Needing to regroup...advise, please!

[@llli*3kidsmama]

Hi all,

I feel like I've sort of been running around chasing every possible source of our problems...and it's time to take a breath and regroup.

A quick summary of us: my daughter is 3 months old (today!). I started out with an oversupply and was coached to block nurse to regulate it. I did that for several weeks and my daughter started to become fussy during nursings. After emailing with Dr. Newman, it seemed apparent that my "flow" had slowed too much for her liking and his suggestion was to increase my supply, thereby increasing the flow. Domperidone was his suggestion for that.

In the midst of all of that communication, in working with a great IBCLC, I've also realized that my daughter is mostly chomping and pinching during feedings, not sucking/drawing the milk out strongly. The majority of the milk she drinks is during letdowns or because I'm constantly doing breast compressions and squeezing the milk out for her.

I've started taking Dom (and more milk plus tincture) have more milk available for her, but I'm at a bit of a crossroads with it. I'm taking 2caplets times a day, which is more than my prescription was written for, but less than Newman recommends. So, I either need to stick with the dose of the RX I have or order more from overseas, which I feel a bit nervous about. I haven't seen much increase yet from 3 days of the Dom. I'm also pumping after feedings about 3-4 times a day, in addition to breast compressions during every feeding.

Our IBCLC thinks there's a chance she has a slight posterior tongue tie (iBCLC admits that those are not her area of expertise) and is checking around our area to see if anyone would treat it. So, that may be the source of her weak suck/latch.

Long story short, I really don't know where to go from here. If there is a tie and we can get it clipped, that's obviously what we'll focus on. If not, is it possible to teach a baby to use her tongue properly? The LC says there is very little peristaltic movement...just chomping. And, as hard as I try, she very rarely latches on deeply. So much of her nursing is chompy, pinchy nipple feeding. I'm embarrassed that we're just now dealing with this, but in her earlier weeks she was gaining great and I had (and have) no pain at all, so I figured all was ok.

Thoughts? Advise? Thank you!

[@llli*lllmeg]

I'm sorry if I'm being dense but I'm trying to figure out what the problem is now. You suspected low supply or rather low flow due to your baby being fussy at the breast. But many many things could cause a baby to be fussy at the breast was there ever a loss of weight or a great slowdown in weight gain? In other words besides the fussiness at the breast and Dr. Newman's suspicion that this was caused by a slowdown in milk flow what makes you think you need to be on domperidone? I have a great deal of respect for Dr. Newman and would not question his professional advice. But in this case since he never saw you he is making giving that advice based on what you reported not on what he saw and in that case it could be questionable if that makes sense.
So I guess I would suggest ascertaining if indeed you truly have low milk supply or you have low milk supply that is so severe at this point but it cannot be brought back to normal levels by additional pumping or encouraging baby to nurse more frequently. In other words if you're concerned about taking domperidone I would suggest you consider whether it is necessary for you to be taking domperidone.
Even if the fussiness at the breast was caused or is being caused by a slowdown in milk flow, a slowdown in milk flow is a normal aspect of breast-feeding at this age isn't it many babies have to learn to deal with that and unless there is a true low supply issue I don't see that a slowdown in milk flow is that serious an issue.

[@llli*lllmeg]

As far as the way your baby latches and nurses. If the way your baby latches and nurses results in baby getting enough milk and is not painful or extremely uncomfortable to you it is not that serious an issue in my opinion. Of course you do want to make breast-feeding as comfortable as possible so it is a good idea to make sure there is no posterior tongue tied and to fix that if possible. But the fact of the matter is many people can look at a baby's mouth and see many different things even trained experienced people. I had an experience with my newborn where I had extremely painful latch for the first 2 to 3 weeks I had my baby looked at by a pediatrician who can diagnose posterior tongue-tie and two different IBC LCs none of them thought my baby had tt then last night a friend who is also an IBCLC barely glanced in my daughter's mouth (she was crying at the time so her mouth was open)and said hey she has posterior tounge tie! I no longer have pain when I am nursing as long as I do not have her positioned funky, she's gaining great and I have plenty of milk so I am not going to do anything about it. But I found it an interesting experience.

What positions have you tried have you tried laid-back breast-feeding positions sidelying, breast sandwich technique etc. have you as your IBC LC sat with you and worked with you on finding a more comfortable latch if not or if she cannot do that maybe you can find a breast-feeding helper who can or you can just keep experimenting yourself.

[@llli*lllmeg]

Oh and sorry yes there are methods to train a baby to suckle more effectively or use their tounge more effectively if necessary it's called suck training or supporting sucking skills and yourIB CLC should know about these techniques. There is a book called supporting sucking skills in the newborn infant something like that that should be on the shelf of every IBC LC.

[@llli*3kidsmama]

Thanks for your replies, Meg!
To answer your first question, her fussiness is the key reason that he feels my flow is too slow. I'd told him about initially having oversupply and block nursing to regulate it. He said often the fixes for oversupply slow down flow a bunch. I told him her output was still fine and her weight gain is usually ok (some weeks its 5-7oz, occasionally a little less...used to be consistently 7oz), but he said supply can be adequate, but flow still too slow.

His reasoning behind boosting my supply/flow may also be because of my doubts about the efficacy of her suck/latch. I suppose it's a matter of making sure there's plenty and that it basically drips right out to compensate for the fact that she really never has the deep, jaw pulling rhythmic sucking.

My concern is that, unless we fix her tongue movements/latch/suck, that I'm going to have to essentially maintain an oversupply (not that it's problematic - she's not having tummy troubles or anything, so my current "oversupply" isn't causing her issues...I would just rather not be pumping and taking herbs/Dom if I don't need to).

She's fussy through less feedings lately, but still usually gets the majority of her drinks during letdown or when I'm able to do good breast compressions. Also, she'll nap at the breast and barely nibble and I'll have a handful of letdowns during her naps. I also dreamfeed her 3 times overnight. I just don't think this is going to be a good long-term plan...she'll start sleeping less during the day,
etc.

Does that help explain my concerns?

[@llli*joe.s.mom]

If you had oversupply before, it would probably be easy for you to increase your supply just by nursing more. So I'm not seeing why Dom is necessary. I had oversupply with Joe, had to wean completely off one breast and cut my supply by about half in order to heal from a breast surgery, and then relactate that side and increase my supply, and I was able to do it, and it really only took a few weeks to get 85% of my supply back (the rest took longer). I credit my early OS and generally responsive supply with being able to do this - I never even considered taking drugs. So I'm just a little confused here. If you reduced your supply too much by block feeding, you should be able to get it back just by nursing more and switching sides more (and if you're really dedicated, pumping a little).

[@llli*joe.s.mom]

As far as the tongue tie, I went through that with my little baby. I would just have it looked at by an ENT. Even at three months, if she has a tie and it's clipped, I think you'd see improvement in the latch. There are exercises you can do to encourage babies to use their tongues more/better post clip. But from your post, it seems like there's some doubt about whether there is a PTT. So first thing's first, I'd find an ENT (preferably one who specializes in dealing with tongue tie that causes breastfeeding issues) to take a look. If she has been gaining weight well and you weren't in pain, you might not have a PTT at all.

[@llli*3kidsmama]

I've been a little surprised by how adamant he has been about the Dom. Seriously, every email would begin and end with that suggestion. I told him I had started more milk plus and he said that works best in the few weeks after birth and basically, that dom was the best chance at this point.

I really haven't seen it do much (at the dose I mentioned), so, given my discomfort with increasing and ordering overseas, I may start weaning off and make sure it doesn't decrease.

Nursing more often isn't really an option - I honestly think that's part of the fussiness. She seems way less fussy when I follow her cues (and maybe offer very infrequently if she hasn't cued). When I was offering all the time, she was super fussy. Would latch on, bring a letdown and pop off and scream. She seems to be much happier on her own terms...

[@llli*lllmeg]

Sure I understand your concerns and I understand Dr. Newman's reasoning. But sometimes we have to look at advice and see whether it's working well for us and it sounds like the domperidone is not working well for you. I don't think you need to worry about if what is working right now will work long-range or not because one thing about breast-feeding is if you don't like how it's going one-week wait a week because it will almost certainly change. Assuming baby is gaining appropriately at the breast, and you are not having pain or nipple damage from nursing, then i think as long as you're not doing anything to harm your milk supply or harm your baby's ability to latch you could just let things go as they are going now and relax a little and see what happens. No two mothers have the same exact milk production ability or capacity. So what you call oversupply, if it's working for you and your baby, would actually be perfectly normal supply.

[@llli*3kidsmama]

Update!! I took her into an ENT and she agreed there was a significant enough posterior tie to clip it. That was done Friday afternoon and I can tell a difference in the strength of her suck. She's drinking more between letdowns, etc. My nipples are a little sore, but that could be because I had the pump set a little too high last week. I'll turn it down and see if that helps, and see about having her new latch checked out if not.

I was disappointed to weigh her this evening and find she only gained 4oz again this week. Here's her weight histor for the past several weeks (her birth weight was 6lbs, 13oz and she was only 6lbs, 10oz at her 5 day checkup):

8/12: 10lb, 6oz
8/19: 10lb, 13.5oz
8/26: 11lb
9/2: 11lb, 5oz
9/9: 11lb, 12oz
9/16: 12lb
9/23: 12lb, 4oz

She was 3months on 9/21. Is this pattern concerning at all? I don't know her length measurements beyond her birth (18.5in) and 2 month checkup (22.5 inches).

She has 6-7 wet diapers and at least one (sometimes several) big dirty diaper daily. Very alert, bright eyed, arms and legs moving constantly, trying hard to sit up, etc...

Weight gain a concern? Give her tongue tie release more time to see if she transfers milk better?