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Thread: Struggling . . . thinking about giving up

  1. #1
    Join Date
    Jul 2012
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    20

    Default Struggling . . . thinking about giving up

    Hello,

    My name is Amanda, and I just gave birth to my third son 12 days ago. I have struggled with breastfeeding all three of my boys.

    With my first, his latch was bad, and I dried up by the time he was five days old. He would scream every time I would try to feed him, so we took him back to the hospital and found out he had lost two pounds. I started bottle feeding him and pumping to get my supply back. I ended up getting my supply to about 24 oz a day and exclusively pumped for 5 months. He never latched on as he had gotten used to the bottle flow. I had to pump every two hours the entire five months as my supply would never stabilize. If I tried to go three hours, my supply would drop almost in half in one day, and it would take weeks to get it back up.

    With my second, he was in the NICU until he was five days old, and was only allowed to finger feed as his blood sugar and o2 levels would drop too low when breastfeeding. I got a bunch of plugged ducts when my milk came in, and could not get them out. As a result, my supply plummeted. I was able to get my milk supply back up (and really well on one side), so that my second son would breastfeed from one side. He still needed to be topped off afterwards, but he always started at the breast. I breastfed/pumped for four months. He ended up in the hospital at four months with pneumonia and RSV, and after an entire day at the ER, an ambulance ride, and a trip home before I could get my pump, my supply vanished.

    As you can imagine, I was very fearful that I would have issues breastfeeding again(I was mostly fearful that my supply would be too low again), so I started pumping in between feedings before my milk even came in. My newest son has a great latch (according to my LC), so I never thought I would be writing this. My milk came in right before the third day. He was nursing well the first day or two. I started getting lazy about pumping after every feeding, and ended up only pumping about four additional times a day (on top of the 8-10 nursing sessions). By the time my son was 7 days old, he was "nursing" for three hours, and then acting as though he was still starving afterwards. I realized that he was only sucking for a minute or two, swallowing maybe once or twice, and then sleeping for 15-20 minutes. When I pumped afterwards, I was getting about an ounce an hour, so I knew my supply was okay (since the highest supply I ever had really). I knew he wasn't getting enough to eat because he stopped having wet/poopy diapers. I went to see my LC (she is board certified) as I wasn't sure if this was normal. She called it cluster feeding at first, but after watching him nurse, she decided that he was a lazy nurser. She gave me an SNS to use when feeding him to encourage him to actually breastfeed at the nipple as opposed to napping through his feedings. I have been using it for three days, and nothing has changed. It still takes hours to feed him. He is only eating 1/2 ounce to an ounce from the SNS, and I really don't think he's getting much more from my breast. I have to constantly prick and prod him to get him to eat even that much!

    After thinking about it, I realized that all three of my children did this - even the first. He didn't start crying when I tried to feed him until he had starved for five days. Before that, he was content to use me as a pacifier.

    I spoke with my LC today, and it almost sounded as if she was ready to give up (although I don't think I am just yet). She said that for my sanity I needed to feed him for 25 minutes at the breast only (NO MORE), and then pump for twenty minutes while my husband bottle feeds him (he'll down a 2 ounce bottle in a matter of minutes). My husband works during the day, so I'll have to give him the bottle most of the time, and I REALLY don't want to. My OB called in a prescription for Reglan for me just in case increasing my supply makes it so he can actually empty the milk from my breasts, but to be honest I have enough milk. I haven't had to use any of my stash in the freezer from the first few days. I have been able to pump exactly what he needs (a little more even) every day.

    If you've made it this far, I guess I'm just looking for encouragement, stories like mine, or any advice you have to offer. I just don't know what to do. I can't be attached to the pump like I was with my first son. Back then, I only had him to worry about, but I am home for the summer with my older two children now, and they need more from me.


    Thank you in advance for your help. I am feeling very discouraged, frustrated, saddened, and as though I have failed my son - yet again. I just wish this was something that came naturally to me.

  2. #2
    Join Date
    Jun 2009
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    5,905

    Default Re: Struggling . . . thinking about giving up

    Hmmmm. There is so much going on here and so many possibilities, I am glad you have an IBCLC helping you.

    I want to concentrate right now on what is happening with this baby. What happened with your other kids may leave clues to what is happening now, however, it is also possible the fact you had issues with the other two is irrelevant to what is going on now, except that it obviously makes you even more frustrated and probably undermines your confidence even more. Many moms have very different experiences with each baby.

    You have been through it all twice before, so I realize what I say next is likely not new to you, but here goes:

    You are not failing your baby. You are doing everything you can, under very difficult circumstances. Your baby loves you, needs you and finds you perfect in every way no matter what happnes.

    Ok-so a baby does not gain well due to three possibilities: 1) Mom does not make enough milk, 2) baby is unable to transfer the milk well, (these could occur in a combo as well.) or 3) baby is getting enough but there is a medical issue.

    I know you say you make enough milk, which, if that is the case, that is very good news as that is half the battle when breastfeeding is not going well in the early days. But FYI, Low milk supply is caused by something. It is either caused by things that happen with breastfeeding (baby cannot nurse well or will not/can not nurse frequently enough, harming supply) or by some physical issue with mom. Have you ever had yourself checked out for hormonal issues, PCOS, thyroid issues?

    How did the latch early on feel to you? How does it feel now? Did baby ever nurse vigorously? Was baby pooping well for a time, but then stop? If so, what changed do you think?

    Is baby actually not gaining or losing weight? Output is only part of the story. The best way to tell a baby is getting enough is weight gain.

    Nursing 10 times a 24 hour day is the minimum a newborn should nurse. Will baby nurse more often?

    How a baby acts after nursing gives us clues but it does not in any way tell the whole story. Many babies will act fussy after nursing a long time & take a bottle and drink everything in it after nursing, even if they get plenty at the breast. This is because what makes a baby suckle is not based entirely on tummy feeling full, a baby needs to suckle, lots and lots. This is why carefully measuring weight gain is so important.

    If baby can and will nurse, nursing frequently is usually the best way to build milk supply. Pumping helps/is needed if baby cannot nurse well and when supplements are given.

    Allowing baby to suck on a pacifier and/or swaddling baby can create or worsen the situation when baby is not nursing well enough/cuing enough in the early days.

    If you are pumping to build supply, best to use a hospital grade rental pump.

    When supplementing with a cup or bottle, it may work better to give the supplement first and allow baby to "finish at the breast."

    When using the sns, can't you simply measure how much baby is getting? How much do you think baby should take per feeding session?

    Did your IBCLC do a before and after nursing weight check? These are controversial but when a baby’s ability to transfer milk is in question, it may give you helpful data. However, I think it is best to do several, at least three, maybe over a couple of days, as each one only tells you what happened at that particular nursing session, and a baby will typically vary in how much he transfers at each session. After two weeks of age, a “good” before and after weight check would show a gain of 2 ounces or more.

    All weight gain checks should be done on the same scale, with baby in a dry diaper only or naked, and should be double checked. Weight gain should be measured from lowest knows weight, or from the last accurate weight check, not from birth weight.

    What resources have you looked at for your own reseach? I suggest the book Making More Milk. Kellymom.com also has lots of articles on low supply and building supply. If you do not have low milk supply, I do not understand why Reglan was prescribed. If you do, have you looked into herbal galactagogues? Reglan has some side affects you should be aware of.

  3. #3
    Join Date
    Sep 2009
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    Default Re: Struggling . . . thinking about giving up

    Welcome, and congratulations on your baby boy!

    I'm so sorry to hear about the stress that the first few weeks is causing, but keep hanging in there - it sounds like you're determined, and right now that's a huge factor in your favor.

    That said, can you answer a few questions to help get an idea of how he is nursing?

    1. Weight history from birth?
    2. When you say that he stopped having wet/poopy diapers, did the number drop or stop completely?
    3. How is his output (diapers) using the SNS?

    FWIW, my first was a lazy nurser, and as a preemie was very small. It was a constant struggle to get her to nurse. But eventually we did establish a solid relationship. You can do this. If you take steps now to protect your supply, then you can definitely do this.

  4. #4
    Join Date
    Jul 2012
    Posts
    20

    Default Re: Struggling . . . thinking about giving up

    Thank you so much for taking an interest in me. I have answered all of your questions below. I did want to say that I tried nursing him with my nipple shield (I used this with my second son) because I wanted to see if he was actually drawing milk out with his barely there nursing, and I can see the milk in the shield when he's done. Not only was the shield filled with milk, but his mouth was full of milk when he would let go as well. He still barely sucked, and fell asleep within a matter of minutes. As soon as I tried to put him down, he would scream and start rooting as though he was starving. He drank 2 ounces of expressed breastmilk after a two hour nursing session that I gave him in a bottle. You mentioned that they will take more milk from supplements after feeding even if they aren't hungry. Do you think I should stop? I just don't know how to get him to sleep then, since he won't let me put him down, and if I try to hold him, he does the same rooting, crying thing. But, I clearly have enough milk, and he could eat enough at the breast if he would actively try. I had to keep touching him with a wipe to get him to feed this last time.

    Okay, sorry. Now to answer all of your questions:

    lllmeg:

    #1
    I have had my thyroid checked. It is fine. Not sure about the others, but babies are fairly easy for me to conceive.

    #2
    The latch hurt in the beginning. It feels better now that I am using a different hold. I think the hold I was using before was making it so that the baby was only halfway on my nipple at times. They got pretty torn up in the beginning. They are recovering nicely now.

    #3
    He did nurse vigorously on days 3-6 (right after my milk came in). When he stopped nursing vigorously, I noticed that I was pumping almost nothing after a feeding. I started supplementing with the bottle just to check on my supply, and I was only able to pump 1/2 an ounce per hour at that time. I started taking fenugreek, drinking tea, made sure I was getting enough water, even had a couple of nonalcoholic beers, and pumping every hour to hour and a half for 24 hours, and now my supply is up to about 25 oz a day (that I pump . . . he may get some when nursing as well).
    I'm not sure what changed, other than I got lazy about pumping after every feeding.

    #4:
    The baby is gaining weight very well - but we have been supplementing with expressed milk to make sure he was thriving. He had jaundice, so we needed to make sure he ate enough to get his levels down.

    #5
    The bay would nurse nonstop for 24 hours if I let him - at least that what it feels like. The night before I started supplementing, he "nursed" for almost five hours until he finally slept for a block of time longer than a couple of minutes. He slept for an hour, and was then up to nurse again for 4 more hours. He didn't really nurse that much each time though. These were the first sessions that I noticed him just sleeping at the breast as opposed to feeding. If I tried to put him down, he would be up seconds or minutes later rooting around and screaming.

    #6
    I do see how much he gets using the SNS. He usually takes in about 1/2 and ounce to an ounce over a 2 or 3 hour time frame. I feel like if the sessions were shorter then that would be enough, but that if he is feeding for 3 hours, and took a 2 hour nap prior to that, then he should be eating at least 2 ounces. Otherwise, he would only eat 6 ounces a day.

    #7
    There was no before and after weight check done.

    #8
    I have read "The Womanly Art of Breastfeeding" and used Kellymom.com a lot for answers to my questions. I have also called and visited my LC a lot! lol

    #9
    Reglan was prescribed because My supply was down at 1/2 ounce per hour. This was on Friday morning when my doctor was not in the office. She got the message today, and sent in the prescription today. I picked it up, but haven't taken it since I think my supply is high enough, and I don't want to risk getting the depression if I don't need to.

    aphimama:

    #1:
    Birth weight: 8 lbs, 3 oz.
    2 days old: 7 lbs, 7 oz (milk came in 12 hours after this weight check)
    3 days old: 7 lbs, 7 oz
    5 days old: 7 lbs, 9 oz (diaper output stopped when baby was 7 days old)
    10 days old: 7 lbs, 15 oz. (Baby had 60 hours of supplementing with a bottle after breastfeeding prior to the weight check)

    #2:
    His diaper output dropped drastically. From 5 or 6 wet diapers and 5 or 6 poopy diapers to 2 wet diapers and zero poopy diapers. This was at 7 days old.

    #3:
    6 wet diapers daily (VERY wet, not just piddles like when he was exclusively breastfeeding) and two very messy poopy diapers (we've had a few explosions). He is still getting supplementation after using the SNS usually though since he never seems satisfied. I usually make it about 3 1/2 into a nursing session using the SNS before supplementing another way (I do this because I can see that he is not actively nursing and I know how temperamental my supply is, so I make sure to get pumping sessions in). Sometimes, he is given a bottle and others, he is finger fed.

  5. #5
    Join Date
    Jun 2009
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    5,905

    Default Re: Struggling . . . thinking about giving up

    I cannot advise you to stop supplementing with the bottle or sns. At this point, you are supplementing so much, you will probably need to wean off the supplementing gradually, under taht care of your IBCLC or pediatrician, just to be on the safe side. I can only say this-

    Your baby’s weight gain appears normal. I understand that is at least partly due to supplementing with your pumped milk. But since baby IS gaining well with just your milk, that suggests you indeed have no issues with supply at this point.

    Also if you are pumping 25 ounces a day, that is about all you could expect a newborn to typically take in the early weeks (after milk came in.) After a few more weeks the average baby takes between 25-35 ounces per day.

    Output (poops) is a way to double check that baby is getting enough. If accurate weight checks suggest baby is getting enough, the no pooping could be due to something else.

    Milk supply cannot be measured accurately by what a mother pumps. If I understand what is happening, you are nursing frequently and pumping as well. NORMAL pump output when a mom is nursing as well would be 1/2 ounce to 2 ounces per session.

    When using an sns, the assumption is (as long as mom has milk, which you clearly do) that baby is extracting milk from the breast at the same time baby is getting supplemented at the breast.

    I have never used a lactation aids, but if the baby is having that much difficulty extracting anything with the aid, I would suggest there is something up with the aid or how you care suing it?

    A baby who is not nursing well needs to be taught to nurse well. This requires practice nursing at the breast, so baby needs to nurse frequently. It also may require suck training which is something your LC could be doing with you. I would also suggest you ask her if she thinks some before and after weight checks (perhaps both with and without the aid) may help gain a better idea of what is going on.

    It is typical newborn behavior to need to nurse basically constantly in the early weeks. The minimum amount a newborn (up to 6-8 weeks or longer) should be nursing is 10-12 times in 24 hours. This is the MINIMUM. Some babies need to nurse more often. In cultures that never learned via bottle feeding to time or schedule feedings, infants are held constantly and nursed constantly, 20 or more times a day.

    Taking a top off bottle does not mean baby did not get enoguh at teh breast. An alternative, if you need to supplement, is to supplement an ounce prior to nursing and let baby finish at the breast.

    A baby will typically nurse for a time, then stop, then want to nurse again very soon-just a few minutes-after, for a top off. A baby will often fall asleep at the breast, breastfeeding sends hormonal signals that relax both baby and mother. A baby will often nurse at least once an hour if not more often for part of the day. Also in the early days, long nursing sessions are common, 45 minuts to an hour, sometimes longer. However, 3 hours straight, with baby never coming off the breast that whole time, seems unusual. And if baby is unable to transfer milk well, those kind of long feedings are a red flag.

    A painful latch, especially with nipple injury, would suggest a shallow latch. A shallow latch can definitely lead to a baby not being able to get enough at the breast.

    Bottom line? Right now, it sounds like you make enough milk. That is really great, but the less you nurse, the more precarious that milk production becomes. Long term, it is very difficult for many moms to maintain appropriate milk production by pumping (as opposed to nursing.)

    Baby seems to have had a milk transfer issue at some point, but I cannot tell if that is still occurring.

    Nursing more frequently almost always helps with any breastfeeding issue.

    You will need to keep doing regular accurate weight checks for now until what is going on with milk transfer is figured out.

    Ideas to keep baby awake and getting enough at the breast: 1) nurse very frequently. Nurse at the earliest subtle cues. If baby does not cue enough, go ahead and offer. When baby slows down: 2) Try Breast Compressions 3) "pump" or stroke baby's hand or foot. 3) stroke baby's back 4) pat/rub his bottom 4) Gently Jiggle baby's chin

    Babies CAN nurse in their sleep as well. Maybe not your baby right now at least not effectively-, but nursing when asleep, or just waking or to sleep is very normal.

  6. #6
    Join Date
    Jun 2009
    Posts
    5,905

    Default Re: Struggling . . . thinking about giving up

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

    Lactation aid handout: http://www.nbci.ca/index.php?option=...tion&Itemid=17

    Videos-includs one of baby using a lactation aid: http://www.nbci.ca/index.php?option=...id=6&Itemid=13

    waking sleepy newborn: http://www.llli.org/docs/00000000000...py_newborn.pdf

    Also: Nipple shield. If you are seeing milk in the tip, when you are not using the sns, then baby is obviously extracting milk. I would suggest that if baby can extract milk with a shield, he can do so without a shield. Shields are only needed if a baby is unable to latch or nurse at all without it, ad they also cause issues, so I would suggest staying away from shields unless that appears to be the only way baby can extract milk.

    Oh and pumping nothing after a feeding could mean baby nursed really well at that feeding. You know? Again not a good idea to measure milk production based on pump output. This almost always undermines a moms confidence unnecessarily.

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