Weaning the last 2 feedings - morning and bedtime

[ditty]

DS will be 8 months next week and I have weaned to only feeding him in the morning and the last feeding at bedtime. It was starting to be too difficult to pump at work and I was partly ready to have some freedom. Not wearing a nursing bra and being able to wear dresses to work is a plus too. I'm actually really happy with our routine now.

I have severe rheumatoid arthritis and had to go off my medication in order to start trying for DS. We had to do infertility treatments which kept me off my meds for quite a while, plus the length of my pregnancy. I have been so fortunate to have been in remission since DS was born, but over the past few months I've started to regress. I saw my doctor today and he recommended going back on Enbrel injections so that we can get it under control before DH and I want to start trying for another DC. So that means I have to stop nursing to start meds.

I guess I'm ready if this is what it takes to get healthy so we can have another DC. I suppose we're just nervous it will take as long to conceive as it did last time so I don't want my condition to delay things further and I'll need several months on meds to get everything back under control.

So to the point of this post (sorry!). . . I am so scared to cut out a feeding and go 24 hours between feedings! Is that the best way to do it? I'm assuming bedtime feeding is cut out last. Any recommendations?! And how do you cut out the last feeding? Cold turkey? Or do you just pump a little bit? I'm just really nervous about all of this!

[Snow mom]

It sounds like you are in a bit of hurry to cut out nursing so that you can get back on meds. If you have a week or two though I would probably cut one feeding, then the other at least a week later. I actually cut bedtime and then morning but my DD was much older and I was worried about her getting too attached to nursing to sleep. By the time I quit nursing my supply was very "on demand" so I never had problems with engorgement. If you end up having some engorgement I would only express whatever is necessary to relieve pressure. Is your DC getting formula and tolerating it okay?

[sntm]

I agree that I'd only pump or hand express if you feel engorged and then just to the point of relief. Ideally try to eliminate one and then wait a week. You could try some of the no-no drugs to see if that dries you up faster - sudafed, sage.

Be sure though to check enbrel in the hale's medications and mother's milk. I have a patient on it but she is 60 so I haven't ever looked it up. I can tomorrow though

[BabbyO]

I cut my last two feedings over the course of 2 weeks. I was at 2x/day then went down to 1x/day (I think in the AM) for a week, then stopped all together. DS was 13 mo at the time and it went very smoothly for us.

Then I bought a head of cabbage (cabbage leaves in the bra...they work) and drank tea with sage...it helped. I was uncomfortable for about a week or so, but then was fine. I also put ice packs on my breasts in the evenings and first thing in the AM (always my highest production).

GL!

[sntm]

FWIW: Enbrel in Hale
One nonbreastfeeding mom getting 25 mg weekly had measurable quantities, but because she was not breastfeeding, the involution process would have made it more "leaky" and more likely to have higher quantities. Hale reports that enbrel has an "enormous" molecular weight and it is unlikely to have clinically relevant amounts in the milk of a breastfeeding mother. Also in addition to protein structure, it would not be orally bioavailable to infant (couldn't absorb it in the gut, which is why you have to get the sucky shots) Suggested infliximab as a possible alternative as this is not secreted in milk at all.

So, if the meds are the only reason to wean, I think there is enough medical support that you could go back on Enbrel and continue to breastfeed. If your doctor has any issues, feel free to PM me and I can send him/her the relevant data. I'm a member of the Academy of Breastfeeding Medicine and a breast surgeon, so I have some cred

[ditty]

Thanks for all the advice and the research!! sntm, I definitely think you have cred My rheumatologist told me yesterday that he doesn't feel like Enbrel would be an issue with breastfeeding based on the "acids in the body" if I remember correctly?? He probably said more of what you mentioned but I don't know or remember all the scientific stuff. He told me that he had recently discussed it with the cheif of rheumatology at SLU and they were both in agreement that a very small amount if any would be in the breastmilk and it shouldn't be an issue. But based on Enbrel's recommendations I should wean.

When we were trying to get pregnant, he told me there have been women who stayed on it their entire pregnancies, but it's recommended that you don't. He just said there isn't a lot of research on it to say it's okay. I was lucky enough to feel "okay" during our infertility treatments and during pregnancy. Hopefully that will be the case next time too.

I don't have to start Enbrel immediately because I can tolerate the pain I'm experiencing now. I just figure it's best to start now versus waiting if we're really thinking about trying for a baby towards the end of summer/early fall. If I wait too much longer then I fear I'll need to be on the meds longer because I'll just keep getting worse and it will take longer to dig out of that hole.

So if I decide to wean, you guys think give up the night feeding first? I always assumed that was last, but thinking about it now I guess it makes sense to leave the morning for last. I'd be less uncomfortable during the day that way. DS must have sensed it's coming because he was up early this morning and I fell asleep with him in the chair after nursing and got some snuggle time. It's definitely bittersweet. . .

[AustenFan]

With all three of mine, the morning feeding was the last to go.