Tuesday, 8 October 2013

Triumphant Tuesday - Breastfeeding with High Lipase

All breast milk contains lipase, an enzyme that aids in the digestion of fats by breaking them down. Fat contributes to breast milk’s appealing flavor, so if you have an unusually high level of liapse, it may cause problems if you need to pump and store your breast milk for prolonged periods. This is because during storage, the high level of liapse will break down the fat to such an extent that when you serve the milk to your baby, they may not like the taste. Some babies in this position will outright reject pumped breast milk.

So what about the mother who needs to return to work? Formula time? No lady, step away from the powder. You are about to read the story of a mother who discovered she had this problem; yet, rather than switch to formula, she devised an ingenious method, right in her very own kitchen, to deactivate the lipase in her milk! Find out how she discovered she had the problem, and how she addressed it.

“My son recently self-weaned and looking back, I now realize how difficult my nursing journey was. This prompted me to send it to The Alpha Parent.

Issues from the start

I had a pretty easy/textbook home water birth but nevertheless ended up with two second degree tears.  By the time my midwife finished sewing me up we were at the critical hour point for breastfeeding and my baby didn't want to latch.  When I took my nursing bra off to try to latch him I remember my midwife, surprised, saying "oh you have flat nipples."  I had never heard of such a thing and wish someone would have warned me sooner.  My son had a really hard time learning to latch and breastfeeding was very, very painful for me.  I had some cracking and bleeding but worst of all was the bruising - my nipples turned purple/black for the first few weeks and it was excruciatingly painful every time he latched on and while he was nursing.

I also had a very strong letdown at first and he would choke sometimes - it was very frustrating.  On the third day when my midwife came to check me I asked her about the problems and she suggested pumping for a minute or two to get the milk going and get the nipple to stand up better for him to latch onto.  I asked her about the thick white coating on his tongue, could it be thrush?  (See photo). No, she told me, it was just milk. There was one diagnosis she was willing to make however - jaundice, and pretty bad jaundice at that. So we loaded up our sweet three day old baby and took him to the nearest children's hospital.

Imprisoned at hospital

Here they pressured me to supplement him with formula (I refused) and insisted I have one successful nursing session and he have one poopy diaper before they would let us leave.  We were prisoners. My sweet awesome husband helped me get my uncooperative nipples to stand up, baby ate and pooped and then hubby angrily delivered the poopy diaper to the doctor and demanded they sign us out immediately.  I love him :)

Our struggles continued at home.  My baby wanted to nurse around the clock and pumping to get your nipples to stand up while your baby is screaming ain’t easy.  My nipple pain was not going away but I was so hell-bent on nursing I suffered through it.  My baby was getting chubby and thriving despite having projectile spit up after almost every feeding - often accompanied with painful gas.

Dairy allergy

After some trial and error I cut out dairy - all dairy, even lactose and other hidden dairy in other foods.  It was hard, there's dairy in EVERYTHING.  I ate mainly rice, bread, fruits, veggies and tofu. I discovered to my horror that when I had even a tiny bit of dairy (like butter in baked goods) he would break out in eczema all over. 

One consequence of restricting my diet was that my milk supply was very touchy - if I didn't eat just right or drink just the right amount of liquid, or if I exercised AT ALL, baby seemed like he wasn't getting enough (would latch, thrash angrily, unlatch, cry, repeat).  


Around Week 3 I started pumping because I had to go back to work after my 12 week leave ended.  Around week 4 my nipple pain was too much to bear - it felt like shards of glass coming out instead of milk - and I made an appointment with my doctor and found out we both had thrush, pretty badly. Nystatin wouldn't get rid of it but eventually, after days of application, gentian violet worked.  I still had some pain but it wasn't nearly as bad.  Yet despite the thrush healing, I still had a lot of bruising which continued.

High lipase

We noticed baby would only take milk that had not been frozen, and we couldn't figure out why.  I thawed some of my earliest freezer milk and it smelled crazy - not sour but kind of like a metallic smell.  No wonder he wouldn't even let the bottles near his mouth!  I googled "frozen breast milk smells metallic" and the answer popped up..."high lipase". I had never heard of this before! After a lot of research I discovered how to stop the lipase breaking down the fat in my milk which had been making it taste unpalatable. The answer was simply...to scald the milk. This had to be done as soon after expression as possible, before freezing. It meant heating the milk in a pan until bubbles appeared, quickly cooling, then storing it. Fortunately, the heating process was so brief that the breast milk would still retain most of its protective immunity factors and its nutritional value, but keep its flavor from spoiling.

The process was burdensome. I was getting very worried at this point about how I was going to keep this process going once I went back to work. I combined several suggestions that I found online to create a scalding routine that worked the best - first I used a bottle warmer to heat the milk, in a glass pyrex beaker (like the kind you used in chemistry class) to 140 for one minute; Then I used an infrared thermometer to measure the temperature. Once the minute was up I poured the milk immediately into silicone ice cube trays and put it in the freezer.  When the tray got full I would dump the cubes into a ziploc bag and label it with the month/year, then put it in the deep freeze in the garage.

Glass pyrex beaker containing breast milk.

Infrared thermometer prevents contamination

Breast milk ice cubes!

'Raynauds' - say wha?

The hits just kept on coming. At my six week check-up, my midwife diagnosed me with raynaud's, - a disorder resulting from decreased blood supply. This, my midwife believed, was causing the bruising. She offered meds but I was kind of used to it at that point and didn't want to take anything that could interfere with breastfeeding so declined.

Meanwhile, baby was doing well and growing fast. By eliminating dairy I had eliminated his eczema, gas, and projectile spit up.  Also, we had our scalding routine down to where I had some milk stockpiled for work.  I had finally gotten rid of the thrush and was tolerating the Raynaud's pretty well.  I still had a lot of pain until my son was around 4 months old and found out at his 15 month appointment he had a lip tie and probable posterior tongue tie, which I think explains why I had so much pain at first.

The work/breastfeeding juggle

I'm an attorney and work in an otherwise all-male office so pumping was an adventure.  I kept a small fridge in my office and had a sign that said "PUMPING" in big letters on it that I would put on my door every 2-3 hours for 20-30 minutes. A portion of the wall in my office is glass to a hallway so I covered it with maps. I regularly pumped in my car on my way to/from meetings.  I washed pump parts between sessions in my communal office kitchen, sometimes while talking to my coworkers about cases. It was very time consuming. I would leave at 4:30 every day and nurse my son as soon as I got home, while my wonderful husband (see photo!) prepared the next day's bottles, scalded any excess milk to freeze, and washed/sanitized the pumping parts for the next day.

Vulnerable milk supply

Through this journey, I have always had a touchy supply - I couldn't run more than a few miles a few times a week without my pumping output plummeting. To keep my supply sufficient, I had to pump every 2-3 hours and take Fenugreek herbs until my baby was around 10 months old.  It was very time consuming and difficult. Thank goodness for a supportive workplace and spouse!

Nevertheless I was able to breastfeed until my son self-weaned at 17 months (I think my touchy milk supply finally just gave up). My son is almost two now, incredibly healthy and smart, and shows no sign of the allergies and asthma that have plagued me since birth (my mother never breastfed me). I’m incredibly proud to say that despite my many challenges, my baby never had a drop of formula.  

Sometimes when I hear new moms talk about how hard breastfeeding is - moms who had none of the issues I faced - I get irritated and want to tell them it could be so much worse.  But instead I remind them that it does get easier and it is worth it in the long run. I always advise them to seek professional help if there is ANYTHING, anything at all - no matter how minor - that is causing them to think breastfeeding may not be worth it. It is always worth it”.

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Unknown said...

Amazing. Way to go you for continuing. Inspiring. I also had that problem with frozen milk. So bizarre! I guess we didn't evolve with freezers in mind! ;)

Sarah M said...

Good for you! I have high lipase milk too! i didn't understand what I was doing wrong for the longest time. I ended up throwing out a full freezer full of milk. So glad I read this so next baby I can do what you did. Way to go mama!

Andrew Sennett said...

ya we just figured this Lipase out. ... we have BEEN TRYING HARD!!!!! to get her to the bottle, just turned 6 months. an a break for momma would be awesome! I just tasted her milk ... an OK I am a huge fan of milk from the source, so I was the best choice. OMG THE FROZEN ALMOST MADE ME BARF! So a HUGE supply either goes to waste... OR I read that you get vanilla quick or flavored mix to bring it back up to the tasty stuff. Since it was Immediatley frozen it still should have somewhat fat left. SO gonna try a bit of the Quik method while we rebuild up a supply.

Jessica Wekke said...

Be careful of becoming sanctimonious about your success. I just had my third baby and had an awful time. I gave up at 7 weeks and pumped, along with feeding her formula. I did NOT want to do this but had to for my sanity and to be present for my other kids and my husband. I breast-fed my first two for a year without giving formula. I had LOTS of trouble with my first baby and I weathered all the challenges and stuck with it. Am I proud of that? Yes, in a way, but I also regret not enjoying him enough. The third time around I could not deal with all the problems and I've been humbled enough in this journey of motherhood to realize that the way I feed my baby does not define my success as a mom. I was not breast fed and I was very healthy, had few allergies, and went entire school years without missing a day of class. I'm still blessed with good health, and I know people and kids who were nursed for an extended period of time who have all kinds of physical issues. Breast milk is best, but it doesn't always mean you get ahead in life. I came across this blog when googling lipase b/c I'm still pumping and don't want to waste my precious time doing it and freezing it only to have it be rejected (like I'm wasting my time commenting on this). Just be careful. You may have overcome some struggles but other moms have different struggles you aren't going through. You never know how you'd react in their shoes. Don't get irritated when people say it's hard. It IS hard, and some, depending on what they deal with from day to day, just can't deal with it. It doesn't make them failures.

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