OS, OALD, Fore-Hind imbalance w/3.5 mo old?
My DD (our first) was born 3 weeks early via c-section. I had issues with her latching due to many factors, one which I blame on the c-section and not being able to try breastfeeding until after I recovered which was a few hours after she was born. She also was tongue-tied and the pedi didn't notice it until she was about 48 hrs old and still hadn't been able to latch. Finally, the LC said that "late premies" often have the hardest time learning to breastfeed, for whatever reason...and my DD was considered a "late premie."
When my DD was about 6 weeks old I visited with a LC because my nipples were still SO SORE while breastfeeding and I figured my DD's latch was poor. The LC did say that she didn't have the best latch. She was latching towards the tip of my nipple and doesn't get enough of the whole breast in her mouth. The LC would try to reposition my DD, but my DD was NOT having anything to do with it. The LC basically said that because my DD was thriving (she gained almost 3 lbs in 6 weeks) that she didn't want to try to fix the latch that wasn't technically "broken" since DD was gaining weight.
We have struggled through the last 3.5 months and am proud that we made it this far. She really isn't a very good nurser even now, she pulls at my breast, delatches, and I am never quite sure if she actually empties my breast(s). She is just still so fussy yet, hiccuppy, gassy, that I am questioning a possible OS issue or at least a foremilk/hindmilk imbalance. I don't really think it is reflux, because she has been sleeping so well at night (10+ hrs consecutively). We also have tried our pedi's suggestion and given her 1/4 tsp Maalox, which, we were told would help with any reflux if it was present. She will be 4 months in two weeks, shouldn't she be getting less fussy by now?
I do know at times I have an OALD, because she will sputter and cough at the breast, especially my right one. I wonder if this is why she latches more at my nipple, so she can slow the flow of milk when it is shooting out so fast? And unfortunately, I NEVER feel my letdowns. But because I have OALD, I think DD has gotten used to only when my milk is flowing fast, and doesn't want to work for the hind milk. Or possibly because her latch is at my nipple, can't extract the hind milk??
About a month ago I was questioning an OS issue when DD was having green poops. I called my clinic's LC, and they told me to express a bit of milk first before feeding my DD, especially right before the first morning feeding when my breasts are so engorged due to DD sleeping through the night. It really didn't seem to help too much. Finally, out of frustration, I began pumping at night and emptying my breasts completely that way. My husband gives DD a bottle for her last feeding instead of being at breast. I pump about 6-8 oz total from both breasts, but DD only eats about 4 oz at that feeding. I figured this way she was at least getting hind milk at her last feeding then. And the green poops have gone away.
What should I do? I am thinking of throwing in the towel with breastfeeding and switching to EPing. Is it too late to try and remedy our situation? I always had visions of EBFing her until after cold and flu season next winter (she will be about 15 months by the time it is over).
Any help or insight would be greatly appreciated. Thanks in advance!!
Re: OS, OALD, Fore-Hind imbalance w/3.5 mo old?
Don't give up! I think it is possible to be successful bfing and use the pump sometimes. I have been struggling with some of the same questions since my twins started sleeping longer and I get very full. Do I have OALD and could it stop them from nursing effectively? Are they getting enough hindmilk when I put them on such a full breast? How can I tell? I keep hearing about green poops. Is that a sign that they are getting too much foremilk?
I have seen lots of advice here for regulating milk production and trying to get it in-sync with baby. I am trying to pump at night just enough to relieve fullness and nurse more frequently during the day. Don't know if it will work yet but I think there are lots of things to keep trying.
Sounds like your LO is growing great so you must be doing something right!
Re: OS, OALD, Fore-Hind imbalance w/3.5 mo old?
First off, congratulations on nursing for 3.5 months! Awesome, especially when you're facing challenges
I think you're on the right track with an OS/OALD issue. So many of the things you describe fit- a baby who gains weight very quickly despite a suboptimal latch, and gassiness, fussiness, unlatching during nursing, pulling at the breast, spluttering, coughing, green poops...
Latching onto the nipple and not the breast can also indicate OS/OALD- my LC compared it to "crimping the straw" as the baby drinks. It's a good way to slow down to speed of milk coming from the breast.
Maybe, maybe not! Babies are such little individuals, and some have higher needs than others for touch and attention. My kid was a fusspot until she was a lot older than yours- heck, she's 4 and still has a high need for attention.
She will be 4 months in two weeks, shouldn't she be getting less fussy by now?
Just FYI, it's totally normal not to feel letdowns. You can usually identify them by the way the baby acts- switching from sucking with little or no swallowing to sucking with a lot of gulping (or choking/coughing/spluttering in the case of OALD).
unfortunately, I NEVER feel my letdowns.
If OS is the problem, the problem isn't likely that the baby can't extract the hindmilk because of her imperfect latch- it's more likely that she can't reach it because she's filling up on foremilk and isn't very hungry when the hindmilk starts coming out.
But because I have OALD, I think DD has gotten used to only when my milk is flowing fast, and doesn't want to work for the hind milk. Or possibly because her latch is at my nipple, can't extract the hind milk??
I understand your frustration, but unfortunately, I think the thorough pumping you've been doing has made the OS issue worse. Every time you completely empty the breast, you're telling your body "please make the same amount of milk again, every drop you just made was needed." Pumping less (less milk, less often, for less time) or even just putting up with the engorgement should tell your body to reduce production.
Finally, out of frustration, I began pumping at night and emptying my breasts completely that way.
My husband gives DD a bottle for her last feeding instead of being at breast. I pump about 6-8 oz total from both breasts, but DD only eats about 4 oz at that feeding. I figured this way she was at least getting hind milk at her last feeding then. And the green poops have gone away.
It's definitely not too late to remedy the situation. And I wouldn't switch to EP because hard as BF is, EP is generally MUCH harder (harder to maintain supply, have to decide between baby care and pumping, have to store, transport, and warm milk, you need to wash bottles and pump parts, harder to express milk in public, etc.). That doesn't mean you can't do some pumping, though- if your baby will willingly go back and forth between bottle and breast, you may be able to have the best of both worlds.
What should I do? I am thinking of throwing in the towel with breastfeeding and switching to EPing. Is it too late to try and remedy our situation?
This link has great tips on coping with OS/OALD: http://www.kellymom.com/bf/supply/fast-letdown.html It sounds to me like you might really benefit from trying the positioning tricks, and maybe doing some block feeding (especially during those times of day when you have the most issues.).