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Jul032006

Word Search - How to Wean

Folks coming to my site from Google use the most interesting keywords. In the interest of answering the keywords, here is the search criteria and then my answer.

going to bottle feeding from breast feeding

Several searches have asked this question and in the interest of helping where needed, I thought perhaps I should address this as if a woman were sitting in front of me asking the same thing. This post will hold no judgement towards bottle-feeding, but will be informational and offer ideas on how to remain physically close to your child even as they are not fed by breast. I will, however, call the formula "artificial infant milk - AIM" because that is what it is. If we lived in another place and time, all children would nurse from someone or they would perish. So, calling it AIM isn't meant to be judgemental at all, but stating a fact.

ALL of this is geared towards changing from breast to bottle feeding. Some ideas for problems might or might not be appropriate in a strictly breast feeding mother-baby pair. Instead of offering ways to "fix" the problems (of which there are dozens of books that can address those), I will be focusing only on the ending breastfeeding process.

So, you're nursing and it isn't going well. You've tried La Leche League, Lactation Consultants, meds, helpful (and not so helpful) friends, the OB/GYN and the Pediatrician. You eschewed the AIM samples the hospital tried to give you and read Womanly Art of Breastfeeding until your eyes bugged out.

or

You had breast implants or a breast reduction that didn't offer one iota of swelling postpartum, much less engorgement - no milk leaking even when squeezed by those that know how to express milk from breasts. You tried the SNS and fenugreek and all the tricks everyone said to do.

or

You cannot nurse one more time or you will simply die from pain. Your nipples are bleeding chasms of suffering; your breasts never get any softer than a bowling ball despite using sage, cabbage leaves, binding, ice alternated with heat - everything the books said to do to help with severe engorgement. If you haven't asked for professional help at this point, I highly encourage you to do so before moving to the AIM. But, if you cringe when your baby needs to nurse and you feel blood on your tongue when the baby latches, I can absolutely imagine wanting to go to a bottle.

or

You are going to be put on a medication that is absolutely contraindicated with nursing and you've made sure of that fact via Dr. Hale's site and must wean quickly and as painlessly (physically) as possible.

or

Nursing is repulsive to you for a variety of reasons that you might or might not recognize. It isn't uncommon for women who were sexually abused (especially with their breasts as targets) to either work through the shuddering uncomfortableness or to not want to nurse at all.

or

While I have serious issues with women who believe their breasts belong to their husbands, I have heard this reason on more than one occasion. Who am I to understand the type of relationship they have if it works for both of them?

or

Your baby is medically starving and you and your doctor are extremely concerned that supplementation must be given or the baby could be hospitalized. If nursing has been difficult and seems to be the cause, weaning might seem to be the answer for you.

So, let's tackle one thing at a time, eh?

Engorgement - to make engorgement go away, the first thing to do is not pump or express the milk - doing so sends the message that someone is nursing and more milk will be made. If you are in excruciating pain, standing in the shower, leaning over should release some of the milk without expressing. If you feel you have to or they are going to explode, do it ONLY until the first hint of relief.

Ice only - no heat (even make showers cooler than usual - only warmed more if you need to lean over to get some milk out). Engorgement isn't so much milk as it is blood perfusion. Similar to an erect penis isn't all semen, but blood rushing to the area as construction workers building a project. So, the ice sends the message to lessen that swelling.

Binding - Some women simply cannot touch their breasts during this type of serious engorgement, but if you are able to, binding your breasts with a well-fitting (not underwire which can cause clogged ducts) bra can help. Binding them with Ace bandages works for some, but isn't something I have had a lot of success with. You are welcome to try anything, of course.

Cabbage leaves - No one seems to know exactly why cabbage leaves help to relieve engorgement, but it does. I have women put the leaves (whole ones) in the freezer and switch them out as the leaf thaws and softens with the heat of the breast.

Sage - Eat some stuffing with a hefty dose of sage in it! Over and over, we see women's milk production plummet at Thanksgiving, almost always because of sage-decorated stuffing. Some women are so sensitive to sage drying up their milk that even sage-tinged deoderant has lessened their supply.

Not nursing - This really should go without saying and could be combined with the "not expressing or pumping" section. The more you nurse, the more milk you'll make; supply and demand principal in action.

Plugged ducts - A hard mass that isn't necessarily red or hot can be a plugged duct and require some extra work to get out so it doesn't turn into mastitis (a breast infection that many times requires antibiotics). Massaging as best as you can... and this would be the only time I'd encourage heat, before the massage... to dislodge the clogged duct is the way to move things along. Only do the heat minimally, until the lump is softer, and then begin the ice again if you are still engorged.

Watching for Mastitis - When abruptly weaning, it is crucial to watch closely for signs of a breast infection. Single hot spots, sometimes with "legs" radiating outward, can point out the beginnings of infection or even an infection already set in. Antiobiotics might be needed, so be sure to stay in contact with your OB/GYN or Pediatrician in case they need to prescribe something for you.

Weaning Slowly - If you aren't weaning abruptly, replacing one bottle for a feeding will slowly diminish the milk supply. Keep replacing a nursing with AIM and within a few days, your baby will not be on the breast anymore. Weaning gradually also lessens the engorgement issues mentioned above.

Pumping and Dumping - If a short-term medication is necessary or a procedure such as a contrast CT scan (which Dr. Hale says is fine to nurse after, but some women aren't comfortable with that) occurs, you can pump and dump your milk for the days of the medication and most recommend for 24-48 hours after the medication is complete or the procedure is done. It isn't uncommon to have some engorgement during the pump and dump period and then, contrasing this, once the baby is nursing again, the supply will be much lower than previously. The baby nursing will build the supply again, but it will take a few days of almost constant nursing. Go to bed with the baby for a couple of days and that will help a lot.

Others' comments - Weaning to a bottle seems to be an open invitation for family, friends and strangers to frown and tsk tsk you for not nursing. Remembering that the great majority of women bottle feed is soothing during times of extreme judgement. Even those closest to you are not in your body and cannot possibly understand your circumstances. Remembering that they don't have all the information can help to be a tad more patient with them. It can be especially painful when successful nursing moms or your own mom put pressure on you to continue against all odds; this is your choice. Please remember that vital part. None of us is inside your body; none of us feels your emotions or how your nipples feel.

Your sadness - Despite knowing you are doing what is best for you and your baby, for many women, there is a distinct sadness upon weaning. I encourage a bittersweet mindset - parts are emotionally painful, while some aspects are a relief. Feeling the emotions is the best you can do. Write about how it feels, talk to other moms who do understand and express your thoughts to your partner - who, almost always, is extremely relieved to see you out of pain and moving on from such a difficult experience postpartum.

Glee without sadness - Some women feel no sadness at all and even that brings disapproving looks thinking you should be heartbroken. If you don't feel sad, don't let others' judgement try to make you feel guilty when you haven't before their thoughts were expressed. Be happy and move forward.

What AIM to use? - This I defer to your pediatrician. Controversy exists regarding soy AIMs and estrogens and there's always the debate between cow's milk and goat's milk. Does your family have a lot of allergies? Perhaps a more contrived AIM such as Nutramigen would be best. Ask your baby's pediatrician and listen to your instincts. Don't overlook organic AIM sold in natural food stores, too.

Skin-to-Skin - Mention has to be made about continuing to offer your baby skin-to-skin contact, even if AIM is the nourishment given. Please, please don't prop your baby's bottle, even if they are able to hold it themselves. Your child deserves enormous amounts of skin-to-skin contact even after weaning. Don't forget they need your touch!

As a midwife, I am asked a wide array of questions and weaning happens to be one of them. I know some will be livid I even have this information in my blog, but they haven't been in my office listening as women sob about their lack of sleep and ever-increasing depression because of the cost of getting help nursing, their partner's heightening agitation with the committment to nursing or their words of anger and even hate towards their babies that they feel are leeching off of them.

Sometimes, weaning is appropriate and they simply need to be told it's okay. Thankfully, they are relieved when their midwife doesn't berate them and accepts them for who they are as women in pain and conflict.

My acceptance of their giving AIM doesn't come cavalierly, but after I have worked with them, LCs have worked with them and they have exhausted all of their possible solutions. Blessedly, we live in a country where AIM is clean, water is clean and babies do well overall.

I hope this piece helps those that need it and I am glad to add other ideas if I've forgotten anything.

Reader Comments (7)

I advise mothers to keep their breasts full but not miserably so. It's okay to express a little bit -- the slightly less full breast still sends a powerful message to the body. As the breast fills, the level of FIL (feedback inhibitor of lactation) rises, telling the body to slow down production. (This is why it's such rotten advice to let your breasts fill up between feedings!)

Involution might happen slightly faster with no expression at all, but sometimes a smidge of expression can make a mother much more comfortable. Mastitis is wretched, and more likely to occur in a mother who gets and stays uncomfortably full.

July 4, 2006 | Unregistered CommenterJamie

You have such a wealth of information to share, and I am glad to see every bit of it.

July 5, 2006 | Unregistered CommenterAnonymous

Jamie: Great information... thanks so much.

July 6, 2006 | Unregistered CommenterNavelgazing Midwife

Great post! Your understanding attitude is wonderful.

July 15, 2006 | Unregistered CommenterAwesome Mom

With my first son, I pumped for 3 months solid, and he couldn't use any of it, at all, ever (extreme case of short-gut--post-transplant he's doing well now). In fact, I had to leave the house and have friends come over to dispose of the frozen milk, because it was too painful for me to do myself. (There was literally nothing in my large freezer except breastmilk.)

With my second son I was determined to breastfeed, since I'd been "cheated" out of the opportunity the first time 'round. He was equally determined to put forth no effort whatsoever in the eating dept. After going round and round with doctors, nurses, PNPs, lactation consultants, other moms, La Leche League advisors, etc. and making no progress whatsoever, I again hauled out that breast pump...but during #1 son's extended hospitalization for a line infection, my supply gave out (stress, worry, not pumping enough, etc.) and we had to go to formula.

For almost 2 years now I've been beating myself up about the breastmilk thing. I really wish I'd had this post to refer to back then. Thanks for writingn it.

July 16, 2006 | Unregistered Commenterfrostedlexicharm

With my first son, I pumped for 3 months solid, and he couldn't use any of it, at all, ever (extreme case of short-gut--post-transplant he's doing well now). In fact, I had to leave the house and have friends come over to dispose of the frozen milk, because it was too painful for me to do myself. (There was literally nothing in my large freezer except breastmilk.)

With my second son I was determined to breastfeed, since I'd been "cheated" out of the opportunity the first time 'round. He was equally determined to put forth no effort whatsoever in the eating dept. After going round and round with doctors, nurses, PNPs, lactation consultants, other moms, La Leche League advisors, etc. and making no progress whatsoever, I again hauled out that breast pump...but during #1 son's extended hospitalization for a line infection, my supply gave out (stress, worry, not pumping enough, etc.) and we had to go to formula.

For almost 2 years now I've been beating myself up about the breastmilk thing. I really wish I'd had this post to refer to back then. Thanks for writingn it.

July 16, 2006 | Unregistered Commenterfrostedlexicharm

Thank you so much! I have felt like such a bad person for considering weaning. My left nipple burns and itches and there is a large lump in that same breast. I went to the OB and she suggested going to the breast surgeon, but told me that I cannot have a mammogram if I am breastfeeding. She didn't even consider that I might be okay with weaning to get the mammogram; she just made it sound like it was not possible. After a bit of reasearch, I have decided that I want to get a mammogram done and get the best results possible without having to search high and low for a radiologist who will interpret the x-ray results for lactating breasts.
I have to say that your open-minded attitude made me feel more okay with: a) my ambivalence over the subject, and b) the fact that noone can totally understand how I feel.

Thank you so very much. I now feel more confident in my decision.

October 14, 2006 | Unregistered CommenterAnonymous

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