Previous problems BFing due to very low supply. Can I do it this time?

[Frazzlerock]

Bastarding PCOS took away my ability to BF my babies 9 and 13 years ago.
It's not hugely known but PCOS can prevent the development of breast tissue during puberty. I didn't know this when I was desperately trying to feed my DC and also had no help - only advice was from a GP who told me to 'feed more'... I was already feeding 24/7 with a perfect latch and no tongue tie.

Anyway, I am pregnant again now and I am desperate to feed my baby.
Can anyone advise me? Should I try and get the little supply I have going before I give birth?
Can I fool my body into producing milk?
I really don't want to have to use that supplemental device thing that you hang around your neck, it seems like such a palava.

I had low supply due to breast hypoplasia and couldn't exclusively BF either of mine. I tried absolutely everything with my first, to the detriment of my mental health - domperidone, supplemental nursing systems, etc, but to be honest it wasn't worth it . I did BF a lot and with my first we successfully mix fed until about 18months. With my second I was a bit more realistic (although the feeling shit about not being able to do it never went away) and it was much harder, because I didn't have time to sit on a sofa all day breastfeeding, so I BFed until about 6 or 9 months. DC2 was much less needier anyway than DC1.

I think that low supply is more common than people think, and if it's due to lack of appropriate breast tissue there's very little you can actually do. I had support out the wazoo, tongue ties snipped early days etc but ultimately it was of limited use.

Be kind to yourself; breastfeeding (or more appropriately, my lack of ability to) is an issue that was very, very detrimental to my mental health.

@NotAnotherJaffaCake I'm sorry it has affected you so badly.

It has affected me for years. I hate that I had to give up when so many women can do it.
PCOS has completely destroyed me. It nearly sabotaged my fertility, then when I did get pregnant I lost two, then when my babies are finally here, I find can't BF them. I feel like PCOS is just constantly there laughing at me

I absolutely need to feed my baby this time. There has to be a way.

I'll be honest. With your history it is highly likely that you will have low supply again.

The best way to establish as full a supply as possible is feeding. Feeding, feeding, feeding. Especially in those early weeks. The early stimulation is what brings on lactation. Antenatal expressing can be useful if you are, for example, likely to have a section, so that your colostrum can be given to the baby as supplements instead of formula should the need arise. However, it is birthing your baby and feeding them which signals your body to start to produce mature milk. If you have a lack of breast tissue then you may always need to supplement.

Early feeding, skin to skin and responsive breast feeding are how to maximise your milk but don't beat yourself up if you need to supplement. If you do then give a combination of breast and formula at each feed rather than replacing whole feeds. This will mean that your breasts don't miss out on stimulation and also the breast milk given before formula will help protect the git and calm an inflammatory response to formula.

Take it one day at a time. If baby is weeing, pooing, settled between feeds and gaining weight then brilliant, no need to supplement.

@PlayingForKittens my two DC were c-sections which didn't help but they were never given formula in the hospital.
I don't think I ever produced mature milk.
I fed and fed and fed and fed - quite literally 24/7 yet they both still failed to gain weight. I can't help but wonder if 9 years later things may have changed for me and perhaps in the medical world to help me produce milk?
I asked the GP for Domperidone and she told me no as it isn't used for producing milk. She just told me to feed more - like I could create more hours in the day! I walked out of that surgery in tears.

I plan to join LLL at some point during my pregnancy in the hope they can help me. My boobs have grown/swollen a little so I'm hoping that is a good sign, but I think they did the same with my DC too...

Domperidone is occasionally used but very much as a last resort. It would be a good idea to identify the lead infant feeding midwife in your trust and ensure than you are referred to her, perhaps even antenatally to chat about plans.

Good information about domperidone here www.breastfeedingnetwork.org.uk/wp-content/dibm/BfN%20statement%20on%20domperidone%20as%20a%20galactogogue.pdf

If you don't think you ever produced mature milk at all then I would suggest, given the history, that you express right from the start as well as feeding. Hand expressing at first for around 10 mins after each feed (and of course you can collect what you get and give it if necessary to your baby) and if/when you are getting good volumes of around 5ml per session use a breast pump.

I would suggest using a cycle on the pump to initiate lactation. Many electric pumps have this built in. If you have one where you adjust the settings yourself then this would be using high cycles (how frequently it sucks) and low vacuum (how string it sucks). Decreasing the cycles and increasing the vacuum to comfort level if/when you get a milk flow.

However, you need to balance this with your mental health/sanity/family life etc. A regime like this is very, very draining for you.

When expressing like this give yourself a break of 5 hours once in every 24. Use it when it will give you the greatest benefit. For you it might be to spend time with your other children, or it might be for sleep. Though do make sure you express at least once in the early hours of the morning when circulating prolactin levels are highest.

The most important thing is to enjoy your baby. Give it all you have but mostly enjoy it. You can't help the past, the PCOS, the breast development. None of that can be changed. That you have given your children any breastmilk at all is amazing and has helped them to have stronger immune systems and the best start in life.

It is great that you have had breast changes in pregnancy. Will you be having a section again? Make sure you talk to the midwife caring for you about skin to skin in theatre or if not possible in theatre because you are not well enough then in recovery. The earlier you have that skin to skin the earlier those hormones get to work.

I wish you the best of luck on the road ahead.

Thank you @PlayingForKittens that is all very useful information and advice.

I don't know if I will be having another section. It was 9 years since my last one so I am wondering if that might make a vaginal birth okay given the time that has passed. I just want to do whatever is best for this baby. Whether that's a section or vaginal delivery. I know for breastfeeding, a vaginal delivery is best so if it's not too stressful for baby then I would prefer that.

My first DC got stuck trying to come out ear first! So I had to have an EMCS (he was also huge, which I didn't know). My second DC was breech so that was an elective. I guess, in theory, I could have either c-section or vaginal birth...

With each pregnancy you grown a bit more glandular tissue so you may increase your supply from previous times.
It might be worth seeking out an IBCLC who has experience in supporting Insufficient a Glandular tissue.
There’s a book called Finding sufficiency. It might be helpful as you prepare for breastfeeding this time.