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Sunday, November 21, 2010

Breastfeeding and Losing Weight---or Not

Well, I haven't posted much here because I've been trying to keep this a little more WLS-appropriate, and I don't have much WLS stuff to post right now. Losing weight isn't really my plan at the moment. But that's not to say I wouldn't like to, it just doesn't seem to be happening, and I'd rather make sure I can produce milk.

I did learn, rather interestingly, that breastfeeding does NOT actually help most people lose weight, as is popularly said. I'll try to find the particular study, but I recently read that on average, women who are nursing actually gain a few pounds versus those who formula feed their babies. This is presumed to be because elevated levels of prolactin, the hormone that causes lactation, also increases appetite--presumably because lactation requires more calories.

This is significant to me because I am taking domperidone to increase my prolactin levels and thus increase my milk supply. My weight has levelled off, but I gained back some weight after getting very close to pre-pregnancy weight. I knew that this could happen, but it does bug me a tiny bit.

As I have discussed elsewhere on this blog, I had breast reduction surgery in 2001 (long before my lap band). I was told at the time that I wouldn't be able to breastfeed, and I was okay with that at the time. I was recently divorced, and although I wanted children, it didn't seem like it would happen anytime soon, if ever. But when I got pregnant I started researching, and discovered that a lot of women who have had the same surgery have been able to breastfeed at least somewhat. I read everything I could about the subject and was very hopeful that it could work for me. The fact that it had been 9 years since that surgery was a plus in my favor. But there is no way to know until you try.

Just like giving birth, nothing with breastfeeding has happened exactly the way I envisioned it. My daughter did nurse very soon after birth, and was placed on my skin immediately after birth, and stayed there for the first 2 hours. She nursed exclusively until the day after we got her home, when she started seeming a lot more lethargic and jaundiced. We brought her to her pediatrician that day, and she had lost quite a bit of weight from her birth weight--almost a pound. Sometimes a large weight loss can be attributed to the fact that birth weight is falsely elevated by IV fluids given to mom during labor--but in our case, I arrived at the hospital and Lucy was born 15 minutes later. There was no time for an IV, so this obviously couldn't have been the case. And if she wasn't obviously symptomatic, we might have been able to let her nurse a little more without intervention, but she was too sleepy to nurse, and looked obviously dehydrated, so right there in the ped's office we gave her her first bottle of formula, which she gulped right down. (And I cried my eyes out, seeing how hungry she was. It was hard to feel that I couldn't provide what my baby needed.) It turned out that my surgery left only the inner most milk ducts intact, and that plus a large nipple meant that she was just not big or strong enough to compress enough to get much colostrom out.

I continued to try to nurse her as we gave her bottles, but over time she became less interested in the breast. We tried the non-bottle methods of supplementation, but we couldn't get any of them to work well for us. I started taking domperidone when she was about 4 days old, but it still took close to 2 weeks for my milk to come in. I've been pumping constantly since then, and now am making about 60-70% of the milk she takes in each day. Considering the surgery I had, and the fact that only the left breast produces enough to pump or nurse from, I feel pretty good about that, but I am still trying to get her to nurse more so I can pump less. I've been working with some great lactation consultants on this, and have a lot of support and information about it. I won't be able to really lose weight until I stop taking this medication, but as long as it doesn't increase anymore I think I'm probably okay with this.

This whole nursing/lactation deal has been very emotionally intense. I was much more invested in things going the way I envisioned than I realized, even though I knew intellectually that the chances were that it wouldn't go perfectly. I'm happy we are doing as well as we are, but it has been hard to let go of the high hopes I had of feeding her exclusively from my breast. Despite all of this, I'm not sorry I had the surgery. It gave me a much better quality of life, and enabled me to exercise so I could lose weight and keep it off. Whenever I decide I am done having children and lactating, I will probably need to have another reduction or lift, which I do want to do, but it is worth it. (I was a 38H preop, down to 38C post op. I ended up a 34D after losing weight, then was a 36DD during pregnancy, and now am a 34F. There will be a lot of sag when I am done nursing, and I will be pretty lopsided.) If I have another baby later, it should be easier to nurse, because breast tissue continues to develop as the first baby nurses, so the second usually has an easier time.

I don't know if this stayed more on-topic, but oh well. :) Lucy is doing great...getting big and sassy, and cuter by the day. We are having a great time together! Being a mommy is pretty fun so far.

Wednesday, November 3, 2010

Getting Back On Track

Someone asked in the comments how pregnancy with the band was different. I don't know, since I wasn't pregnant without a lap band. But for the most part, it wasn't much of an issue for me. I did have some, but not all, fill removed; I went from about 3.5cc (in 4cc band) to 2.5 at about 10 weeks. I considered trying to remove more at the end of my pregnancy but decided not to; I couldn't eat much at the end (and felt very full anyway) but it wasn't a "restriction" issue, my stomach was just too compressed by the baby, and I don't think the band was making much of a difference there. I do think the band helped keep my weight gain within the recommended range--since I started out overweight, the recommended weight gain for pregnancy was 15-25 lbs. (My total ended up being 29 lbs, but I gained the last 7 pounds in the last 2 weeks, all in fluid.) I did have a lot of heartburn throughout the pregnancy, but I don't think that would have changed at all with less fill in the band, either.

My final verdict: band helped keep my weight in check, and really no negative effects noted.

Yesterday, I went back to the gym for the first time since about a week before Lucy's birth. (6 weeks total). I was swimming there pretty regularly through the last trimester, but not doing anything else. Now, I want to start running again. I spent 30 minutes on the treadmill, mostly at a brisk walk, but I did run a few minutes. This was the first time in almost a year! I stopped running just a few weeks into my pregnancy because I couldn't keep my heart rate within the recommended range, so I just walked. It felt good to run again. Maybe I'll go outside to run today--it's a beautiful, sunny Portland day, unseasonably warm for November.

The next step is improving my eating, and determining if I need to bump up my fill again. I graze a lot. And lately, I've grazed a lot of sugary goods, so I need to work on that. I didn't really pay too much attention to what I was eating at the end of my pregnancy--I wasn't worried about weight gain, I wasn't able to eat very much at a time anyway, and I was getting good nutrition. But now, I have a goal weight that I would like to see again within the next year.

I probably won't return for a fill before going back to work, and when I do, I know they will want me to have an upper GI, since they recommended that when I switched to the local band doc in Spokane (who declined to do the upper GI, deeming it unnecessary.) I don't mind doing it, but I'm not sure insurance will cover it, so I definitely need to be working again.

Baby's fussing--got to go.

Monday, November 1, 2010

Lucy Pics--10-15-2010

A New Life

It has already been a month since Lucy was born. It seems hard to believe. In fact, tomorrow is 5 weeks. The time has certainly flown quickly. I can't believe I have to go back to work in just 4 weeks. I don't mind working, but leaving Lucy will be hard, even if only for 3 days a week.

So far, I have to say that I enjoy every bit of being a mother. I didn't necessarily expect this. I have been childless for a long time--37 years, in fact. While I have always known that I wanted children, when it came to be time, I didn't know if I would miss my old life, the convenience of not having to worry about all the things that go along with having children. So far, this hasn't happened once. It's just such a different life, but I haven't found anything about it I don't love yet.

I'm also enjoying the SAHM thing for this brief time. I'm sure lots of moms think the same thing when they are on maternity leave, and find that months or years of it is a very different proposition. But right now, it's something that I didn't think I would enjoy so much. Of course, I have a pretty low maintenance little baby, and only one of them. She can't really get into anything or talk back to me, or make much of a mess. She sleeps a lot. So other than sleeplessness, this is probably about the easiest it gets as a SAHM. Still, I am enjoying it, and appreciating the fact that it is such a short time. It's definitely work, and a different kind of work, trying to keep up with housekeeping, baby laundry, and taking care of baby and myself, plus trying to support my hubby, who is working hard. I could stay home rather than go back to work, but having just finished school and started my new career, and with all the student loans I have, it just doesn't make a lot of sense to me not to go back to work. And I do enjoy what I do, and want to get my practice really going, and become a better anesthetist. As I have noted before, I work 3 days a week, so while they are long ones, it's a pretty good schedule for a parent. I'll see how I feel after a few months of it.

My weight is another matter. I'm not checking it now. It went back up about 5 pounds after my lowest weight. I believe this is because I am taking domperidone to increase my milk supply. (This is because of my breast reduction surgery which I had in 2001, which impacted my ability to produce milk.) I have read about this before, and most women say that the weight comes off once the drug is discontinued. But, I don't like my weight going back up, and I was really looking forward to working towards my goal weight again. I am stuck in my sort of "in between" clothes. All in all, it's not a huge deal to me at this point, but this being a WLS blog, it is worth mentioning. In six months, if I am still dealing with this, it WILL be a big deal. But hopefully we won't have to worry about that!