Last month we made it to four years breastfeeding and six months tandem nursing with insufficient glandular tissue. During my first pregnancy I was already concerned. Every pregnant woman I’d known had complained about their sore breasts, about going up a bra cup size. I told my midwife that my breasts hadn’t changed at all, but she told me not to worry about it – that almost all women can breastfeed, it’s very rare to not make enough milk.

After an uncomplicated birth we had lots of cuddles, skin to skin. It took my baby a few hours to figure out how to attach, but once he did, the midwives said he had a great latch. Over that first night in the hospital he became increasingly distressed. He would nurse for an hour, then scream inconsolably for the next hour before falling into an exhausted sleep, then repeat. Each nursing session would start out okay, then would become increasingly painful. I would keep trying to re-latch him, thinking that was the problem, but in retrospect I know that’s what if feels like when a baby sucks and nothing is coming out.

When he was about 36 hours old, he had lost 9% of his birth weight and was getting jaundiced. The next day I was getting really worried. After two days of almost constant hysterical crying whenever he wasn’t nursing, he was getting lethargic. His fontanelle was becoming sunken and I just felt something wasn’t right. When the midwives came to check on him, he had lost over 11%, and the jaundice was getting worse. They told us to feed him formula immediately and to start three-hourly triple feeding: nurse, bottle top-up with EBM (if any), then formula, then pump. This would take about 1.5 hours, then we’d try to get some sleep, and start again. After a couple of top-ups, he was suddenly a happy baby. He was more annoyed about being woken up every few hours to eat.

A week later, we got in to see a hospital lactation consultant. By then it was clear that my supply wasn’t increasing. I was getting about 5ml each pumping session, and the formula top-ups were getting bigger and bigger. She looked at my breasts, asked about my history (were there any breast changes during pregnancy? Did I have any history of PCOS, IR, etc.) and told me she thought I had insufficient glandular tissue (IGT). My breasts simply don’t have enough milk-producing tissue to make a full supply. She told me I could do some things that might increase my supply a little, but that I should prepare myself for never being able exclusively breastfeed. She also told me about supply line feeding. This is where you place a small tube next to your nipple during feeds so that the baby can drink supplement (EBM or formula) while they are breastfeeding. The idea is to make sure that your breasts keep getting plenty of stimulation, so they keep producing milk, and to avoid bottle preference.

We got a supplemental nursing system (SNS) and it took us a few weeks to get the hang of it, but eventually we were using it for every feed and things started to get so much easier. When I became pregnant with my youngest, my eldest was 2 years old and still breastfeeding. Despite trying everything that I could think of, again, my breasts did not develop during pregnancy. My supply was very slightly higher, but still far short of feeding my baby. This time, however, I was prepared. I had my old SNS and purchased eight Lact-Aids, which I find even easier to use than the SNS. I had a peer milk donor lined up and a freezer stocked with breast milk by the time he was born. I saw an IBCLC before birth and had a supplementation plan in place. Although I still have IGT, my second breastfeeding experience has been much less stressful. I knew how to use the SNS and I didn’t fall into the triple-feeding trap. My eldest is now four years old. He still breastfeeds at bedtime, often with the SNS, which he calls “breast milk.” Sometimes he’ll ask for just “breasts” (no SNS) when he’s upset or unwell. My six-month-old happily chugs his donor milk at the breast through a Lact-Aid. Sometimes, this is what breastfeeding looks like.