Ineffective nursing

[@llli*newmama9876]

I'm having the same issue! My baby just turned two months old (nine weeks) and I feel like she is never going be nursing efficiently enough for me to be able to exclusively breastfeed her. I cannot pump enough to satisfy her. She was born at 8 pounds, but I had iv fluids during labor so I'm not sure if that caused swelling for her to weigh more. When we left the hospital her weight was fine and she was gaining well at her one week appointment. She did not have a two week appointment because the pediatrician didn't tell us to come back then and we ended up getting a different doctor for her one month. I saw a lactation consultant when she was one week to make sure I was breastfeeding her correctly and I was. Everything was fine. She was quite a crabby baby for the first month. I would breastfeed and let her finish the feed and would do compressions and tickle her feet, etc to keep her awake. It would take her an hour to eat, but I was trying to feed her on demand and at least every two hours. She was crying a lot and was rooting a lot and i didn't understand what was going on. She would seem completely satisfied and then be crying less than 30 minutes later. I was going crazy because my husbands job keeps him away from home for a few days at a time so it was so hard for me with a non stop crying unsatisfied baby. I did not know what to do and got the horrible advice that babies need to suck and to give her a pacifier in between the two hour feedings. At four weeks, we found out she only weighed 7.6 which was under her birthweight of 8.1. The lactation nurse watched me feed her and helped me try to keep her actively eating as much as possible. We weighed her before and after the feed and the nurse determined she had only eaten an ounce and a half, so I needed to give her an ounce of formula after each feed to try and get her weight up. So in emergency mode I did as she said and my baby was HAPPY and a totally different baby. She gained 11 ounces in one week. I saw a different lactation consultant for two more appointments following that and we determined that my baby was not being an efficient eater and my milk supply was low. So for five weeks now I've been battling with the vicious cycle of a supplemental nursing system, a hospital grade pump, formula, bottles, etc. I want so badly to exclusively breastfeed, but I cannot get away from the formula and I feel like nothing I do will increase my supply. Today, for example, I breastfed her with switch nursing for an hour and a half straight and she still came off the breast hungry. I'm trying now to pump as much as possible, but life gets in the way. My new strategy this week has been to pump first, put what I get in the sns and then add formula to it if needed so the sns bottle has two ounces. Then I feed her on one breast and try to get her drinking as much as possible, and then I'll try to give her the second breast. My thinking behind this is that I pump as much as I can out and then she can be eating the supplement plus stimulating me to make more because she will actively eat with the sns but not always with my breast alone. I'm not sure if it will work or not. I'm so unbelievably frustrated because it started out with supplementing a small amount and now more than half of her feeds are formula! I want just plain stop the formula cold turkey but I can't until she eats more efficiently and stops falling asleep at the breast and I can make enough milk for her. I'm so exhausted from this battle. I'm glad that the formula fills her tummy and makes her a happy baby, but I want my breastmilk to do that for her. I'm hoping if I can stick with this plan I can start decreasing the formula. I bought a baby scale too. She is now just over ten pounds at nine weeks so she has gained almost three pounds in a month. Also, my doctor prescribed reglan to me but I don't dare take it because of the SCARY side effects warning. I just don't know how to stop this vicious cycle.

[@llli*monika.h]

Are there any lactation consultants in your area? If you're having trouble finding one, you could contact your LLL leader. They would be able to recommend one.

I think it would be helpful for you and your baby to be seen in person. There are a number of things that might be going on. It's possible he's not suckling effectively, in which case it would be helpful for you to have hands-on help with the latch. It's also possible he just needs to be at the breast more. More stimulation=more milk production. A 3rd thing is that your breasts may have trouble producing enough milk. If you could figure out what's going on, you'd be on your way to a solution. You could ask your doctor about domperidone to increase your milk supply, however it's not a solution on it's own.

Re the pumping. The more frequently and more thoroughly you empty your breasts, the more milk you will make. Pumping is a useful tool, however, it is a lot of work and may not be necessary. IF your baby is suckling effectively, all you need to do is have him at the breast more and your milk supply will increase. A baby that is suckling well will remove more milk than the best pump. It's hard to tell over the internet how well he's sucking. There may or may not be issues with his tongue or he could be a sleepy baby. Hard to tell, he may have none of these issues. If he's suckling effectively, he's better at the breast, rather than you pumping.

[@llli*newmama9876]

Also, I've been taking herbs and I think they help a tiny bit but not enough. The fenugreek makes both of us gassy. My daughter eats greats when my breasts are engorged after sleeping for three hours, except once the flow slows she will either fall asleep or pound at my breasts with her hands and pull on my nipple and get frustrated and cry.

[@llli*newmama9876]

I've seen three different lactation consultants, and have been trying to do the perfect latch according to Jack Newman's videos. I prefer the cradle position though because the cross cradle makes my arm really tired.

[@llli*lllmeg]

This is for newmama9876 (We should probably have a separate thread for your situation but in the meantime)

My daughter eats greats when my breasts are engorged after sleeping for three hours,

You get engorged if your baby has not fed in three hours? At 2 months of age? That sounds like overproduction, not low supply. What would happen if you just nursed every three hours? That would be 8 times a day-if baby took in 3 ounces 8 times a day, that would be 24 ounces-about right...but just in case baby only transfers an average of 2.5 ounces, what if you made it every 2.5 hours? that would be 10 times a 24 hour day..

I am not really suggesting that you need to schedule feedings. As I am sure you know, feeding on cue is the typical recommendation. But if your baby needs a fast flow (which would explain baby nursing well only when you feel very full) then giving baby a fast flow, on a regular basis, could perhaps bring baby back to the breast and begin to normalize the situation?

It sounds like you have seen several IBCLC's. Don't any of them offer follow up? I suggest you go back to the one you liked best, (or find a new one) and tell them that now that babies weight gain is stable (assuming it is) you want to concentrate on fully breastfeeding and that is what you want help doing... This would possibly require fixing any latch issues that still exist, teaching/reteaching baby to nurse effectively, nursing frequently, maybe pumping as needed, and closely monitoring weigh gain as you move from supplements to the breast. Have any of the IBCLC's helped you figure out WHY your baby was/is not transferring milk well and working on that? A baby who can nurse effectively is better at extracting milk than any pump...
Kellymom.com has an article with a protocol for weaning off formula back to the breast. But once you are supplementing this much, it is recommended to be done under the supervision of a doctor and/or an IBCLC.

I've seen three different lactation consultants, and have been trying to do the perfect latch according to Jack Newman's videos. I prefer the cradle position though because the cross cradle makes my arm really tired

The perfect latch and nursing position is the one that is comfortable for mom and baby gets milk. It is going to be slightly (or dramatically) different for every mom and baby. Didn't any of the IBCLC's show you different positioning or latch techniques? have you tried laid back positioning, side lying, any other ideas?

she will either fall asleep or pound at my breasts with her hands and pull on my nipple and get frustrated and cry.

falling asleep at the breast is normal. all babies do it. Do you mean it haoppens too fast, before baby has gotten 'enough?" but how do you know baby has not gotten enough?

As far as the pounding, pulling and crying-I have oversupply, so my 2 month old is gaining fantastically, and she does this as well at a few feedings every day. Sometimes these are signs baby is unhappy with a slow flow, but it can also mean many other things.

[@llli*newmama9876]

lllmeg,

What you said makes complete sense! My daughter had her two month checkup today and the doctor said the same things. He said to start getting her on a good schedule and try feeding her three hours apart because her weight is fine and it sounds like she is breastfeeding perfectly fine. He said to relax and take myself out of panic mode. I've read the Kellymom weaning of supplements article and will definitely be doing that. The doctor said to give him an update in two weeks. Thanks for the advice! Sorry for jumping in on the post, but this sounded so close to what I've been dealing with too. I hope everything works out for sha.mum and this can help other people needing help. Thanks!!

[@llli*mommal]

He said to start getting her on a good schedule and try feeding her three hours apart because her weight is fine and it sounds like she is breastfeeding perfectly fine.

Just checking, but: you have no intention of following the doc's absolutely idiotic, totally incorrect advice, right? A "good schedule" is what derails breastfeeding for many moms. Restrict demand and you're going to restrict supply, as well.

[@llli*lllmeg]

Mommal, up thread i suggested newmama9876 feed every three hours or so since, according to her, baby only nursed well every three hours when she was very full. this was not a suggestion to restrict nursing frequency, but rather to suggest to the mom a pathway off the pump/supplement/feed treadmill. I hoped once baby began to feed more often and well at the breast that would encourage baby to feed even more often and well at the breast.

I think the doctor's advice to get baby on ' a good schedule' sounded to newmama9876 like a similar suggestion to mine. And it may have been! But you and i hear 'get baby on a schedule' as a suggestion to restrict feedings. I am not sure what the doctor meant. ‘good schedule’ is open to interpretation. my 2 month old baby is on a 'good scedule'-she nurses when she wants. i am not even aware of how often that is. i just know it is plenty.

Just to clarify my idea further, I just meant, if a baby is only interested in nursing every three hours, it may be ok to let baby nurse every three hours, which would be 8 times a day and not terribly low frequency for this age. Of course it would also be fine and maybe necessary to nurse more often, as baby and/or mom pleases, what is important is that it is frequent enough. What I hope is that once mom & baby are simply nursing more rather than the constant pump/supplement treadmill, it would encourage a more natural cue feeding rhythm.

newmama9876, remember that every nursing session need not be perfect or a certain length. baby popping off, crying, falling asleep, acting like baby wants to nurse and then really not wanting to, or wanting to nurse again a short time after nursing etc. etc. are all normal, but a mom will have a harder time learning her baby's quirks and getting comfortable with them when she is stressing over pumping and the rest rather than just nursing.

[@llli*mommal]

Thanks for the clarification, Meg! It's true: when I hear "schedule" I usually think "restrict demand" and "space out the feedings". If it means "follow baby's natural routine and relax", then it's a completely different matter!

ducks head in shame for failing to read thread thoroughly enough

[@llli*lllmeg]

mommal no shame! i was glad you said what you did because i also wanted to clarify that a restrictive scedule is counterproductive.