As we prepared for Ethan’s arrival I started to get excited about breastfeeding. I was committed to raising our baby “green”. I went out and purchased nursing bras, went to a breastfeeding class and paid ahead of time to have a lactation consultant come support me in our home after his birth. I had heard of the challenge of breastfeeding from many moms  and wanted to be prepared ahead of time.  Finally on August 3, 2008, 10 days late, Ethan Paul Dumouchel, 8lbs 8 oz, arrived after a 13 ½ hr, unmedicated labour, with the support of our doula and Obstetrician. I remember that as soon as they put him on my chest, I felt such relief as I observed his perfect little face and ten fingers and toes. He was perfect and beautiful. His APGAR scores were awesome and they took us to our room right away. Through the night I tried nursing him several times as he woke up hungry to be fed. It was a holiday weekend and so the hospital lactation consultant was unavailable. We got Ethan to latch a few times but every time we would hear large “clucking” sounds and then he would fall off. I felt so frustrated as I listened to him scream. I thought the problem was that my breast was too large for his little mouth. I satisfied him as best I could by squeezing colostrum into his mouth. Matt, my husband and I had decided ahead of time that no formula was to be given to our baby and that we would spend as little time as possible in the hospital so we were eager to be discharged.  I remember the next morning as clear as day in my mind. I don’t think I will ever forget the words of the pediatrician who came to check him over in preparation to discharge us. “Did anyone tell you about his mouth?”, he asked. What we learned next was that Ethan was born with a cleft in his soft palate. This was the reason for the clucking sounds while breastfeeding; Ethan could not get a good seal while breastfeeding with a hole in the roof of his mouth; . I remember the horror that I felt as I listened to the doctor. Seeing my distress he quickly reassured me that it was “the best kind of cleft to have” because of how small it was. At the time neither Matt nor I knew what a cleft palate would mean for us or for Ethan. They discharged us after setting us up with an appointment with the “Cleft Palate Team” a few days later. The nurse was reluctant but I assured her that the lactation consultant that I had hired would be coming to the house that day to help me. My lactation consultant was wonderful. She got Ethan on my breast right away and although I felt him sucking, it wasn’t very hard and he would quickly fall asleep only to pull away screaming full of air a few moments later. She constantly reassured me that “all babies can breastfeed”. After the first night however, it was clear that it wasn’t working. My lactation consultant suggested nipple shields, whichseemed to do the trick in terms of getting Ethan to latch. He still seemed to struggle with gas from swallowing so much air through his cleft. After weighing him two days after birth, it was evident that Ethan wasn’t getting enough sucking on me. I began pumping and syringe feeding him. I would put him to breast first and let him suck for as long as he wanted and then I would syringe feed him. The “cleft palate team” came on the Thursday, four days after Ethan was born. I remember the words of the feeding specialist very clearly. “Only 1% of babies with a cleft palate successfully breastfeed. I am sorry you won’t be able to breastfeed your son. Does that make you feel disappointed?” To me her words were like a shotgun to my heart. One part of me immediately disliked her and wanted to prove her horribly wrong. The other part of me wanted to succumb to the disappointment and accept what she was saying and move on. I couldn’t even respond to her, I just stood and cried. I remember nothing else that she said that day. I couldn’t bring myself to look at the literature that they provided or to talk about surgeries etc, for weeks after. They gave us a bottle called a Haberman feeder which allows a baby to eat without sucking. I had been determined to avoid giving our baby a bottle for fear that he would prefer it over my breast. My lactation consultant told me that everything that was happening with Ethan was normal for a baby with a cleft palate and that she had helped many moms to successfully breastfeed post surgery if they kept offering the breast every time. I found it really hard to believe. I continued to pump and syringe feed every two hours until Ethan was about 10 days old. He hadn’t pooped since he was born and I was worried that he just wasn’t getting enough. I finally caved and gave him the bottle. It took Ethan thirty minutes to finish a bottle and he immediately pooped. We continued with this trend of giving him the bottle after offering him the breast. My lactation consultant kept encouraging me that we would be that 1% and that babies will always prefer the breast.

Ethan’s weight gain was slow and both the Cleft Palate Team (CPT)and some of the doctors discouraged my desire to breastfeed prior to bottle feeding at every turn. I felt as though they thought I was a bad mother for wanting to breastfeed. The feeding specialist from the CPT kept encouraging me to quit. When Ethan was six weeks he returned to his birth weight. I learned later that, whether breastfed or bottle fed, it’s normal for a baby with a cleft palate to have extremely slow weight gain and that it is common for them to not return to their birth weight until six weeks. I continued to encounter many challenges along the way. At nine weeks my milk supply dropped drastically down to nothing. A combination of exclusive pumping, PCOS and stress over Ethan’s slow weight gain forced us to have to supplement with organic formula. The first time we gave Ethan formula I cried. I felt like such a failure. Not only could I not successfully breastfeed our baby “normally”, I could not make enough milk for him. I tried everything and anything that I could. I tried Domperidone, Blessed Thistle and Fenugreek. I also took Goat’s Rue an herb tincture specially formulated for women with PCOS who are breastfeeding . It was shortly after this that my milk supply came back up a bit. Ethan began taking more and more formula and at three months his weight finally took off and started to catch up with other babies. During this time Ethan went on countless nursing strikes as he learned very quickly that the bottle was the easier way to get food. Each time my lactation consultant promised me that Ethan would come back to breast and he always did. I was determined to not let him forget how to latch. As much as I wanted to believe that someday, if I kept going, Ethan would breastfeed like a normal baby, it was a constant battle in my mind. It was that hope and desire that made me keep going every time I wanted to quit and just give him the bottle.  I tried not to take it personally when Ethan would reject the breast but I would often cry in frustration.  All along the way I struggled with blocked ducts, and sore, nipples from pumping. Every time I thought about stopping, my husband and my lactation consultant would encourage me on. When Ethan had finally started to catch up with his weight we introduced a supplementary nursing system (SNS). It was messy and awkward and most days Ethan wanted nothing to do with it, but it convinced him to come back to breast after one of the longest nursing strikes that we had ever had. It had been three weeks and he happily sucked away with his new gratification. I continued pumping and using the nipple shields, SNS and Haberman until Ethan was almost ten months old. At this point Ethan had surgery to repair his cleft palate. I pumped while he was in the hospital and sippy cup fed him after his surgery for about a week. In an effort to prevent him from doing too much sucking after his surgery I used the SNS, squeezing the milk into his mouth and offered the breast. He took to it immediately and refused to use the sippy cup. After three weeks the surgeon informed us that his mouth was healing nicely and he could now suck I pulled out the SNS and let Ethan suck away. The first time I felt Ethan suck on the nipple shield after his surgery I cried. I had no idea what a normal suck was supposed to feel like. I was amazed. Ethan had surgery May 25, 2009. For the entire month of June, I began cutting away pieces of the side of the nipple shield and then finally started to cut away pieces of the nipple. Every time I tried to offer my nipple without the shield Ethan would freak out. Finally on July 7, 2009 when Ethan was eleven months old, I slipped the nipple shield off when he wasn’t looking and he latched on and sucked away happily. It was at this moment that I breastfed my baby normally for the first time. I cried. I had known that I was always meant to breastfeed our child but I had doubts that it would ever happen.  Hope is a powerful motivator; it kept me going when I thought I had nothing left.

Today, Ethan is a happy, healthy, beautiful, fifteen month old. I nurse him anywhere from 3 to 4 times a day around my part-time teaching schedule. I plan to continue nursing until he is ready to quit. One of the complications of a cleft palate is malfunctioning Eustachian tubes. As such Ethan has tubes in his ears and will need to have them until the soft palate muscle allows the Eustachian tubes to function on their own. Until this time he is prone to ear infections. Breastfeeding as long as we have has helped us to be ear infection. I have never been so proud of anything that I have ever accomplished in my life as I have in the fact that Ethan and I did not give up. I feel joy and happiness every time I breastfeed my son. I am so eternally grateful for what we have accomplished and so proud of Ethan for how far he has come. I never would have breastfed my son if it hadn’t been for my lactation consultant and my wonderfully supportive husband. I now truly believe that “all babies were meant to breastfeed.”

This article in a slightly abridged form first appeared in Nurture magazine’s Winter edition 2009. It’s taken a long time to write (4 + years!) and was hard to be honest, due to the emotions I experienced being unable to breastfeed my daughter the ‘traditional’ way. I hope this is of interest to someone, and may even inspire someone else to do similar. Breast Milk is a baby’s birth right. While I have nothing but sympathy for women unable to breastfeed, and would never ‘blame’ anyone for feeling exclusive expressing is too difficult-I also want to reassure some for whom exclusive expressing may be an option that it is very worthwhile and while not easy at times, very rewarding and perhaps, less difficult than some might imagine.

Warning-this is LONG!!

Just as I was due to give birth to my second child, my first born was aged 3 years and 8 months-and was still breastfeeding morning and night. Liam and I had weathered the trials of the early days of breastfeeding together, and had come out victorious. The fact that I was still breastfeeding, with no plans to wean him at almost age 4 is due to my belief in the benefits of breast milk for toddlers and older children. It’s safe to say I was and am quite a lactavist. And it puzzled me why others didn’t always feel the same way. Sure breastfeeding was sometimes hard-but ultimately rewarding. I had little understanding about the reasons why some women couldn’t breast-feed-really there wasn’t all that much to it was there?

So while I was anxious about other issues surrounding the imminent birth and arrival of my daughter, breastfeeding her wasn’t something I anticipated having any problem with at all. In the early hours following her birth, she suckled a few times half heartedly, but soon gave up. A highly alert baby from the very second her head pushed out into the world, Sienna seemed more interested in observing those around her than in feeding. So the fact she didn’t seem to feed nor attach properly for several hours didn’t concern either the midwives or me. She was probably both tired from a difficult labour, and not all that interested.

Eventually though, hunger go the better of her, and her interest in feeding was piqued by the juicy colostrum on offer. She still couldn’t seem to get a proper ‘grip’ and after a few minutes gave up. I still wasn’t concerned-after all it had taken weeks for Liam to learn to attach. However, a maternity ward nurse noticed something that had pretty much not even crossed my radar yet-the fact that milk was coming out of Sienna’s nose. She informed me she was just taking my baby off for a couple of minutes to examine her, and would bring her back very soon.

Of course, this immediately set alarm bells ringing. I tried to stay calm-but internally I was panicking-why would they take her away like that? I’d had one baby already, I knew that wasn’t usual. The negative voices in my head battled with the voices of reason, alternately screaming ‘something is very wrong!’ and ‘It’s nothing, she’s probably just checking for jaundice or something else normal like that’. When Sienna was returned 5 or so minutes later, by the nurse, the panic levels had risen a notch or 10. However the nurse was matter of fact. “Sorry to worry you, your daughter is fine-but I just needed to check something I suspected-and it turns out I was right. Your baby has a cleft palate-she has a hole in the roof of her mouth. It’s ok, it’s easily fixed these days by surgery. But she isn’t able to get the vacuum seal required to breast feed, so she’ll need to be bottle fed. We’ll go get the equipment and show you”.

I was gobsmacked. In 5 short minutes the relatively uncomplicated existence I had foreseen bonding with my newborn baby, snuggling up in bed to breastfeed and getting to know each other had forever been altered by the utterance of those 6 words ‘she’ll have to be bottle-fed’. Just like that-so matter of fact, and yet so devastating. I thought stupidly, “But I’m a passionate breast feeder! I can’t bottle feed!” It seemed inconceivable. I knew at the back of my mind I ought to be grateful it was nothing too bad- this thing after all could be fixed. I knew nothing about clefts, and the fear and uncertainty about the whole medical side of that especially the idea of my baby facing surgery would come later. At that moment however, all I could think was that they were wrong-I refused to bottle feed, that’s not who I am!

After a few minutes discussion with the hospital staff however, I soon realised that if I wanted my baby to thrive it was in fact going to be necessary to bottle feed her. Babies with cleft palates usually cannot attach to breastfeed, because due to the air escaping out the top of their mouth where the cleft is, they are unable to form the airtight seal required to form the action. So really there was only one thing to say; “Ok then. I need a breast pump”. Because I had functioning, lactating breasts-and as long as I had functioning boobies, my baby would have breast milk. I gave strict instructions that absolutely NO formula was to pass her lips. I think my expression and general demeanour was such that no one in that room dared to argue! Instead, a lactation consultant armed with blue hospital issue Medela pump was despatched to my room immediately, and so began the process of learning to express full time for my newborn daughter.

Sitting in the nursery every couple of hours (when the portable pump wasn’t available) attached to a pump that looked like something out of a 1800s steam train engine, trying to stimulate the let down reflex in such a completely artificial environment and manner was a surreal experience. I am sure the nurses thought me odd insisting on having Sienna in her plastic cradle next to me at all times, rather than lined up with all the other nursery babies. Aside from wanting her close because I am an attached parent, having her to look at, and imagine she was really suckling at my breast (rather than the sterile, inanimate pump) was the best way to stimulate letdown. During these first few hours and days I felt sadness creep in at times, but I was determined not to let it take over. I just couldn’t afford to feel that too much; to allow this to defeat my resolve to feed my child exclusive breast milk, as I believed was her birthright. I was so lucky to have lovely supportive midwives and a lactation consultant (LC) to help me at this time. During the first day of expressing, they brought the pump to me for every feed, because I’d had a post partum haemorrhage requiring blood transfusion and couldn’t get out of bed. The LC spent hours with me, and gave me a calendar from her office with a picture of the Italian town Siena on it, because of my daughter’s name. Small kindnesses like this made it much easier to cope with the challenges of full time pumping. Friends, family and my independent midwife came and visited and brought me information printed from the internet about cleft palates and breastfeeding. They said it was OK to be sad I couldn’t breastfeed her. But I buried that feeling down deep, because I didn’t want to feel it. I was completely scared of falling in a heap and succumbing again to post natal depression as I had in the weeks after my son was born. I just had to make this work-it was as simple as that.

After coming home from the hospital my milk came in full force, and I was expressing at least 250 mls per breast each time. This was immensely satisfying. Despite the annoyance factor of having to get out the pump, wash and sterilise bottles instead of just putting my newborn on the breast I loved watching that gorgeous white-yellow milk flow into the bottles. I loved stocking the fridge up with bottles, and I loved bottle-feeding my baby staring into her eyes, in my arms or in the sling, just as if I were breastfeeding. I was fortunate to have a lovely Maternal and Child Health Nurse (MCHN) and LC from the local Maternal and Child Health Clinic come out, who were fully supportive, even pro attachment parenting and gave me loads of praise and encouragement to keep going with the expressing. The only dodgy bit of advice I ever received was from a hospital midwife on a home visit, who told me I was producing too much milk-she said my body ‘thought it was feeding twins’ and advised me to increase the amount of time in between expressings. Just as stupidly, I followed this advice. Of course my supply diminished, and I cursed myself for listening. As a result, I had to go onto galactagogues such as fenugreek, oats, Motilium and the occasional Guinness sooner to build up my supply. When full time expressing, it is good for your body to produce more in the early days, because you can freeze it and stockpile for later when the supply will naturally drop. To keep milk supply up, not only must you feed every 2-3 hours or so, but the actual action of the baby sucking works to promote and stimulate supply. Of course you don’t get that when expressing. And it’s very hard to keep up expressing every 2 hours over a long period of time. You just…get over it. And your boobs hurt.

I would sometimes curse that I had to get up to express during the night. I co-slept so by rights I should have only had to turn over and let Sienna attach. I’d gotten up to my first baby who slept in a bassinet in my room for the first few months, and experienced massive sleep deprivation as a result. I’d looked forward to full time co sleeping from birth with my second child, and felt ripped off that even as a co-sleeper, to feed her necessitated getting out of bed. Likewise I cursed the fact that the days of grabbing the baby, a couple of nappies and a change of clothes and rushing out the door were gone. Going out sometimes required the planning and logistics of a military operation. Bottles? Check. EBM? Check. Cooler bag for EBM? Check. Breast pump? Check? Bottle warmer? Check. Extra bottles…and so on. I am most definitely NOT an organised, routine oriented type person! I found this aspect extremely challenging.

It wasn’t all bad however. In some ways it gave me more freedom-I could leave Sienna with her dad or my Mum and have some time to myself-to work, study or just relax. I found other ways to form a bond with my baby, such as baby-wearing and skin to skin contacts. The sadness never left completely but it faded-and was largely replaced with gratitude for her health. Sienna was exclusively breast milk fed for one week short of 7 months. At which point she began eating solids, and a week later, some formula was necessary. At 12 months of age in addition to food, she was drinking a ratio of around 80% breast milk and 20% formula. At 15 months it was around 60% breast milk, 40% cow’s milk. And at 20 month it was 30% breast milk and 70% cow’s milk. I expressed until she was 21 months of age, and was getting a pathetic 15-20 mls. I then decided it was time to stop. I had wanted to reach 2 years-but at that point there didn’t seem much point continuing for such a paltry amount. Not to mention I was OVER it. If I never saw another breast pump in my life, it’d be too soon!!

The benefits to Sienna’s heath were obvious when after having the surgery to fix her palate, the nurses all commented that her recovery was one of the fastest they’d ever seen. I just smiled and said ‘Breast milk ‘! And knowing she had that foundation for a healthy gut allows me to worry less that now as a fussy 4 year old her diet is often less than optimal! Being unable to breastfeed also gave me insight and increased compassion to those mothers who are unable to breast feed. Inability to breastfeed when you really want to is a kind of emotional torture. Giving formula when you know it’s not the optimal food, but you have no other choice hurts. It insidiously worms its way into your inbuilt mother-guilt gene, and taunts you with feelings of failure, self doubt, and inadequacy. I will never again judge (even unthinkingly) anyone who tried their best to breastfeed but wasn’t able to. I am not the first and won’t be the last to solely express for my baby. I was so proud and grateful though that I was able to do this for my child. As parents often we find we need to extend our parenting, in ways we hadn’t ever imagined we would. This was the first way I did this for my daughter.

Jayne is the author of Spiralmumma and the woman behind the Australian-based online attachment parenting community, Alternative Baby. You can read Jayne’s story about breastfeeding her first child, Liam, right here on ibreastfed.com.

Liam was fed with a nasal tube for the first 3 days of his life – mostly with formula. I gave him everything I could – seemed like I was expressing every hour – and by the time I was ready to go home with him (after 5 days) we were giving him mostly ebm.

Once we got home I realised that no-one in my town could hire me a breast pump and went into full panic mode. My local hospital let me go & use their pump for the first day, but then I rang my ‘local’ breastfeeding association contact (40 minutes away) who hired me a pump that afternoon. I was then pumping every 2 hours.

I was very lucky that both me and my husband was home full-time to care for our son.  He fed him my expressed milk while I pumped out the next lot. It seemed a never-ending circle with lots of clean-up and mess. I knew it was worth it though as he would need an operation around 10 months of age and I knew the EBM would help him recover.

I went on 2 courses of medication to help my milk flow (as well as every natural remedy I could think of!) but after reading how in can increase your risk of breast cancer, I stopped the medications. I’m already in a high risk category as my Mother and Aunty both died of the disease and my grandmother had it too (both sides of the family). Of all the remedies – the Aktavite milkshake was the best!  Yum!

After 2 1/2 months, I knew I couldn’t keep going much longer. I was only just getting enough for him and we were beginning to need to top up with formula. I felt really defeated and miserable, but I knew I had done what I could. I began to wind the expressing down (didn’t want an infection setting in). After 3 months I stopped altogether. I was very sad to do so, but relieved too as it was wearing me out and I felt like I was missing out on my son because I would have to ‘opt-out’ of caring for him up to 10 times a day to express.  I felt very helpless.

I am very lucky to have such a great husband who helped me every step of the way.