When breast isn't best

During my second pregnancy I saw the slogans everywhere:

"BREAST IS BEST," was proclaimed on lanyards, posters, in newspapers, on blogs and in books.

I hadn't really noticed this with my first pregnancy. Back then I had every intention of fully breastfeeding. Formula wasn't even on my radar.

By my second pregnancy I knew better. I understood that the genetic lottery had dealt me a bad hand. My breasts don't produce enough milk, and what little there is comes out watery and slow.

We discovered the problem when my first daughter, L, was weighed three days after birth. She had lost 12% of her body weight; anything over 10% is cause for concern. Luckily we were in hospital to treat her jaundice, so I got help around the clock. Midwives observed as I breastfed. Our latch was good but L wasn't swallowing often - a sure sign there wasn't much to swallow.

We tracked her nappies. She often had urates in them - bright orange streaks that meant she wasn't getting enough to drink.

Still, I was determined that L wasn't touching formula. I had read too many negative things about it to give up so easily.

The midwives were worried enough to call in a lactation consultant and she wrote up a plan: Breastfeed every three hours, time how long the feeds are, express in between feeds, eat muesli bars and take Domperidone (a pill that is supposed to boost supply). I also took a natural supplement called Lactation AOK that my husband picked up from the health store.

Nothing worked.

20 minutes of expressing produced about 10mls of milk, but I kept it up in the vain hope it would stimulate my supply. Instead it turned me into a hysterical wreck.

I didn't sleep. There was no time to.

I was so wound up and I couldn't drift off knowing I only had a half hour window before the next feed. Hospital staff brought me ear plugs and an eye mask since I was in a shared room, but I still didn't sleep. They wondered if that was the problem with my supply, so as soon as a private room came free I was transferred into it. I still couldn't sleep.

It had been five days and I was so wired a doctor prescribed me a sleeping tablet. What a relief it was to finally switch off.

By day seven L's bilirubin (jaundice) levels had dropped to a safe level, thanks to a week of sleeping in a UV bed.

L sleeping in a UV bed to treat jaundice.

Her paediatrician asked us to stay one more night with L sleeping in a normal bed, to make sure her levels didn't spike again. They didn't, so we were set to go home.

However, her weight still wasn't going up and I finally decided to introduce formula. This was eight days after birth.

A midwife showed us how to give it to her using a lactaid, so I could breastfeed her at the same time. The milk was siphoned out of a bottle through a little straw that I slipped into L's mouth before latching her onto my nipple.

Trying out the lactaid for the first time.

Our hope was that as soon as she felt the formula coming in from the lactaid, she would suck more strongly and this would stimulate my breasts to produce more. L wolfed the milk down, finally getting a full tummy for the first time in her life.

We hoped to see improvement in my milk supply at home, where I would be more relaxed and able to sleep. Unfortunately that wasn't the case.

L gained weight quickly on the formula, but we had difficulty using the lactaid and in our second day at home we couldn't get her to drink from it at all. I was still breastfeeding each feed, and we wondered if she was resisting the lactaid because she was getting enough from me. Her next weigh-in with the midwife showed she had lost all the weight she had gained on day one at home. Obviously she wasn't getting much from me at all.

L getting weighed at home.

After faffing with the lactaid for a few days we gave up. It was the middle of the night and we had spent 45 minutes trying to get it in her mouth at the right angle along with my nipple. I had called Paul in to help because I couldn't get it in on my own. We decided to try a bottle instead and L downed the whole thing in less than 5 minutes.

Decision made. We scrapped the lactaid and used a bottle from then on in. I would start a feed by breastfeeding, and then switch to a bottle to finish off.

This lasted till L was almost four months old, at which point she realised the breast wasn't worth her time and refused to take it any more. She's been bottle feeding ever since and has been as healthy as a horse. All my worrying about the dangers of formula seem to have been for nothing.

Fast-forward a year to pregnancy number two.

We moved cities while I was newly pregnant with our second daughter, S, so I signed up with a new set of midwives. They didn't know my history with L and I had to try and explain that my breasts aren't wired right. It was difficult to convince them.

Most people assume that anyone can breastfeed, that it's just a matter of feeding and feeding and feeding to signal to your body it needs to produce more.

Part of me hoped it would be different the second time around, but I was prepared to give S formula if it wasn't.

We found that things were slightly better because she feeds strongly and didn't have jaundice to make her sleepy like L did. Sometimes I would express as much as 20mls - twice what I had with L but still not enough.

S is an unusually hungry baby and I definitely wasn't making enough to satisfy her. We gave her formula after just 24 hours, while we were still in hospital. And then gave her more an hour later because even that wasn't enough to satisfy her. By a few days old she was downing 50mls of formula and that quickly increased to 100mls, then 150mls.

No surprise, with all her feeding, at her eight-week weigh-in S measured in the 98th percentile for height, and the 91st percentile for weight and head circumference.

It's been so relaxing this time around as we haven't had to desperately time feeds and track nappies. I breastfeed S first thing in the morning, lying next to her in bed. Then she has a bottle and nappy change and goes back to sleep.

Snuggling up in bed with S.

I've been more focused on getting her into a good sleeping pattern, so at some feeds she just gets a bottle and goes back to bed. If she's looking sleepy and a breastfeed is going to overstimulate her, I don't bother with it. However, if nothing but the breast will comfort and settle her, I'm still able to offer her that too. It's the best of both worlds.

One of my midwives is a lactation consultant, so she has loaned me the manual attachment to my Medela Symphony breast pump. That allows me to express at times to help keep my supply up. I haven't been strict about using it. I just try to fit it in where I can. I made the decision that I'm not going to kill myself trying to boost supply from 10-15mls. It's just not worth it.

I think S is better off having a happy mother than those extra 5mls of breast milk.

The nice thing about formula is you only have to give it four-hourly, instead of three-hourly like breastfeeding. This makes life a whole lot easier. If S is up for one hour and settles straight away, I still get a three hour rest before her next feed. And if I'm desperate for a sleep, Paul can give S her bottle. I'm not indispensable to the process!

A satisfied S sleeping in her bassinet.

On an emotional level, it does upset me that I can't produce enough. I often struggle with feeling less womanly, less of a mother. Sometimes I wonder if I should even be a mother, since I can't feed my babies the way I'm supposed to, the way the posters tell me I should.

But then I look at my girls and see that they are healthy, happy, lovely, content and I think, what does it really matter? In their case, formula has been best. At least they have been fed!