exclusive pumping - some quesions

[@llli*eva026]

Hi, I think I will have to switch from BF to exclusive pumping and I would greatly appreciate some advice on how to go about it.

My LO is almost 7 weeks old and we have had a rough BF experience. She was given formula straight after birth as I had a c-section and was also too inexperienced to know how much trouble it would cause later. My milk came in on day 3 so honestly I don't think they had to give her a bottle at all. But what's done is done....
When we got home I managed to get her to latch on but she has always been a terrible nurser - nursing for over an hour at a time and having to use nipple shields.
Despite all hat time nursing, it turned out that she wasn't putting on enough weight and I had to bottle feed expressed milk when she sill gave hunger cues after nursing. We managed to get her putting on weight and for 6 weeks nursed and only needed 2 bottles of expressed milk a day. She had no problems moving from breast to bottle.

Suddenly from day to day it all went downhill. She stared nursing for shorter and shorter intervals and then screaming from hunger. I don't really get why because the nipple shield would be full of milk when she unlatched. We ended up having to op her off after every feed. I got worried that she would totally transfer to the bottle so we decided to go cold turkey and not give her the bottle at all. After 2 days of hell I have up. Having a baby screaming from hunger was just too much for me and I was starting to feel really depressed. Hence the decision to pump.

I didn't realise exactly how exclusive pumping worked I though that seeing as nursing is a supply-demand thing I only needed to pump enough to feed her and didn't empty the breast. Today after the whole day of pumping only enough to feed her plus 2 oz more to freeze I started reading more about pumping and was aghast to read that I should have been emptying and doing massages while pumping. Hopefully I haven't been doing it wrong for long enough to hurt my supply permanently!

I have a few questions to the exclusive pumpers because I couldn't find clear answers anywhere.

1. I have the medela swing pump as the in style double is just too expensive but the mini electric double is within my price range. Would that one be ok to shorten my pump sessions to 20 min total instead of the 20min per breast I have started to do?

2. I have large breasts and feeling the full milk ducts during pumping is difficult. I just blindly rub downwards from my armpit towards the nipple and do breast compressions for 10 min then switch to the other breast 10min and switch back to breast no 1 for 10min and then back again to breast no 2 for the final 10min. In the breaks I try feel for the ducts and massage them out. Is this ok or should I be pumping non-sop for 20 min per breast? How Can i tell if I emptied my breast as I cant really feel a big difference besides the fact that no more milk flows for a few min. I get between 60 and 150ml per session - depending how much time passed between.

3. I started using the medela calma bottle and I looks like it helped a little. LO is now nursing a little at least before yelling for the bottle. I let her nurse for however long she wants and the feed her a bottle with milk from the previous pumping session. When she is done I pump. Sometime when it's puping time for me she is still sleeping so I pump one breast only and leave the other for her in case she will want to nurse. When she is done I pump that one. Is that ok or should I empty both and if she wants to nurse, let her try get out what is left?

4. finally, I read that it is ok to pump 4 times in 24h as long as one of them is at night. currently I pump every 3h and this is exhausting. Would is be ok to pump every 4 and slowly start reducing it to 4 sessions ?

Sorry about the long post, would love some help with these issues. I want my LO to get breast milk as long as I can but now I am super paranoid about my supply going down because of the lack of breastfeeding.

[@llli*eva026]

Sorry, didn't notice the EP sub forum - please could you move this post?

[@llli*mommal]

I can completely understand why you'd think that EP is the way to go, considering how difficult nursing has been for you. But I strongly encourage you not to go down the EP road unless you absolutely have to. Nursing gets easier in the long run, but pumping never does. If you think pumping every 3 hours is hard now, with a new baby, imagine the future where you must choose between caring for an active, mobile baby and maintaining your pumping schedule. It is highly unlikely that you can move to a 4 hour interval between pumping sessions. Some EP moms can pump that infrequently without having milk supply decrease, but that's rare. Most EPing moms must pump about as often as the average baby nurses in order to maintain supply, which means pumping every 2-3 hours, or at least 8-12 sessions per day. And even doing that, it can be difficult to maintain supply: many EP moms ultimately struggle to provide enough for their babies.

If you've managed thus far with only 2 bottles of expressed milk per day, and your baby is now 6 weeks old, I think the probable issue you're facing is the big 6 week growth spurt, which causes babies to want to nurse constantly and act fussy after feedings- their way of saying "Hey, put me back on the breast, mom! I am growing fast and I need more!" This is when a lot of moms do what you did: give in to the bottle. I understand why- it's really challenging and upsetting and it's easy for a desperate mom to look for a way out of the situation. But this is one of those "when the going gets tough, the tough get going" times, when the best way through the rough patch is just to glue your butt to the couch and nurse, nurse, nurse. And then nurse some more.

To answer your specific questions:
1. The pump you have is not likely to be adequate for EP. A PISA is probably the minimum tool for the job, but a hospital-grade rental is the best choice. A better pump might allow you to shorten your pumping sessions to 20 minutes total, provided you maintained or increased your current pumping frequency.

2. Judge the efficacy of your massage technique not by what you feel under your hand but by what you see coming out in the pump. If the massage you are doing seems to result in more milk coming out, you're doing it right.

3. This is a difficult choice when a mom is struggling to nurse her baby- believe me, I know! One thing you could do would be to pump immediately after your baby nurses. That would allow your breasts to fill up again before baby wants to nurse. Ordinarily, you can empty the breast very completely and then nurse, since milk is always being made and a baby who is nursing well and willing to nurse has no trouble getting the milk out even when the breast has been well-drained. It just takes the baby more time and effort. Which is why this is a tough choice for a baby who resists nursing: she may scream for a bottle when she realizes that it's not going to be easy to get at the milk.

4. No.

Can you tell us more about how nursing is going? Are you in any pain when you nurse? I notice that you've been using a shield- will baby nurse without it?

[@llli*eva026]

Thanks so much for your quick reply!
I don't think it was a GS as she's been through 2 of those and they looked more like she was constantly hungry and constantly eating, this time she was hungry but refusing to eat from me It was heartbreaking especially after all the work we put into getting her off the bottle and onto the breast in the first week.
It got to the point where she would scream when she got anywhere near my breast and refused to eat at all - hence the decision to look at EP. Not taken lightly because I had a friend who EP'd using a hand pump and saw how awful it was.
I also got my husband to get the medela calma bottle in the hopes that if she had to work to get milk for a bottle, she would not find the breast such a big difference. As of 5am this morning this seems to have worked and now she accepts the breast and nurses for a few min each side before crying and pulling away. I dont want to force her in case it totally puts her off.

I use a nipple shield and have done so from week 2 when we had the weight problem, not from any pain. The paediatrician said that she is very slight and may be having problems maintaining a suck, and to use a nipple shield when she gets tired and then get more food into her via bottle. It fixed the weight problem but the pattern of nursing on the breast then 10min later with a shield stayed - till last week...
My milk supply has been more than enough (even thought I had oversupply and one stage), even partially using the shield.
At the moment it's like she has forgotten what to do with the nipple and just tongues it. She only begins to suck with a shield on and that's 2-3min tops before pushing away and crying. She refuses to take more from that side and I have to move her to the other breast to get another 2-3min out of her.
I just have no idea how to get her on for longer (I don't care if its with a shield or without right now):-(
As I mentioned earlier, the shield is full of milk when she pulls away so I really dont understand how it can be an effort thing. I even initially thought she may have learnt to nurse faster like 'normal' babies and was pulling away, getting irritated because she was full and milk still flowed but she was still obviously very, very hungry after and just refused to drink more from me.

I must admit that I went pump-crazy when I read about the decreasing supply if you don't empty breasts and I think I will try relax a bit and do what you suggest: pump after every feed to empty the breast and not set my alarm clock and pump on a 2h schedule day and a 3-4h schedule at night. Hopefully this plus the stimulation of her sucking a few min each side will be enough to maintain my supply.

Any advice on how to get her nursing back to the 45-60min on the breast it was before, hoping for a 20-30min nursing session feels out of reach right now? Totally removing the bottle is not an option as I was an emotional wreck when we tried and what's more I will have to go back to work part time in 3 weeks so she will have to get about 2-3 bottles a day when I am not home.

[@llli*browncow]

Sorry didn't see your reply.

[@llli*aprilsmagic]

I would strongly suggest you see an IBCLC and stop using bottles at home to save your BFing relationship. Because what you write does not fit what you have been told is the problem.

EPing is extremely difficult. Only about 1 in 10 women who start EPing make it, and 99% of those quit earlier than they might have had they been BFing.

You need to rent a hospital grade pump.

I have spent $2000 in EPing. The $100 you will spend on the IBCLC is way cheaper.

It is NOT Ok to pump 4 times in 24 hours right now. At this point, you need to pump 8 times a day, for a total of 120 minutes. This is to establish supply. You can back down eventually. I pumped 4-6 times a day for about 6 months, but it was after I had my supply firmly established, but it takes longer to do that than it would while nursing. And once i went to that, i did see a major drop in supply (but it was fine...the freezer was full). And if I missed a session, I noticed it, and it is much harder to make up for it later, and it takes longer to get your supply up after missing a session. It is exhausting. Quite honestly, EPing is way worse than BFing ever is. It's more tiring. Pumping and bottlefeeding is more work in many ways. I was often pumping. Trying to comfort a crying baby. Taking care of other kids. It was a disaster. Immjust now catching back up. I had to do it -- my baby was born unable to nurse -- but it was hell on earth.

I would always double pump. It's better for your supply.

I know you think this is your only option, but I doubt it myself.