Every Drop Counts

The sound of a plastic cap tapping on the rim of a plastic bottle. That’s the sound every pumping mom knows, because every drop counts. That’s the sound of desperation and distress knowing you must bringing home enough to feed your baby the next day. I first heard the sound while watching a breastfeeding documentary towards the end of my pregnancy. There was a teacher pumping in a classroom while eating her lunch. She got two ounces no matter what she tried to increase her supply. You could hear disappointment in her voice. Now it is my turn to pump three times a day in the wellness room at work. There are people working directly outside of it. Sometimes I wonder if they can hear me tapping inside, trying to get every last drop into the bottle.
These are things you would never know unless you’re a breastfeeding and pumping mama. Pumping is harder than it looks and is more often than not it is unsustainable. In most cases it ultimately leads to an end to an otherwise healthy and successful breastfeeding journey. Think of it as the first steps in weaning. Surely, some moms are able to exclusively pump and bottle feed their babies, possibly for medical reasons. Some moms are also able to continue to pump at work for extended amount of time. However, the majority of moms experience a decrease in supply overtime upon returning to work and eventually end pumping or breastfeeding all together due to insufficient supply, lack of time and/or facility to pump.
As it turns out, breastmilk production is directly induced by demand from the baby. The more milk is removed through nursing the more milk is produced. Less frequent nursing and longer time intervals away from the baby inevitably leads to a reduction in supply for the mom. The pump, a seemingly convenient invention, is an inferior replacement of the baby. It does not remove milk as efficiently as the baby, and thus fail to stimulate more milk production. Everyone also reactions differently to the pump, some don’t react at all and can’t get any milk out. These moms may resort to hand pump or hand expressing. In any case, what moms can pump is not indicative of how much is produced or consumed by the baby directly from the breasts.
In the early weeks, it’s common to experience engorgement and oversupply as the mom and baby pair work out the proper level. Usually after six weeks the body matches up with the baby’s demand and manages to produce exactly what is needed: 25-28oz/day for the average pair. The total amount of breastmilk a baby takes each day stays consistent through the first six months. However, this is not the case for formula feeding. The content of breastmilk actually changes overtime to meet a baby’s nutritional needs. The content of formula stays the same so bigger portions are needed over time. While the total amount of breastmilk stays the same, the frequency of feeding may spread out after the first couple of months. Owen went from nursing every 30 minutes in the early days to now being able to nurse every 2-3 hours. Once proper supply is established, a number of things can still adversely effect it, such as stress, pregnancy, birth control, hydration, etc. But the biggest factor is still demand. This is why early supplementation with formula can be so detrimental to establish breastmilk supply. The less breastmilk a baby takes, the less it is produced.
All things staying the same, replacing nursing sessions with pumping sessions at work tends to decrease supply over time because not as much milk is removed by the pumps. It is simply math. To trigger more milk production away from the baby, the mom would have to pump more often, which is very unlikely to happen at work. Most women are luck to even be able to pump. There are laws mandating employers of certain size to make “reasonable” accommodations for pumping. However, the protection starts and ends with what is “reasonable.” Some states only have such requirement for moms with infants under one year old. Hourly workers are not required to be paid while they pump. And high demanding jobs like hospital staff and teachers simply don’t have the time or place to do it. Breastfeeding becomes an uphill battle the second moms are separated from the babies.
To abridge the gap between what is produced from one day to what is needed the next day, moms are forced to dip into their freezer stash, if they have one, or supplement with formula, which inevitably further reduces supply. It is difficult to build a freezer stash of breastmilk while exclusively breastfeeding. The body naturally calibrates to make exactly the amount of milk needed to feed the baby. Too little the baby will go hungry. Too much the mom will get mastitis. It’s a delicate balance. In order to trick the body into producing more than what a baby takes, moms must pump more frequently than the usual number of nursing sessions. Some moms power pump when they are home, which means they sit around with the pump and alternate ten minutes on, ten minutes off for an hour or longer every couple to a few days. Moms also sneak in extra pumping sessions at night and on weekends in additional to nursing their babies. Many women simply don’t respond well to the pump and no amount of pumping can bring up supply. It is a frustrating, stressful and vicious cycle.
Towards the end of my maternity leave, my work brought up the possibility of me traveling for five straight days on my first week of returning to work. When I mentioned how difficult it would be for breastfeeding, the reply was simply: why don’t you have milk stored in the freezer?
I never had an oversupply. My body produced exactly what is necessary, and that is with constant nursing. When I first started pumping after returning from our PCT trip, I was barely getting enough out to wet the bottle, and that’s after sitting with the pump on for half hour at a time while firmly massaging my breasts (or what they call “hands on pumping’). One of the days I squeezed so hard blood was coming out of my nipples instead of milk. It was physically painful to pump and to nurse. It was mentally painful to see nothing coming out and fear for an untimely end of breastfeeding. It was all together taxing. I eased up on hands on pumping. I reduced the suction level on the pump. Just give it time and relax, I tell myself. Things improved very slowly. After a week of pumping I was able to get an extra ounce of two each day. That’s not even enough for one feeding but it’s something. I combine tiny amounts from day to day and slowly small bags of frozen milk started to appear in the freezer. By the time I started working again I had cumulated 15oz. It’s literally a drop in the bucket, enough only for half a day!
Thankfully, I have been able to pump more at work. Instead of pumping for extra, I am getting approximately the amount that would have gone directly to the baby. Again, the pump is not as efficient as nursing. On average I get between 9 and 11 ounces over each 9-hour work day. I breastfeed just before I leave and immediately upon returning. Each morning I put in my reservation for the pump room with the admin guys at the office. One recent morning a different guy took over the task and told me the room is “first come first serve.” I was perplexed and confused as to how to respond. I timed my three pump sessions throughout the day meticulously, giving consideration to duration in between each session and work demands. My entire day evolves around pumping. To be uncertain of whether the pump room will be available when I need to pump is not only inconvenient but it jeopardizes how much milk my baby can get the next day. My breasts are not faucets that can be turned on and off on demand. It produces milk on a schedule and no more is produced until the existing milk is removed. If I get two ounces every two hours, it doesn’t mean if I wait for four hours I would get four ounces! I barely get enough as it is, any delay or less frequency in removal would simply mean less milk. I know this is not something most none pumping person knows or think about. Yet, I was not in the mood to provide such lesson. Instead I just looked confused and said, really? The other person made reservations everyday.
The World Health Organization recommends breastfeeding for the first two years. Currently no country in the world meets that recommendation. The US, with a long list of hostilities towards women and female related healthcare issues, unsurprisingly also falls to the bottom of the list for breastfeeding. It’s said that less than 20% of babies born in this country are breastfed until six months of age. Even that number seems high to me. I doubt the 20% is for exclusive breastfeeding. The cards are stacked against us. To demand mothers to go back to work at six weeks postpartum makes breastfeeding simply impossible. There is barely enough time to even establish sufficient supply at that stage, not to mention the lack of time and facility to pump and other problems like nipple confusion, and babies refusing to nurse after becoming accustomed to the fast flow of the bottle. Fast feeding alone can put a quick end to a healthy breastfeeding relationship.
In comparison, I have the best set up possible. I was able to stay with my baby for six months, be able to now pump at work on my own schedule, and have a peace of mind knowing that Peter is pace feeding the baby at home at a slow rate, so a feeding session can last almost as long as nursing. Still, even this I know is unsustainable. It’s not something to dwell upon while the pump running because, you know, stressing about diminishing supply further diminishes supply. Prior to having the baby, there was no question that I would breastfeed but I had no preference in how long it would last. Now that I am on this path, I want to keep breastfeeding for as long as it is beneficial to the baby. I want us to be the ones deciding our breastfeeding journey and not have it be dictated by the circumstances. It’s an uphill battle too many moms know all so well. For now, I drink  lactation herbal tea nonstop at work, look pictures of the baby and remember to take it one day at a time.

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