I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance. I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave (neither of which my group has or supports). Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns. This is their option. Unfortunately, the women physicians in our group are not afforded that same luxury. There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs. During this time, we are not paid. State disability is a joke bc it’s not even enough to cover a mortgage payment. Look at other large companies, there’s often paid leave or sick leave available to the employees. Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay ridiculously high premiums to cover the wide age gap of partners in our practice. I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Breastfeeding is hard. The first week after Arden was born was a really rough one — lack of sleep, whole new routine/schedule, physical pain, soreness, learning new parenting skills, etc. It took a while for my milk to come in… almost a week for me. Once it did, it wasn’t much. So my pediatrician recommended that we start supplementing with formula as Arden had lost 10% of her birth weight. This made me so sad as I was committed and ready to exclusively breast feed. But, my body was not ready. So, I continued breastfeeding her every 3 hours (we set alarms to make sure I was on time) while also supplementing her with 2 oz. of Enfamil Premium Newborn. I started going to a breastfeeding support group which is so wonderful because it connects mothers with other mothers and helps us all troubleshoot our breastfeeding challenges. It’s interesting to hear other moms speak of their troubles because everyone seems to have different questions at various points in their baby’s life. After doing a week of formula supplementation, I went back to the pediatrician and Arden not only met her birth weight but also gained some as well. This made me feel better as a mom because she was getting the nutrition she needed despite my best efforts at breastfeeding. But, I wasn’t giving up on the boob. The more I searched the internet and asked at our breastfeeding support group, the more I learned and started brainstorming to see if I could get my body to produce more breastmilk.
Breastfeeding 10 minutes on each breast every 3 hours (starting from the initial feed, not at the end of the feed). Nipples were extremely sore. Arden had a great latch and would suckle vigorously. I even considered a nipple shield for pain. I used breastmilk and lanolin around the nipple after each feed. This was the most painful week.
I started experimenting with pumping as there was one day where my nipples were too sore to allow Arden to breastfeed. I still went every 3 hours on the breast pump (Medela In-Style Advanced). After 1 day of pumping, I revisited trying to breastfeed her and my nipples felt better. I read somewhere that I should try and pump at the halfway point of my breastfeeding times. So, I would pump 1.5 hours after I started breastfeeding. This helped increase my milk supply. I went from doing 0.5 oz per breast to 1oz per breast. I think this more closely mimics a cluster feed and helps the body adapt to feed a hungry baby. Halfway through week 2, Arden started doing 15 minutes at each breast. I would often see milk in and around her mouth, so I know she was getting some breast milk. The biggest trouble was getting her to stay awake at the breast. Burping her and changing her diaper helped wake her up for the 2nd breast. Towards the end of the week, Arden started only taking one breast at each feed. She would pass out at the breast and even when we tried burping her and changing her diaper, she was satisfied enough that she did not want the second breast. This was a new behavior and I’m not sure what to do. So, I would pump the second breast…and then start her on that pumped breast at the next feed.
One of the days, Arden fed 12 times in a day. My nipples were incredibly sore from the constant feeding. I called three different local board certified lactation consultants to help — currently scheduling when that will be.
1) Undress Arden down to diaper to feed and feed every 3 hours or sooner if she cues.
2) Use Breastfriend pillow to get her to nipple height. Turn her tummy to tummy. Firm up nipple. Touch top lip, wait for wide open mouth and bring her to you quickly. (RAM = rapid arm movement).
3) Stimulate breast (5 o’clock position) for squirt to wake her at breast. Feed effectively for goal 15 minutes (ok 10-15 min) on one breast.
4) Burp her in front position. Change her diaper. Then offer second breast for 10-15 minutes (goal 15 minutes).
5) Handoff to help when available —> Supplement with previously pumped breast milk first, then formula to meet goal of 2.75oz (full feed goal).
6) Pump while help in supplementing her. Do 15 minutes of pumping both breasts simultaneously directly after breastfeeding (or after supplementing if no help available). Every 5 minutes: increase the suction as tolerated and hand massage both breasts simultaneously and lean over for another letdown. Don’t need to hit the letdown button on Medela pump if just came off breastfeeding bc Arden already stimulated the letdown.
7) Save what is pumped from breasts for supplemental feed the next time at feeding.
8) Journal all feeds, supplement, wet diapers, stools, spit ups, behavior, etc.
Things are going better with the combo breastfeeding, pumping, and supplementing. Arden seemed like she had a growth spurt a couple of days ago that left her almost inconsolable and crying and fussy for most of the 2 days. Her intake has gone up (and that’s self-guided by her). The pump output has increased (but I’m still popping the galactogogue pills and cookies/drinks). The tatas are sore, but not like week 1 or 2 sore. I’m slowly becoming okay with the reality that she may be a formula baby. But, I want to give her the best I can. The other change that happened this week is that I rented a hospital grade breast pump for a month –> Medela Symphony. I like it…. it is definitely bigger than my small portable Medela In Style Advanced and I think the Symphony has better suction capability. Perhaps that is really helping to increase my supply and the other pills/cookies/drinks are just placebos!
For the first time, my letdown has ejected milk from the other boob while Arden is feeding on the opposite boob. I got the NatureBond Manual breast pump to place on the “free” boob while Arden is nursing and it collected 0.8 oz of liquid gold! This is a new thing for me and I’m so stoked to be able to collect every single drop!
Looking back at what I have taken consistently to get to an increase in milk supply:
I’m decreasing the pumping after breastfeeding to just 2-3x/day. On days where I pump only and don’t breastfeed, I’m getting roughly 3oz total. How do women create freezer stashes? I don’t get it. I’m poppin’ pills like a druggie, putting Arden to my breast at least 8x/day, pumping after feeds at least 2-3x/day (now I’ve spaced them out instead of pumping directly after a feed…I now pump about an hour after a feed — to resemble a cluster feed). I could do a better job of hydrating. I’m watching my nutrition. I’ve started to workout. Then when I look at the real facts… I had a prolactinoma… that was resected… and it may have affected my milk production from a hormone standpoint. Even if all the working parts are there in my breasts, I have come to the realization that it’s ok if I’m not fully able to give my baby 100% of what she needs from nursing. I’m happy if I’m still able to transfer at least some of my milk and antibodies and goodness to her…. as well as help her develop and gain weight with the addition of formula supplement.
Things are going well. I’ve come to terms that I just don’t have enough milk. My letdown is fine. There’s fullness in the breasts if I go more than 5 hours for a feed. SO, I scheduled an appointment with an endocrinologist to follow up on my prolactinoma to see if that’s it. Either way, I’m enjoying breastfeeding with what I can supply and then having my husband or family pitch in to bottle feed. She just went through a growth spurt and was eating and fussing a ton.
Through all of my breastfeeding challenges, here are my thoughts/reviews on what has and hasn’t worked for me:
Medela Personal In-Style Advanced (PISA) — This is a great pump for me and it was covered by my insurance. When I got out of the hospital after delivery, this is what I used to help boost my milk supply. Granted, I was super sore the first two weeks, but I think that was because I was breastfeeding and then pumping right after. Plus, I don’t think it’s that uncommon to have sore nipples when first learning to breast feed and/or pump.Medela Pump in Style Advanced Breast Pump with On the Go Tote
Medela Symphony — I would highly recommend using this pump first for the first month bc it has such a gentle cycle of letdown/expression. Rent one from the hospital if they have availability. I think it’s a tad gentler and smoother than the Medela PISA.
Maymom flanges — same reason I got these flanges. Both manufacturers work nicely and you can’t go wrong. What I don’t like as much about the Medela fitting flanges is the little suction piece with that fragile plastic flap. It’s a pain in the ass to clean and find.
Philips Avent manual breast pump — I purchased this in the event I was stuck in a long case and couldn’t get relief to go pump. Perhaps I’m not as comfortable with it as my double electric pumps, but I don’t feel that it empties me out as much as the electric pumps. I’m sure hand tiredness attributes to that as I can go 20minutes on an electric pump no problem….but after 10 minutes on one breast, my hand gets tired. But, I do think it’s a very comfortable manual pump to be used in a pinch or bind.
Willow Pump — I had such high hopes for this pump. I wanted it to work to not be tethered to a pump with cords and such. However, when I tried this pump, it hurt. It was heavy in my bra and I felt like it pulled my breasts down. The suction is HIGH even at the lowest setting — even my more seasoned/withered nipples couldn’t weather the pull of the Willow. I’m going to give it another go as I used the 24mm flange that comes with it… and I ordered the 27mm ones and haven’t tried those yet. For reference, I started with the 24mm flanges on Medela…. then moved to a 27mm which I think is more comfortable.
Medela breast milk freezer pack bottles– these are great to pump into. Plus, since I don’t have enough of a stash to freeze, it’s great to put these bottles directly into the fridge. I use the standard Dr. Brown nipples or generic nipples on these for a feed.Breast Milk Freezer Pack, 2.7 oz (80ml) Bottles (Pack of 12)
NatureBond Silicone Manual Breast pump — this is a great asset to catch the milk letdown from the opposite breast that you’re nursing. You’ll be amazed at how much collects in this device.
If I were to do it all over again I’d get:
Medela Symphony rental for the first month or two after leaving the hospital.
I like both my Medela PISA as well as my Lansinoh. Both are highly portable and perfect for returning to work. KEEP IN MIND that the Freemie collection cups work with the PISA and not the Lansinoh (as of this writing on April 10, 2018). For a second go, I would get the Spectra S1 just to try it bc I hear the suction is so gentle. Update March 22, 2019: I got the Spectra S2 and it is wonderful. I use it as my primary pump when I don’t have the hospital grade pump. I ended up returning the Lansinoh bc it couldn’t work with my Freemie cups that I love for portability and ability to pump at work.
Freemie Collection Cups — I’d get two sets.
Medela breast milk freezer pack bottles
NatureBond Silicone Manual Breast pump
I’ve been back at work for a month. Breastfeeding/pumping has been a challenge. My job is a bit difficult in terms of getting a set schedule to breastpump at work. See my schedule below for what I’ve been trying to do:
6:00a breast pump
Try and get a 1-2 pump sessions at work when possible
6:00p breast feed
9:00p breast pump
I can definitely see my supply going down, but I’m trying my best with what I can. Arden has been thriving on what I’ve been able to give her supplemented with formula (see 4 month update here).
This was a rough week. It took 5 days for my milk to come in (vs 7 days with Arden) and when it did… it just was pretty weak/low. I would put Garrett to the breast every 2-3 hours, and he would fight the breast with frustration bc there wasn’t much milk flow. By our pediatrician visit on day 3, he had dropped 8% from his birth weight. Plus, my nipples were so sore from him breastfeeding and then me following up with pumping 8x/day. So, I choose to supplement him as my goal is a healthy baby. I started pumping with a hospital grade pump that I rented from the hospital. I also started taking herbal supplements from Legendairy Milk (phenomenal – I ordered the sampler) which has really helped a lot. Each day since day 5, I have seen increases in my milk supply and G has gotten less and less frustrated at the breast. In fact, it seems that sometimes he gets that good “milk drunk” satisfaction at the breast and I’m able to decrease pumping. Our pediatrician put in a referral for a lactation consultant.
I highly encourage ALL MOMS (especially first time moms) to schedule an appointment with a lactation consultant the first week baby is born. I wish I had done this with my first pregnancy. I think it sets moms up to get a good latch, get comfortable with all the positions, help with pumps/parts/pumping schedule, herbal supplements, resources, mom groups that are available, etc. So, today at day 8, I had an LC appointment and learned some new things and was able to see that baby G gained weight at each breast during the feeding (they weigh him pre/post feed on each side). That really helped reassure me that I was doing well and doing the right thing for him… and if I need to supplement, well there’s no harm in that either. While breastfeeding and establishing a milk supply, it was suggested to pump 4x/day for 15 minutes. It seems that everyone focuses on fenugreek for herbal supplement, but my LC who is evidence-based highlighted moringa… which studies have shown to increase milk supply!! So, I just got some moringa powder and will update with that later. What I appreciated was that this LC highlighted the importance of a happy mom, a happy baby. Don’t stress it.
Garrett nurses on one breast for 10-15 minutes and then gets really tired and loves falling asleep at the boob. I usually play with his hands, arms, feet, change positions to wake him up. Oftentimes, I’ll move him to the other boob… but he’s usually still sleepy. So, what I’ve decided to do is do more hand massage after a feed/pump. I’d like to get 4 regular 15 minute pumps during the day or 2 power pumps in a day.
I’m going to give this a try with both my rented hospital-grade Medela Symphony as well as my Spectra S1 that I got from my insurance via Aeroflow for free for my first pregnancy. Right now, I’m going to do 1 morning power pump and 1 evening power pump and everything in between will be Garrett to the breast followed by a regular 15-20 minute pump. We’ll see how the nips hold up.
Today, I ordered the Motif Duo from my insurance via Aeroflow for free for this pregnancy. It got great reviews and is super portable so I’m curious to see how well it works around the house (and when I go back to work).
So after 2 days of power pumping, I saw my supply go down (probably bc my nips were so sore!) and then come up meagerly. I don’t know that I would try power pumping again as it was pretty taxing on the nips.
Advice from Elisabeth Anderson-Sierra from One Ounce At A Time has the following recommendations for the Baby Buddha:
1. Make sure your flanges are fitted CORRECTLY! It’s the number one issue I see. If you need flange help, please let me know!
2. Are you using provided equipment or have you hacked this pump? Make sure everything is connected properly and tightly.
What pump(s) have you used prior to the Baby Buddha?
3. Start in expression mode. (Yes backwards) the drop symbol on the pump. Stay in level one until your nipples have warmed up to pumping, or a letdown is triggered.
4. Once the letdown is triggered or you are ready for more intense pumping, switch to the stimulation mode. (Yes still backwards) stay at a comfortable level. It shouldn’t be excruciating pain. I typically stay at level one, maybe 2 as the pump session goes on.
5. Switch back to expression mode once your letdown has stopped. Stay in level 1 and if you want, move up a level for higher strength.
6. Massage and RELAX. Work with the pump and breast tissue to trigger another letdown.
7. Switch back to the stimulation mode once a letdown is triggered and repeat. Levels may be increased, but not always needed.
So, here’s where I’m at:
Lil G has a great latch and powerful suck (just like Bug). He gets super milk drunk/falls asleep around the 10 minute mark. At that time, I’ll change his diaper and then nurse him on the other boob… slightly less than 10 minutes. He seems satiated as he is oftentimes sleepy and doesn’t need supplementation. We’ve been supplementing anyways because it’s more important to me that he is healthy with adequate growth. He can take anywhere from 0.5 oz to 3 oz after nursing. It’s just too tricky for me to guess how much I was able to give him at the breast. When I’ve gone in for weighings or pumped, it looks like I give roughly 1.5 oz… hardly sustainable for his size.
The Legendairy Milk company was the most helpful of all the brands I tried. I actually used a combo of their bundle — essentially taking 6 pills (2 from each sample bottle) 3x/day. In trying to increase my supply…I’d have baby nurse 8x/day and take these pills… and occasionally pump. Perhaps I can incorporate the pumping 4x/day on top of all this… but I just didn’t want to lose my sanity. It’s already a lot.
Updated May 10, 2019
Currently, I only breastfeed during my waking hours. I do not pump after and so far, I haven’t seen any change in my output. This tells me I have a set point for my production. G is happy, I’m happy. It’s a win. My nipples aren’t going to fall off and neither is my sanity. Right now, he gets up twice in the night: around 3a and 6a. It’s a huge improvement from before as he approaches his 2 month bday.
This is a must see! I saw it on Amazon Prime Video (hence free); The Milky Way.
“We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites.”