8 weeks and failing miserably

[@llli*phi]

Auderey is right, more frequent nursing is probably critical to getting off the supplements.

Pls note I have also tried lying down but the latch is even worse when I do this...

I doesn't work for everyone - just a suggestion. However, I rarely actually laid down. I would lean back on a few pillows, put my baby on my chest, and let him latch himself. It helped me enormously. But again, it's not a magic bullet or everyone would be doing it!

Off the top of your head, is his thrashing at the breast to do with a) bad latching b) his frustration at poor milk supply? Any ideas?!

There are a lot of reasons for this. Poor milk supply is one. Tummy aches from gas can cause it, in which case you can help baby work the gas out between nursing sessions. And then sometimes it is just normal fidgetiness/fussiness, in which case walking or rocking or bouncing or otherwise creating motion while nursing can be very helpful.

[@llli*lllmeg]

Do you have a LLL Leader or any breastfeeding peer support organization near you or that you can call? When there are several concerns it can really help to talk things out with someone who is supportive and knowledgeable and has time to really delve into it all with you, something doctors and even sometimes IBCLCs do not have time to do. Also were you given a written plan by your IBCLC? If so does that plan still make sense? (things change and best ways to proceed can change rapidly in the early weeks.) Are you able to contact her with follow up questions? I would be very curious to see what a few before and after nursing weight checks would show, and also what an IBCLC or other breastfeeding helper would be able to note/suggest about this thrashing at the breast you describe.

Because it would be easier to know what steps to take now if you can solve some mysteries. No matter what happened earlier, the question is, IF baby is unable to get enough at the breast, WHY is baby not getting enough at the breast-at this point? Is it because baby is unable to transfer milk well? Is it due to low milk supply? Is it due to scheduling feedings rather than cue feeding? Is it due to supplementing past the time supplements are needed? Or some combination of factors?

OK so some basics-1) If you are supplementing baby, generally the recommendation is to also be pumping, with the best pump you can get, a double sided electric pump, preferably a hospital grade rental pump. Using a hand pump when there is a suspected supply issue is not typically recommended, although better than nothing. Do not worry about how much you get when you pump, every mom is different in how well they do with pumping, and pump output is a very poor indicator of milk supply. (But you do want to be sure your pump is in good working order and that the flanges fit you properly.) The pumping is needed to offset the effects of supplementing on supply-milk supply is largely a supply and demand game.

2) If baby will nurse and it is comfortable for you, no need to take baby off the breast. Long feedings, baby falling asleep at the breast, fussiness at the breast are all considered normal behaviors. What is important is if baby is able to get enough overall, when nursing frequently enough (cue feeding.) Even at this age, especially when there is an issue with baby not getting enough, you could try to make sure baby is nursing a minimum of 10 times per 24 hour day. This is usually not going to be every such and such hours, babies normally cluster feed part of the time and then take a longer sleep break here and there.

3) If you need to supplement, you can try giving the supplement bottle before nursing, rather than after. Try giving baby a small amount of supplement-maybe an ounce or so, then let baby finish the feeding at the breast. Babies will almost always take the "top off" feed from a bottle, hungry or no. So baby taking a top off bottle is not a good indicator baby actually needs the top off.

Some tips: Many moms have found that baby's frustration or fighting at the breast is due to an uncomfortable or insecure (for baby) nursing position. Try different positions, anything you can think of-try laid back positioning-you do not have to be literally laying down, you can be just slightly reclined.
Many moms find breast compressions help when baby is not getting enough, falls asleep at the breast, or has frequent very long nursing sessions.
When a baby does not gain well, the assumption usually is that mom does not make enough milk. But this may or may not be so. And organic low milk supply is fairly RARE. Most low milk supply issues are caused by poor breastfeeding management (supplementing unnecessarily, supplementing without pumping as well, baby having issues with milk transfer, sleepy non-cueing baby, scheduling feedings or just in general baby not nursing frequently or well enough.) This type of low milk supply is usually easy to rectify by removing milk from the breasts frequently, preferably with baby nursing but with added pumping if needed. In other cases, galactagogues may help. IN other words, there are thing you can do to help increase low milk supply, but sometimes that is not even the issue.
You may want to clarify with your doctor how much weight gain is expected. A general rule of thumb for the early months is that baby will gain an ounce a day (after about the first week) but some babies gain more or less rapidly without it being an issue. Make sure you are always measuring weight gain from lowest known weight, not birth weight!

Breast compressions: http://www.nbci.ca/index.php?option=...tion&Itemid=17

Increasing low milk supply: http://kellymom.com/bf/got-milk/supp...es/low-supply/

Weaning from formula supplements: http://kellymom.com/bf/got-milk/basi...rease-formula/

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

Feeding cues: http://www.llli.org/docs/00000000000...eding_cues.pdf

[@llli*hubelle]

Thank you everyone. We REALLY appreciate the time everyone has put into responding. It is much appreciated. Lots to ponder on and very helpful to see some common themes emerging here which we are already up and running with adjusting to.

We are just about to hit the sack now, prompting this question (again thanks!): If we are now aiming for more frequent feeds (although without a "set" schedule as such), should we set alarm clocks every so often, or just wait for Hugo to cue ? (he wakes us easily if so, so no worries there). Note, he has been sleeping 4-5 hours at a stretch during nights - which may be too much? Perhaps with more regular, efficient feeding during the daytime, slightly more frequent night feeding will automatically happen?

One comment: sorry if we didn't make it clear first up, but we only started supplements about 2-3 days ago, in particular in response to his latest weighing. So his slow weight gain was without supplements (other than his first few jaundice days).

Good night all, very grateful for this!

[@llli*auderey]

i'm very glad to hear that you only started supplements 2-3 days ago, because that solves a big part of the mystery. you might be able to dream feed tonight: when he's stirring, put your breast near his face and see if you can get him to root & latch on, even without really/fully waking up. with a baby gaining well, 4-5 hours is no problem, but i would probably want to get that extra feeding in tonight if i were you.

keep us posted!!

[@llli*phi]

You should be able to drop the supplements with no problem. Just nurse at every possible hunger cue. You can offer more frequently too, but don't push it if he refuses.

Breast compressions are an excellent thing to try too!

[@llli*hubelle]

Update is more frequent feeding (9 x so far today) inc. an extra night feed. Still using supplement (4 top ups of 2oz each) , we're worried about stopping that until the b/f is much improved. A little bit more confident and calmer today and he is less thrashy. Have stopped expressing until we can get a double action electric as suggested (hopefully not long). Am also working on working in all the other helpful suggestions: compressions, alternative nursing positions, motion when nursing etc.

Another question pls (!): when he falls asleep at the boob, what's the best of way nudging him back on track? For example, he still regularly has a feed, chat, walkabout and then we're due another feed (which often he offers the cue for) BUT then within a few moments he's snoozing (or, at best, dreamfeeding, which surely is not 100% feeding). Any thoughts again welcome.

Thank you all!!

[@llli*phi]

Dream feeding can absolutely be 100% feeding. You can keep the lights bright, strip him to his diaper before nursing, tickle his cheeks/feet, and use a cool washcloth to encourage him to stay awake at the breast.

The formula may keep him full for an unnaturally long time and it may be inhibiting how well he nurses. Be very careful with the supplementation because it can easily sabotage your nursing relationship. It would be safest to feed the formula using a Lactaid or SNS.

[@llli*lllmeg]

Have stopped expressing until we can get a double action electric as suggested (hopefully not long). Am also working on working in all the other helpful suggestions: compressions, alternative nursing positions, motion when nursing etc.

Another question pls (!): when he falls asleep at the boob, what's the best of way nudging him back on track? For example, he still regularly has a feed, chat, walkabout and then we're due another feed (which often he offers the cue for) BUT then within a few moments he's snoozing (or, at best, dreamfeeding, which surely is not 100% feeding). Any thoughts again welcome.

Was the hand pump hurting you? Because if not, I would suggest keep using it until you get the better pump. And remember you can stop pumping altogether as soon as you are able to stop supplementing, so you may not need a double electric. It just depends on several things.

To get baby actively sucking again, try breast compression, gently "pumping" (rhythmically squeezing) or stroking baby’s hands or feet, stroking babies back, whatever feels natural to you to try. I used to gently jiggle my son's chin with my pinky when he slowed down and that always revved him back up. And yes even dream nursing can definitely be effective nursing! Look for signs and sounds of active swallowing (these are subtle!) If baby is swallowing, he is getting milk.

Have you clarified with your ped about the weight gain concern and his expectations? I admit I am math challenged and I did this quickly but when I ran your overall numbers yesterday they came out pretty good to me...I was assuming you had written pounds and ounces? Weight gain is often not totally steady.

[@llli*hubelle]

Just an update: Hugo is doing better (weight at 4.448kg), so a solid gain since weighing him on Monday (and when we started supplements ). Anyway, that's good, and we are still keeping a lid on overall supplementing (c. 400mls / day). [@Meg: I think the math works ?! - anyway, he's up towards the 9th centile from around the 2nd centile). And we are still aiming to cut this 400mls down to zero (?!) if possible!

Question: Nipples are still v v sore. should I try to drain 1 boob only per feed and give the other one a break; or will such rotation affect milk supply? Thing is, he is such a slow feeder still (feeds up to 1hr), that often my boobs only have a 60min max (or less!) between maulings.

thanks all!

H

[@llli*auderey]

sounds like it's time, now that he's gaining well and that panic is settling, to see an IBCLC who will help you work on his latch. things should not still be so painful. long feedings like that is normal, but pain is not. and your baby is in need of milk, so limiting his acess to 1 breast might not be the best idea right now. an IBCLC will help you with the latch and with the weaning off supplements. indeed, the latch and the need to supplement are probably two sides of the same coin.

400 mls is 13.5 oz - so that's actually not bad, certainly the minority of your feedings. i think you can totally get back to EBF.

good work!