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Thread: Feeding/Pumping Questions

  1. #1
    Join Date
    Nov 2006
    Posts
    17

    Default Feeding/Pumping Questions

    Hi there, I'm trying to increase my milk supply.

    I am in the middle of a transition from one lactation consultant to another and would like some advice if you can offer it in the meantime.

    First the history:

    My son was born September 10 (that makes him just two months old). He was premature (born at 35.3 weeks) and had trouble latching and sucking at the beginning. He has since learned to do so, between offering him the breast at every feeding and topping off with the bottle/formula. Between the breast and bottle, he is gaining well and is very healthy. His latch has improved although he tends not to open his mouth very wide and his tongue doesn't always go or stay down.

    I have thyroid disease and polycystic ovarian disease. All these factors have probably contributed to the low milk supply. I am taking Domperidone, 20mg X4 a day and have gone from 15ml a breast to 30 ml a breast since then.

    I have tried the SNS and when it works it is great, but I find it to be a hit and miss and it has become too frustrating (for me and baby) to continue. It is a good idea in theory though if I could make it work.

    I'm offering the breast 9-10 times a day. Breastfeeding, plus bottle feeding and then pumping takes me 45-60 minutes total everytime. If I manage to feed 10 times a day, then this is every 2 hours from when I started the last feed. Should I keep pumping after every feed? I always find I feel less full at the next feed when I pump. I'm pumping for 15 minutes after the feed. Should I cut back the time?

    Another question: how long is let down, typically? How long before I am supposed to feel full again after a feeding and pumping?

    And... if baby only eats 9 times instead of 10, and I pump to remove milk, should this be considered one of the 10 times I log or should I offer the breast one more time? I mean, if baby missed a feeding because he wasn't hungry, I don't suppose offering the breast again will help...

    Oh! And how long between feedings is considered the next feeding?

    Thanks in advance
    Renee

  2. #2
    Join Date
    Jan 2006
    Posts
    1,368

    Default Re: Feeding/Pumping Questions

    Hi Renee and welcome!

    I will try to give you the information you are looking for, and you will certainly get the support you need here at these boards!

    First of all, congratulations on your healthy little boy. It's probably hard to believe 2 months have gone by since his birth. You probably already know this, but it is often helpful to remember his adjusted age. If he were born full term he would only be 3 weeks old right now. That puts some of these issues into a different light. You might want to visit the Premature Forum as well.

    You are right that your thyroid disease and PCOS most likely are affecting you milk supply. You are really weathering a lot right now. It is so important to understand that you are doing a great job! It really sounds like you are committed to BF in whatever capacity you can, and your ds is very lucky to have such a caring a committed mom.

    Here are some links for you:

    http://www.llli.org/ba/Feb06.html
    (this has some ideas to help with milk delivery)

    http://www.llli.org/llleaderweb/LV/LVAprMay05p27.html
    (this one was written for Leaders, but it can be helpful for moms, too)

    Is your ds receiving formula supplements right now? If so, how do you feel about that? Would you be satisfied with partial BF?

    Reading through your questions I realized this: you have a LOT on your plate! You are truly doing double-time with nursing and pumping and feeding. This can't be easy for you.

    Anytime you are taking milk out, you are signaling your body to make more. Empty breasts=make more milk. Full breasts=slow down production. (of course your thyroid problem and PCOS greatly complicates this basic explanation.) So, if ds doesn't want to nurse and you are shooting for a certain number, then by all means you can go ahead and pump. Am I correct in understanding that you believe the pump empties you better than ds?

    Have you tried breast compressions?
    http://www.kellymom.com/newman/15bre...mpression.html (not LLL source)

    I can't say whether or not you should continue to pump after every feed. The reason for doing that is that ds is not eating enough/getting enough milk. They only way to know that is by charting his growth/diaper output without the addition of supplements. Is this what you are doing now? If he is gaining and having wet/dirty diapers with just nursing, then you might consider eliminating the pumping. But again, this is something I can't say without more info.

    I'm not sure about your question on let-down. Do you think you could ask it again in other words, then I will attempt to give you a clear answer!

    Typically, when a mom is counting time between feedings it is from the *end* of the feed to the *beginning* of the next feed. So if ds starts at 9:00 and feeds til 9:30, and then wants to nurse again at 11:00, that was 1.5 hours between feeds. Make sense?

    Please let me know if any of this is helpful. I am thinking that since you are working with an LC that it would be an IBCLC. Is this right? Have you tried to contact a local LLLL? That might be something to consider as well.

    Hang in there! You are doing great!

  3. #3
    Join Date
    Nov 2006
    Posts
    17

    Default Re: Feeding/Pumping Questions

    Wow, Kate! Thank you for all the info!

    Now that I have a new LC, I am working with her so many of my issues are being worked out. On the other hand, she is quite busy so sometimes I get quicker tips on here. :-)

    To answer your question about supplements, yes I am offering formula and I am not crazy about it. I realise that it offers some benefits (more for me than for my son ex. he sleeps longer at night) but I really wanted to breastfeed exclusively and I feel like the hospital had to rush us out and gave us formula as a quick fix to the imperfect latch/low-milk supply problem. I still want to breastfeed (almost) exclusively and weaning off the formula is slowly happening. Yay! I am very determined. My LC suggested I can keep like 4-5 oz. of formula for the night. Sounds like a good idea. Then he would still get enough breast milk for all the health benefits it offers.

    About the pumping: I understand that emptying the breasts signals to my body to make more. But with such a short time between feeds, I feel like I'm removing what my son could be getting himself. Someone suggested that 2 hours after pumping is when it is best to offer the breast again. I found this tip to be helpful and so I have adjusted my schedule accordingly. It means feeding/pumping less frequently in a day, but I feel my son gets more in the end. Would you say that that is a correct assumption?

    Yes, I am charting everything. My new LC wanted me to drop the logs and go with instincts more, but I guess I find comfort in numbers so I have resumed my logs. They've worked so far!

    I guess I just don't really understand let down. So my breasts make milk constantly, but every once in a while they make a greater quantity? Another mom I spoke to says let downs are every 7 minutes (for her I guess). How can I figure out when mine are?

    Sorry, I can't figure out what LBCLC is. No, I have not consulted with a LLLL because my LC is paid by public health and I don't think I can afford a personal LC.

    Thanks again for all your help!

  4. #4
    Join Date
    Jan 2006
    Posts
    1,368

    Default Re: Feeding/Pumping Questions

    You are welcome!

    IBCLC stands for International Board Certified Lactation Consultant. It is the gold-standard for lactation consultants. These ladies (and some men) will typically have the most training and experience. It doesn't mean that your LC isn't good, though, if she doesn't have those initials after her name. But it often helps.

    LLL Leaders are free! We will take phone calls, emails, and some do home visits. We also hold monthly meetings which are great for support and encouragement as well as getting your questions answered. I would highly suggest callling a local Leader and getting more info on LLL in your area. She would be happy to hear from you, and will benefit from having other moms to chat with! You can check this link to find a group/Leader in your area:
    http://www.lalecheleague.org/leaderinfo.html

    The two-hours is similar to what my information from the LLL Breastfeeding Answer Book suggests. Usually it is suggested that a wait of at least 90 minutes is helpful when going back to pump to increase supply. So that sounds about right.

    Ok, the basic idea of let-down is this:
    Some milk accumulates in the milk ducts near the nipple, but most of the milk is made and stored in other parts of the breast. The let-down reflex causes the milk to flow toward the nipple, making it available to the baby. A baby's suck will stimulate let-down. (For some moms all it takes is a baby's cry.)

    Some moms will feel let-down as a tingling sensation, but some never do. Others signs of let-down are: milk leaking from the other breast, a change in the baby's suck-swallow rhythm (from quick sucks to long, slow sucks with regular swallowing), milk appearing in the corner of the baby's mouth and a feeling of relaxation in the mother.

    Does this help?

  5. #5
    Join Date
    Nov 2006
    Posts
    17

    Default Re: Feeding/Pumping Questions

    Wow, you've been very helpful. Thanks again!
    Renée

  6. #6
    Join Date
    Jan 2006
    Posts
    1,368

    Default Re: Feeding/Pumping Questions

    My pleasure!

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