Wednesday, April 11, 2012

Got Milk? The Link Between Breastfeeding Difficulties and Infertility

Let me start out by saying, breastfeeding is not easy. In fact, let me take that statement a step further and say that it is downright hard. I liken it to trying to learn a complicated waltz with a partner you’ve never met before, when you yourself have never danced before. Initially things are clumsy and frustrating…even painful at times. But slowly, both partners start to get the hang of it and it becomes easier and more rewarding. Before you know it, though it is still work, you find that you're enjoying yourselves. For Ian and I, it took us about three months to really get our “dance steps” down. I know lactation consultants tell people that it can take two weeks to get the hang of breastfeeding (BF), but I think that's an optimistic estimate.

Because Ian was born prematurely, he wasn't able to really latch and suck for a long time. I started pumping within hours of his birth and had such an amazing supply, we actually discussed the possibility of me donating breast milk. Then I took Ian home and, over time, his appetite increased. The problem was, the more he ate, the less I produced. Slowly, the frozen stockpile I had accumulated while he was in the NICU dwindled down to a single vial of 2.5 ounces of milk...that's half of one meal for Ian. I felt like a failure. I worked with the doula, increased my water intake, drank disgusting mother's milk tea, ate oatmeal until I wanted to puke, and meditated while pumping. Nothing worked. I can’t tell you how many tears I shed, or the number of hours I spent awake in bed worrying because there was only one bottle of milk in the fridge for Ian.

I decided to look into what research, if any, had been performed on women having trouble with milk supply, so that I could “fix” the problem. While asking Dr. Google my questions, I stumbled across references to research showing that women who used ART to achieve pregnancy were more likely to have breastfeeding problems. One of my close IF friends had also mentioned to me that she was having milk supply issues and that she had been told that there could be a hormonal connection between IF and decreased milk supply. At that point, my interest was piqued and I started focusing on the IF-BF connection.

My online research turned up some speculation from the medical community that the same hormone problems that cause female-factor infertility can also cause difficulty with lactation (specifically, there appears to be a link between problems with breast milk supply and PCOS, possibly attributable to increased adrogen or estrogen levels). But I could find no actual study defining such a link. It makes sense to me that there could be a physical link and I hope that the issue will be researched further by those far smarter than I.

The only “actual” study I could find addressed the emotional/mental causes of lactation problems after ART. That study, a 150 subject Australian study, showed that there is a link between difficulties with BF and women who have undergone infertility treatments. Specifically, that study found that the link seemed to be explained by psychological factors. The researchers found that women who conceive through ART often have less confidence in their ability to care for their newborns and have greater levels of anxiety when compared to women who conceive naturally. The researchers found that the lack of confidence in mothering skills, anxiety and feelings of guilt bleed over into breastfeeding. The study showed that women who undergo IF treatments are less likely to try, or continue, to breastfeed. And those who do try are more likely to report milk supply problems.

It makes sense in a way. Anyone who has ever breastfed, or tried to breastfeed, will tell you that there is a definite mental/emotional component to breastfeeding. For me personally, I have to close my eyes, take a deep breath and think about my milk flowing down in order to get “let down.” If I'm stressed or upset about something, Ian will get frustrated because I just can't get the milk to him. So, I have no doubt that emotional and mental perceptions effect BF.

I also know from experience that IF has a significant impact on confidence. Prior to writing this post, I though that I had not experienced a lack of confidence in my mothering skills (I happen to think I'm a really good far)...but I forgot about how I felt when I was struggling with my milk supply. When my supply started to dwindle, I absolutely panicked and overreacted to the situation. Ian was not going to die if my milk supply stayed sucky. We just would have had to supplement with formula. Not my ideal, but not the end of the world. If I truly am honest with myself, I think my extreme level of stress and anxiety when my supply started to go down was a result of my residual fear that my body will fail me (and Ian). I learned to stop trusting my body during IF. Perhaps I haven't been able to build that trust back up. At the first sign of my body faltering, I jumped right to the conclusion that I was heading for a catastrophic failure. And I'm betting I'm not alone in that feeling. Once that ball starts rolling, the usual suspects follow...frustration, guilt, anger. All of the emotions that will further inhibit BF creep in and before you know it, you are in a vicious cycle of milk supply decreasing due to stress, which causes more stress, which causes more supply problems, etc. etc. etc.

Please understand, I am NOT saying that if you have used ART to get pregnant, you are going to have breastfeeding problems. I don't even think the researchers mentioned above would argue that is the case. Lots of women report that they have problems with BF after their doctor tells them they will have problems breastfeeding. It's a self-fulfilling negative prophecy of sorts. So to be clear...I am not saying any of you will definitely have BF issues. I don't think IF or ART is a direct cause of BF problems across the board. Rather, I think the baggage that us former IF'ers sometimes pick up during our journey (and never put down) CAN cause breastfeeding problems...and that's worth acknowledging and examining. So for those of you out there struggling with your supply, please know that you are not alone and it is not your fault that you are having a tough time. There's a bunch of us in this together and I am sure we will all be there to support one another through this obstacle, just as we supported each other through IF.

(P.S. For anyone who is interested, I wanted to let you know that I have really improved my milk supply by taking the prescription Reglan. It is an acid reflux medication that, for some reason, has the side effect of causing increased lactation. My OB said it doesn't always work for everyone, but it has worked extremely well for me. It has no known negative effects on the baby, so if you get to the point where you are really might be worth asking your doctor about that option).


DandelionBreeze... aka NYMum said...

Breastfeeding is so so hard... and no-one ever really warns us about that before our little ones arrive. You're so right - "there is a definite mental/emotional component to breastfeeding." and confidence is a huge issue too. So glad that your supply has picked up. I had trouble in the start then was about to breastfeed until our daughter was 12 months... hard work but so glad I did it, now that I look back. Love always xo

Anonymous said...

I had a lot of trouble breastfeeding my first. We didn't find out until months later, but she is tongue tied. I remember being up one night for one of her many feeding and completely breaking down from pain and discouragement. It was after that breakdown that things finally turned around for us, just a week later and I was completely pain free, and our nursing schedule started to seem much less intense. I think sometimes we need to just have the mental breakdown in order to get passed our hurdles in life.

Congrats on getting your milk supply back up, and you rock for working so hard to give your little man the best life possible

Molly W. (infertilemommy) said...

I feel very blessed that breastfeeding was "easy" for me and my miracle (who took 4 years to conceive) but I know numerous friends who had supply issues after IF so I found this very interesting. I also want to tell you "way to go" for sticking with it and getting your supply back. I hope from here on out BF is enjoyable and easier for you :)

Lindsey said...

I love your insights into things! I think you probably hit the nail on the head regarding the link between BF issues and IF being our lost confidence in our bodies. I know I feel that way almost every day about pregnancy... I'm working on it but I think this post will help me go into BF with more of a positive "I can do it!" attitude.

Tippy said...

Very interesting post! I completely get what you are saying and can imagine that the reduced confidence in our bodies could correlate to some difficulty breast feeding. I just took a breastfeeding class and am excited about it, but trying to remain realistic. We are due in 10 weeks with twins from donor eggs and I really hope that we can exclusively breast feed for the first 6 months. But in the end, if we have to use formula, it's not a big deal. Thanks for sharing your thoughts

Christina said...

Everything about this makes sense. The hormonal imbalances that tend to be the cause of IF will impact lactation and therefore breastfeeding. Studies have shown that even in healthy non-IF women, milk production dips prior to ovulation due to all that extra estrogen.

And the self-esteem/confidence aspect- heck-freaking-yeah. I haven't had any true difficulties with feeding, but my output is just a tiny bit above her demand. I have 20oz in the freezer and half an extra bottle in the fridge on a good day. When I start to freak that I won't have enough to feed Em, my output that day(s) is several ounces less. The mindset of "Any breastmilk I can provide is great" works so much better!

You can do it! You are a great mom and if you can overcome all those other obstacles to get here, you can keep moving forward now as well!

Danni Brewer said...

Breastfeeding is so very hard. And that's what pushed me to persue a career that can help new mothers reach their breastfeeding goals successfully. If anyone ever needs some support I am a lactation counselor on the Gold Coast, Queensland. I have just started up my facebook page. Feel free to add me. I also offer postpartum support as I am a student postpartum doula :)

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