Got Milk?

Yesterday we met with one of the staff lactation consultants, an awkwardly tall, ghost of a woman. We'll call her Helga.* Her fair, Scandinavian features appeared to have been uncomfortably stretched and forced onto a hard-angled, Teutonic frame. The iceberg-white skin of her nose and shoulders had the painful, reddish hue that extremely pale people acquire when they spend more than a couple of hours outdoors. At some point in our conversation, she mentioned that she'd just returned from vacation, and I imagined her suffering for a week beneath the unrelenting Caribbean sun. She had a sort of sad cow demeanor, and spoke with an ill-fitting, mousy voice. She wore her white-blonde hair in the standard issue Mormon bob, and in that respect looked as if she'd been plucked from some tabernacle in the middle of Utah. Or maybe it was just that she offered her advice with the same shrill, judgmental certitude that one usually expects from proselytizing religious zealots.** If all this seems like a less-than-flattering description, consider Anna's more succinct take on Helga: "I wanted to smack that lazy-eyed bitch." I was willing to leave her lazy eye out of it.

The worst part was that we'd waited for Helga all day. Since the day after Frankie was born, Anna has been expressing breastmilk and storing it for later use. She uses a hospital-grade breast pump (the Medela Symphony, which came highly recommended), maintains a rigorous schedule (every three hours during the day, every four hours at night), drinks plenty of fluids, eats well, and otherwise follows all of the advice and suggestions offered to improve production. Still, her output has been less than she'd hoped, and over the past couple of days has even seemed to decline. In layperson's terms, her milk supply hasn't "dropped." She's still pumping out a thin trickle of colostrum, and we're saving every precious bit, but it's disheartening to spend two-and-a-half hours each day strapped to a machine for that kind of pay off. Then, of course, there's the added worry that her milk supply will simply dry up, and the associated guilt and second-guessing: Did I wait too long to start pumping? Was I doing it frequently enough? Was sleeping through the night a mistake? Are my boobs simply defective? Does this mean I'm a bad mother? Anna shared these fears with me, and I tried my best to console her, but we both wanted the reassurance and practical wisdom that only a professional could provide. So, we waited for Helga.

On our way to the hospital yesterday morning, we stopped at the maternity supply store to stock up on nursing bras and to pick up another pumping bustier (those of you with the appropriate security clearance can backchannel me for some priceless shots of Anna in full breastmilk pumping regalia). We also bought a book with tips for breastfeeding a premature baby (appropriately titled Breastfeeding Your Premature Baby). We're studious folks by nature, so we've been reading pregnancy books and baby care manuals throughout the pregnancy. Since Frankie's early arrival last week, we've turned our attention to the more specialized subject of preterm birth and premature babies. All of the experts weigh in on the subject of breastfeeding, and they are unanimously and enthusiastically in support of the practice. In fact, the lion's share of information on the subject focuses on the benefits of breastfeeding and the drawbacks of bottle-feeding. At first glance, Anna and I were confused by these impassioned appeals. We wondered, do women really need to be convinced to breastfeed? Now, in hindsight, we're beginning to understand the desire to present a compelling case. For many women, breastfeeding is difficult, painful, and a source of significant anxiety. In Anna's case, these drawbacks are magnified by Frankie's absence from the process. Aside from the obvious psychological trauma of trying to provide milk for a machine instead of your baby, there is a very real, biological obstacle to be overcome. Several factors cause a woman's breasts to begin producing milk, among which is the triggering hormone that's released when the nipple is stimulated by baby's mouth. Physical touch is the best way to promote the production of this activating hormone, and Anna won't be able to place his mouth to her breast for at least another week. That she's having difficulty producing more than a few cc's of fluid with each pumping session is hardly shocking, and certainly not her fault, but you wouldn't know it by the way Helga responded to our concerns.

I knew we were in trouble less than half a minute into our conversation with Helga. Anna explained that she was having trouble expressing milk, and that her output remained little more than a trickle. Helga asked when Frankie was born, then began to frown as she counted the days between then and now. "So, when did you start expressing milk?"

"Well, Frankie was born Thursday morning, and I guess I started on Saturday morning."

Helga didn't even try to conceal her concern. "Oooh, that's bad. Who told you to wait that long?"

I stepped in, appalled by her utter lack of tact. "Let's see, the doctor who delivered Frankie, Anna's admitting physician, the nurses, even the lactation consultant." The tone of my voice should've tipped Helga off, but she was undeterred.

"Well, that's not good. And how often are you pumping?"

Anna looked a little stunned, but answered honestly. She told Helga that she was now pumping every three hours, but only for the past couple of days. "At first, I was sleeping through the night to heal up from the surgery, but now I'm even waking up twice during the night."

"Well, that's just not enough. You should really think about pumping every two hours. Usually, milk production begins within three days. With some older mothers, such as yourself, it may take between 6 and 8 days. So, you still have another day or so before we need to start worrying. Let's see how it goes. Have you tried massaging your breasts?"

At this point, I was ready to strangle Helga. Not only was she the single most uncompassionate person I've encountered in the last couple of weeks, but she essentially laid the blame for our breastmilk production difficulties squarely at Anna's feet. I tried to help. "Well, it's not that unusual for mothers to have problems producing milk when they don't have contact with their babies, right? I mean, it's at least partially a hormonal problem, right?"

"No. Once the placenta is out, milk production should begin." She turned back to Anna, gave her one or two more bits of advice, then left us alone. I turned to Anna as soon as Helga was out of earshot.

"You realize she's totally out of it, right?" I thought I'd have to do some serious damage control, but Anna didn't seem too upset. We've both read enough about breastfeeding to recognize misinformation when we hear it. Still, when the staff lactation consultant tells you there's a good chance you're not going to be able to lactate, it's cause for concern. So, this morning we made an appointment with Anna's new Ob-Gyn to get another perspective. As we sat in the waiting room, I tried to figure out why the blonde woman talking to the receptionist looked familiar. Anna nudged me with her elbow, her eyes wide as saucers, just as the woman turned. "Hey you guys! We met yesterday, remember?" It was Helga. I choked back an ironic guffaw and mumbled through several uncomfortable seconds of small talk before the nurse called for Anna.

As I suspected, things aren't nearly as dire as nurse Helga made them out to be. In the first place, the circumstances of Frankie's birth make breastmilk production especially difficult for Anna. Because Frankie was born prematurely, Anna's body was not geared up for milk production. Preterm births often result in delayed and diminished lactation. Additionally, giving birth by cesarean section bypasses long hours of labor, which sounds like a great deal, but in fact often results in diminished milk production. It seems the struggle and pain of labor acts as a stimulant for lactation. Finally, add to all of this the stress of being separated from your baby and you can easily understand Anna's difficulties. Instead of callously blaming Anna, the nurse reassured her that her troubles were natural, and easily treated with medication. Anna felt especially upbeat after the nurse practitioner explained that injections can even make women who haven't been pregnant lactate. Anna still might try to strangle Helga next time we run into her, but for the moment, we both felt a little better about the whole situation.


* Not her real name, but Anna can confirm that she "looked like a Helga."
** Not that all Mormons are proselytizing religious zealots. Some of my best friends are Mormons. I mean, not really, but you know...