Not gaining enough
This question is for a friend of mine (Lindsay) who for one reason or another does not want to use the boards... w/e you guys are wonderful :love
Anyway she's still struggling so I thought I'd ask on her behalf. :
Her daughter Elizabeth is 4 months old. Lindsay is away at work from 5AM - 3:30PM. Her husband watches her until 7AM and she gets one bottle then (3oz). She then goes to daycare where she gets 2 bottles of 3oz - about one every three hours. She then nurses her daughter in the evening and at night at will.
Her daughter has stopped gaining weight and was very small to start with. The Peds are concerned for sure, and have recommended a supplementer (SNS?) to get Elizabeth more milk when she's nursing.
She pumps plenty (shes very sore as it is) , and she has plenty of milk - however she states that when it separates out there is barely 1/8th of an inch of hind milk on the top. She does compressions and hand expresses after pumping to get the last tiny drops.. I really do think she's doing her best there.
She admits to eating a crappy diet-
Elizabeth is no longer interested in bf-ing once the letdown is over, but Lindsay hasn't seen any major results with the SNS either- which I would think would be a great improvement if she was disappointed with flow. Seems she just has a tiny stomach.
I told her to see if she'd be interested in a bottle every 2 hours instead of 3...?
I am not experienced enough to offer any other advice to her? She's already doing everything I can think of ? I did read a post where some woman was adding oil to the milk to help with weight gain. NOt sure.
Awaiting your valuable insight!
Re: Not gaining enough
Offering a bottle of 2-3 ounces every two hours is a great idea! Breastmilk digests very quickly (90 minutes or so) so she may be drink more if offered more, ya know? As for the 1/8 of an inch of hindmilk, that's about what I would get, sometimes less.
And the reason that she doesn't want to nurse after letdown may be because she is use to the faster flow of the bottles. It takes a lot more work to get milk directly out of the breast for baby. Is she doing breast compressions while she nurses? That could increase the flow. It's also important for her to make sure that the first breast is empty before offering the second. Think of the first as dinner and the second as dessert.... with dessert not being necessary after every dinner ;) It's more important for baby to get the hindmilk (way more calories) of the first breast than the foremilk from the second.
It sounds like your friend is definitely on the right track and seems to be very informed about breastfeeding :ita Trying a few new things may get her through this rough spot. Tell her to hang in there! :hug
Re: Not gaining enough
Wow! This sounds so familiar! :) I am really shocked that you paid that much attention. Carmen talked me into checking out the forum when we were pumping together at work today. Thanks for bringing my bad diet into this. LOL I just don't eat very healthy. Once I am not so freaked out about an exercise bra causing me mastitis, I am planning to eat better and exercise.
I only rarely compress while nursing. I used to when we were having a hard time getting her to gain weight in the early days because she was so sleepy. I don't know why I stopped but I will start again. I have been pumping 3 oz more than what she eats every day. That's not counting what I get when pumping after nursing. I am certain that it is not a supply problem. She gets really frustrated and goes on and off the breast after letdown. I am certain it is because she wants me to be like a bottle. I usually give up and switch because I am already sore from pumping and her doing that makes it so much worse. When she's done nursing, she will either fall asleep, bite, or just unlatch and hang out. We nurse on demand all evening and night. I wake her up in the evening if she goes up to 3 hours between nursing just because her weight is an issue. We have a cosleeper, but she spends most of the night in bed with me. I nurse her, fall asleep, and wake up 2 hours later and she's still latched on. Elizabeth's Ped and I decided to try to get that extra 3 oz into her through an SNS. I've been able to get a couple extra ounces every night, but usually not all 3. I want to avoid bottles at home at all costs since she is already having issues with me vs bottles. Regarding making sure the breast is empty, I definitely try to do that but it is difficult when the baby would rather give up than work for the hindmilk. I had mastitis 2 weeks postpartum because I was timing the baby at each breast and then switching. We don't do that anymore - that was a painful lesson to learn.
Here is my plan. I will give her an extra 3 oz bottle to give to daycare to feed her, and pump after our evening feeds and use the SNS to get more hindmilk into her, but at a rate that she won't get frustrated with. She's occasionally come home with an ounce of milk from the 6 she gets at daycare. She's just not hungry it seems. I am concerned about giving more at one feeding because if her stomach gets stretched out and she wants more each feed, I don't think I would be able to keep up. I am hoping that one day I will be able to get off the SNS. I hope she will somehow make the distinction between daycare and home. If I could, I'd somehow have daycare not use bottles at all, since I think her being frustrated that I'm not a bottle is a big part of the problem. I tried a syringe, sippy, and cup, and most of what I get in her mouth comes right back out. I am determined to continue with breast milk only. She has 7-10 diapers a day, and can already roll front to back and back to front, reaches out and grabs things (And takes it straight to her mouth) and seems to be meeting milestones. Her ped has said that she does take into consideration our family history of being small babies, but she is concerned about how quickly she's dropped on the charts. She doesn't seem sickly to me. I do trust our Ped. She was a breast feeder herself, and has given some really good advice in the early days that worked well. She's not once suggested formula. The way I look at it is, it can only help her to get the extra milk into her, and won't harm her, so this is something that I need to do. I tell myself every day that this is such a short time in my life if I look at the big picture, I will get through this. Sorry this was a book, just wanted to give some detail.
Re: Not gaining enough
What bottles/nipples are you using now?
Because they are a necessity, it may be a good idea to go back to using the slowest nipple that you can find, or something like the Breast Flow bottles. That way baby won't be used to a slower flow and won't be as frustrated with the flow from you. :gvibes
Re: Not gaining enough
My son sounds THE SAME. With one exception. He ate 2oz every 2 hrs until he was 4mo. From 2mo-4mo he only gained 1lb, and dropped to the 2% for weight.
His Ped wanted me to keep breastfeeding, but only if I could get 4oz to him at a time. Not sure why, but that's the # I was given. I did extra pumpings, took Fenugreek, and made Fennel tea. Got my supply up, and LO was wonderful after that.
As far as the Let Down, my LO was a very lazy nurser. My let down was so forceful, that he didn't have to work. So usually between the forceful let down, and his compression, I was pretty empty when he was ready to get off. They really do know when there is none left in there. It's not unheard of for an efficiant nurser to feed for 3-5 min each breast. Mine did, and he jumped 4lbs on me in 3mo! It was a wonderful thing for me to see :clap
My milk is nearly fat free, I joke about it all of the time. HOWEVER when your LO is done, squeeze a bit of milk out of your nipple, and if it looks thick, and kinda white, then your LO got hind milk, and most likely is ready for the other side. If it's still pretty clear, then you know LO didn't reach the hind milk. I was told to switch to drinking whole milk, and using real butter, but I don't think it made a difference as far as the fat content in my milk.
I would try and give baby 4oz bottles at a time. It worked for us. Also, baby is probably getting more from you than the bottle. Which is why LO doesn't want to feed after a nursing session. My BEST piece of advise is to visit your LC and weigh baby before/after a feeding. You'll know how much your giving baby, and that will give you a better idea of how much LO is taking in.