Not Sure Where to Go From Here

[@llli*brooklynsavage]

Trying to get my 2nd baby to nurse and having a tough time. She's two-wks tomorrow and our current routine is:

Every three hours, I use a shield (small, flat-ish nipples) to nurse her. She'll usually latch and suck for 15-20 minutes, sometimes getting fussy and/or sleepy on and off. I do compressions for most of the session as she usually gets fussy when I don't. I follow-up each nursing session with a bottle (pediatrician's recommendation to insure weight gain), which she has happily taken every time but once. She proceeds to drink anywhere from 2-3.5 oz from the bottle. Once she's done, I make sure she's settled and I pump the breast that she nursed at.

Some background facts:
-My supply is good and I have extensive experience using a shield, as my first baby needed one for almost 5 months before being able to nurse without it.

-First baby had bad silent reflux which caused most of our breast-feeding problems. So far have not seen same signs with 2nd baby.

The current process takes at least an hour, if not longer, and I'm not sure I can do it for more than another week or two. If she's not full-on nursing and getting enough by the end of her first month, I might have to convert to bottle-feeding and pumping, which I really don't want to do. I have talked with a lactation consultant over the phone but have not pulled the (expensive) trigger of scheduling a visit with her, as I'm on a tight budget. The LC suggested I not go much longer without seeing someone and finding out how much the baby is getting at the breast. While I understand this, I'm wondering if there is anything I can do on my own before paying for the appointment. I do have a baby scale (not the fancy-schmancy type the LC has, but measures to the .5oz) and am willing to try anything to get breastfeeding going full-force.

Thanks for any advice/tips in advance.

S

[@llli*mommal]

I think it's time to pull the trigger and see the LC. I am sure it's not cheap- but think about it this way: a year's supply of formula is likely to run you $1500-2000. And even if you pump exclusively and make it to a year, you're still going to spend a big chunk of change on pump supplies.

Will your baby latch and nurse without the shield? If so, I strongly suggest trying that because the 2 big problems with shields are slowed-down feedings and reduced milk transfer.

I would get out your non-fancy-schmancy baby scale and do a day's worth of before and after nursing weigh-ins. It's not going to give you ideal data, since the difference between an adequate feeding (usually about 2-3 oz) and an inadequate one can be as little as 0.5 oz. Nevertheless, if your baby scale indicates that your baby is getting several oz when nursing, you can probably relax a lot and wean off of the bottles. 2-3.5 oz bottles after feedings are kind of huge for a 2 week-old baby- again, babies that age usually take just 2-3 oz when nursing. It's very common for a baby to take a large bottle even after nursing well, since babies love to suck and when they suck on a bottle they must swallow or else they'll choke. This is why babies often overeat when presented with a bottle.

Are you nursing on just one breast per feeding, or both? I wasn't sure from your post. If you're using just one, I strongly suggest offering both, since that usually improves oth supply and weight gain. Also, when you say your baby nurses every 3 hours, is that yor idea or hers? Every 3 hours works out to just 8 feedings a day, and a newborn is usually nursing more in the neighborhood of 10-12. More nursing- particularly if you can do it without the shield- should translate to more weight gain and better supply.

Tips for waking a sleepy baby:
- Keep her cool- a cool baby is often more alert. So strip her down to a onesie or diaper when it's time to nurse, and keep a fan blowing in the room where you nurse, though not directly on the baby!
- Annoy her- an annoyed baby is often more alert. Tickle the soles of her feet or rub against the grain of her hair using your hand or a cool damp washrag.
- Keep the lights low- new babiesay close their eyes in response to bright light.
- Breast compressions.
- Switch nursing: when suckling slows and baby appears to be dozing off, take her off the breast, burp her, change her diaper, and put her onto the other breast. When she dozes off again, repeat the process, and keep repeating it until she will no longer wake.

[@llli*lllmeg]

I agree with mommal. See an IB CLC , try to nurse more frequently and try to cut down on the amount of each bottle

[@llli*mommal]

One more question: why did the pediatrician recommend bottle top-ups? Was there a known problem, or was he just recommending this as insurance? The reason I ask is that it's normal for newborns to lose weight (up to 10% is normal), and they are only expected to have regained their birth weight by 2 weeks. Some docs don't realize this and freak out over normal weight loss.

[@llli*littleturtlelove]

I wanted to add a few things to what the others recommended, do you have a WIC office where you live? You don't have to be on WIC to get your baby weighed. Most of them have a baby weigh scale that you can weigh, then feed and then weigh again. They don't charge anything to do that and sometimes there are LC's there that won't charge anything. If that isn't a possibility, is there a way to sced a visit with a lactation person at the hospital you delivered at? Sometimes they are willing to help for free if you delivered there. It sounds like your LO is getting a lot of food, feeding at breast and then getting 2-3 oz of formula? That seems like a lot to me. (Mommal I guess already said that ) There is one GREAT way to increase your supply, nurse, nurse nurse and nurse! Cutting down the time spent at breast and adding in more supplimentation cuts your supply a lot.

[@llli*aprilsmagic]

Exclusively pumping is MUCH harder and way, way, WAY more expensive than seeing an IBCLC in the long run. I EPed for 18 months. And BTW, it will take just as much time...you will be pumping 8-12 times a day, plus feeding the baby...as what you are doing now. Add a second kid on top, and it's much more difficult in the long run. And not nearly as nice. You can't cuddle a pump!

What about giving a teeny bit of supplement -- why were you told to do this anyway? -- and then finish at the breast?

You can do this. 2 weeks is so, so young. There is research that shows that most babies, if their mother persists, learn to nurse by 8 weeks of age.

I guess one major question I have, since you have a good supply, is a) why are you supplementing and b) how has baby's weights, wets and poops been?

[@llli*brooklynsavage]

Thank you all for your comments! Here are some answers to your questions and our updated situation:

-I have emailed the LC and plan on making an appointment with her as soon as she's back from vacation, hopefully this week
-The baby had a weight check right after I wrote my original post. At two-weeks, she still had not reached her birth weight, she was 7oz shy. The pediatrician recommended I continue with bottle supplement for another week and was confident that at the next weight-check (this coming Wednesday) the baby would be back at birth weight (7lb 9oz) and I could reduce the supplements.
-Baby will not latch without a shield. I tried in the hospital and for days after with no luck. I occasionally try during nursing now and she flips.
-I tried using my scale and each time it said she only got .5oz after 15 min on each side. That was depressing so I stopped using the scale after 2 days.
-I was originally nursing on just one side but have been doing 15 min on each side since reading the comments here.
-I am nursing every three hours based on the pediatrician's recommendation AND because each feeding (nursing for 30, giving a bottle and then pumping) takes over an hour, so feeding more often would be practically impossible.
-As for keeping her awake while feeding, I was incorporating most of your tips already and have added some new tricks. There are still times when keeping her awake is incredibly hard and increases the time of the feeding to almost two hours, but I'll keep pressing on.
-As for bottles after nursing, I do this mostly because she's almost always still hungry after nursing and, as mentioned before, the doctor recommended I supplement until she is back to her birth weight. And all supplements are breast milk, she's never had formula, thanks to my ample supply.
-I tried calling the hospital where I delivered about a breastfeeding support group they supposedly run, but the number was disconnected. I will try to investigate further, but they did not have LCs on staff there, only LC students. I will look into it this week.
-I will also look into a local WIC office, I knew nothing about that option.

Thank you all again for your advice, I will update again soon.

Sheila

[@llli*pizanite]

I'm glad you are getting into see an LC! She will be able to check for tongue tie and other physical barriers.

Like Susan or other PP mentioned, I wonder if you can try to do the bottle first and then finishing at the breast. Since she is rejecting the breast without the shield, maybe this might make her more receptive to nursing without the shield since she's not super hungry. I have small, flat nipples, and I used a Latch Assist to draw out the nipple and then a nipple sandwich technique to get her to nurse directly. I'm mentioning it because I understand that nipple shields can inhibit milk transfer as well.

We had a lot of problems but everything was significantly better for us around 2 months, and smooth sailing after about 3. I didn't have another LO to take care of though. You are doing a great job, mama!!

[@llli*lllmeg]

I have emailed the LC and plan on making an appointment with her as soon as she's back from vacation, hopefully this week

Is this the hospital based LC? Are you paying for this appt or is it included? Please make sure she is an IBCLC and has experience with helping with latch and milk transfer issues in a baby this age. Some folks who work primarily in hospitals work primarily with brand newborns a few hours or days old and do not have much clinical training with “older” babies. This is a problem as things change rapidly in those early weeks. I always suggest moms talk to a few-2 or 3- IBCLCs prior to hiring to make sure this is someone they can feel confident in and comfortable with. This is not always an option, of course.

-The baby had a weight check right after I wrote my original post. At two-weeks, she still had not reached her birth weight, she was 7oz shy. The pediatrician recommended I continue with bottle supplement for another week and was confident that at the next weight-check (this coming Wednesday) the baby would be back at birth weight (7lb 9oz) and I could reduce the supplements.

Just be sure baby is always being weighed on the same scale in a dry diaper or naked. Always. Otherwise the weight check will very likely be off. Also, while yes the rule of thumb is for baby to be back to birth weight by two weeks, it is important that weight gain or loss is measured from the lowest known weight or the last weigh in.

-Baby will not latch without a shield. I tried in the hospital and for days after with no luck. I occasionally try during nursing now and she flips.

If your baby is nursing with a shield, your baby IS nursing at the breast, just with help. Far far better better to nurse with a shield than to not nurse at all. You can worry about weaning off the sheild later.

-I tried using my scale and each time it said she only got .5oz after 15 min on each side. That was depressing so I stopped using the scale after 2 days.

With before and after weight checks, AFTER two weeks of age, it is very good to see a weight gain of 2 ounces. Brand newborns under two weeks typically take an ounce or less at the breast each session. That is one reason why baby needs to nurse lots. Also, “official” before and after weight checks are very difficult to do, with a specific protocol of zeroing out the scale, weighing diaper before and after, I do not know what all. IMO This is something only IBCLCs should do. So I am glad you are not obsessing over the home scale anymore.

-I was originally nursing on just one side but have been doing 15 min on each side since reading the comments here.

I guess you mean you are switch nursing to build milk supply-Or is this to keep baby awake? IN either case, I would not time nursing on both sides, or if you do, be prepared to go back and forth several times per feeding. What I am trying to say is, generally best not to time feedings at all.

-I am nursing every three hours based on the pediatrician's recommendation AND because each feeding (nursing for 30, giving a bottle and then pumping) takes over an hour, so feeding more often would be practically impossible.

Well, maybe you can check in witj your pediatricain about WHY it was suggested to nurse every three hours, and if it is OK to nurse more if you want. 9 years ago, I was exactly where you are now, where my newborn was very sleepy, could only nurse with a nipple shield, took 45-60 minutes to latch and nurse, and I had to pump for 10-15 minutes per side (I never got double pumping down) after each nursing session. The only difference, we did not need to supplement so no bottles. And I was told by MY pediatrician to nurse every TWO hours, which I did, for about the first month. It was hell, and I fell asleep over the pump a lot, but not impossible.

But guess what? Neither the advice to nurse every 2 hours OR every 3 hours is really helpful. Because it is not natural. Babies do not normally nurse every such and such hours, they cluster feed, which means they will need to nurse very frequently (maybe more than once an hour) much of the time with the occasionally longer break. This is why we try to say "nurse a minimum of such and such times per DAY." Because you want to encourage this normal behavior, because a baby who is allowed/encouraged to cluster feed and nurse as soon as baby wants/prior to hunger will be calmer and/or, more awake at feedings, and will thus nurse better. Yes it seems impossible ( I thought the same thing) because you are caught up in thinking about the clock, but in practice nursing more often will rapidly become easier. Nursing more often will be easier because your baby will more quickly learn to nurse better, will transfer milk better, will get more milk at the breast, and thus nursing sessions will become more efficient more quickly, and you can then stop or cut down on pumping, and stop giving bottles. (Pumping may or may not be needed as long as baby nurses with a shield, but bottles are only needed until baby starts getting enough at the breast which baby can only do if baby nurses often enough.) You will also probably wean off the shield faster. Cue feeding as nature intended will make life more normal more quickly. Please see the stickied thread "do you think your baby nurses to much-read this."
Telling moms to nurse every such and such hours is very common advice. It is also almost never good advice for the breastfeeding mother, ESPECIALLY if there are weight gain issues. We know that the vast majority of newborns need to nurse a minimum of 10-12 times a 24 hour day in order to get enough. MINIMUM. Some need to nurse more than that. How is your baby going to gain appropriately at the breast if your baby cannot nurse frequently enough?

-As for keeping her awake while feeding, I was incorporating most of your tips already and have added some new tricks. There are still times when keeping her awake is incredibly hard and increases the time of the feeding to almost two hours, but I'll keep pressing on.

Again, if you start cue feeding, you may find you get into your baby's natural sleep/wake rhythm and baby will not need to be awoken so much to nurse. There is not doubt having to wake baby every time to nurse makes nursing harder, although at times it is needed in the early days. Will baby nurse in sleep?

-As for bottles after nursing, I do this mostly because she's almost always still hungry after nursing and, as mentioned before, the doctor recommended I supplement until she is back to her birth weight. And all supplements are breast milk, she's never had formula, thanks to my ample supply.

Great you have such fantastic milk production at this age, that took hard work, all that pumping is paying off. But again, this suggests to me that simply nursing more often will resolve some of these weight gain issues more quickly. The milk is there! If you need to supplement, the usual suggestion is to supplement a small amount (say an ounce-baby has a teeny tiny tummy still) PRIOR to nursing and letting baby finish at the breast. Babies this age act hungry and as if they need “more” even after nursing well, because they do-they pretty much want to nurse all the time unless they are asleep. This is normal. This does not mean your baby actually needs more milk. You tell a baby needs supplements by if baby is not gaining as needed or pooping as expected.

-I tried calling the hospital where I delivered about a breastfeeding support group they supposedly run, but the number was disconnected. I will try to investigate further, but they did not have LCs on staff there, only LC students. I will look into it this week.
-I will also look into a local WIC office, I knew nothing about that option.

Any local LLL? And great to call WIC, some offices have wonderful breastfeedign peer counselors as well as appts with IBCLCs. But just make sure you talk to the WIC lactation program, not everyone at WIC is going to have good breastfeeding knowledge.

Thank you all again for your advice, I will update again soon.

You are doing so great Sheila. I know you are probably more tired than you have ever been in your life-or have beeen since last baby- but it will get better, and you will never regret the hard work you are doing now.
If you do not have a copy of The Womanly Art of Breastfeeding (8th edition, 2010) yet, I strongly suggest getting that. It "should" be in the public library, costs less than $15 online.