BF after reduction -struggles at week four
I am at week four with my first LO and am having a host of issues but not sure of how to make changes. I had a breast reduction when I was 18 (22 years ago) and I have flat nipples bc of the reduction. I knew I would most likely have a low milk supply, if any at all. After the (vaginal) birth, I was thrilled to see that I could express colostrum and the nurses suggested I BF with a nipple shield to help LO with my huge breasts and flat nipples. I have been using it ever since, though trying to get him to latch to my nipple for at least a part of each BF session. He was 6lb 14oz at birth, left the hospital at 6lb, 4 oz and gained 5 oz by his week one dr visit. Last week I decided to bring him back to get weighed because my nipples have been hurting so much that I knew I was taking him off when he could have been eating more. I was right, he had only gained 4 oz in 13 days. The Dr told me to supplement. For the last week I have been BF 8-10 times a day, following each session with supplementation (he takes about 1-2 oz of half formula, half expressed milk) and pumping with Ameda Platinum 5-6 times a day. This plan resulted in a healthy weight gain of 6 oz in 4 days.
I so desperately want to EBF but I worry about my supply, about his latch and the pain, and about weaning him from the nipple shield. I had a LC come in the first week but at that point I was not experiencing much of what I am now.
The pain is bad when it is bad, but also comes and goes. Of every day I might have 4-5 sessions where I am not in pain, and the rest I might be in toe-curling pain. It is not consistent.
When I pump I get anywhere from 1/2 oz to 1 1/2 oz. I always pump after I feed.
Feeding him without the nipple shield is a struggle and almost always frustrates him in unproductive ways. The best results I have are when I have him latched on the shield and halfway through a session, and then relatch him onto me. Sometimes it works, sometimes not.
Re: BF after reduction -struggles at week four
hi mama, it sounds like you're doing everything right, actually. is this current plan sustainable for you? for another few weeks, maybe another 4 weeks? because it sounds like at this point he is actually getting only about 8 oz/day of formula, which is GREAT, and you are providing the rest (nursing or pumping). and that weight gain is good. so IF this is sustainable for you for a little while, then i'd suggest continuing to do everythign you're doing. if the shield is working for you right now, keep using it. you can sort that out after you sort out supply and latch. the only big problem is the pain which fixing that will probably help with several issues - you'll be able to nurse longer so you won't have to pump as much, and the stimulation for your supply will be better, and of course the no pain thing is big too :)
can you figure out any pattern to when you're feeling pain? with or without shield? morning or night? beginning or end of feed?
can you have someone look at the latch in person? an IBCLC or LLL leader?
Re: BF after reduction -struggles at week four
I agree with Auderey that you are doing a great job. I think you need to see the LC again, or at least call her. Or if you think it would be more helpful, see someone else. Nipple pain is not normal and may indicate a poor latch which would also explain slow gain. So that needs to be figured out. Also, I think it would help you to gain an idea of how much baby is able to transfer when nursing, so several before and after nursing weight checks may give you a better idea. Supplementation can be a slippery slope, where it goes from enough to too much and harms milk production further. Baby went from gaining very slowly to very quickly, so to me that suggest the possibility baby does not need quite as much supplement as baby is getting, (but it is hard to draw any very accurate conclusions about weight gain with such a small sample of time.) Also, you may want to consider changing up how baby is supplemented so it is not always after a breastfeeding. Another option is to supplement a small amount before nursing, or nursing, giving a little supplement, then nursing again. These allow baby to 'finish at the breast' nurse to sleep, and thus associate nursing at the breast with comfort and satiety.
Were you instructed to pump after nursing when using a shield? Sometimes shields cause (or mask a latch issue that causes) a reduction in milk production. So pumping after nursing or as much as possible is often recommended as a precaution. You are pumping now, so that is good. My major point is the issues with slow gain may have more to do with a poor latch and nipple shield use and possibly nothing to do with your breast reduction.
The book Making More Milk is an excellent source of info about increasing low milk production