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Wednesday, November 9, 2011

Supply & Demand: bottle, breast feeding & the pump

Warning: For some of you this post is TMI (Too Much Information).
Please feel free to skip this post, if you want.

I love to nurse. I know nursing and feeding babies is an intensely personal decision. I know many moms who wanted to nurse and for whatever reason, they couldn't. I'm sure I took nursing for granted with my first two children. Yes, there are uncomfortable moments--even downright excruciatingly painful moments--especially in the beginning. Yes, it makes my babies very dependent on me and sometimes that can be less convenient. But the trade-off is the unique connection I feel with them. I also love the convenience of not having to make a bottle. And, I really appreciate the cost savings of not having to buy formula.

Fragile X

Then, came my last two children. I hate to sound like a broken record, but now that I know about Fragile X so many things fit together. Fragile X babies are poor nursers. The pediatrician explained that it takes a great deal of muscle control for babies to nurse. They have to use their tongue and mouth muscles to massage the breast in order to produce the milk. In contrast, they only need to move their checks to drink from a bottle--a lot less work for a tiny baby. With inherit poor muscle control, these Fragile X babies are behind from the start.

"Failure to Thrive" and Formula

Jacob was diagnosed with 'failure to thrive' at six months old. Don't ask me how I missed it, but at the time he was only 9 pounds! (Some babies are BORN at nine pounds.) If I showed you the pictures of his emaciated body it would make you cry. It makes me cry every time I see them. How did I miss that?? I was solely nursing at the time and obviously he was not getting enough nutrients from breast feeding in order to survive. To think he was slowly dying is such a heart ache to me. Luckily, he responded very well to formula. I am so grateful for formula!

Fast forward to now. I was very cautious of Oliver and his weight gain. When he showed early signs of not getting the nutrition from me and solely from nursing. I was very quick to take the pediatrician's advice and supplement with formula. We started with Nutramigen by Enfamil . It had a lot of calories. But...not enough. When the next week check-up showed that Oliver had hardly gained any weight, we then changed to a higher calorie formula--Similac's Expert Care NeoSure (22 calorie/fl oz). This helped him gain the weight he needed.

Unfortunately, the Similac made his tummy really upset. (We suspected it might be a result of the milk-based formula because Jacob has developed an intolerance to milk-based foods.) We saw yet another pediatric specialist--this time a dietician-- who prescribed a mixture of a soy-based Similac formula called Isomil. That's what's working well now.


Early in this process the pediatrician told me I could stop nursing if I wanted to, but I didn't want to. I kept thinking that if this child had Fragile X and was going to be behind anyway, then I needed to do everything in my power to give him the best possible foundation. For me, that meant nursing. I took supplements to help the quality of my milk. I got a prescription from my OB to help with my milk supply, and I rented a pump from the hospital.

The pump

In my experience, breast milk production works on Supply & Demand. If the baby demands it, the body (usually) supplies it. If my child can not demand enough milk because of his poor muscle tone, then it was up to me...and the "demand" in order to maintain the supply. Once again, I am very grateful for technology that helped to create breast pumps.

Unfortunately, by the time I realized that I could pump and then feed my baby breast milk through a bottle--it had been a number of weeks since he had been born and I could tell that, due to our necessary bottle feeding, my supply of breast milk was dwindling.

So, now the challenge is to keep pumping in order to maintain my supply. It sounds simple. But time is the constraint. Feeding the baby his bottle requires time. Sitting down again and plugging into the pump requires more time, and it requires both hands free. I wish I had unlimited time. But, that's not our luxury.

Most days the older kids need something--like driving them to school. Or Jacob needs something. Or the phone rings...or we have to run to the grocery store...or something! By the time I look at the clock I've missed 2 scheduled pumping sessions. (I should also add that when we were doing remodeling I had male construction workers in my house non-stop. It was impossible to sit down and pump with all these men in my house! Even if I went into my bedroom, it would only be a few minutes before someone had a question I had to answer. Ugh! That didn't help my regularly required pumping sessions. )

But we are working on it. My best pumping time is late at night. It usually takes 2-3 sessions of pumping to make up one bottle. (See below. Pumped bottle on the right after two sessions verses one feedings worth made by formula.) That's a lot of work for one bottle. But it's worth it. This is a short season of our lives, and I want to give this baby the best I can. In fact, I refer to the breast-milk-bottle as "The Good Stuff". I love feeding it to him.
I feel like its an inoculation of sorts.

Good, Better, Best

(Formula on the left, breast milk, pumped on the right.)

A nurse friend of mine told me that breast milk looses some of its nutrients when bottle fed. (Can't a girl catch a break!) I'm sure that's true. I recognize that "Breast is Best". Oliver does nurse. I'm not sure how much he gets or if its just comfort sucking. I really don't care. It's the closeness with him that counts.

Yes, I've created a monster of sorts. David will try to calm the baby down and give him a bottle only to conclude with, " I think he wants you". I guess I've made Oliver more dependent on me. Gone are the early days when I could leave him with a bottle and a trusted baby sitter so I could go to the temple with David. The more I nurse, the more we're attached. It's less convenient, but I don't mind.

Good= Formula. I am very grateful to have it and its ability to nourish my child!
Better= Breast milk from a bottle. Hard to come by, but glad to have it when I can.
Best= From the breast. Even harder to come by, but worth the effort.


  1. Wow! What a great mom! I know to many friends that just gave up breast feeding cause it was too hard! Oliver has the best mommy for working so hard to give him breast milk! Keep eating the "marshmallows" and pumping, only good things can come!:)

  2. Oh, honey. Good for you for all that you are doing to giving him the best start possible. He's so lucky to have you. I love nursing, too. During Annie's recent UTI, she went on "nursing strike" and screamed and screamed until she was so hungry/tired she took it and then drank like she had been starved. It brought me to tears a couple of times. It's humbling to be *the* source of nutrients. To be a "fount of living water" of sorts. I agree that nursing is about more than nutrition -- it's about closeness, comfort, security. Wishing you the best in this season. . . .

  3. Deborah, I can't imagine a newborn with a UTI! How awful. It would break my heart, too, to watch my little one have to struggle with such an infection. I am sure once she finally nursed her body was more quickly able to fight it. It is a humbling experience to be a care-giver for this little developing person. It makes me grateful for our own mothers and fathers that helped to bring us into this world and gave us our strong foundations. Thanks for your comment!