Pumping vs really painful nursing

[@llli*jisil]

I am about 3 days post partum with my second child. After a few attempts at getting him to latch on, my nipples got really sore and cracked. I tried to persevere through it, but it got to the point where I was screaming during our attempts and in terrible pain if I let him stay on. I didn't want to give up completely, so I spent today pumping and giving him the expressed milk in a bottle. Hopefully, that hasn't ruined my chances to have him latch on correctly. My nipples are still very sore, but I think they are getting better today and my milk came in this afternoon. The problem now is that I'm feeling terribly engorged and I'm not sure what my next step should be. Since the baby went practically all of yesterday without eating anything, I pumped about every 2 hours today and he gobbled up everything I gave him. Should I keep pumping at that schedule or is that what's causing the engorgement? Like, am I overproducing now because of all of the pumping? Would it be better to try to get him to latch on now that I know there's milk, even if that will probably still be very painful?

I successfully nursed my first for 9 months, so I know I can do this, but I'm really worried that I'm screwing things up by using the bottle already. Please help!

[@llli*lllmeg]

I don't think you are screwing anything up. If it's simply too painful to nurse, you are doing exactly what you need to do-feed baby & maintain milk supply until you can get help. See this: http://www.llli.org/docs/00000000000...ching_baby.pdf

(I realize your baby CAN latch but it hurts, but many of the tips will still be relevant for you.)

If you are engorged you likely need to pump more frequently and perhaps add some hand expression. If baby is not nursing at all it's important to aim for at least 8-10 pumping sessions a day. Hopefully you have a good, effective, well working electric pump that is not causing more nipple injury. Pump on a lower setting if you need to due to pain. If this (pumping exclusively) goes on for more than a day or two, you may want to consider renting a hospital grade pump.

As far as how to feed baby to help lessen nipple/flow confusion, you might consider cup, spoon or syringe feeding. If you want to stick with bottles, perhaps use these suggestions for bottle feeding the breastfed baby. http://www.llli.org/docs/00000000000...astfedbaby.pdf

Hand expression: http://www.llli.org/docs/00000000000...expression.pdf

See video clip on here for cup feeding: http://nbci.ca/index.php?option=com_...id=6&Itemid=13

Get help! You are an experienced nursing mom so you know you can do this. Something is up. Of course you could work on different latch and positioning techniques on your own, but when things are this bad I usually suggest moms get good, and, if possible, clinically trained, professional hands on help ASAP. This usually means hiring an IBCLC. Look up local International Board Certified lactation Consultants for your area here.: www.ilca.org You could also contact your local LLL Leader(s.)
Oh and some babies will "gobble" when given bottles. Look at output (poops) to make sure baby is getting enough just as you would if nursing. See: http://www.llli.org/docs/00000000000...diaper_log.pdf

[@llli*jisil]

Thanks, lllmeg! I really appreciate your quick response. It's tricky since there's a lot of confusing information out there about pumping and engorgement. I ended up pumping again for the most recent feeding and I got twice as much as I had been before. Like you suggested, he gobbled it all up (like 40ml!). He hasn't had a poop since yesterday though, so I hope that means he's not getting too much from the pumping. He's had a good number of wet diapers and he had a lot of meconium come out in the hospital. Both breasts felt full and hard again right after I was finished pumping. I think if I wake up in pain before he seems hungry again, I'll just hand express so I don't start to over produce. I think I will look into getting in touch with a local consultant. Our pediatrician's office seems to have one on staff, so that should help! I just need to get through this first weekend.

[@llli*mommal]

Not pooping can mean nothing, or can be a sign of a baby not getting enough to eat. It never indicates that baby is getting too much to eat.

I agree with LLLMeg that a trip to a lactation consultant, preferably an IBCLC, is your best shot at getting this sorted out. I can totally understand why you don't want to nurse right now. However, I strongly suggest that you put the baby to the breast at least once or twice a day, more if you can stand it. It isn't generally recommended to introduce bottles so early, because babies often come to prefer the ease of bottle feeding and start rejecting the breast. If you can stand nursing just a one time per day, or better yet a few times a day, your baby is more likely to retain his latching skills and willingness to nurse. And nursing just a few times a day is unlikely to lead to severe nipple damage.

[@llli*jisil]

Yes, I knew it was a bad idea to start with the bottle. :-( I tried for hours this morning trying to get him to nurse, but he just angrily refused. Eventually, I pumped and we gave him the milk using a syringe instead of a nipple. I just really don't want to do this pump and then feed thing anymore. It takes so much longer and, even though I get to see exactly what's going in, which is nice, I know I'm probably just making things worse. I imagine that it will be impossible to talk to an LC today since it's Easter Sunday, but our pediatrician office does have emergency appointments available in the morning. I might call them about the not pooping and maybe they'll be able to help me with the nursing issues too.

[@llli*lllmeg]

It's tricky since there's a lot of confusing information out there about pumping and engorgement.

Well this is not controversial. EXTRA pumping, on top of nursing frequently, will likely cause engorgement. But pumping (or very effective hand expression) INSTEAD of nursing, because you or baby cannot nurse, is vital for milk supply. In the early days, a mom gets engorged because the milk is not being removed from the breasts frequently and effectively-and pumps can and usually are much less effective at milk removal than a nursing baby. You can hand express instead of pumping, or right after pumping, or just before pumping to help “empty” the breasts. Right now, your hormones are telling your body to make milk but if you do not remove it frequently and effectively, your breasts feeling full will send the message to your body to reduce supply.

40 mils is like 1.3 ounces, right? That would seem like a normal amount for baby to take per feeding at this age. If a baby takes that much 12 times a day, that would be about 15 ounces. After the first week or two, the amount of milk a baby needs is around 25 ounces per day. (Some take more, some less.) So you are doing about as well as can be expected at this point, but certainly it does not sound like you are pumping too much milk.

I think it is fine to call an LC. If they are not taking calls today you can leave a message. IBCLCs and LLL Leaders know that moms & babies need help on weekends and holidays as well.

There are exceptions, of course, but I suggest you be aware that, unfortunately, pediatricians are neither required to know how to help moms with breastfeeding issues nor, in many cases, do they even understand the importance of supporting breastfeeding. Formula supplements are recommended unnecessarily on a regular basis. This is not my opinion, the AAP even recognizes this fact and this lack of support and help for mothers has been noted time and time again by pediatricians themselves. Your baby not pooping for one or two days, especially as he has pooped since birth, means very little. He has lots of pees and (if you have been keeping track) you know exactly how much milk baby is getting, so you have more info to go on than just poops. Sorry if I confused you about looking at poops. Poops are a very good indicator but not the only indicator baby is getting enough.

And I agree with mommal it is a good idea to keep attempting to nurse and/or, do lots of cuddling and snuggling baby to you, skin to skin if you like.

[@llli*lllmeg]

Also if you are ready to try to nurse but the issue now is that baby is refusing to nurse, look at the ideas here: http://kellymom.com/bf/concerns/child/back-to-breast/

[@llli*aprilsmagic]

You are finding the awful and not discussed truth about pumping....it takes about twice as long as just nursing. But, right now, this is what you need to do to maintain a supply while you get help from an IBCLC. There are causes of pain that can be mother based, such as vasospasm or thrush, baby based, such as a high palate or tongue tie, or a combination of both. Most can be fixed!

I would avoid a bottle like the plague myself for now. Yes, it's time consuming, but in the long run, it will be worth every minute to spend now making sure your baby does not start preferring bottles...otherwise, you might be trapped into EPing, which is incredible time consuming for as long as you pump.

[@llli*mamaDuMonte]

I am at work so I dont have time to read all the other responses. But I used one of these when we were having latch issues at first. That was he was not getting a bottle, I got mine from the lactation consultants at the hospital. For me it was easier than the syringe. GOOD LUCK

http://www.motheringfromtheheart.com...ger_Feeder.htm