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.