BM Dump isn't what you think

Refrigeration is important. 

Sunday, I made a quick trip to the grocery store to grab something we needed for dinner and came home to Paul fiddling with the longest extension cord I'd ever seen indoor.  Turns out that the deep freeze in the garage had lost power at some point.  Yes, the deep freeze holding a couple thousand ounces of frozen breast milk.

It was still cool, but all was melted, so this meant the milk got to go in the trash:

And yes, that box is completely full of milk too:

And here's what you see when you remove the box to take one more picture, just because you are a bit crazy:

I didn't cry or suffer a breakdown and I am veryproud of this fact.

Now, you might be asking yourself why did I still have this milk?  I guess I was thinking somewhere in the back of my mind that maybe the gastroenterologist would put him back on breastmilk at the three week followup and so I was holding off taking it to the milk bank, just in case?

Sorry milk bank!

The trash got picked up this morning, so it's gone.  Sigh.  I am proud of myself though.  I have intentionally avoided grabbing the data and calculating what amount of time that quantity of milk translates to.  I also didn't actually go through the milk and systematically add up the volume.  See, some sanity!

I pumped to:

I pumped to feel competent, to escape feelings of failure, to assuage guilt. 
I pumped to give action to grief, to honor the existence of a person who died before she was born.
I pumped to feel control, to do something, the one thing uniquely in my power to give my son.
I pumped to feel security in the milk stockpiling in the deep freeze.
I pumped because of the mothers I met in the NICU who weren’t able to provide their fragile child with the milk that was needed despite giving their all
I pumped because of the seemingly stable preemies who are lost to NEC every year. 
I pumped for all these reasons, but first and foremost, I pumped because access to breast milk matters.  So for both my son and other babies in NICUs, both met and unmet, I pumped and my grief, my fears, my hopes and my strength all flowed into the bottles.

I pumped to honor our stillborn daughter, to protect and grow our premature son, to help their four-year-old brother learn more of the gift of giving and to help provide access to breastmilk to other babies needing it. 

As I'm closing out my pumping career as Chiron is on Neocate and I just can't justify the time and medication restrictions to keep pumping just to donate, these are my thoughts.  Over 40 gallons of milk to the milk bank and even more than that into Chiron.

Pumping

So, I finally broke down and asked the question of what am I supposed to feed Chiron if I stop pumping.  Doesn't mean that I've stopped or have identified a time to stop, but does mean that I'm closer.

Here's a crazy graphic that shows a positive.  I am not pumping as much or as often.  I am not pumping during the night.  Each line is a day with the most recent at the top.  See the big gap on the left?  That's sleep!  It's updated through the morning of 7/29/2011.  I mainly put this graphic together because I knew it would help give me a push towards more pumping, and I think it has.

So, I did this a couple weeks ago and it has had two effects.  One, it has made me have a better attitude towards pumping and two, it has motivated me to pump during the night if I do happen to wake up.  I'm not seeking to wake up, but if I do, I'm sucking it up and taking a little time and pumping.  And it's had a DRAMATIC effect on supply.  The week of July 29 I was at a 1036.3 daily average and this week I'm at 1231.8 and still going up a little.

I really should write a post some day of my tips for pumping.  I wrote a word document with Trajan that I gave a couple friends, but I can't find it and I wasn't as much of a pro then.  But, for now, I will go with my short three most important tips.

1. Get hands-free.  Seriously.  Chiron was hours old and I sent someone to buy a hands-free strip of cloth (normally sticking them in a bra works)

2. USE your hands.  You don't have to the whole time (I find doing something else with them keeps me pumping longer), but for at least part of the pump, provide pressure to the breast and help express.  Also, particularly if you are establishing supply or worried about it, take a little time to hand express without the pump at the end as well.  Good motivating video for upping your production with a pump.

3. Hydrate.

And a bonus because I'm not sure this applies to most people, but is huge for me, document.  I use Trixie Tracker.  You can use a log book, google docs, or whatever, but keeping these stats has really helped me.  In particular, it has helped me get comfortable with pumping less often which is great for the sanity.  Trixie Tracker is nice because it is phone friendly, produces some useful graphics and also exports to excel great.

Speaking of which: here's the same visual but for the time since July 29:

See the four middle of the night pumps!

Oh yeah, for the sake of disclosure, Trixie Tracker does charge.  For me, it is well worth it for the pumping data.  We actually have stopped keeping stats on everything else in the last couple weeks, but our original six-month subscription after the free trial is about to expire and I'm definitely going to be renewing and I think probably even the six month version...

Breastfeeding doesn't follow the Laws of Thermodynamics

Something has bothered me since the NICU and I'm wondering if someone has an answer.  In the NICU, they said the typical breastmilk contained 2/3s of a calorie per milliliter or 20 calories per ounce.  They also said the average woman makes around 30 ounces a day.  All seems reasonable, right?  Add in a third factoid that it is important to get an extra caloric load of 200 to 500 calories. 

This would seem to say that the average woman produces about 600 calories of breastmilk a day.  And that is 600 calories contained within the milk without accounting for any calories used in the creation of the milk.  This is HIGHER than the 500 calories they give as the high end of the caloric load.

I recognize they were just trying to get some basic facts in with a pumping log, but this seems to clearly violate the laws of thermodynamics.  Breastfeeding mothers as perpetual motion machines? 

My guess is that these amounts are due to an assumption that lactating mothers will also draw upon their maternal stores.

Other interesting trivia fact: based on this, I've produced 190,000 calories worth of breastmilk just counting the amounts that have been pumped and logged, excluding direct breastfeeding and the first two weeks that I don't have my pump log for.

Dagnabit and Decisions

This is the trend of my total milk production (I lost the first two weeks of data so this is 1/5/11 to now.  Also, the dip at the beginning is dual mastitis that earned me my six-day readmit):

I thought it was because of the passage of time since he was born plus the evidence from this graph of my total daily pumping time:

(odd trivia fact: I always subtract three minutes from my pumping time... originally I think I had some theory about it being letdown time, but now I just do it to seem consistent with other weeks.  Well, and the real reason is to probably make it seem like less time.)

I should have been suspicious that the drop was too much to be explained by just the pumping time because after an initial drop, the number of times I have pumped a day has stayed pretty even:

Today I finally figured out what is going on.  I use two pumps: a Medela Symphony at the house and a pump in style at the office.  The pump in style seems to have reached it's last leg.  I had thought this a few times in the last months, but I convinced myself I was crazy.  Today it was obvious that it just ain't cutting it.  Pumped twice so far today and under 50 mL total each time.  And after the second time I experimented with hand expressing.  With a good pump with the Symphony, I can then remove maybe 5 mL per breast.  I got over 30 mL from each breast working less than three minutes per side.

I think I should have been suspicious based on the change in the ratio between the two sides (this is right divided by left):

When I was falling off more naturally, it seemed like the right deteriorated my quickly, but despite the serious decrease in each breast over the last two months, the ratio stayed pretty constant.

So Decisions....

• Do I cart the symphony back and forth?  This is one I bought myself, so it doesn't have a hard case, so I worry about damage to it.  Also it would be huge, I really don't want to do that.
• Do I try just pumping once or twice during the work day and running home?
• Do I rent a second symphony and leave it here?
• Do I just buy a new pump in style as it's handy... Also, I have a trip to Canada coming up that I was considering taking the pump in style instead of the symphony just due to size anyway.
• Do I declare myself done/incompetent and just quit?

Seriously, how did I not notice earlier?  Despite an average of less pumps on the weekends, the production is better... Argh.

I'm leaning towards just buying another pump in style.  If I remember right, that's around $300?  I feel like I've tried everything.  Replacing all the membranes has seemed to improve the performance of the Symphony, but the PIS is just getting worse and worse.

I went home and pumped (just finished) and got more than double what I had gotten from the two pumps I had done at work today!

For the sake of visual completeness, here's total broken down by left and right to make the problem a bit more obvious (yes, I know I should make more useful graphics given the data, but these are fast to autogenerate):

I really do need to take some sort of action, like today.  Thoughts?