Insufficient latch/suck? Or low supply?

[@llli*abowles]

My son was born 10-11-12 via C-section and we nursed exclusively in the hospital. By the 13th he had only 1 wet diaper all day. They sent us home and said that happens. On the 14th, he again had only 1 wet diaper and by that evening I was concerned and bottle fed EBM. Since then Ive been pumping and doing formula but his diapers have increased.
Today after a 35 min nursing session he was still hungry and devoured 1.5oz of EMB and another 1oz of forumla. I generally get 1-1.5 oz per breast when pumping after a 5 hour break.
Is he a lazy nurser or am I not producing enough?

[@llli*mommal]

Welcome to the forum and congratulations on the new baby!

Based on the information provided, it's hard to say what the problem is. Some questions for you:
- How often does baby nurse? Is he nursing at least 10-12 times per day?
- How does nursing feel?
- Is baby sleepy or jaundiced at all?
- How often are you pumping? (You mentioned getting 1.5 oz after a 5 hour break- are you generally going 5 hours in between pump sessions?)
- What sort of pump are you using?

[@llli*lllmeg]

Mommal has good ?'s. I also wonder, How many poops (if any) per day? You are talking a days old baby here. Output is going to normally be not much. How much do you think baby should have been peeing?

Weight gain? What have weight checks told you?

Since then Ive been pumping and doing formula but his diapers have increased.

If you feel you have to supplement, then do so-but that does not mean you have to stop nursing and only pump and give bottles, if that is what you are doing-it is generally best to keep baby nursing even if supplements are (presumably temporarily) needed.

after a 5 hour break

Do you mean a five hour break with neither pumping OR nursing? That is too long for these first weeks. Baby needs to be nursing a mimimum of 10 -12 times a day, with no more than maybe a three hour breaks here and there, especially if you are concerened baby is not getting enough. I know it sounds like a lot especially as you are recovering from surgery, but since it sounds like nursing was going well, by which I trust it does not hurt and baby is/was nursing without much trouble, trust me nursing very frequently is going to be way easier than pumping, supplementing etc.

[@llli*abowles]

He started out at 8lb-11oz and 3 days later at discharge was 8-0. Two days later at first checkup he was still 8-0. I've been trying to pump/nurse or nurse/pump for most sessions, but he gets very frustrated with each session and we both end up upset. When he does nurse it's for 30 mins at first breast then15 at second. Inevitably he falls asleep within 5min on each side and I spend the remaining time trying to wake him or keep him awake.

Nursing continues to be painful, although with all the pumping the initial dry/cracked/bleeding nipples have healed. I am using a Medela Symphony that I rented from the hospital.

[@llli*lllmeg]

He started out at 8lb-11oz and 3 days later at discharge was 8-0. Two days later at first checkup he was still 8-0.

This sounds pretty normal. The initial weight loss appears to be 11 oz, or about 8% of baby's birth weight. For a normal/good birth weight baby like yours, up to 7% initial weight loss is expected and fine and even up to 10% is usually OK. Add in the fact this was a c-sectionm, you are usually talking about a very inflated birth weight due to excess water from your IVs, which in turn makes the early days weight loss appear alarming when it is actually normal. At around day 3 or so, if baby is nursing enough, weight loss levels off and baby begins (often slowly) to gain. Given that you don't really know what baby's lowest weight was, (that may have happend after the day three weight check) only what we assume it was, and given that presumably different scales were used between birth and later weight checks, which can make a difference, these numbers, while limited in what they tell us, are certainly not alarming. Again, what has the poop output been? has baby pooped at all since birth? How often? Have they changed in consistency and color? That might tell you more...

I've been trying to pump/nurse or nurse/pump for most sessions, but he gets very frustrated with each session and we both end up upset.

Do you mean you are trying to pump just prior to nursing, just after nursing, or during nursing? That is a lot to juggle especailly while you are learning to breastfeed. No wonder you both are upset. Did someone tell you you have to be pumping every nursing session? Normally mothers do not need to pump at all to "bring milk in," baby does that fine if they are encouraged to nurse enough. So you may need not be pumping at all as long as you can stop supplementing. What if you just nursed?

When he does nurse it's for 30 mins at first breast then15 at second. Inevitably he falls asleep within 5min on each side and I spend the remaining time trying to wake him or keep him awake.

I am not sure what you mean-is baby nursing 30 minutes or 5? Or only 30 if you try to keep him awake? I am confused...

In any case, 45 minutes or longer is entirely normal nursing session length at this age. So would some shorter sessions be normal. It is typically all over the map at this age. As long as baby is nursing pretty well and FREQUENTLY it is usually OK. Also babies are often sleepy at this age. (Less than 2 weeks.) Again, especaill when mom has had lots of birth interventions or is on pain meds. It is fairly common in these cases to have to waking baby to feed and to encourage them to nurse. Have you tried breast compressions?

You are using a good pump. That is great! But if you don't need to be pumping, or don't need to be pumping so much, pumping is just making lots of extra work for you.

It sounds like your nipples are healing, which would indicate that either latch is improving or you are now pumping so much instead of nursing they are healing due to that. If latch is still painful and not improving enough that you can exclusively nurse, it may be time to get really proactive about fixing the latch so you can stop all this extra work and simply nurse. What have you tried, positioning and latch wise? Does your hcp provide outpatient services with a IBCLC (board certified lactation consultant) or is there any other way you can see someone who will help you work on the latch issues?

Meanwhile, these are tips that are generally helpful for painful latch:
1) Nurse very frequently, at the earliest cues. Or don't even wait for a cue. IN general a calm baby will latch and nurse better than an upset and frantic baby.
2)experiment with different positions. Experiment with changing not only baby's positon but yours. Try sidelying, or nursing while standing. Try laid back positioning which simply means mom is tilted back rather than ramrod straight or hunched over baby. Mom be slightly reclined or very reclined as you choose, baby can be in any position you like.
3) Breast sandwich technique for encouraging a deep latch.
4) use a nipple cream such as lanolin or simply expressed breastmilk constantly to speed healing.
5)If you are pumping, make sure PUMPING is not hurting or causing further injury. It happens.

Please let us know if you want more info about any of these suggestions, there are lots of good articles.