Please help!!

[@llli*onyxmr]

I am starting to get really discouraged with my supply and having to supplement My baby is 2 weeks old.

Here's the story...baby girl was born at 37w4d via an unmedicated natural birth.
She was 6lb 11oz at birth and 5lb 14 oz at 3 days old. We were having latch difficulties (she would latch, suck 1 or 2 times, and pull off over and over) so we started using the nipple shield at the recommendation of our doula who said she was
showing signs of dehydration. She is at the breast very well with the nipple shield. I still attempt to get her to latch without it, but she's not getting it. I'm ok with
using the shield at this point. I'm just glad she's at the breast at all. We were
exclusively nursing until she was about a week old when we encountered some
problems. I thought if I just kept nursing, things would get better but they didn't.
At a week old, her jaundice was pretty high, she was not peeing enough, no poops at all after the meconium, and the pedi recommended we supplement. I
supplemented for 2 days,she had a poop, more pees, and gained a little weight (up to 6lb 3 oz) so I went back to just nursing. Diaper output went back down and she stayed at the same weight for 5 days. Pedi recommended supplementing again with Alimentum to help her poop. Since starting the supplementing again, she is having plenty of wet/dirty diapers and is generally more content.

For feedings, we are nursing first, then offering 1.5 oz formula via bottle, which she usually finishes. When I pump, I usually get 1/4 to 1 oz total from both sides. I
have been pumping after some feedings, and adding pumping sessions in between
feedings to try to up my supply. When I pump after feedings, I don't get anything
so I'm pretty sure she is effectively getting the milk. The most I have ever gotten
from pumping is 1.5 oz, but it's usually around 1/2 oz..

I would like to get back to EBF, but I just don't know where to start. How to wean off the formula? What to do to increase supply? Please help!

[@llli*mommal]

Welcome and congratulations on the new baby!

It sounds like you've been pursuing the correct course of action so far. When you have a small, sleepy, jaundiced baby who isn't peeing of pooping enough, supplementing is probably absolutely necessary. And it's probably temporary!

Here are some things I suggest doing to increase supply and transition to exclusive nursing:
1. See a lactation consultant, preferably an IBCLC, for hands-on help.
2. Use the best possible pump- for most moms, this means a hospital-grade rental with correctly sized shields (the LC should be able to help you with both of those things).
3. Pump as much as possible. You want to be filling every supplemental bottle with your milk. If you can do that, you will know that your supply is equal to the baby's demand and it will be easier to transition to nursing exclusively.
4. Consider renting a professional scale, one that is accurate to the 1/10 of an oz. If you weigh baby before and after nursing you can gain a good picture of how much milk she is taking in, and use that information to decide whether or not supplementing after a feeding is necessary.
5. If/when you feel confident that baby is nursing well, use the technique in this link to wean from supplements: http://www.kellymom.com/bf/supply/decrease-formula.html

Questions for you:
- How does nursing feel? Any pain, blistering, cracking?
- Does baby still fall asleep very rapidly at the breast?
- How often does baby seem to want to nurse? Is she nursing at least 8-10 times in 24 hours?
- Has the jaundice gone away yet?

[@llli*lovemygirlso1]

with pp. You could also try eating more oatmeal and perhaps some More Mother's Milk Tea. And keep trying to get her to latch without the shield as the shield can also diminish your supply. Most importantly remember we are all behind you and support you and don't give up You can do it mama!

ETA: Remember also to drink lots and lots of water yourself.

[@llli*lllmeg]

Don't lose hope onyxmr! This is very early days yet, and you may indeed be able to exclusively nurse should that be your goal. Even if you have low supply that remains too low for exclusively nursing baby no matter what you do (rare, actually, but it happens,) you can try combo feeding-nursing and supplementing as neccesary. Breastfeeding need not be all or nothing, and low supply does not mean you cannot nurse your child.

pposts have good tips and questions. Keep coming here for help.

I would also suggest the book Making More Milk, and kellymom.com has lots of info on increasing milk supply.

[@llli*onyxmr]

Thanks for the tips! In answer to your questions, nursing feels fine. No pain. Baby does still fall asleep fairly quickly, and gets upset when taken off the breast. Seems very hungry after being taken off the breast too. I really need to start paying attention to the clock. If you count the cluster feeds as more than one feeding, then I'm pretty sure its at least 8 times. Although, she sleeps really well at night & I know I could be feeding more during that time. I'm just too tired to wake up if she doesn't The jaundice level is on its way down.

I feel like I'm pumping as much as possible, but I'm lucky if all the sessions add up to enough for one bottle. I dont know how I will ever get to supplement with just my own milk.

I am going to call a LC tomorrow!

[@llli*lovemygirlso1]

Don't worry about paying attention to the clock that way you just feed off your baby hunger cues rather than the clock

[@llli*miguelsmamma]

Just takes some time! Make sure to keep stimulating your breast and working on latch! You'll get it! I have faith! . When your lil one falls asleep at the breast and you think she hasn't sufficiently nursed, don't take her off, just stimulate her to wake up while still latched and keep sucking... Like moving her arms or rubbing her head, etc. Whatever works for you,! It's kinda like a reminder for her to keep sucking. And I know it sucks, but if you don't have great supply and she is not gaining well, you should be feeding her every 3 hours at least no matter what time... It stinks now, because crap we get tired, but it will stimulate good milk supply and help her gain! Once she is gaining well and your supply is good (off supplementing with formula) then you can go back to letting her sttn. And remember for each time you supplement her with formula, you should be pumping too to stimulate your milk supply---letting your body know how many times your baby needs to feed. Also, pump about 5 min longer than milk easily comes out to tell your body to produce more.
I had to supplement too due to jaundice and low supply in the beginning. So these are the things I had to do. And I am ebf now.
Also agree with all previous posts!!! Water should be top on your list for drinks!! I know it's hard when you are tired... But it's so important! I even kept a water bottle by my bed (or wherever I slept). So I could drink easily when up during the night for the baby!

[@llli*lllmeg]

Although, she sleeps really well at night & I know I could be feeding more during that time.

If you would be able to increase nursing sessions, you might be able to decrease pumping times. NOTHING is more exhausting than trying to nurse AND pump especially in the early weeks. If you are using a nipple shield it is likely a good idea to pump still but maybe you would not have to pump so much.

A baby will normally want to nurse very frequently part of the time and take longer breaks here and there. A newborn could "act hungry" shortly after even a great feeding. Behavior alone can make mom concerned her baby is hungry when baby just wants to nurse more because that is what babies do. That is why you generally want to look at output and not behavior to make sure baby is getting enough. Behavior tells you some things but it can be confusing.

A two week old baby should be nursing a minimum of 10-12 times a 24 hour day. Rarely a baby gets by with less but that is rare. And yes, that means overnight as well. While building your supply, if baby cluster feeds and nurses at least that many times the rest of the day, you could go for up to a 4 hour stretch ONE time at night but not more than that. This is not forever but this very frequent nursing is the general norm for about the first two months at least. If they do not nurse that much they may not get enough and over time mom's milk supply may suffer. If you were only nursing 8 times a day, its entirely possible that is why or at least one reason why your baby was not getting enough overall in that second week of life, and it may have nothing to do with low supply. If baby DOES nurse that much (and milk transfer is appropriate), they can get enough at the breast and there is no need to pump or supplement.
This is a great article on what is normal in the early weeks with a breastfed baby: http://www.kellymom.com/bf/normal/newborn-nursing.html

Oh and what you are able to pump is not a good indicator of overall milk supply. Babies are usually much better at getting milk out than even a very good pump.

[@llli*onyxmr]

LLLMeg- If baby seems satisfied after a feeding, I haven't been supplementing with formula. When I'm not supplementing, she seems to want to nurse about every 2 hours. If I do supplement, she is satisfied longer, so I've been pumping if 2 hours have passed. Will this work or should I be doing something else? Generally, its only been one four hour stretch at night after she cluster feeds in the evenings...although the cluster feed usually ends with a formula supplement b/c I'm worried she's not getting enough.

I have seen a very slight increase in my supply, although I still don't know if it is enough to EBF. I ordered some More Milk Plus which should be here today. How many ounces is normal for a 3 week old to consume in 24 hours?

[@llli*mommal]

Nursing every 2 hours is normal, because breastmilk digests fast and baby tummies are tiny. So if you're supplementing out of fear that baby is not going long enough between feedings unless supplemented, you can relax on that score.