Hi I went back to work at 3.5 months and am at 4.5 months now. At 2 months we had some nursing challenges but we were able to get baby back to the breast eventually - with a LOT of great advice from this forum- and she would nurse at most scheduled times.
However, once I started back at work she was getting pumped BM (and one formula feeding a day) and over time started refusing to nurse even when I was home (2x a week plus weekends) - would arch her back and refuse to lie in any position to nurse. Middle of the night nursing is still good and she will sometimes nurse for a bit when I am putting her to sleep when she is asleep or when she wakes up in the morning. For the latter, if some one else picks her up or too much time has gone by since she work up, she will again refuse to nurse. She will babble and smile and want to play, but will not want the breast and will cry if I lie her down on my lap (or elsewhere) .
I finally decided last week to stop trying to nurse during the day when we are together (she is still being cared for by her nanny on weekdays; I am just working at home) and decided to increase my 3x a day pumping sessions in number. I did 2-3 days of 5x pumping but have now found my nipples are super painful (I had also upped the pumping intensity in a bid to get more milk faster) and sore ALL the time, to the point where I dread pumping. At the same time, I know that having her not nurse (other than the middle of the night) is probably already impacting my supply.
She drinks about 4 bottles of 4 oz during the day before I come home for her evening feed and I am definitely not producing enough to keep up. I have now switched to 2 formula feedings a day to avoid depleting my entire stash as we deal with the transition.
My questions are
a) What else can I do to help my nipples deal with the additional pumping and intensity? The pain is quite extreme. I have the Medela pump in style which has worked well for me; I bought a second pump a couple of weeks back and used that last week. I have been applying the APNO of late and also massaging some BM droplets back on them after pumping. Plus trying to air dry; though this is a pain at work.
b) How can I keep supply up at least such that I can provide 14-16 oz a day for her feedings other than the 1 of formula that I want to keep up? I take fenugreek three times a day. With the nipple soreness, I have switched back to pumping 4x a day starting today, and I know that while I am not getting enough milk at each set, that should improve over 1-2 weeks with regular and timely pumping. I also think she drinks more from the bottle than the breast.
c) She is sleeping longer during the night and my pedi thinks she can go the whole night without a feed soon. So, while I value the fact that her middle of the night feed helps build supply for me, I am reluctant to feed her in her sleep (unless she wakes up) because I certainly dont want to create a dependency of needing milk and me at night when she is ready to transition out. She sleeps around 7-7.30 and went back to getting up twice for a few nights just after I started work but now is back to once on most nights, somewhere between 2-4 am and then is up between 6-7 am. I know BF experts believe BF babies cant go for much more than 1 6 hr stretch without feeding but I think she may be an outlier as she started doing this very early in the day. I also have very busy work days and would love to be able to sleep more at night - I tried pumping a couple of nights but found that too exhausting.
d) I dont believe that I can bring her back to nursing without a significant investment in letting her not get a bottle, be hungry, cry etc (I have read many of the forum suggestions on this subject here). Do you have any advice on efficient ways to try and keep this alive, in case this is just a phase (though I dont think it is - she is now super aware of things and totally associates milk with the bottle). We have been using slow-flow pre newborn nipples on Dr brown bottles till now but have just bought the newborn ones.
While I am sad she doesnt associate nursing with me anymore, I believe it will be difficult for me to invest a lot of time (and more angst) in addressing this. The reality is that she spends most of her awake time during the week with the nanny and sees me for a couple of hours each evening. As my workload increases and I start traveling, this will remain the norm. My goal had been to BF till 6 mo to a large extent, which I guess I can still achieve with the pumping.
Thank you for your help!