Photo by Pekuna Hong, Lei by Ocean Dreamer.
There’s no better satisfaction for a mama than a sleeping baby with a full tummy (and even a fresh 💩) because we know that those things are signs of a healthy baby. Whether it’s through the breast, bottle or a combo of both, I’ve learned that weʻve gotta choose the option that is most sustainable for our whole ‘Ohana even if itʻs not part of our original “plan”.
It’s officially been 3 years since I began my breastfeeding journey. Iʻve enjoyed so much of it, especially the bond with each child. But now with a 3 year old, 21 month old and a 3 month old, I feel the end is near. TBH Keōwai my third child, has been the most challenging of all. Probably because I already have two tiny, needy toddlers in diapers who take all of my energy. Also because physically, I don’t knw HOW the F my body is doing any of this... 3 back to back pregnancies, lack of sleep and producing milk to breastfeed 3 hungry little birds for 3 straight years. 🤷🏽♀️😳 🐮 💦
Breastfeeding has been a challenge for me with all 3 children, each one consecutively harder. But I never understood why my babies struggled with feeding or why I was losing my milk supply until now. Have you heard of a lip/tongue tie? More on that below. I am a willfully stubborn mama who will exhaust all of my options no matter how hard it is or how tired I am. I want to provide the best for my children and am willing to put in the work even if it means going to extreme measures for a short period of time. I consulted lactation specialists, endured extra long feedings, took supplements, opted for the frenotomy surgery with post surgery stretches, and power pumped my ass off to keep my supply up.
I’ve learned so much on this journey about acceptance and letting go of the things I cannot change. I learned that my body hasn’t had the proper time to heal, rejuvenate and build itself back up again and thus isn’t functioning at its full capacity. I’ve learned that it’s ok to stop breastfeeding and give the baby formula or even donor milk if it just isn’t working. Trust me your baby will thank you!! Iʻve commiserated with other struggling mamaʻs. I learned that tandem feeding wasn’t sustainable for me. Most importantly, I allowed myself space to grieve the special bond I held with each child that was ultimately cut short because of my back-to-back pregnancies.
At the end of the day, I can feel good about where I am now, mostly formula feeding my growing, chunky 3 month old son. I know I tried my best and did everything I could to exclusively breastfeed, Lord knows! But it just didnʻt work out that way for me. I worked closely with the wonderful lactation consultant team at Mahinaona Pediatrics. If you are struggling with breastfeeding and don’t know what to do I would highly recommend seeing Dr. Kahikina and her Mahinaona team. They customize treatment to your journey and they use both in person and tele-health.
💪🏽 YOU GOT THIS MAMA!! Whatever that ends up looking like let go of what you thought and go with what you got. 💪🏽
Read below for more on my journey and the tools that helped me.
‘Ōmealani, my first, started out great. I constantly carried her, wearing her in her carrier and fed her on demand (the joys of having only one child). Sure I had pieces of my nipples ripped off by her tiny beautiful mouth but those nips quickly healed and it didn’t stop me from feeding through the pain because I was relentless with trying to “exclusively breastfeed”. Her feedings were long, like 30-60 mins but back then I had all kinds of energy and didn’t think I needed a lactation consultant. Around 4-6 months we noticed she wasn’t gaining weight but also discovered I was pregnant (again) so we thought that was why I had a lower milk supply. I started supplementing with food and formula. We had no idea she actually had a tongue/lip tie. Tongue-tie is a condition present at birth that restricts the tongue's range of motion which may interfere with breast-feeding. I didn’t realize that was actually a thing but it really IS!
With my second child, Hokua I was tandem nursing (wtf was I thinking?) both babies and finally realized that the struggle with his feeding and my milk supply was caused by his lip/tongue tie. I also got mastitis 2x!! We released his tie (laser surgery) at 4 months and that helped immediately! But I had already lost a lot of my supply by then so I still had to supplement with formula and donor milk.
So now with number 3, I learned a few things. I weaned Hokua off the day we brought Keōwai home because I knew I didn’t want to do tandem nursing again. I also recognized the symptoms of Keōwai’s tongue/lip ties a lot sooner. He had the laser surgery which released the ties at 7 weeks. We did the stretches and strengthening exercises everyday for 4 weeks (we didn’t do this for Hokua). Since then his latch is much stronger but so is his appetite and I have to supplement. I told myself Iʻd try everything for 3 months but if Iʻm unable to provide enough supply for him by that point I would supplement the rest and get some rest. Thatʻs where weʻre at now, a mix of breast and formula and donor milk when I can get it! The saga continues …
Below I saved you lots of time by compiling some of the things that have helped me the most on my journey thanks to my lactation consultants.
**Always Consult your doctor first with these ideas.
Tools and Information
Mahinaona Pediatrics
Dr. Kahikina and her Mahinaona lactation consultant team are located on Oʻahu. I loved them so much!
Find them at https://www.mahinaona.com/
Tongue Tie
How to tell if your baby has a Tongue Tie. Look for symptoms such as an inability to properly nurse, clicking noises while the baby is suckling, excessive drooling, poor weight gain, or “gumming” and chewing of the nipple when feeding. These are all potential signs of tongue and lip ties. There are even more details about the surgery and post stretches further down.
Nursing On Demand and Syringe Feeding.
If a baby this young (7-10 days) is not satisfied after nursing for 60 minutes, they are starting to enter fatigue - they will fatigue, and use too much energy, and yet still not get enough milk; when this happens he should syringe feed. Whenever he seems hungry and not milk drunk, feed him. He needs to “let go” on his own to signal that he is done with nursing. If he has not “let go” but he is not swallowing, consider syringe feeding until he let’s go.
Breast Compressions:
This helps babies to feed better and drain the breast more completely. Consider warming up your breast and massaging before nursing. All the areas that are hard, massage first to soften it. It will help for the milk to flow better while baby is nursing. Breast Compression while nursing and pumping!
https://www.youtube.com/watch?v=1zPWZ9-BGKI
https://realbabymilk.org/breast-compression/
https://www.youtube.com/watch?v=RymUDeCAt18
Hand expressing:
One of the best ways to increase milk production, as well as prevent plugged ducts and mastitis:
https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html
Latching Videos:
https://www.youtube.com/watch?v=0I-OAr7Dr48
https://www.youtube.com/watch?v=7FJuBn2bgNk
Newborn behavior cues and feeding cues:
https://www.youtube.com/watch?v=ABAXgubx58Q
Suck-swallow video for baby:
https://www.youtube.com/watch?v=rFdr8QECo4U
Burping baby:
https://www.youtube.com/watch?v=m50PTFmmlxw
KellyMom.com
I’ve geeked out on kellymom.com and YouTube searching topics like breast compressions, slow letdown, milk supply, tongue ties and supplementing. Visit https://kellymom.com/ to search for advice on all things including:
Nipple pain
Engorgement advice
Plugged ducts advice
Lecithin for recurrent plugged ducts
Milk bleb
Nipple vasospasm
Nursing a distracted baby
Teething/biting
How long should I breastfeed for?
The AAP (American Academy of Pediatrics) recommends at least 6 months for everyone, but states that it is beneficial for the first 1 year.
The WHO (World Health Organization) recommends 2 years and as long as it is mutually beneficial for mom and baby. This means that there is no detriment to mom or baby for breastfeeding to go on longer.
Delayed Letdown:
https://kellymom.com/bf/got-milk/supply-worries/letdown/
DURING pump sessions, if flow slows down after initial letdown subsides, press the letdown button to go back in to the stimulation mode to help trigger another letdown.
Power Pumping:
Power pumping 2x daily is an option for collecting extra milk. Suggested times 10pm or 11pm, then again between 4am and 6am. Just before and just after your longest sleep stretch.
Traditional power pumping is 20 minutes on, 10 minutes off, 10 on, 10 off, 10 on. An alternative is to do 15 on, 10 off, 15 on.
Your baby could take 4oz bottles at these times and the rest of your milk could be stored.
Donor Milk:
We were really blessed to meet our donor through a mutual midwife. She over produced a lot of milk and was generous enough to share it with me for 2 of our babies who were only a couple weeks apart both times.
From the Academy of Breastfeeding Medicine about milk-sharing.
Tongue-tie and Frenotomy:
Controversial evidence of upper lip tie:
https://www.ncbi.nlm.nih.gov/pubmed/30681376
Controversial evidence of tongue ties:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011065.pub2/full
After-care Dr. Ghaheri:
https://www.drghaheri.com/aftercare
Treating a tongue-tie, especially if it is because of problems with extraction and suction does not always result in immediate improvement unless also coupled with suck training. See a lactation consultant! An in-person evaluation can help them to determine how important suck training will be to the process of improving nursing after treating the tongue-tie. It's harder for the lactation consultant to tell improvement without having an initial evaluation first.
Where to get your frenotomy:
If your baby is over 2 weeks old, you can also choose to have it done by a dentist. You will need dental insurance to have the procedure covered.
Dentist - the dentist will use a laser technique. Dr. Bren Chun: 808-261-5354 (Kailua, HI)
This specialist has experience performing a posterior frenotomy, which will give your baby the best tongue flexibility.
Suck Training Resources:
This video is helpful with babies who are a little tight in their bodies.
https://www.youtube.com/watch?v=VR_OCKpIhyo
Lisa Lahey, RN, IBCLC, OMT (myofunctional therapist): suck training videos
https://www.youtube.com/watch?v=JhOnRXH146w
Post-frenotomy resource -