help weaning from formula supplemen
OK... where to start? I just found these boards a bit ago and already have learned so much! I have to admit that breastfeeding was one of the few things that I wasn't stressed about before my daughter was born, because I figured it was simple and natural- put baby to breast and done! I definitely wish I had known more before we started (I'm sure you guys hear that all the time!).
Anyways, I am currently supplementing my six-week old with formula and really want to get her completely off of it. I'm just not sure where to start.
Her background- She was born two weeks early via emergency c-sec. I had been extremely sick with the flu up until the day she was born, was running a 103ish temp, and hadn't eaten anything in days. (Others have said those things may have contributed to our problems). After she was born, she was slightly jandiced, but no major problems. On our first day in the hospital, she nursed like a pro, or so I thought. Looking back, she might not have had the best latch, because I quickly ended up with bloody nipples with skin peeling off. During night 2, a nurse came in and baby had just woken up crying. I told the nurse that I didn't know why she was crying, because I had just fed her an hour ago. The nurse said that she could go grab a pacifier for me if I wanted. I was hesitant, because I did at least know that sometimes that can interfere with BF, but the nurse convinced me that it would be ok. (If only the nurse had told me that I should just keep nursing her! I was so worried about overfeeding her though!) So I gave her the bink and we went back to sleep.
The next day, she all of the sudden stopped. She would latch for a second or two, pull off, and then try to latch again, over and over. I figured that maybe she wasn't getting any colostrum anymore, and since my milk hadn't come in yet, that she was getting frustrated because there wasn't anything for her. There were no LCs in that day, so we just kept trying. The next day when they weighed her, her weight had dropped to 6 lbs 5 oz (she was 7.1 at birth), so they brought in formula to have me start supplementing. Again, I didn't really want to go down that path, but I certainly didn't want to be starving my child either. We were able to meet with a LC who tried to help with my latch, but baby girl still fought like crazy against it. She had us finger feed with a tube- I held her and used my finger, and my husband held the syringe and inserted (and reinserted!) the tube into her mouth. The LC brought me a pump to use, but I was in so much pain that I could hardly stand to attach the pump, and I didn't use it nearly as much as I should have. I didn't need any meds for my c-sec, but the nipple pain about killed me! It felt like a searing pain shooting through my nerves. For some reason, the LC put the pump on the highest level. A nurse later showed me that there were lower settings I could put it on.
Four days later we went home, but my milk still hadn't come in, and she still wasn't latching. We had met with another LC there as well, but no progress. Finger feeding was fine when my hubs was there to help, but he had to go back to work, and it spiraled downward from there. I was still putting her to the breast before I fed her each time, but she was screaming, kicking, flailing, pushing away, arching her back, and doing anything possible to avoid it. I'd only last two or three minutes before I'd be in tears too, so I'd quickly give up and grab the formula. That was almost impossible too though, because I was holding her in one arm and my other finger in her mouth. I would try to get the tube in with my remaining fingers, but she would keep pushing it out as she flailed around. It was just a mess and I dreaded feeding time. This was day 4 and 5 and my milk still hadn't come in.
(Yikes... I thought I could easily type up a short version... this is a novel! Sorry!)
Two days after we went home we went to our first ped appointment. Her ped was mine growing up, and I really like and trust him. I told him about my milk not coming in and about our issues with breastfeeding. He could tell the tube system was creating such anxiety, and so he recommended just using bottles to make it less stressful for me. He said that nipple confusion wasn't something to be too worried about, and that baby could be taught to go back to the breast. It was better to eliminate the stress around feeding time. I went and rented a hospital grade pump to try to get my supply going, but was getting absolutely nothing when I pumped.
Fast forward to two weeks later, and one night I noticed her face looked a little chubbier than normal. I dismissed it, and we went to bed. I fed her two times that night, and the next time I thought her face looked a bit chubby again. She had been really gassy and had irregular BMs, so I thought she was just trying to push something out. It wasn't until the last feeding that I realized her face was swelling up. (I know, I score major bad mom points!) For some reason, I knew immediately that she was having an allergic reaction to her formula. We got into her doc a few hours later, and he recommending switching to Similac Allimentum.
At this point, my milk still hadn't come in, and I was still pumping as much as I could and putting her to the breast before each feeding. She was still fighting tooth & nail each time. When I pumped I only got drops (sometimes up to 2 or 3 ml), and it was still just colostrum. I think I only kept doing this because I was in denial about not being able to breastfeed. I cried myself to sleep every night because I felt like I was already letting my daughter down. My husband, mom, MIL, SIL, OBGYN, and baby's ped all tried to tell me nicely that it was time to give it up and just plan on formula feeding. Luckily I happened to find these boards and Kellymom, and found a little bit of hope in the info about relactating and adoptive breastfeeding.
When I was about 16 days postpartum, after taking a shower one day, I found that I somehow had milk. I never felt it "come in", I wasn't engorged (or even the slightest bit "fuller"), but it was white and I could tell it wasn't colostrum. Over the next two weeks I pushed mine and my baby's patience to the max but we started making progress. She started latching for longer amounts of time and now, she averages about 45 minutes on one side (she's a sleepy baby!) but only about 15 on the other.
So, if there's anyone actually still reading this- I'm looking for help on finally weaning her off of her formula supplements. Supplement is not quite the right word though, because she's getting about 18-20 oz a day. After each nursing session, we've been feeding her a bottle. Occasionally she'll fall asleep after nursing, but if we let her just sleep, she's up 30 minutes later and hungry again. At that point, hubs usually wants me to just give her a bottle because he worries she's too hungry. I'm stressed because I don't have any idea how much she's getting, or if she's getting any at all during some feedings. Sometimes I feel let-down while she's eating, sometimes I don't. Sometimes I feel it at completely random times during the day. When I pump now, I'm getting about 13 ml from one side and 5 or 6 from the other. Her wet diaper count is good I think, but she usually only has a dirty diaper once every few days. The past three days she's had one a day though. Weight gain is good I think- 7 lbs 1 oz at birth, 6 lbs 5 oz at two days, 6 lbs 7 oz at 4 days, and 7 lbs 10 oz at two weeks. We don't have another doc appt until two months, but I'm going to take her in tomorrow just for a weight check. SHe's finally starting to fit into some of her clothes though and her face is filling out so I know she's gaining weight.
So, do I win an award for the longest post ever? Sorry to be so long winded, I just wanted to include as much info as possible in case any of it is helpful in determining what is going on.
THANKS for reading it all and THANKS in advance for any input!
Re: help weaning from formula supplemen
Sounds like you've been put through the wringer. I am sure others will chime in but here is some information to get you started.
And it is stressful if you have been watching the amounts of bottles to go completely to breastfeeding where you cannot measure how much your LO is getting. What you can do, however, is monitor wet and poopy diapers: output = input.
Re: help weaning from formula supplemen
Ok, this is a good link. Also how often are you pumping? Because she's receiving so much formula your supply will have to increase to her demand. This link talks about how to decrease the formula slowly.
Re: help weaning from formula supplemen
Im sorry you had so many obstacles. I had to establish my supply pumping, so i can relate to how hard that is. Here is what I would suggest:
1) go to bed with your baby
2) stay there for at least a week, as much as you can. Probably more like 2 (bc once you are nursing, you will be so tired you'll need another week to recover)
3) have dh rent you a hospital grade pump, if you dont already have one in the house
4) feed/pump every 2-3 hrs during the day, 3-4 at night
5) dont pump for time, pump for feeling. Empty the breast at each session, using breast compressions. It may take 45 minutes, but it will do wonders for your supply. If your breasts empty quickly, then pump at least 20 min on each side, with compressions even if they feel empty. Order one of those tops to pump both at the same time (or make one)
6) pump on the highest level that doesnt hurt ( you might start low and go up)
7) nurse before you pump, until LO is tired. If LO is supplementing also, you are pumping. If LO is not supplementing now, but is done and you dont feel empty, you are pumping.
8) if lo is fussy at the start, try nursing more frequently. If she just wont settle, supplement .5 to 1 oz then try nursing again. Repeat as necessary until she is calmed.
9) Let her finish on the breast each time, even if youve just pumped--though with help you can arrange it: prepare bottle from last pumping/formula, feed 1 oz, nurse, (more at bottle if nec., more nurse to finish,) pump, give everything to dh to wash, eat, go to sleep. You can also eat while pumping if hands free. Wake, repeat. (dh may want to sleep on the couch)
10) use lowest flow nipples, and follow kellymom bottle directions: rub on cheek to get rooting, make lo open wide, tip bottle down so that lo has to suck a lot. Let her work for it.
11) have a support person (dh, mom, mil, kind neighbor) wash the pump for you and get it ready for the next pumping while you nap and cuddle with lo. Keep a cooler by the bed for the milk you just pumped, with a thermos of hot water for warming it as necessary for the feed. Keep a bunch of clean bottles on hand.
12) have support people feed you and do everything else in the house. Obviously you will have no time. Ask friends to bring meals, not visit.
13) get dvds or books or netflix, and plan to indulge your trashiest or least socially useful pleasures. For instance, I have a sick love of British tv, and I watched all of the rebooted doctor who while pumping. Headphones help others sleep through it.
It sounds elaborate, and it is, but it may also work. The key is to pump (for me 5-10 min for each ounce) whatever she eats from a bottle. As she eats more at the breast, reward yourself by pumping less, and watch the diapers. Try to intuit if she's eating enough rather than measure. If you feel that shes happy and full at the breast, dont bottle. If shes hungry an hour later, breast again. Remember hourly breast feedings are your goal here! Not 3hr intervals. To build your supply, you want her at the breast every 1-2 hours (from start to start), eating happily and getting satiated, taking a short break, and then eating more. Her intervals can lengthen once your supply is settled.
Good luck, and let us know how it goes! You can do it!
Re: help weaning from formula supplemen
It is normal for a young baby to want to nurse very frequently, yes, even every half hour. So this does not neccesarily mean she is not getting enough, although since you are supplementing so much it is hard to say. But this behavior is NORMAL. Let her nurse again.
Occasionally she'll fall asleep after nursing, but if we let her just sleep, she's up 30 minutes later and hungry again. At that point, hubs usually wants me to just give her a bottle because he worries she's too hungry.
Let down sensation is not a reliable sign of how much a mom makes. Some moms with plenty of milk never feel a letdown.
I'm stressed because I don't have any idea how much she's getting, or if she's getting any at all during some feedings. Sometimes I feel let-down while she's eating, sometimes I don't. Sometimes I feel it at completely random times during the day.
You might want to consider seeing a Lactation Consultant for a before and after nursing weight check. These have to be done carefully on an extremely sensitive scale, and they give limited info, just a snapshot of that particular nursing session. Of course, the more before/after weight checks you do, you do, the more info you will have. Your baby may very well be taking more at the breast then you are able to pump, for example.
Don't worry about pump output. Just pump, as frequently as you can. If she has a "good" nursing session, you could not pump then, but otherwise, pump after nursing and/or anytime you supplement, up to 10 times a day. Don't do more than that you don't want to exhaust yourself. Use the best pump you can get, a hospital grade rented pump if possible. Don't pump forever, mayby 15-20 monutes per side. (if you can pump both sides at once great.) Frequent milk removal is more important when building supply then pumping forever so you get a certain amount.
When I pump now, I'm getting about 13 ml from one side and 5 or 6 from the other.
Formula changes poop patterns. An exclusively breastfed baby should have a decent size poop at least 3 times a day up until 6 weeks, when it may start being less (in some babies) But formula changes this so much it makes this measure irrelevant for now. You will need to keep a close eye on babies weight as you make this transition.
Her wet diaper count is good I think, but she usually only has a dirty diaper once every few days. The past three days she's had one a day though.
The rule of thumb for an exclusively breastfed baby is to be back to birth weight by 2 weeks. So that gain sounds very good. But since you are supplementing so much, it would be very odd if baby was not gaining well.
Weight gain is good I think- 7 lbs 1 oz at birth, 6 lbs 5 oz at two days, 6 lbs 7 oz at 4 days, and 7 lbs 10 oz at two weeks.
The kellymom article referenced above is very informative. I also stongly urge you to get the book Making More Milk, contact your local La Leche League Leader(s) and attend a meetiing (it is absolutely fine to attend a LLL meeting if you are bottle/formula feeding, btw, some moms are concerned about this) and consider hiring a Board Certified Lactation Consultant (IBCLC) who is experienced in helping moms with this transition. Also remember breastfeeding need not be all or nothing. I think it is very possible you will be able to exclusively breastfeed, but in any case any amount of your delicous milk baby gets, any time spent nursing at the breast, is so important for baby & you. It's a gift of health and connection.
Nipple confusion and flow confusion are real. Some babies don't seem to be affected by it, but it is certainly a factor when a breastfeeding baby is being supplemented. I suggest you reconsider using an at the breast supplementor, (not on your finger, at the breast) or consider cup feeding baby supplemental feedings. Another option which can help is to keep bottle feeding but use the bottle feeding technique described here: http://www.llli.org/docs/00000000000...astfedbaby.pdf
This article gives a good idea of what is normal and expected with a breastfeeding baby in the early weeks. Even though your baby is 6 weeks now it still applies, for sure. One big issue I see when moms cannot make enough milk or are concerned they do not make enough is mom thinks every baby fuss or cry is hunger realted. So its important to understand that babies nurse for reasons other than hunger and this is normal and expected. Also that babies fuss for many reasons. http://www.kellymom.com/bf/normal/newborn-nursing.html