Wednesday, July 29, 2009

Inducing Lactation: Pros and Cons

The lactation project has been going well. I spend every other night in the bedroom with Ira, while Lyn gets a good night's sleep in the living room. Most of the nights I am able to feed Ira all night without even using the supplemental nurser or a bottle. On the nights I'm going to be feeding him I don't pump or nurse him at all after 3pm so that I am full enough by night time to go the whole night. I worry a little that this will have a negative impact on my supply, but so far the situation is sustainable. We're also actively looking for more opportunities for me to nurse Ira during the day.

Things are going so well, in fact, that we've started calling the project a success. It's great that we're feeling so good about it, but we've paradoxically also been wondering if it is worth it at all. Let me sketch out the reasons to induce lactation and the reasons not to and you can decide for yourself.

Why Induce?

The three biggest benefits of induction are more time with the baby, more decision making responsibility over the baby, and more milk in the freezer.
  • More time with the baby. As soon as I started nursing I began to spend more time with Ira and less time with the pump. However, note that I could have found ways to spend more time with the baby even if I wasn't lactating. Lyn and I might have agreed to do a certain number of bottles each day, I could have worn Ira more, or I could have prioritized spending every possible moment with our son. The real benefit of induction is that this additional time was simply built in. My nursing also frees up time for Lyn to spend with our toddler which has helped strengthen their relationship after the stresses of pregnancy and new-babyhood.
  • More decision-making responsibility for the baby. In my mind, this is really the biggest benefit. I realized around the time I started nursing that I was deferring to Lyn around every aspect of feeding. I counted on Lyn to keep track his feeding needs, and everything else in a young baby's life revolves around the food. When I got involved, it was often because Lyn asked me to do something rather than because I decided something needed to be done. Even as I started to nurse, I treated her as the gatekeeper of Ira's needs. Now that I am nursing Ira -- particularly now that I feed him all night long half of the time -- I feel that I know what is going on with him, and Lyn often also looks to me for guidance. This started happening the morning after my first night feeding him, but it has since spread to a more equal sharing of daytime responsibilities as well. This was a benefit of the induction, but it could be replicated by couples who were committed to sharing nighttime care. However, needing to give bottles creates its own problems, and it would not necessarily be easy.
  • More milk in the freezer. More milk in the freezer means never having to worry about giving the baby a bottle. We always have an oversupply of frozen milk since between Lyn and I we put about 10-15oz a day into the freezer (and at this point have never had to defrost milk to give a bottle). This makes going back to work easier. It would be an incredible help if we had any supply problems. We are also getting to donate some of our excess milk, which just makes us feel good.

Why Not Induce?

The main reasons you should not induce lactation are the excessive work involved, the potential for conflict in your family, the potential for feeling like a failure, and reduction in time available to bond as a family.
  • Excessive work involved. How much work is it to induce lactation? Depending on the protocol, you'll be taking birth control pills for perhaps five months before the baby's birth. Then you'll be taking 6-8 pills four times a day and pumping at least five times a day for several weeks before the birth. That might seem like hard work, but it's nothing compared to doing all of that and taking care of a new baby, a recovering bio-mom, and an older child. The nights that I feed Ira represent half a year of work and probably around 60+ hours of accumulated pumping. There are far more efficient uses of all of that parenting energy, like trying to keep a toddler fed and clothed.
  • Potential for family conflict. Navigating a second nursing relationship in your family is like trying to cross a landmine field. You never know when you are going to accidentally cause a major crisis. The bio-mom might get jealous -- after all, she is giving up something to allow the non-bio-mom to nurse. The non-bio-mom might get frustrated that she's not getting enough time to nurse. For a while at least, every nursing session by the nonbiomom will be a negotiation, and your family might not be prepared to handle that much negotiation. You've also got two nursing relationships to juggle, not just one, and remember that any nursing relationship means frustration for the baby and the mom as it gets started. And then there's the sticky issue of what happens if your baby likes to nurse with one of you more than the other. If the bio-mom had mixed feelings about her partner lactating, she may unintentionally sabotage the project. And I'm sure there's more potential conflict that I haven't thought of but might accidentally step into.
  • Potential to feel like a failure. If you try to induce lactation, you might fail. You might never get more than an ounce from a pumping, or you might never be able to handle a feeding without a supplemental nurser. You should think before you induce about what your goals are and what you'll do if you can't meet them. I would suggest pumping for several weeks before the baby's arrival so that you can get a good idea of whether or not you are going to be successful before a new baby throws your house into chaos. If you aren't pumping a decent amount of milk (perhaps 1.5-2oz a session) by the time the baby arrives, put down the pump and decide that comfort nursing is a great alternative (it is!). But even if you are successful, you will probably always be the lesser of two nursers. You'll have less milk and you'll nurse less often. I tend to feel pretty good about what I pump, but the other day I went head to head with Lyn (not on purpose, we just both ended up pumping at the same time). She got three times the milk that I did in half the time and she had just fed the baby. It can be hard not to feel inferior. Sometimes I have to feed him and then hand him over to her for more, I have to feed him and then do a bottle, or I have to feed him using a supplemental nurser. The potential to feel inferior is a real risk. I'm not usually bothered, but this is in large part due to the fact that I have already nursed one baby and I feel confident in my abilities as a mother. I think this could be much harder for a first-time mother to deal with.
  • Reduction in time to bond. This is really just a corrollary of the first point. Inducing lactation is hard work and it will take you away from your family. Time with the pump is not time with the baby. I spent hours during Ira's first few weeks pumping when I could have been holding him. And I still pump. Earlier today I was pumping while he was sitting in a chair looking at me. It makes a person feel a bit stupid. Then he started fussing so Lyn scooped him up and tied him on in the Ellaroo since I was busy pumping. That could have been me holding him or tying him on.
I know a lot of people have been reading our blog and wondering if they should induce lactation themselves. I'm glad that we did it, but if we had another baby, I doubt that either of us would do it again. It's been interesting and has had benefits, but inducing has risks and costs as well. If you are sure that you want to induce, think through those risks and costs before you start. Or decide that the costs are too great and spend some time thinking of all of the other ways that you can bond with your new baby and become a parent.


N said...

My biggest concern with inducing lactation (specifically for us) is that J has several issues that specifically indicate that she should not take the various medications used in the protocol. It makes me sad, but we're contemplating other ideas. Can I ask how well the supplemental nurser actually works?

Lex said...

Thanks for taking the time to break it down like this for us all. I'm so glad that it is working out so well; it really sounds like your results are the best-case scenario, and I've never heard of a lesbian couple being able to be quite this successful in sharing the nursing (aside from those couples who get pregnant and give birth simultaneously).

I was still lactating and nursing our 2-year-old when my wife gave birth to our new baby. I don't have an excess of milk at this point (though I'm guessing that pumping and taking herbs could increase my supply pretty decently since I started out with extreme oversupply), but I have enough that if I had to nurse the baby (i.e. if my wife was out at an appointment and the baby was unexpectedly hungry), I could tide him over with my milk. I'm not sure if I could fill in for a regular feeding on a regular basis, but at this point that's not our goal. Also, I am still nursing our toddler through the night (though trying to nightwean him a bit), so I can't help out with the nighttime feedings just yet, but that is a possibility for the future (since I am especially good at sleeping through nursing sessions with older babies).

What's been most important for me is having the ability to comfort nurse the new babe. I actually am more able to do this than my wife is, since she has so much milk (also extreme oversupply, what are the odds?) that our babe is often choking on her and won't nurse her if he's not really hungry. But he'll ALWAYS happily nurse on me. So sometimes when he's tired and fussing at her breast, I'll nurse him and he'll happily fall right to sleep. It feels really good to be able to comfort him so easily with my breasts, and I imagine that this will only become more significant as he gets older.

It's also really great for both of us to be able to spray milk on his bottom during diaper changes (since we think breastmilk is the best cure/prevention for diaper rash)!

I don't think either of us would ever choose to go through hormonal therapy to induce lactation, but I do think that IF we have any more babies, we will definitely continue to share in the comfort nursing department (and/or use a lact-aid with pumped milk).

That's also wonderful that you're able to donate milk; I always wanted to do that but without having a REASON to pump otherwise, never found the time to do it.

Angela V-C said...

Lex: thanks for the great comment, particularly the support of comfort nursing. Lyn comfort nursed our first and it was a really nice experience. I'd encourage all NGP's to do it -- dad's too!

N: The supplemental nurser is great, sort of. It is a terrific way to nurse and feed at the same time, but it can be very frustrating to use. Sometimes it can flow out too fast, sometimes the baby's fingers get all tangled in the tubing, sometimes I have difficulty getting the baby to latch using it. Overall, though, I would vote for trying it because there's no loss at all (except for about $50). You simply tape it on with the tubing going just past the tip of the nipple, get the baby to latch, then uncrimp the tubing so the milk can flow. My #1 advice is don't try to do it with baby on a nursing pillow like a boppy/breastfriend as that puts baby up too high (the nurser hangs between your boobs). Let me know if you have more Q and I'm happy to answer!

Lex said...

Angela-- Are you using the SNS or the Lact-aid? In my experience most people hugely prefer the Lact-aid because it works by vacuum (not gravity), so you can nurse lying down and don't have to worry about milk dripping out when the baby's not sucking (I wondered if maybe you were using the SNS because you mentioned crimping the tube).

For anyone else considering this (very worthwhile) option, I would definitely recommend the Lact-aid, and that you have more than one set-up if you plan to nurse the baby more than once a day (because cleaning them is a bit of a hassle).