Mai was born on 20th Dec 2008 at 42wks. It wasn’t a straightforward birth and as a result I was unable to hold her for a few hours. Right from the start we struggled with breastfeeding. Various midwives tried to help, by forcing Mai onto the breast but this left us both distressed. More than one midwife suggested nipple shields, which we used with mixed success, but then another midwife disagreed. This summed up our time in hospital - I was offered lots of mixed, sometimes conflicting, advice, and no one spent more than five minutes trying to help us. The midwives did not have enough time to spend with each mum, helping them to successful breastfeed. It was not the start I was hoping for.
One midwife mentioned expressing the colostrum and I did this on the first day and we then fed Mai this via a syringe, but no-one showed us how to use the pump or explained what to do. After a day or so we decided to give her some formula due to her becoming jaundiced, we knew from our NCT classes that her stomach would be so small that she would only need a tiny amount so we gave her 10ml. She was immediately alert and bright eyed. Had we been helped to express, we would have been able to give her breast milk which would have been even more effective at helping her to eliminate the cause of the jaundice.
Once home we continued trying to breastfeed with mixed success - Mai was on and off the breast, not always sucking for long. Mai was then weighed and had dropped to 7lb from her birth weight of 8lb 3oz. We even had to go out and buy tiny baby size clothes as the clothes which had fitted her in hospital were now too big for her. It was crushing.
The midwife advised topping up with formula to make sure Mai did not lose any more weight, as well as persevering with breastfeeding but it became too stressful for us and on the 27th December I bought a breast pump and started pumping that day. I got 40ml the first time and it was fascinating to watch the milk squirting out and collecting it in the bottle.
I’m not sure at what point, but I decided to stop breastfeeding and just pump or “exclusively pump” (EP’ing) as it’s known, although I didn’t know that at the time. Our health visitor kept telling me that I needed to get her back onto the breast, but after a week of EPing my mind was made up. This is what we were going to do. I found once I had made my decision the pressure from others to breastfeed ceased, however no information or advice about pumping was forthcoming. Logic told me this was possible as it is about supply and demand, the pump was creating the demand instead of a baby but for how long this would work I had no idea.
I was pumping six to seven times a day with lots of help from my husband, we were lucky as he had four weeks off which helped us adjust to pumping and fitting it into a routine. By the time he went back to work it was just part of what we did. Paul fed Mai in the morning, evening and night while I pumped, then during the day I managed to feed Mai with a bottle of expressed breast milk and pump at the same time. In addition we knew exactly how much milk Mai was feeding and how much I was producing. After her initial weight loss we found this important.
We had to top up with formula once a day for the first few months, the need to top-up is high for mothers who EP. I know now it was because I wasn’t pumping enough, babies feed on average two hourly for the first few weeks whereas I was only pumping three hourly and not at night. It is essential to pump during the night when pro-lactin, the hormone which is linked to milk supply, is highest; hence why babies feed at night; Mother Nature is a wonderful thing!
After a month or so I started looking into the subject of expressing and I bought a great book called “Exclusively expressing to feed your baby” by Stephanie Casemore, an American mum, who wrote the book from her experiences. I felt a huge relief and recognition and hope - there was a name for what we were doing and others were doing it too, had done it, and for over a year!
The majority of the information I found was on expressing in conjunction with rather than instead of breastfeeding, and what little I could find on this topic was mostly from American sites where pumping is extremely common due to maternity leave being only six weeks - so if mums want to continue breastfeeding they have to pump. What struck me most about my experience in this area is the lack of awareness, advice and support of pumping.
Being at home a lot with a new baby the internet was my saviour! I was an avid user of the website babycentre.co.uk and part of the December 2008 birth club, and it dawned on me that there must be others in similar situations so I set up a group - “Pumping Mummies”. There are now over 2700 pumping mummies since starting in February 2009 and is a place to find advice and support for those who pump whether it’s exclusively or in conjunction with breastfeeding or mixed feeding.
Some women pump because their babies have to be initially tube fed. If babies are in SCBU or premature often mums are encouraged to express but this is the only time that pumping is encouraged within the NHS.
Most women who EP fall into it when breastfeeding doesn’t work out but for others it can be an active decision as they don’t want to breastfeed but want to give their babies breast milk. EPing makes that possible.
I strongly believe health professionals should talk to mums-to-be and new mums about expressing. There should be a tiered level of advice, concentrating on encouraging and supporting breastfeeding whilst mentioning expressing as a feeding option. Also where mums are not keen to breastfeed or are having difficulties breastfeeding expressing should be discussed as an option before anything else as it is often left too late when women feel they have no other option than to give up breastfeeding. If mentioned at the right time many more babies would probably get breast milk for longer. All NHS hospitals should be following the NICE guidelines, which clearly state that all mothers should be taught how to hand-express their milk. If there are problems with the baby, mum should be supported to express by hand or pump and given information for storage and freezing of expressed milk. The NICE guidelines also state that formula milk should only be given if there is a sound medical reason for doing so. The fact that many midwives may not mention expressing to a struggling mum is probably because they haven’t read the guidelines! Breast milk regardless of how its fed is beneficial for babies and more mums may express if they realised it was a viable long term option.
My husband and our families have supported what we are doing and never suggested giving formula instead. I think it’s because everyone understands that breast is best but have never heard of EPing as an option, so it’s assumed that if you are not breastfeeding then you must be giving formula. EPing is the next best thing if breastfeeding doesn’t work out or a mum doesn’t want to breastfeed for whatever reason.
At around a year or so I noticed a gap in Mai’s top teeth and did a bit of online research and discovered she has a lip tie, this can be an indicator of tongue tie, a condition which affects the ability to latch onto the breast and also gives a high palate shape due to its formation in the womb. We took her to a private paediatric surgeon at around 18months and he confirmed she has a tongue tie and a lip tie. We decided on his advice that we would take no action as she was able to speak well and also able to stick her tongue out and he felt the risks of a general anaesthetic were greater than the benefits as it wasn’t any longer causing any issues and the likelihood that it would in the future was slim.
Tongue tie is the biggest reason for people finding themselves Eping long term, we try on the board to point people to get proper qualified breastfeeding support (not a HV or MW) or even an IBCLC, its too late for us but if it is caught soon enough it can mean saving a breastfeeding relationship and that’s why the board works so well, if we can help make others journey that bit easier through us having gone through it then its worth while.
For more information on pumping:
community.babycentre.co.uk/...
Born too soon group on Baby centre post specific to premature babies:
community.babycentre.co.uk/...
community.babycentre.co.uk/...
milkmatters.org.uk/2011/04/...
blog.nurturedchild.ca/index...
