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Thread: lost here, need guidance/reassure desperately

  1. #1
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    Default lost here, need guidance/reassure desperately

    dear all,
    reading these fora have saved me many a time from going absolutely crazy, so please accept my thanks for the work you are doing.
    i am a FTM, 35 years old, an academic who works way too much (80 hour weeks), is rather underpaid, and we have a little girl who is 4.5 months old.
    I have breastfed DD for this whole time, despite considering giving up due to thrush, mastitis, bad treatments for both, and then a range of emotional issues (anxiety, OCD-type stuff, panic). I go back to work in one week's time.

    The story: DD used to feed for 20 minutes each side for the first over two months, but something changed after Week 12/13, we both got sick with the virus and then sinus infection (no medication), she would cry a lot at night, was in teething discomfort, and would never really fall asleep. She also just nursed about 10 minutes, 20 minutes on a rare occasion, and sometimes does the sleep-nurse thing for 40-45 minute cycles, whether in the middle of the day or at night. We went on a 90-minute awake time, then sleep, cycle, so now she sleeps for 45 minutes at at time, about 3-4 times a day, and nurses every time after waking up. Then bedtime is 6 pm, but while she used to fall asleep nursing, she doesn't quite do that and starts getting frfrenetic and now needs to be rocked, and then wakes up every hour or so, until 10-12 pm, and then might, if lucky, stay asleep for two 3 hour stretches, with one more feeding between 3 and 4. These are all rough estimates, since she is not very regular about that. I just dread bedtime, because I never know what lies ahead, and her short naps in the evening somehow seem more frustrating and depressing, for I worry she will never sleep. I am continually tethered to her, feel too anxious to leave, and cannot quite relax when I am away from our room (we co-sleep), for I think she will never fall asleep again, or would be up for an hour and two and fuss, if I missed the opportunity to nurse her back to sleep immediately.
    She also does this weird thing that she pulls away after 5-6 minutes on each side, and sometimes approaches the breast and doesn't nurse. I worried about OALD, for her mouth is always full for the first few minutes, but I have recently gotten some advice from a lactation consultant that really worries me.
    Granted she has been sick and teething (no teeth yet), but is this "normal." She is gaining weight (75th percentile) and height (off the charts), and is happy and very amiable. Also, she was born with one kidney, and has some indications of potential hypertension, so I am over-concerned about dehydration (especially at night) and crying too much.
    So, my questions are:
    (1) I thought my supply was "fine" (after worrying about it too much), and convinced myself that DD was just getting more efficient, and that cluster feeding at night was okay, and that at 4-5 months, babies till need 7-8 feedings. However, the NP at the pediatrician's office suggested solids that would make her sleep more (I find that silly, reading all the things here). But, speaking to the lactation consultant who didn't quite ask good questions and sent me spinningly worried about whether "I had enough" makes me very very anxious, especially with a few days left to me leaving for work. She suggested that since DD was eating very frequently, there was a chance I didn't make enough milk, and that my supply would was bound to be affected adversely once I go back. I thought all this while that just feeding DD more often would actually serve to build supply rather than not, but this suggests a different story. Can anyone weigh in on this? I suggested to LC about OALD, but she ignored it.
    (2) The other thing has to do with pumping and going back to work. I will be away from DD for three days for 5-6 hours, and for one day for 8 hours. What would you recommend I do, since I will have one 10-15 minute break on the shorter days, and probably 2 of those on the longer day. I pumped a while back more than a couple of months ago for many days, but couldn't keep it up, what with feeding DD every hour and a half or so, and then worrying like hell about her lack of sleeping pattern. How am I supposed to plan for this--I cannot even fully fathom all that will change and all this will take, and my work, even though I am a professor, is quite unrelenting.
    (3) Is there something harmful in a 4.5 month old having no fixed sleep pattern, and this strange "pattern" at night that I have mentioned above? Could this be because of hunger on her part? Or needing pacification. I don't mind filling either need any number of times at night, but could I not be doing it well enough which in turn isn't helping her sleep well?

    Thank you for any help you can give me. I am all alone, and just don't have any support system besides my DH who is amazing and tries to fix things that he just cannot fix. With my anxiety issues, and not taking any medication, that can be a lot. I hate going back to work so soon.

    best always.
    pandora

    DD weighs 16 pounds, is 27.5 inches long. 4.5 months, (birth weight 6 lb 14 ounces; length 20.5 inches)
    Last edited by @llli*pandora; January 12th, 2013 at 02:31 PM.

  2. #2
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    Default Re: lost here, need guidance/reassure desperately

    also the LC has no emotional presence, so speaking with her is hard on me. thus I am posting on this forum.

  3. #3
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    Default Re: lost here, need guidance/reassure desperately

    Welcome to the forum and congratulations on making it through the first few months of nursing, and some unusually difficult circumstances!

    It sounds like you were okay with your LO's habits until the LC put a bug in your ear regarding your milk supply. I wish she hadn't done that! Waking 7-8 times a night is pretty extreme, but it's also normal. Babies wake frequently at night and need to nurse at night for several reasons. The first, and most obvious, is hunger. The second is that babies have shorter sleep cycles than adults, they transition more easily into light sleep, and they are often woken by teething and developmental milestones like rolling or learning to sit up- babies will do those things in their sleep. Once they rouse, they usually need help in order to go back to sleep, and for a nursing baby, help = nursing. Nothing soothes like the breast.

    All the night feeding you're doing is terrific for supply, and your nighttime generosity will be helpful once you're back at work. The night feedings should help your daytime pump output, and if you have trouble pumping- and some moms do, regardless of their supply- your baby's nighttime feedings may mean she needs less milk in her bottles during the day.

    Regarding pumping, it sounds like you have sufficient break time to pump every 2-3 hours, and once you're pumping instead of nursing you should have better results than when you were pumping in addition to nursing. Some questions for you:
    - what sort of pump do you have?
    - how does pumping feel?
    - do you have a freezer stash at this point? And if so, how much is in it?
    - does your baby take a bottle, or has she taken one recently?

    4-5 month old babies are notorious for having erratic sleep patterns, in particular because teething is usually going strong by that point. You want to be aiming to get your LO into bed and into her first stretch of nighttime sleep at a more or less consistent time, and you also want to make sure her morning wake-up time and nap times are both routine and responsive (sometimes a baby won't need sleep at her "usual" time). Beyond that, there's nothing much you can or should be doing- just roll with it and try to remember than no matter how frustrating things are right now, your LO is going to change everything o ER and over again in the next months.
    Last edited by @llli*mommal; January 12th, 2013 at 02:59 PM.
    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!"

  4. #4
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    Default Re: lost here, need guidance/reassure desperately

    Hi mama, welcome to the forum! Sorry you haven't gotten good support. Sounds like your lactation consultant has given you some questionable advice as well. Is she an IBCLC?
    From what you say about your daughter's weight gain and her being happy and amiable, it sounds like your supply has been fine. Is she making 5-6 wet diapers per day? Babies do become more efficient as they get older, and it's common for nursing sessions to shorten as baby gets older and more experienced with nursing. Babies continue to need minimum 8 sessions per day (in most cases) through the first year, with many babies having 10-12 sessions per day. Because they need 24-32 ounces and a typical "serving size" per session is 3 ounces or so. DD eating frequently is completely normal breastfeeding behavior and does not suggest that your milk supply is too low! And you're right, the more you feed DD, the more it stimulates your supply. Let her lead the way. Supply = demand, feed on demand and your supply will match. It's also common for babies to have some nursing sessions that are spaced out, and others that are closer together (cluster feeding).

    On to question 2. Yes, I'm concerned that one 10 - 15 minute pumping session in a 6 hour workday is not going to be enough. You want to mimic what you do when you're together with baby, so in 6 hours you would be feeding more than just once, right? And 10-15 minutes is short for a pumping session. It depends a bit on what your storage capacity is like, but as a starting point the usual recommendation is at least every 3 hours for 15-20 minutes, and some mothers need more than that. So usually 2 sessions in the 5-6 hour day and 3 in the 8 hour day. So... is there any wiggle room in your schedule? If there is absolutely no way, then another consideration is to pump to and from work in the car. And like mommal says, nighttime nursing is great for working moms.

    Question 3. Your baby sounds completely normal in her sleep pattern. And giving her solids will not change her sleep pattern. There's really no need to start solids before six months, and even between six months and a year, it's for baby to learn about the taste and texture of food, and develop the motor skills to feed herself. Breastmilk remains her primary form of nutrition. Then starting at a year, solids GRADUALLY become the primary form of nutrition.

  5. #5
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    Default Re: lost here, need guidance/reassure desperately

    thank you, mommal and bfwmomof3, really appreciate your taking the time to respond. it means a lot at this crazy time.
    so, to answer your questions:
    1) i have the ameda purely yours (i think that's what it's called)
    2) i hate pumping but i hate many things that must be done!
    3) i have some frozen milk for a few feedings, say, if i were to be gone a day. but that's about it.
    4) yes, baby takes a bottle, and has had some breast milk and formula mix once in a while when her grandmother or someone else keeps her or when we have freaked out about her hunger in the past (including 2 nights ago). she doesn't love the bottle, but it works in a pinch, we still use the newborn nipple as i didn't want her to prefer that over this. but, yes, she doesn't reject it completely.

    so, here are a couple of additional questions:
    1) so, does it matter that my pumping session be aligned with her feedings with the caregiver, or am i just trying to get a certain frequency/length of stimulation over a period of time? does spacing them equally and consistently matter?
    2) my work schedule is (i) tight and (ii) uneven. for instance, M, lv home 9:00, come back 2:30 (15 minute break at 12:15); T, lv home 12:30, come back 5:30, (possible few minutes at 1:30), W: lv home 9:30, come back 5:30 (15 min break at 12:15, 15 min at 3 pm); R: lv home 2:00, come back 5:30 (might find 15 minutes therein somewhere).
    3) also, can one re-use the pump a second time without washing everything? I am OCD about hygiene, and my worry is that I will spend too much time washing it all and then have no time left to pump a second time at work. how do people do this?!!
    what would you recommend?

    warmest thanks,
    pandora

  6. #6
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    Default Re: lost here, need guidance/reassure desperately

    You should have enough freezer stash to get your through the 1st day and a little bit of back up. The idea is that you pump enough while gone to feed her the next day that you work. So I would spend a little time this week pumping to up your stash. The rule of thumb is 1-1.5 oz a milk for every hour that you are away from her. So on the days you are gone for 6hours she needs 6-9oz of milk. And on the 8 hour day she needs 8-12oz of milk. So you NEED to find your 15 minute breaks. Because if you don't pump your supply WILL be affected and you wan't have the milk for the next day. Don't treat pumping casually or like something you might not be able to fit in. Wrap your mind around the idea that it's NEEDED and set up clear boundaries with your supervisors and make it happen. And you actually don't need to wash the pump at all inbetween pummping sessions just throw the horns and tubing in a ziplock back in the fridge and you are fine. Even Not doing that seem like time wise you are fine. Breastmilk stays good out at room temp for up to 8 hours. And it stays good in the fridge for up to 7days. The largest waste of time is washing everything between sessions. If you want to take it home and wash it every night fine. But if it's in the fridge it really doesn't even need to be that often.
    I would say based on your child's growth you have ZERO supply issues to worry about up until this point. I also would like you wrap your mind around the fact that 2 3hour long stretches at night at this age is AMAZING and you should not waste your time worrying about sleep. Because it could be way worse than that and it'd still be normal. Anyone who is getting 6hours with only 2 wake up calls is LUCKY. And worrying about it isn't going to change anything. The one thing you can count on in terms of sleep the 1st year, is that it's all going to change every 4-6 weeks. Because it's interrupted by teething, development, and by the amount of sleep they get during the day. You can't control it or change it.
    So work on your your stash this week. And communicate with staff how important and NEEDED pumping is at this point. And do it. Because the only thing your LC said that was right is that your supply WILL be damamged if you don't. It's all supply and demand. Your supply at 4.5 is way to too volitale to not be attended to. If you go 5 or 6 hours without pumping (which your baby at this age would NEVER do) your body will simply assume that your baby needs less milk. Which isn't true. Don't allow that. Mimic your sessions as normally as possible by utilizing your 15minute breaks. Which By law you can insist upon.

    Way too lazy for formula

  7. #7
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    Default Re: lost here, need guidance/reassure desperately

    Quote Originally Posted by @llli*pandora View Post

    so, here are a couple of additional questions:
    1) so, does it matter that my pumping session be aligned with her feedings with the caregiver, or am i just trying to get a certain frequency/length of stimulation over a period of time? does spacing them equally and consistently matter?
    2) my work schedule is (i) tight and (ii) uneven. for instance, M, lv home 9:00, come back 2:30 (15 minute break at 12:15); T, lv home 12:30, come back 5:30, (possible few minutes at 1:30), W: lv home 9:30, come back 5:30 (15 min break at 12:15, 15 min at 3 pm); R: lv home 2:00, come back 5:30 (might find 15 minutes therein somewhere).
    3) also, can one re-use the pump a second time without washing everything? I am OCD about hygiene, and my worry is that I will spend too much time washing it all and then have no time left to pump a second time at work. how do people do this?!!
    what would you recommend?

    warmest thanks,
    pandora
    The most important thing, as djs.mom says, is to make sure your breasts are getting that signal to make milk. It does help to be on a consistent schedule but less important than making sure you are pumping an adequate number of times during the day and for long enough. I haven't used the Purely Yours but from what I know about it, it is a less efficient pump than some of the others available. If you can't figure out a way to get more time to pump (or even if you do), you may want to consider a more efficient pump. Such as renting a Medela Symphony (hospital-grade) or a top-of-the-line personal use pump, such as the Medela Pump in Style Advanced.

    Agree with djs.mom about not having to clean your pump parts between sessions. Spend your time pumping, not cleaning.

  8. #8
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    Default Re: lost here, need guidance/reassure desperately

    1) i have the ameda purely yours (i think that's what it's called)
    You might want to look into a better pump. You hate pumping and you have a tight schedule. The APY is a good pump but the models which are a step up (Medela Pump in Style, Hygeia Enjoye) might enable you to get more milk in less time.

    2) i hate pumping but i hate many things that must be done!
    3) i have some frozen milk for a few feedings, say, if i were to be gone a day. but that's about it.
    I know, pumping is horrible! But DJs.mom gave good advice- you want your stash to be at least a day or two ahead of your baby's needs before you go back to work.

    4) yes, baby takes a bottle, and has had some breast milk and formula mix once in a while when her grandmother or someone else keeps her or when we have freaked out about her hunger in the past (including 2 nights ago). she doesn't love the bottle, but it works in a pinch, we still use the newborn nipple as i didn't want her to prefer that over this. but, yes, she doesn't reject it completely.
    Okay, this is good. I wasn't sure if you'd tried a bottle yet, and you want a baby to be comfortable taking one before you go back to work.

    1) so, does it matter that my pumping session be aligned with her feedings with the caregiver, or am i just trying to get a certain frequency/length of stimulation over a period of time? does spacing them equally and consistently matter?
    It might be ideal if you can get your pump times more or less in line with baby's bottles. That way you won't be pumping out a lot of milk right before baby needs to nurse, and hopefully baby won't be getting a big bottle right before you come to nurse her. But don't expect things to always work out perfectly. There will be times when someone will screw up and give a bottle right before you come to nurse, and times when you pump right before nursing the baby. It's all going to even out.

    What really matters, when it comes to maintaining supply, is not to always aim for consistency but to give yourself the stimulation necessary to produce the milk you need. Sometimes you're going to be okay with fewer sessions, other times you're going to have to add sessions in order to make tomorrow's bottles. If adding sessions isn't possible during the workday, you may need to add them after feedings when you're at home.

    2) my work schedule is (i) tight and (ii) uneven. for instance, M, lv home 9:00, come back 2:30 (15 minute break at 12:15); T, lv home 12:30, come back 5:30, (possible few minutes at 1:30), W: lv home 9:30, come back 5:30 (15 min break at 12:15, 15 min at 3 pm); R: lv home 2:00, come back 5:30 (might find 15 minutes therein somewhere).
    This erratic schedule shouldn't be a problem. I would just make sure your pump is set up in your office or wherever you need to pump, so that you can jump right into pumping the moment your break begins.

    3) also, can one re-use the pump a second time without washing everything? I am OCD about hygiene, and my worry is that I will spend too much time washing it all and then have no time left to pump a second time at work. how do people do this?!!
    what would you recommend?
    According to my LC, the answer is a definite yes. She told me to save myself time by simply leaving the pump screwed onto the bottle and pumping new milk on top of old, and said it was perfectly safe to do so provided I washed- not sterilized!- the pump parts afterwards. Since your pump time is so limited, I suggest not washing the pump parts in between sessions. Just store them in a big ziploc bag in the fridge.
    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!"

  9. #9
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    Default Re: lost here, need guidance/reassure desperately

    thank you for the reassurance and advice.
    1) I have called my insurance and it seems like with a prescription, I could get a better pump.
    2) The new alarming issue is that I pumped yesterday in the morning and got 3 oz, but by mistake I did it too close to LO waking up, and then when she awoke, she was really frustrated. I waited a while, tried nursing her again, but feel like since then, nothing was quite working, she seemed hungry and frustrated all day. And, also, after one of her feeds, I went to the pump again, and got NOTHING. Same this morning, after the second morning feed. NOTHING. Is this an awful curse--that the LC said the words, and that now "low supply" is all that I see? I have been having fennel tea multiple times a day, and started on alfalfa tonic two days ago. And ordered fenugreek? I used to get multiple letdowns, but no more...and LO seems to not want to stay on for long. I try both sides. I am sure my stress isn't helping. I cannot bear the feeling that she might be hungry...her weight has gained only minimally since last Tuesday, but it was also when she got her 4 month vaccines, so probably she is affected by that plus all the virus and cold she has had for 4 weeks. I weighed her this morning before and after feeding her, and it showed only 2 oz difference (of course, not perfect),and that after 15-20 minutes of nursing, which is longer than she would usually give of late!! Can I still recover from this? I also worry I let her have her way when she wanted to nurse for short durations, and that perhaps I should have continued to be a pest and kept her on all the times I finally would give in to her, thinkign she was done, when she was probably being lazy. What if that has damaged my supply, and now that she wants more, she can't have it?
    I am besides myself feeling resentful that I have to be back at work when she is so little. Is there a sense in doing some drastic changes to the work situation if we are fated to move to formula? Or do you see a recovery from this state possible? I cannot bear the thought of not being able to nurse her anymore..., and would always hate work for hurting us this way...
    What is the threshold for supplementing with formula? Should I do that for the times I need to pump the next few days? Small amounts? Any ideas/cautions?
    many thanks. you are my heroines!

  10. #10
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    Default Re: lost here, need guidance/reassure desperately

    Milk production is not going to vanish overnight. The problem with pumping could be 1)the pump- parts wear out, etc, and the motor keeps going but is not working well
    2)stress inhibiting letdown
    3)it was just a crummy day for you and the pump. It happens
    4)? I am sure there are other possibilities.

    The easiest and simplest and usually most effective way to deal with low production (assuming that really is an issue, I am not convinced) is to nurse baby more often. Not longer, more often. IF the problem is low production at this late stage, and production was fine before, and you are not on bc or some other medication or diet change that harms production, then what caused the low production was almost certainly less nursing, and what will fix it is probably more nursing. What would happen if you had a few days to just relax and cuddle and nurse your baby? It's called taking a nursing vacation. Or maybe a bad case of the (nursing) flu...

    I weighed her this morning before and after feeding her, and it showed only 2 oz difference
    That sounds like normal intake. What are you expecting?

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