When Not to Breastfeed

I have met a new mum to premature baby on twitter this week, and we had a brief conversation about breastfeeding. I mentioned I regretted ever allowing bottles, and she said that she'd stopped expressing as her supply was low. I wanted to write about when it isn't working, and this post is primarily for mothers of premature babies. I have written a lot about my sadness about not being able to breastfeed, but my personal feeling is, breast is not always best as a sole source of nutrition for premature babies, in particular for IUGR babies.

It's fairly universal that when your baby is born you will be encouraged to express milk. This encouragement can come across as pressure. One of the reasons that there is a lot of pressure is that breast milk has been linked with preventing some pretty nasty infections such as NEC (necrolitising enterocolitis), however, have said that, babies on breast milk can and do still get infections. It's not a guarantee that your baby won't get sick, but it may help. Joseph had NEC and was breast fed.

It's also proven that expressing breast milk can help the mother feel that she is doing something productive and helpful for her baby, at a time when she cannot do much else, so on that level at least trying is a great thing.

I've mentioned on previous posts that some of the medications used, particularly for pre eclampsia but for other conditions of pregnancy can and do affect supply in some women. Magnesium sulphate, in particular, can cause supply drop often weeks or months down the line. I think its always good to try and express if that is what you want to do, but knowing that this could happen really helps with guilt, it did with me. I had no option but to go on magnesium sulphate and I believe the treatment I had saved my life, and now, looking back, I am grateful that I could express for as long as I could.

Having a baby in NICU is terribly stressful. Milk production is very much hormonal and stress can cause your milk supply to diminish or stop. And that's unfair, but its ok. I don't think its worth upsetting yourself more by continuing to express if you are under immense stress and its not happening. Some women find expressing relaxing, it gives them time out, and they feel they are doing something productive, however others find it completely stressful. I remember toward the end getting so frustrated, I had blood coming from my nipples, I was in pain, no milk was coming out, and I just thought "this is not helpful to anyone".

I think the best we can do, as mothers with babies in special care, is make an informed decision. In my case I looked at the big picture. My supply was diminishing to the point where I was unable to express, my baby was not permitted out for long periods of time to try and establish feeding, I'd had a large amount of medication and on top of all this, my baby was not growing sufficiently on breast milk alone and required fortification.

Looking at the big picture, it was wise to make the decision I did, to stop breastfeeding and introduce formula. It was a very difficult decision to make, but it was the best one.

No one can make the decision for you as to whether to stop expressing or breastfeeding, the best thing you can do is collect as much information as you can, and to listen to your own heart.