Need Help Please! I'm about to throw in the towel...

[@llli*rhettsmom]

All advice it welcome and appreciated! My son is 6 weeks old. I have tried to breastfeed since the start, but he was not getting enough so we began to supplement in the hospital (because he lost too much weight) and then again after a week and a half. I was seeing a lactation consultation because he was crying constantly and would nurse for 45 minutes (or more) on each side. So she suggested that I feed him for 20 minutes on each side and then give him an oz of formula. She also suggested that I pump for 20 minutes after that, but it was too painful, so I rarely did it. This worked for awhile, but he began crying and acting hungry more and more. The one oz turned into 2. I didn't want to give him so much formula, so I started nursing him on demand, which was constant. For the past 3 days he has nursed the majority of the day, literally. He is never satisfied. The first day when well and I only supplemented 4 oz. I assumed it would only get better, but it got worst. Yesterday, I had to give him 8 oz by the end of the day.. and that's after nurse for hours.

Sorry this is so long! Today I am at a crossroads. I think that I may start pumping exclusively to see if I can up my supply. When I pumped after feeding him I would get drops. Even if I pump without him eating, I still only get 1 oz most of the time. Oh yea.. I also think he has a bad latch because there is always a crease across my nipple, but I can't seem to get it to change. From my point of view, it looks like a good latch (whole nipple, lips out) I have tried fenugreek (it made him constipated) and am now drinking mothers milk.. it's kind of helping.

Any advice?? Is is possible I physically just can't make enough milk? Thank you for all advice. I feel like such a bad mom because he is always hungry.

[@llli*carm3]

You're not a bad mom. It sounds to me like you're the mom of a normal breastfeeding baby, and the victim of some crappy advice. Limiting time at the breast is NOT helpful. Most newborns who are breastfed seem to nurse constantly, because they have such tiny tummies and breastmilk digests so quickly. And you're probably in the middle of the 6-week growth spurt at the moment. The way to help your milk supply is to nurse, nurse, nurse, and wean off the formula if you can. Every time you give it, your supply takes a hit.

As for the pumping, it's not really a good indication of how much baby gets...he is much more efficient at removing milk. Most moms get the most milk when they pump in the morning.

That said, how is your LO's weight gain? If you could post a weight history, that would be helpful. What is his diaper output like? In terms of the bad latch, are you having pain? Lastly, is there a different LC that you could see, or maybe call a local LLL leader?

[@llli*mommal]

Welcome to the forum!

The PP asked some good questions- if you can post a complete weight history that may be really helpful. Birthweight, lowest weight, weight at each checkup.

What really matters when it comes to a baby's latch is not how it looks, but rather how it feels. It's very common to have a latch that looks great on the outside but feels bad on the inside, or vice versa. And when it comes to the effectiveness of a baby's latch, a latch that feels good almost always is good. So tell us some more about how latching feels. A creased or lipstick-shaped nipple often indicates that the latch is too shallow, but if there's no pain the problem is usually not so bad.

Whatever you do next, please don't exclusively pump in order to increase supply. A baby is almost always better than a pump at getting milk out. And you mentioned that pumping hurt so much that you rarely did it- that is a good indication that exclusive pumping isn't right for you! What sort of pump are you using and how often are you using it right now?

[@llli*rhettsmom]

Lets see.. He was 7lbs8oz at birth, 6lbs 10oz at discharge. At his one month, he was 8lbs 9 oz. I don't remember every time he was weighed, but he has gained an oz a day. Give or take, but he has received about 8 oz of formula a week and a half old. I don't think I realized what breast feeding really was because they say to feed every 2-3 hours, so i tried to do that, but my son never slept and cried constantly.

It doesn't really hurt when he is eating, but kills all other times and gets so sore it starts to hurt when nursing. Which is why I didn't pump. Originally, the LC said to feed and then pump to increase supply. I couldn't do it because my nipples were sore from feeding. When I take him off, my nipple is creased like he is flattening it in his mouth. I didn't realize this until 2 days ago.

He has never been satisfied after breastfeeding, not even after hours. He has also never taken himself off.

I have a mendela and havent used it is about a week bc I'm saving my nipples for him. is so frustrating and I have to start back to work in a month, so I just wonder if its all worth it. It doesn't look like ill be able to pump enough either.

[@llli*mommal]

I don't think I realized what breast feeding really was because they say to feed every 2-3 hours, so i tried to do that, but my son never slept and cried constantly.

Ugh, I hate it when "they" give this advice! Some babies will feed every 2-3 hours, but a lot of babies will feed far more frequently than that, especially in the newborn days. Most newborns feed at least 10-12 times a day, which means they're often nursing every 2 hours at a minimum. Not nursing enough during the early days may be the explanation for your baby never acting satisfied. But the pain you've been in and the slow feedings suggest that there's also a possibility of something off with the baby's latch. Did the LC check the baby for a tongue tie?

It doesn't really hurt when he is eating, but kills all other times and gets so sore it starts to hurt when nursing.

Creased nipples suggest a shallow latch. Pain in between feedings suggests something like vasospasm or thrush. Can you describe the between-feedings pain a little more? Is it burning? Itching? Do you ever see your nipples blanch (turn white) or blanch and then turn bluish purple before returning to a normal color?

I have a mendela and havent used it is about a week bc I'm saving my nipples for him. is so frustrating and I have to start back to work in a month, so I just wonder if its all worth it. It doesn't look like ill be able to pump enough either.

It's all worth it, I promise! No matter how frustrating this time is, you're never going to look back and wonder "What might have happened if I had given it everything I had?" You'll never regret that you tried your hardest, I promise. And there's still every reason to think that you'll be able to completely turn things around and go on to have the nursing relationship of your dreams, plus good success with the pump!

I'm still concerned that pumping hurt you. It shouldn't, unless your nipples are really cracked or something. The fact that it was painful suggests that there could be a size issue with the shields, or that you turned the suction up too high. When you pumped, did you ever observe your nipples rubbing against the sides of the collection tube?

[@llli*lllmeg]

There is no way to tell if you will be able to pump enough once you are back at work. pumping due to a separation due to work once milk production is well established is just a completely different thing than pumping while also nursing and supplementing when with baby.

But lets just say you are one of those moms who never produces well for the pump, so you don’t pump enough, so baby needs some formula when you are at work. Or what if it turns out you truly have low production, and it cannot be reversed. (I don't think this is the case, but just, what if?)

The benefits of breastfeeding do not just evaporate because the baby also needs supplementation. Yes, of course it is 'best' if baby is ebf. But if that is not possible, it's not possible. But what WOULD still be possible is for your baby to get some of your milk and, hopefully as well, some time at the breast -both or either of which have great benefits for you and baby. It does not have to be all or nothing.

I think the real stickler here is that nipple pain. How can you possibly enjoy nursing if you are in pain? If you can fix that pain, nursing can become pleasurable and normal nursing frequency won't bother you. Please consider seeing another board certified lactation consultant. Call around and find one experienced with helping mothers with latch pain. If money is the issue, check with your insurance agency to see what they cover, or call you local lll, public health office, breastfeeding coalition etc. to see if there are any low cost options in your area.

What kind of a medela? new, used, rented? pump n style, hospital grade (lactina)? Are the flanges the right size?

Mommal is right, pumping should not hurt and there is usually a cause, a problem with the pump or your settings. However, I had pain with pumping when my nipple was very very bruised from a poor latch. Pumping hurt even worse than nursing, so I nursed, while getting help and fixing that latch

[@llli*rhettsmom]

My nipples are sometimes white at the tip, but don't think they turn blue after. I'll keep an eye on it. I haven't paid close enough attention to know how often. The pain is mainly burning or a raw feeling. The pain with the pumping goes away if I turn it lower and it doesn't hurt during the pumping session, just a little at first. It seems like he majority of the pain comes from my areola... I think. It's kind of hard to pinpoint. It's only really bad when I feed him constantly and for long periods. Today, I feed him for 20 mins on each side and supplemented with the bottle and the pain has pretty much gone away.

How would I know if he was tongued tied?

The pump is a mendela in style. I think they are the right size. My nipple doesn't touch the sides until the suction starts, but the part that moves doesn't touch the sides. I'm borrowing it from my sister in law. She used it for 6 weeks.

So what should I do now? Other than trying to find a new LC? When I nurse on demand do i wait until he comes off on his own? Is it ok to let his feed for hours or should I force "breaks"? How long does it take to get supply up? I just feel so lost!

[@llli*rhettsmom]

Af ter watching my nipples closely, I've realized the turn white, go back to normal and then turn white again, but just on the tip. It also looks like there are sores on the tip.

[@llli*lllmeg]

The blanched nipple indicates vasospasm. You could try applying warmth right after nursing to see if that helps any. If my understanding is correct, vasospasm is caused by compression of the nipple, but some moms are more prone to this particular issue than others. Vasospasm can occur along with a poor latch, tt, or thrush, and will likely get better or at least somewhat better if the other issue is fixed.

Pumping-I am glad it does not hurt if you turn the pump down. There is no reason to pump at the highest setting. Start low and dial it up to the highest setting that is still comfortable for you.

That said, unfortunately the pump you are using, while certainly a good, reliable personal use pump, is not the best pump for what you are trying to do. This 'grade' of pump is for mothers who have established a normal milk production and are pumping 2-4 times a day due to being back to work. Mothers who are attempting to increase or establish milk production and are consequently pumping more than that, are typically advised to use a rented "hospital grade' pump. It really does make a difference in the majority of cases.

Different people can diagnose and treat tongue tie. Some pediatricians do, some pediatric dentists do, or an ENT. The problem is that so many do not yet recognize the different forms of tt that can affect breastfeeding and thus, need to be treated. Some even diagnose tt but suggest that baby not be treated until they are a year old, which is of course no help at all in terms of breastfeeding.

I suggest talk to a (if possible) recommended IBCLC that you feel comfortable witht first, (call as many as you can and choose the one you like best) have her assess baby and see if she suspects tt. OR ask if they have any doctors/dentists etc. they suggest may be able to help you with that. You could also again, check with Your local LLL or other breastfeeding support group, WIC or other public health service that has a focus on breastfeeding, etc.

If a baby is latching correctly it typically will not hurt no matter how often or how long baby nurses. Yes it can get a little wearing if it's a particularly long session, and of course if, for example, an infant has fallen asleep nursing and mom needs to get up and do something or is just feeling done, it is fine to take baby off. But nursing should not ever be PAINFUL. Pain in the nipples is almost always due to a shallow latch and/or, more rarely, a fungal or bacterial infection on the nipple or areola. Pain when nursing is not due to a baby nursing too often or too long. Since the pain occurs later in the session, I wonder if baby is slipping down or ‘off’ the nipple or starting to clamp or something, which would give you clues as to what the problem is.

So typical breastfeeding would be, yes, let baby nurse as long and as often as he likes. This is normal newborn behavior and is perfectly normal and fine, although if a baby is doing this and not gaining appropriately, then that means something is wrong.

BUT, since right now you are still in pain, nursing as often and as long as baby likes may not work for you. In that case, I would suggest that more frequent nursing or pumping sessions are more important for increasing milk production than super long sessions. So if you have to choose, choose frequency.

[@llli*lllmeg]

Some tongue tie info resources

http://www.brianpalmerdds.com/

http://kiddsteeth.com/

Vasospasm http://kellymom.com/bf/concerns/moth...ple-blanching/

Find an IBCLC http://www.ilca.org/i4a/pages/index.cfm?pageid=3432