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Thread: Advice and suggestions please for incre!

  1. #1
    Join Date
    Feb 2012
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    Default Advice and suggestions please for incre!

    Hello,

    I am currently trying to build a full milk supply for my four week old. Some background- we planned a homebirth, but circumstances did not cooperate and we ended up with a c-section followed by severe post partum hemmoraging. I needed 8 units of blood and spent 3 days in ICU, during which time the baby did come down to breast feed but was also supplemented with formula.

    Once we moved to post partum recovery we supplemented with a tube and syringe at the breast and continued that for 2.5 weeks. The we switched to a bottle for supplements for my sanity.

    The things I am doing to get my milk up:
    - pumping for 20 min after breastfeeding
    - eating oatmeal and drinking non-alcoholic beer
    - taking more milk plus
    - taking 80 mg of domperidone (just started 2 days ago)

    The baby eats 5 times a day; I'm not sure if I should also try to get another pumping session in right when she goes to sleep? We currently switch nurse, then she gets a bottle if she wants one (usually 2 oz plus what I pumped, usually 0.1 oz), then I pump.

    I just rented a scale. At previous post feed weighs at lactation groups she was getting 1.5+ oz from me. Based on a few days of weighing at home she is getting about an ounce each time. This is so discouraging because I feel we are going backwards. However, I also suspect I have started menstrating again, which I have read can decrease supply.

    I have had my blood checked recently and everything is back to normal. I am waiting on the results of a prolactin level test as well.

    At this point I don't feel like this will ever get better and I am completely heartbroken. I have promised myself that I will push forward until week 6 and then reassess.

    Any advice or suggestions are appreciated!

  2. #2
    Join Date
    May 2006
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    21,117

    Default Re: Advice and suggestions please for in

    Welcome and congratulations on the new baby! I'm so sorry things have been so difficult for you. I know it's got to be rough to plan a homebirth and end up with a totally different experience. Are you healing okay from the c-section?

    It sounds like you are doing a lot right. Pumping after nursing is great. Getting the scale is a very smart move- the data you are collecting is truly valuable in helping you assess how nursing is going. The domperidone and the herbs should help you produce more.

    Here are some additional suggestions which may help you produce more:
    - Use the best possible pump, with correctly sized shields. If you do not currently have a hospital-grade rental pump, you want one!
    - Combine pumping and hand expression.
    - Nurse more, and pump more. The more often you remove milk from the breast, the more milk you will make. Most newborns nurse at least 8-10 times a day, with many nursing more in the 10-12 range, and all that nursing is what encourages a good supply. 5 nursing sessions per day- well, I know it must take a huge amount out of you, but you really want to nurse more than that. If you can't, or baby won't, you need to mimic that frequent stimulation using the pump. When I had supply problems, I pumped every 2 hours during the day and every 3 at night, and if I had a spare moment I slipped in an additional session. Exhausting, yes, but effective!
    - Consider alternate ways of supplementing the baby. You might want to consider getting a Lact-Aid or SNS supplemental feeder- basically, it's a bag of milk or formula that hangs around your neck, with a tube coming out of it. You position the tube next to your nipple and latch the baby on, allowing baby to eat simultaneously from the breast and the supplemental bag. It's fiddly and definitely harder than using a bottle, but it cuts down on the risk of baby coming to prefer the bottle.

    At 4 weeks postpartum, I doubt that your cycle has returned. Lochia often lasts 6 weeks, sometimes more, and can stop and then restart several times during the immediate postpartum period. It often comes back when a mom overexerts herself.

    How is nursing going aside from the difficulties you seem to be having getting baby to transfer milk? It would help to know the following:
    - Are you in pain at any point when you nurse, or afterwards?
    - When baby unlatches, is the nipple misshapen in any way? It might look creased or wedged, or like a brand new lipstick.
    - Is baby sleepy at the breast, perhaps nodding off soon after the feeding begins?
    - Is baby jaundiced at all?
    - Is baby non-demanding? Do you have to wake her to feed, or coax her to nurse?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    Mar 2010
    Location
    Northern Cal.
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    Default Re: Advice and suggestions please for in

    Mommal has some great advice and questions. I just wanted to pop in and say, don't give up yet! You are still in the very early days. A lot can still change. I know it can be very discouraging; try to just take it day by day.


    You can call me JoMo!

    Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

  4. #4
    Join Date
    Feb 2012
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    23

    Default Re: Advice and suggestions please for in

    Thanks for the suggestions. To answer your questions:

    - yes, I'm using a rented hospital pump
    - after pumping I can't hand express anything
    - I know 5 times a day isn't a lot. I let the baby set the schedule. She is up for about 2.5 hours and then sleeps for 2.5 hours to 3 hours. I am going to pump while I feed her a bottle and then pump an hour and a half later, so that it isn't too close to her waking up again. Once I have a better supply we will be able to nurse more because she won't be need to have heavy formula to fill her up, so she should sleep less. I would try to wake her to eat in the afternoon, but she actually hasn't been sleeping very much (which makes pumping so difficult!). She just stays awake exploring the world. Also, I usually comfort nurse her to get her to sleep.
    - We used to supplement with a tube and it was just awful. I'm not up for going back to that. We are using the breast flow bottle and there doesn't seem to be nipple confusion so far.

    And questions about the baby:
    - I have pain for about 7 seconds after she latches, and after nursing and pumping my nipples are a bit sore. But no pain other than that.
    - no nippple shape issue after the baby unlatches. After pumping my nipples are VERY pronounced; is that normal?
    - the baby gets sleepy at the breast once the flow slows, so I keep her up by moving her arm, tickling her cheek, etc. When we are feeding there is a no loitering rule!
    - no juandice at all
    - no need to wake the baby to eat; when she's hungry you know it

    So right now my plan is to double my pumping sessions. Is there any reason she would start getting about half as much from breastfeeding? I'm not pumping any more volume after feeding, so I don't think she is leaving milk in the breast but who knows...

  5. #5
    Join Date
    Mar 2006
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    10,440

    Default Re: Advice and suggestions please for in

    I would nurse, not pump. No pump is as good as a baby at I creasing supply. If baby falls asleep, switch sides so she gets a fast flow again. Do breast compressions.

    5 times a day doesn't seem like enough to me. Yes, she is driving, but you may need to step it up a bit. A baby should be nursing more like 8 times a day, and if you opt to pump more, you need to aim for 8-12 times a day. I exclusively pump, and at that age, I pumped 12 times a day, for a total of 120 minutes. I still pump for 120 minutes a day, but not 12 times a day.

    If you do opt to pump more, maybe try pumping in between nursing sessions. You will have to switch her back and forth, but keep nursing. What I get worried about when I see a mom considering pumping more is that a) because a pump isn't as good as baby, her supply isn't as good and b) you will get sucked into exclusively pumping, which is way more work than what breastfeeding becomes. And it takes a lot of energy and happiness and makes a lot of moms believe they can't do it and they quit


    I bet it is just lochia. It starts and stops.

    Your scale may be weighing her a bit differently than the one you used before. And while it can be useful, it can also be stressful. Don't weigh her all the time. You will just freak yourself out. My doctors did that to me with our fourth baby, a cleft baby, and it derailed, eventually, what little bit of a nursing relationship I had with him and made me EP.

    The latch description sounds normal.
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  6. #6
    Join Date
    May 2006
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    Default Re: Advice and suggestions please for in

    with the PP. Sounds like you have a good latch, which is awesome! That puts you way ahead in the game. Having your nipples look very pronounced is normal. The only thing that wouldn't be normal would be if they looked squished, asymmetrical, flattened, wedged, creased, etc. 7 seconds of pain at latch-on isn't ideal, but it is certainly in the normal realm, and it should disappear as baby grows and becomes better able to latch on very deeply right from the first moment.

    I am also with the PP that in a situation like yours, you don't want to let the baby drive when it comes to nursing frequency. For whatever reason- perhaps the formula, perhaps the newborn sleepiness- she is just not asking to nurse often enough. Aim for at least 8 nursing sessions per day, even if that means waking her up or offering the breast when she seems uninterested. And if she won't nurse enough, make up the difference with the pump. I know it means being harnessed to the machine all. day. long. but when you're trying to bring your supply up there's just no substitute for frequent stimulation and milk removal.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  7. #7
    Join Date
    Mar 2010
    Location
    Northern Cal.
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    Default Re: Advice and suggestions please for in

    Perhaps smaller supplements with formula (like top her off with just an ounce then see how she does?) would help her wake up hungry sooner? At five times a day (whether it's baby driven or not) you're going to be struggling with supply for a really long time. As a newborn, it's normal to nurse 12 times a day or even more. I realize this means hardly any sleep for all parties, let alone time to pump, but it would just be for a couple weeks, hopefully, while you get your supply up.


    You can call me JoMo!

    Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

  8. #8
    Join Date
    Feb 2012
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    Default Re: Advice and suggestions please for in

    Thanks for all the advice! Its hard to get her up to nurse again because she stays up for so long. So, to feed every three hours means I would be waking her up right now from our 8AM feeding and she just went to sleep. We nursed right before she went to sleep on both sides and now I'm pumping. Does that count? Its more comfort nursing than anything, but I did hear some swallowing.

    I've tried cutting back on the supplements, but she screams bloody murder when she's hungry. We take frequent breaks when feeding with the bottle to make sure she really wants it, and I give her pumped milk as well.

    I think I am going to try waking her sooner for feeding and increasing the number of times I pump each day. I'm going to aim for 6 feedings a day for now, and then get up to 7. It will probably take her a couple of days to get used to this new schedule.

    Thanks again for all the advice! I am completely discouraged by this situation, especially since I really believe that if I didn't have the extreme hemmoraging we wouldn't be having all these feeding issues. It just sucks all around, but having a healthy baby makes it worth it. I don't want to give up on breastfeeding, and I don't want to exclusively pump. But right now I don't feel like this situation will ever get better. Hearing words of encouragement and sdvice helps a lot, so thank you all.

  9. #9
    Join Date
    Nov 2011
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    Default Re: Advice and suggestions please for in

    Something else that no else mentioned is WATER. You lost a LOT of blood and it takes a LOT of water to replenish not just the blood but also to replenish BM. When my husband had an internal bleed, he required 2 units of blood, but really needed at least 2 more, but the doctors said normal procedure is to get them just into 'acceptable' range, which wasn't his normal level. If I don't drink at least 90 oz of fluids per day I start to see a small dip in my supply. If you get dizzy if you stand up too fast or are getting frequent dull headaches, those are early signs of dehydradtion. Also, I don't know if this would work or not, but to try to get in more nursings because she wakes when she is hungry, let her fall asleep at the breast and dreamfeed and maybe try to cosleep for awhile everyday so she has full access to the breast. I did this a few times by accident (the full access part) and I woke up nearly engorged.

  10. #10
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    Default Re: Advice and suggestions please for in

    Quote Originally Posted by @llli*krysbe View Post
    Something else that no else mentioned is WATER. You lost a LOT of blood and it takes a LOT of water to replenish not just the blood but also to replenish BM. When my husband had an internal bleed, he required 2 units of blood, but really needed at least 2 more, but the doctors said normal procedure is to get them just into 'acceptable' range, which wasn't his normal level. If I don't drink at least 90 oz of fluids per day I start to see a small dip in my supply. If you get dizzy if you stand up too fast or are getting frequent dull headaches, those are early signs of dehydradtion. Also, I don't know if this would work or not, but to try to get in more nursings because she wakes when she is hungry, let her fall asleep at the breast and dreamfeed and maybe try to cosleep for awhile everyday so she has full access to the breast. I did this a few times by accident (the full access part) and I woke up nearly engorged.
    This is a good point. I lost a lot of blood during Joe's birth, but not enough to get a transfusion. However, I was severely anemic for a good six weeks after the birth. That really takes it out of you and makes everything harder. I had to make sure to get plenty of food, plenty of iron, and especially, LOTS of water, while I was recovering from that.


    You can call me JoMo!

    Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

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