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Thread: Breastfeeding, Expressed Milk & Formula supplement

  1. #1

    Default Breastfeeding, Expressed Milk & Formula supplement

    I should start by saying that my LO was born 24 days ago at 8lbs 10.5 oz and after the last pedi appt. a week ago, he weighed 8lbs 15oz. He also produces many wet and poopy diapers. So, I know he is getting enough nourishment based on these facts. However, this is my issue. For the first few days he was only breastfed. However, we did have a latching problem, so I was forced to pump and feed him with a bottle. I got a lactation consultant to come and help with the latching, and that helped a lot. He does have a problem latching still, because of a short upper lip, and as a result he flattens out my nipples when he sucks. It isn't painful during breastfeeding, but I feel some discomfort right in the beginning when he latches on and right when he is done. But this is not the issue. He is a very, very slow eater and I am not sure who much milk he is actually getting when he is at the breast. His feedings could last 1.5 hours, with him sucking & falling asleep on and off and right after he lets go of the breast he starts fussing for more. After 1.5 hrs, my nipples can't take much more sucking and my breasts do feel pretty empty. So, I ended up supplementing with a bottle, which most of the time is expressed breast milk and once or twice a day 2 oz of formula. He eats the bottle really quickly and then, he is fully satisfied and falls asleep for 4 hours or so. The ratio is, for every oz of milk he ingests, he then sleeps an hour. I have tried waking him every 2 or 3 hours for feeding, but I've been unsuccessful, regardless what I do: undress and change his diaper, tap his feet or play with his ears etc.
    So, my current issue is that in spite of my constant every 2 hour pumping, it seems that my milk is starting to dwindle. I still put him at the breast for feedings every time he wakes up for at least half hour per breast, but regardless of how much he sucks, he still doesn't seem to get enough. I am now pumping about 1.5 to 2 oz every 2 hours, but it doesn't seem to be enough and I just don't know what to do. I also tried putting him at the breast every time he was fussing which was constantly, but my nipples were taking a beating and he didn't seem any more content, not was he able to sleep. That's when I resorted to supplement with a bottle. I am doing everything in my power, eating, resting as much as I can, taking fenugreek and eating oatmeal. Please help, I am becoming very discouraged and I really want to keep breastfeeding. Oh, and one more thing, in a few weeks I am returning to work, so he will need to be fed from a bottle while I will be gone for 10 hours. I hope, this is not too confusing! I really need some direction. Thank you for all your help!

  2. #2
    Join Date
    May 2006
    Posts
    20,782

    Default Re: Breastfeeding, Expressed Milk & Formula supplement

    Welcome to the forum and congratulations on the new baby!

    I think the first thing you want to do is to see a second LC, preferably an IBCLC. There's no substitute for expert, hands-on help when you are struggling with a newborn and a latching issue. I'd want to have the LC check the baby extremely carefully for tongue tie, and also to use a scale. By weighing the baby before and after feedings and subtracting the before from the after, you can gain an accurate picture of how much the baby takes in over the course of a feeding. Because one weigh-feed-weigh test only provides a snapshot of what is going on, you may want to rent a scale for home use and do several days' worth of measurements; and average of lots of measurements is much more informative. A scale can also tell you when the baby is getting enough from nursing alone, and when supplementing is necessary.

    Based on the extremely long feedings and the nipple compression you're experiencing, I think there's still something off with your baby's latch. Shallow latch often = nipple compression and slow milk transfer. It also sounds as if you have a sleepier-than-average baby. I think you want to keep attempting to wake him every 2-3 hours during the day and every 3-4 at night. Here are some tricks for waking a sleepy baby (some of which it sounds like you are already doing):
    - Keep him cool. When it's time to nurse, strip him down to a diaper or onesie, and keep a fan blowing in the room you're nursing in.
    - Annoy him. Tickle his feet or rub against the grain of his hair using your hand or a cool damp washcloth.
    - Keep the light dim. Very young babies sometimes close their eyes in response to bring light.
    - Do breast compressions to speed milk flow.
    - Try switch nursing. When baby seems to be nodding off, and his suckling is slowing to a gentle, erratic suck...suck...pause...suck sort of pattern, take him off the breast, burp him, change his diaper, and switch him to the other side. Repeat the swap as many times as necessary until baby will no longer wake. In theory, this teaches baby that he must stay awake and active at the breast or you're going to annoy the poop out of him with the constant switching. It's also great for supply!

    You're supplementing right now, but based on your post I am not sure that you need to be. Yes, the constant feeding is super-annoying and I am sure it makes you sore! But I am also not sure that what you describe indicates a milk transfer issue- for that, you'd want to see a baby who is not producing enough wet/poopy diapers or growing adequately when he is exclusively breastfed. And your pump output is pretty good- most moms with adequate supply produce about 1.5 oz per hour when pumping in place of a feeding. You'd expect somewhat less when doing what you're doing, which is pumping in addition to feeding. However, I think you are right to suspect that the slow feedings are indicative of a transfer issue and perhaps low supply. And when a mom has low supply due to ineffective nursing on the part of the baby, the best thing she can do is to pump her heart out. Supplements like fenugreek and oatmeal are nice, but nothing beats increased stimulation to and milk removal from the breast, during a high-quality pump with correctly sized shields. I'd want to pump every 2 hours during the day and every 3-4 at night.

    HTH!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    Feb 2012
    Location
    middle of IA
    Posts
    1,885

    Default Re: Breastfeeding, Expressed Milk & Formula supplement

    i agree with PP, and re: returning to work - i suggest you check out the stickies in the associated forum, and make a separate post for that issue there, AFTER you've seen an IBCLC and started to figure out this issue! good luck mama and keep us posted.
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  4. #4
    Join Date
    Dec 2008
    Location
    Victoria, BC, Canada
    Posts
    940

    Default Re: Breastfeeding, Expressed Milk & Formula supplement

    I've got some latching links for you that may help. If the latch is shallow, some babies will kind of sleep at the breast. They may perk up and nurse more effectively if the latch is deeper.

    I agree with mommal, it would be good to be seen by an IBCLC in person.

    Other than that, I can suggest breast compressions to help make the feedings more efficient. Hope things turn around for you soon, keep us posted!

    http://www.breastfeedinginc.ca/conte...agename=doc-BC

    And a sleep-baby link:

    http://www.breastfeeding-basics.com/...-a-sleepy-baby

    Here are some of my favorite latching links. I personally had good success with the Flipple technique. It helped DS get a good deep latch.

    COMFORT ZONE (Comfort zone explained+your baby knows how to latch)
    http://www.ameda.com/resources/video

    ASYMMETRICAL LATCH (Dr Newman’s info)
    http://www.breastfeedinginc.ca/conte...agename=doc-WL

    THE “FLIPPLE” LATCH (Latching technique where you fold your breast into baby's mouth so your nipple ends up far back in her mouth)
    http://www.breastfeedingmadesimple.c...atedlatch.html
    (animation)
    http://www.rebeccaglover.com.au/grap...aching_big.jpg
    http://www.rebeccaglover.com.au/grap...chment_big.jpg

    THE BABY-LED LATCH (Baby latches himself on while mother helps. A relaxing position and often comfortable latch)
    http://www.biologicalnurturing.com/video/bn3clip.html
    Canadian mom and breastmilk fan.
    We have 2 beautiful children: Luana who's 9 y/o, had breastmilk for 2 years and is smart as a whip. Lucas who came out kickin', is 4 y/o and continues to enjoy his milkies.

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