Resorting to pump, any advice?

[@llli*cosmos07]

So my LO had low weight gain, only gaining 2 oz. between weeks 5 to 7 (three weeks straight on same scale, same method). I was told to start supplementing with formula at 7 weeks. She will be 10 weeks old tomorrow and I have gone through many trials since this began. I was EBF until this began, taking the normal advice of if she was active, had enough diapers and was nursing often (2-3 hours) then everything was fine. Obviously it wasn't fine.

I started on week 7 by continuing to BF her "normally" as long as she would go, then offering her a 2 oz bottle of formula, she only took it half of the time. By the end of this week she gained 4 oz. On week 8 I was told to let her eat for about 15 minutes on each side, give her the 2 oz. of formula and then pump (double pump, electric) for 15 minutes, she continued to gain, but this time only 2oz. or so in a week and during this time she stopped wanting the formula most of the time and wouldn't take it at all during the 3 night time feedings. Week 9 began and I was more confused than ever. I noticed with the pump I could still manually express a ton of milk (well 1/2 an ounce or so, compared to next to none before), so I rented a Medela Symphony pump and also began letting her eat for as long as she wanted to, using each side at each feeding again (more on this below). Her weight gain was only measured after 4 days and was only 1 oz total after using this method.

We are now on week 10, starting 3 days ago (I bought a scale and started checking her weight at home, she wasn't really gaining with the previous method) I started offering her a bottle (first 3 oz, but she wasn't satisfied, so now 4 oz) FIRST, then letting her feed on my left side if she felt the need. As soon as she finished or even during her eating if I she was calm enough I started pumping with the Symphony in single sided fashion for 15-20 minutes. According to my scale (we haven't been able to get back to the Dr. office yet), she's gained about 5 oz. in the three days I've been doing this. I pump the right side since it has always produced more AND because my nipple on that side has had milk blisters and cracking for weeks now, I'm starting to heal since she's been off of it.

My pump output has varied. In the beginning (doing it for stimulation mainly, AFTER she ate) I was getting 2 oz. A DAY or so. After that I was getting maybe 3-4 oz. a day (still after her eating). Using the bottle, then feeding method I am getting AROUND 10-11 oz. a day. About 2 oz. first thing in the morning (2 sessions) and then 1 to 1/2 oz. per session after that. She is eating much more in a scheduled fashion with the bottle first method, 3 hours during the day and about 4 at night for a total of 8 sessions and in generally taking 4-5 oz. a session (if she wants to comfort nurse, I let her, so those intakes are hard to figure out). I pump the left side if she doesn't eat from it. Right now I am using the Symphony like a single pump and using my other hand to massage and stimulate, which seems to work a little bit better, so it take 15 to 30 minutes to pump total each time.

I've tried the whole "nursing vacation" thing during this, I let her eat as much and as often as she wanted. Still no difference in weight gain, this is what I was doing all along in general as well. When she is nursing only she often only goes 2 hours between feedings and takes a long time to finish a feeding, often an hour or longer.

So right now, I am giving her a full BM bottle first thing in the morning (7am or so when she wakes) and last at night (11pm or so, after her first sleep time) and then just the formula with added latching on if she desires during the day and overnight. I've been taking 9 total capsules of Fenugreek a day and have tried adding healthy things into my diet (even more than normal) including carrot juice for 3 weeks now, along with drinking plenty of water. We have seen an IBCLC 4 times total now (2 days, 2 weeks, 4 weeks and 7 1/2 weeks when this began) and was always told her latch was "great", but she has a high pallet. At 4 weeks she took 2 1/2 oz. in a 50 minute feeding, but at 7 1/2 weeks she only took an ounce and a half. I have an appointment with them again next week (soonest available).

What do I do from here? Even if I continue the bottle first method (which at this point I think might be the right thing to do), how can I get more from the pump? I'd love to give her more BM than formula at least. I've tried the normal tips such as double pumping (produces less usually), drinking water right before and during and "relaxing" as much as possible (I have to continue watching her while pumping most of the time). Thanks in advance for any suggestions.

[@llli*lllmeg]

A baby does not gain for a reason. So in these cases it is best to figure out WHY baby is not gaining well so you know how best to proceed. So is it that: 1) baby does not nurse frequently enough 2) baby does not nurse effectively 3) baby nurses fine but mom has low milk production or 4) baby is getting enough but there is an underlying medical condition that is preventing baby from gaining. Or 5) some combination of these.

At 4 weeks she took 2 1/2 oz. in a 50 minute feeding, but at 7 1/2 weeks she only took an ounce and a half. I have an appointment with them again next week (soonest available).

This is pretty good milk transfer, and it is good transfer because you would expect a baby to take about 2-3 ounces a time at the breast at most at that age. So this suggests baby can nurse fairly effectively but maybe not as quickly as would be expected at this age. The problem with before and after weight checks is that they only tell you what happened in that ONE nursing session, and since a baby would typically take in different amounts at different sessions, this is limited information. However, these do show baby can transfer milk. Also, it is unlikely a palate issue or other physical barrier to nursing effectively would get worse as time went on, so I would not worry overmuch that the second transfer was less than the first. Again this is hlepful but limited information.

I know you say that increasing nursing session frequency did not help, but I don't understand how that can be, since baby does seem to be able to transfer milk. Even if baby only gets 1-2 ounces per session, 5 more sessions a day would equal 5-10 more ounces a day into baby.

A newborn baby needs to nurse a MINIMUM of 10-12 times a day. A baby who is nursing every two to three hours is nursing, at best, the minimum amount typically needed, and some babies need to nurse more often than that to get enough.

High frequency feeding is needed and is very normal, but taking an hour or more to feed after the very earliest weeks is a red flag that baby is not nursing as effectively as they should.

What has your LC suggested for helping baby nurse more effectively or to shorten feeding times? Have you tried breast compressions? What about supplementing with a lactation aid (sns or similar?)

No need to slam water. Drink to thirst (a breastfeeding mom will be more thirsty than usual.) Overloading on water does not increase milk supply as was once thought. Ditto foods. Moms do not need to follow a special diet to make milk. Eat what you want, you can add things like oatmeal that have reported milk making properties.

Pump output tells you very little about overall milk production. It makes sense that when you started nursing less you started pumping more milk, put that does not really help anything if the overall production stays the same.

So right now, I am giving her a full BM bottle first thing in the morning (7am or so when she wakes) and last at night (11pm or so, after her first sleep time) and then just the formula with added latching on if she desires during the day and overnight.

How often is baby nursing overnight? While it is OK to take a longer break (up to 4 or 5 hours) in order to sleep, otherwise, a baby should still be nursing frequently overnight. Usually the early am is the best time for good supply, so it may make sense to nurse then, rather than giving a bottle?

What is a 'full" bottle? If baby is taking 4 or more ounces from a bottle, that is a ton and baby is not going to want to nurse for a while after such a big bottle.

Talk to your IBCLC about this, but I think it is important that baby nurses as much as possible, and right now I think that your concern about having time to pump and the output when pumping, plus the large amounts you are supplementing at a time is interfering with this.

So I would suggest-feed more. Feed your baby a minimum of 12 times a day. Do not wait for cues, do not worry how long it has been since the last feeding, offer as much as you like. Nurse more, nurse every feeding, and pump after nursing for 10 or 15 minutes or so, to make sure the breast is well stimulated and "emptied" since baby is apparently not nursing very effectively. (Please note quotes, breasts are never really empty)

Supplement by giving SMALL amount-1 or 2 ounces, at the start of each feeding, and then nurse as long as baby wants or as long as you can keep baby actively sucking and swallowing. and/or, supplement while you nurse using a lactation aid.

What I fear is happening now is you are limiting time at the breast in order to pump more at each pumping session. This is understandable, I get it, but this is generally not the best way to build supply nor to teach baby to nurse better.

If it is too much for you to supplement, nurse and pump at every session, just do what you can, everything can be adjusted as you need-you do not have to do the same thing every time. But remember baby needs time at the breast to learn to nurse, your breasts need lots of stimulation and to have milk extracted as frequently as possible. Frequent extraction of milk is how to build milk supply, much more important than diet or even galactagogues. So upping time at the breast and frequency of milk extraction should help.


More info http://kellymom.com/bf/got-milk/supp...es/low-supply/ I also suggest the book Making More Milk.

[@llli*aprilsmagic]

A baby does not gain for a reason. So in these cases it is best to figure out WHY baby is not gaining well so you know how best to proceed. So is it that: 1) baby does not nurse frequently enough 2) baby does not nurse effectively 3) baby nurses fine but mom has low milk production or 4) baby is getting enough but there is an underlying medical condition that is preventing baby from gaining. Or 5) some combination of these.


This is pretty good milk transfer, and it is good transfer because you would expect a baby to take about 2-3 ounces a time at the breast at most at that age. So this suggests baby can nurse fairly effectively but maybe not as quickly as would be expected at this age. The problem with before and after weight checks is that they only tell you what happened in that ONE nursing session, and since a baby would typically take in different amounts at different sessions, this is limited information. However, these do show baby can transfer milk. Also, it is unlikely a palate issue or other physical barrier to nursing effectively would get worse as time went on, so I would not worry overmuch that the second transfer was less than the first. Again this is hlepful but limited information.

I know you say that increasing nursing session frequency did not help, but I don't understand how that can be, since baby does seem to be able to transfer milk. Even if baby only gets 1-2 ounces per session, 5 more sessions a day would equal 5-10 more ounces a day into baby.

A newborn baby needs to nurse a MINIMUM of 10-12 times a day. A baby who is nursing every two to three hours is nursing, at best, the minimum amount typically needed, and some babies need to nurse more often than that to get enough.

High frequency feeding is needed and is very normal, but taking an hour or more to feed after the very earliest weeks is a red flag that baby is not nursing as effectively as they should.

What has your LC suggested for helping baby nurse more effectively or to shorten feeding times? Have you tried breast compressions? What about supplementing with a lactation aid (sns or similar?)

No need to slam water. Drink to thirst (a breastfeeding mom will be more thirsty than usual.) Overloading on water does not increase milk supply as was once thought. Ditto foods. Moms do not need to follow a special diet to make milk. Eat what you want, you can add things like oatmeal that have reported milk making properties.

Pump output tells you very little about overall milk production. It makes sense that when you started nursing less you started pumping more milk, put that does not really help anything if the overall production stays the same.


How often is baby nursing overnight? While it is OK to take a longer break (up to 4 or 5 hours) in order to sleep, otherwise, a baby should still be nursing frequently overnight. Usually the early am is the best time for good supply, so it may make sense to nurse then, rather than giving a bottle?

What is a 'full" bottle? If baby is taking 4 or more ounces from a bottle, that is a ton and baby is not going to want to nurse for a while after such a big bottle.

Talk to your IBCLC about this, but I think it is important that baby nurses as much as possible, and right now I think that your concern about having time to pump and the output when pumping, plus the large amounts you are supplementing at a time is interfering with this.

So I would suggest-feed more. Feed your baby a minimum of 12 times a day. Do not wait for cues, do not worry how long it has been since the last feeding, offer as much as you like. Nurse more, nurse every feeding, and pump after nursing for 10 or 15 minutes or so, to make sure the breast is well stimulated and "emptied" since baby is apparently not nursing very effectively. (Please note quotes, breasts are never really empty)

Supplement by giving SMALL amount-1 or 2 ounces, at the start of each feeding, and then nurse as long as baby wants or as long as you can keep baby actively sucking and swallowing. and/or, supplement while you nurse using a lactation aid.

What I fear is happening now is you are limiting time at the breast in order to pump more at each pumping session. This is understandable, I get it, but this is generally not the best way to build supply nor to teach baby to nurse better.

If it is too much for you to supplement, nurse and pump at every session, just do what you can, everything can be adjusted as you need-you do not have to do the same thing every time. But remember baby needs time at the breast to learn to nurse, your breasts need lots of stimulation and to have milk extracted as frequently as possible. Frequent extraction of milk is how to build milk supply, much more important than diet or even galactagogues. So upping time at the breast and frequency of milk extraction should help.


More info http://kellymom.com/bf/got-milk/supp...es/low-supply/ I also suggest the book Making More Milk.

with all of it. Sounds like you are thinking of EPing. For a mom who may believe she has a low supply, EPing can actually destroy her supply. A pump isn't as good as a baby, and measuring what you pump can be very discouraging.

I am especially confused as to how nursing more or pumpingnmrie often made less milk

[@llli*desertmama]

I think you need to let go of the obsession with her weight gain. Doctors use charts that were created from the weight ranges of formula-fed babies. These charts aren't as useful for measuring BF babies' weight gain. I think it is probably better to count wet and poo diapers and look at how often she feeds rather than focus solely on her weight. My son was a skinny little guy from birth and gained weight very slowly. But he BF on demand, had plenty of wet and poo diapers and was generally content. So I really didn't worry too much about it. Definitely keep an eye on it but don't let it determine how and when you feed your baby.

As suggested, I would put her to the breast as often as possible, whether she asks for it or not. Your daughter's suckling will increase your supply much more than a pump will. And as Susan mentioned above, pumping is very hard work, much harder than pulling your breast out and latching baby on.