Return to nursing

[@llli*ali4212]

My daughter is 3 weeks old. Nursing was going ok, she would latch and eat but it was pretty painful, the first week. At our 1 week appointment she was gaining weight and doing well so we decided to introduce a pacifier to help get more sleep at night. At her next appointment she had lost weight and did not gain for a whole week so the pediatrician had us supplement with formula. After 1 bottle she no longer wanted to nurse. So now I am pumping and alternating breast milk and formula at feedings. My supply with pumping is not very good, often less than half an ounce from 20 min double pumping. I would really like to try to get her back to nursing regularly but am afraid to stop supplementing because of the weight loss before. I would like any advise.

[@llli*mommal]

Welcome to the forum! I'm sorry breastfeeding has been so challenging thus far. But you must have a lot of persistence and dedication to have made it this far, so I think you have an excellent chance of getting your baby back to the breast if you can just keep on trying. This link is full of useful tips on getting a baby back to the breast: http://kellymom.com/bf/concerns/child/back-to-breast/. In particular, the skin-to-skin and instant reward techniques are supposed to be helpful.

[@llli*lllmeg]

Can you give an exact weight history, with dates, etc? And exactly how long have you been pumping/supplementing? I am trying to get my mind around how there was time for all these weight checks and gain/losses in three weeks. Also note if there were different scales in use. I talked to a mom today who had two different weight checks for her 3 week old in 24 hours, one at the pediatrician and one at WIC, and the difference was half a pound!

Remember what you pump is not a good indicator of milk supply or what baby would get by nursing. Babies are far better at extracting milk than a pump. Plus pumps can have all kinds of issues that can affect performance-is this a new pump? What kind of pump? Did you have help sizing the flanges? How often do you pump?

Young babies need to nurse very frequently in order to get enough and bring in moms milk supply appropriately. At LEAST 10-12 times a day in the first 6-8 weeks. This is why pacifiers are usually not recommended until baby is at least 4-6 weeks old and breastfeeding well established. I have no idea if the pacifier caused baby to not gain well. But it would certainly not be the first time pacifier use has caused slow weight gain and supply issues. On the other hand, if baby was actually gaining that first week, (many babies gain nothing or very little week one) that is a very good sign your milk supply was fine and can be fine again.

Babies have a deep biological need to nurse at the breast. No baby in the world “prefers’ bottles. What happens is a baby may find the bottle is easier to get milk out of, requiring no effort at all, while nursing (by natures design) does require some work. So a baby who has gotten bottles may act fussy at the breast. I am surprised this happened after one bottle, but perhaps the pacifiers and bottle together got baby into some poor habits. I don’t know, but I do know for sure that a baby this young can be brought back to the breast. The ideas in the article mommal linked are excellent. Besides getting baby back to the breast, your biggest hurdle will probably be shoring up your own confidence in your ability to nurse & make enough milk for your baby.

[@llli*ali4212]

Baby was born Monday 4/2 her birthweight was 6lb 2oz. Her discharge weight that Wed was 5lb 9 oz and she was 5lb 15oz at one week check up the following Monday. We had 2week appointment that Friday and she was down to 5lb 13 oz and only gained half an ounce before weight check the following Monday. At that appointment they had me nurse her and then weigh her and she did not gain anything after nursing 20 min on each side. That's when we decided to supplement and by that Thursday she was up to 6lb and had gotten over jaundice that she'd had since birth.

I am using a brand new Madela pump in style double pump every 2-3 hours during the day and taking a break overnight. Output has been all over the place sometimes 1 oz per breast and sometimes less than half an ounce combined. I'm finding that its hard to do all this pumping and still have time to take care of baby and myself so I'm trying to get her back to the breast.

She acts like she wants to nurse and will root almost every time I hold her but when I give her the chance she either does not latch at all, taking in the nipple then spitting it out, or latches for only a few sucks. We have had latching issues since day one, I cannot get her to take in more than the nipple which is very painful for me. I've tried several techniques and nothing seems to work. Each time I try to nurse it is very frustrating for both of us.

Thank you for your reply, I hope this extra information can help you better understand my situation and I would love any additional advice.

[@llli*lllmeg]

Thanks for the weight history. Wow, that is confusing. So the initial weight loss in the first two days was 9 ounces, or just under 10% of birth weight-on the high end of normal. But then baby gained back 6 ounces in 5 days, which is very good weight gain especially that early. 5 days later, baby has lost two ounces-and only gains a half ounce in the next 3 days.

It does not make sense. How many different scales are we talking here? Because either the measurements are off, or something went very, very wrong with nursing after day 7 post birth. I know you said you started using a paci, but how much? How much was baby still nursing (how many times per 24 hour day?)

Besides weight checks, were you keeping a diaper log? Do you know how many times per day baby was pooping during all this? Because that could offer more clues of what happened.

Now, that before and after nursing weight check-these are very tricky and should only be done by people trained how to do them. Who did it? How sensitive was the scale? Did baby pee or poop in between weigh-ins? Was baby wearing exactly the same thing, just a dry diaper-or nothing, for both weights? Because I do not understand how a baby could actively nurse for 40 minutes from a mom who obviously makes at least some milk and get nothing at all! In any case, before and after weight checks are a controversial tool because they only take a snapshot of a single nursing session, and intake per session will normally vary, sometimes quite a bit. So to get a real picture at least 3 should be done (over a few days) if at all possible.

Were you given any suggestions of how this could be? Of why milk transfer was apparently not happening? Were you & baby observed nursing by an IBCLC and were any suggestions to improve things given? Because that is what should have happened. Even if supplementing was deemed necessary, you should have been given help in fixing the underlying problem, which is either 1) low milk supply or 2) poor milk transfer or 3) a combination of both. Or, 4,- baby not nursing frequently enough.

Have you tried the ideas in the Kellymom article for bringing baby back to breast, particularly the instant reward? Have you tried different positions like laid back that facilitate a comfortable latch? And is there any way for you to see a IBCLC, for a private one on one appt? Since you think latch was never good, it’s really important to get help in understanding why and to fix latch.

Meanwhile, keep pumping as much as you can if baby does not latch and nurse. If baby is not nursing at all and especially in the early days when milk supply is being established and/or where low supply is suspected, it is recommended mom use a hospital grade rental pump, is that at all possible? The pump you are using is designed for moms who are pumping up to 2-3 times a day 5 days a week due to being back at work, well after milk supply is well established. You are pumping round the clock and trying to establish milk supply. It really makes a difference.

If baby latches and nurses fairly well, that is one time you will not have to pump. But by nursing and/or pumping frequently, you can keep your milk supply there so you can keep working on this.

There is no reason at all, from this history, to think that your baby cannot nurse or you cannot make enough milk. It is early enough where a solution is not only possible, but likely. It may take some time & persistence to figure it out and it’s frustrating, I know. But many moms who have faced similar or even more difficult situations in the early days go on to nurse their babies happily.


Laid back positioning: http://www.llli.org/docs/00000000000...astfeeding.pdf and http://www.biologicalnurturing.com/

Feeding the non-latching baby: http://www.llli.org/docs/00000000000...ching_baby.pdf

paced bottle feeding: http://www.llli.org/docs/00000000000...astfedbaby.pdf

To recap/additional suggestions to try: Get qualified help. Get local support (local LLL.) Keep trying to get baby to nurse and latch using gentle techniques from kellymom article. Keep pumping until baby is nursing regularly. Consider getting a rental grade pump. When feeding, do so in a breastfeeding friendly manner-use paced bottle feeding and/or give baby an ounce or so of supplement in the bottle and then let baby finish the feeding at the breast. Consider using a lactation aid to supplement instead of bottles.