. Marasco advocates using Metformin throughout the pregnancy and during breastfeeding.

Thomas Hale, the leading authority on the safety of drugs in breastfeeding mothers, has studied Metformin and concluded that it is quite safe. His assessment can be found here (warning: it’s pretty technical). Essentially, Hale found that the levels of Metformin in breastmilk were low, and that no adverse effects on the infants were reported.

He does point out, however, that “since metformin is largely excreted via the kidneys, particular caution should be exercised where the infant renal function is low or compromised (e.g. in premature neonates, or in rare cases of renal failure).” This doesn’t mean that no breastfeeding mother of a preemie should take Metformin; rather, it means that your doctor should consult with your child’s pediatrician and make the decision carefully. Since breastfeeding is beneficial, especially for premature babies, being able to produce more milk may benefit the infant enough to be worth the risk. Kidney function should be carefully monitored, though.

You may also be interested in this study, which examined infants whose mothers took Metformin over the course of their first six months of life. No differences in development or illnesses were found.

Finally, this page from Kellymom has a good list of links about PCOS and breastfeeding, including links to info about Metformin. (How much do I love Kellymom? A whole lot, that’s how much.)

Ultimately, my feeling on this matter is that it’s worth a shot. Metformin, which is a first-line treatment for PCOS, has a lot of benefits for PCOS sufferers; it can improve regularity of cycles and reduce other symptoms. I find it plausible that Met might make some differences to the hormonal balance that promote milk supply. Of course, not all patients find Metformin easy to tolerate; it often has significant GI side effects. Talk to your doctor about prescribing you the name brand (Glucophage) if that is true for you and adjusting your diet doesn’t help. Some PCOS ladies have reported that the generic has more side effects for them than the name brand.

That said, I took Met before I got pregnant with my son (and for the first trimester), and I had almost zero side effects. It regulated my cycle almost immediately and I conceived my son in the second month of trying. As a result, I’m a believer in Met’s ability to affect hormones for the better, which means that if I were going to have more children, I’d be taking it throughout the pregnancy and while breastfeeding.