First-time mom and latching/feeding issues

[@llli*rockthebard]

I had a natural child birth and tried to breast feed within the first hour of my daughter's birth. We had trouble because she kept wanting to put her tongue on the roof of her mouth, she would get frustrated, and after 10 minutes of crying, would fall asleep. The nurses all tried to help me in the hospital including having me pump, and the lactation consultant was on vacation during the week I had her--just saw her this past weekend. My daughter was born on January 19th.

When she would latch it wasn't for very long periods, then she would fall asleep, become very lethargic, and have trouble waking up to be fed again. She would also become frantic and cry a lot even if we started trying to latch before she became fussy (and tried different positions--even made myself hunched over just so she was comfortable to latch!). We had to find a formula she could keep down which has been Enfamil Gentlease. I always try to feed her at the breast first. Then if she refuses, or doesn't get enough, I give her an ounce or two in the bottle. If she is still hungry, I proceed with formula. I even try to calm her when she is more awake and try to get her back on the breast. She will latch maybe once or twice a day really well, but not longer than 10-15 minutes--which is a great improvement from where we were, but not enough for feeding her well.

Once we were home from the hospital she began vomiting up the breast milk that she would get. In the hospital I had whole milk, eggs, wheat, and fruit without any problem. I did not take my singular and nexium in the hospital because we forgot to pack it. I began taking that as my doctor told me to do upon returning home. I also stopped taking the percocet they were giving me for my tailbone, because of my daughter's lethargy. I also consumed coffee at the hospital without an issue. At home I am drinking 1% milk instead of whole--that is about the only difference.

Her pediatrician did note that she is showing signs of acid reflux and we are suppose to keep an eye on it and let her know if it gets worse. It only seems to be with the breast milk that she has a problem--the formula she keeps down, but eats very small amounts at frequent intervals. I am also avoiding harsh spices because I still get acid reflux as well even on the nexium. I keep her upright for 15 minutes to half an hour and even burp her frequently.

I am having trouble keeping up with pumping lately because I was using a hand pump and am getting an electric one tomorrow (well the nipple holders didn't fit otherwise I would of had it sooner!) I did start taking fenugreek to help--4 capsules 3x a day.

I am wondering if I should cut out any foods, or if it could be from the medication I am taking? The pediatrician said it didn't make sense for her to keep stuff down in the hospital and then vomit when I got home unless it is my nexium that is the problem. I would figure that would help with her acid reflux though if it passes through. Any suggestions? From what I understand, the formula contains lactose as well.

I am just really frustrated because I want to be able to provide for my daughter without supplementation and without having to worry about it making her sick. Sorry if the post is long, I wanted to try to make sure I covered details. I have been trying all of the things in the breast feeding packets and from the class I took. I'm not giving up yet. I have my follow-up with the lactation consultant tomorrow.

[@llli*mamamia]

This is a lot! Good for you looking for some answers! I think it might help to get some usable chunks to tackle...

1. Latching. Not sure why your LO isn't latching. A lactation consultant (IBCLC) or La Leche League Leader could probably help figure this out. About her wanting to put her tongue on the roof of her mouth -- could this be tongue tie? If the IBCLC or LLL you see doesn't have some concrete ideas, check with another one!

2. Fussiness. This is tough! It's hard to say if she is fussy because of your breastmilk. What percentage of her milk is formula vs. breastmilk? Lactose intolerance is very, very rare in babies. It more often surfaces in older people (since humans weren't designed to take lactose-containing foods after childhood). It could be a sensitivity to something you're eating (dairy, soy, eggs, etc). It's hard to tell if it's the formula she's getting or your breastmilk.

3. Milk supply. If your baby isn't effectively removing milk (sounds like she's not), then you really do need a hospital-grade pump. These are typically rented from a medical supply place or a hospital. This is different than even a good double-electric pump that is consumer grade. Check to see if yours that you're getting is hospital-grade or consumer-grade. Consumer-grade pumps are designed to maintain a milk supply that has already been established. It won't do the job for building a milk supply. Plan on pumping (or draining breasts fully through nursing) 10 to 12 times per 24 hours. It doesn't have to be every two hours. It can be every forty minutes for two or three times, then take 2-3 hours off.

4. Supplementation. It sounds like your baby is not able to effectively nurse, so she probably does need to have supplements. This can happen at the breast with a nursing supplementer (SNS), so that she can stimulate your milk at the same time she's eating. It could also happen with a cup or a spoon. Babies sometimes learn how easy it is to get milk from a bottle and then have a hard time with the hard work of breastfeeding. The amount you need to supplement is hard to say. Typically babies get 25 ounces of breastmilk (different amount of formula) in 24 hours, starting at about a month old, so your baby may need a little less than that. How much she's getting from you is hard to say, too (remember how much you pump might not be how much she gets when nursing). But just keep in mind that you probably don't need to supplement any more than that.

So, you have a lot going on! I think you would be well-served by getting a good breastfeeding help (IBCLC or LLL) that can help see you through this rough patch. It's definitely possible -- lots of moms have hit these potholes and pressed forward! -- so stick with it!

Take care!

[@llli*lllmeg]

So you saw the lc? Did she help you with latching baby?

If your baby can latch and nurse once or twice a day, then baby can latch or nurse all the time. Just keep working on it. I think you are gettign distracted and worried about things like baby spitting up and your medications and diet and possible reflux which are not your biggest concerns right now. Study after study proves breastfeeding is best for babies even in the very rare circumstances that the baby is having an adverse reaction to something in the mothers diet. I suggest concentrate on getting baby nursing at the breast and then look into any other issues. Seriously. From a long and short term health standpoint, getting baby nursing at the breast (exclusively if possible, and making sure baby can gain appropriately while doing so) is most important.

Her pediatrician did note that she is showing signs of acid reflux and we are suppose to keep an eye on it and let her know if it gets worse. It only seems to be with the breast milk that she has a problem--the formula she keeps down, but eats very small amounts at frequent intervals.

Do you think it is possiby that when she nurses she gets lots at once? Or do you mean when you bottle feed baby your milk?

being fed large amounts all at once would cause lots of spit up. So, if you have a forceful letdown or are giving baby more than they can handle in the bottle, baby is going to spit up. But babies also spit up just because they are babies. Spit up is normal and occurs in both breastfed and formula fed infants and is not in any way a health issue in most cases. When you say baby is vomiting, can you describe in more detail what happens?

enfamil gentle ease contains dairy and soy. So cutting those out of your diet seems useless. It's main ingredient is corn syrup. It is designed to prevent gas and spitting up, both of which are usually NORMAL occurances in infants. It may be a good formula, but I do not like that is is advertised as 'easily digestable.' There is nothing more easily digestable by a baby than breastmilk, spit up or no spit up.

I suggest you call infantrisk for info on the meds you are taking and breastfeeding. Most meds are ok to take but if you have concerns they will have the information you need. www.infantrisk.com
INfant risk helpline- We are now open to answer calls Monday-Friday 8am-5pm central time. Please contact us at (806)-352-2519.

[@llli*lllmeg]

Oh sorry I forgot to say, welcome to the forum and congratulations on the birth of your dear baby!
I think you might find these articles helpful:
Tips for encouraging baby to nurse: http://kellymom.com/bf/concerns/child/back-to-breast/

Normal behavior in the newborn breastfed baby: http://kellymom.com/bf/normal/newborn-nursing/

Spit up and reflux: http://kellymom.com/health/baby-health/reflux/

[@llli*rockthebard]

Thank you for the resources! I did take the time to read through them and much more on the website. So here is an update!

Fussiness - I finally got her to latch on more consistently since around 2am this morning! Normally she will latch for no more than five minutes and freak out and then refuse any other attempt for a day or so. I tried positioning her when bottle feeding (only when breast milk was in the bottle), with the breast exposed, to get her use to being in such a position for a while and it seemed to help! My little one still hates to be stripped down to her diaper so I've given that method up. I keep her clothed and she is much more relaxed. Right now she hurts the nipples, but she is getting food and stayed on for 20 minutes on each side. I also could not bring her to the breast and help her get the nipple in her mouth (it would only make her cry more and I've noticed she has a really sensitive gag reflex). She mostly just seemed to be looking for it frantically, but instead of crying, she found it and grabbed it herself-- though not a good enough latch so my nipples wouldn't hurt. The last feeding, I unlatched her a few times to try to get her to latch better but she still lets some of the nipple out of her mouth and had some gagging issues. I didn't want to re-traumatize her and have to start over so I didn't push it too much. I will still work with the latching though.

As far as her tongue, the doctor and lactation consultant both said her tongue looks fine.

We do have to supplement and she gets maybe 2/3rds of her diet of formula and the rest is breast milk. The lactation consultant did mention that a few health issues I have can cause a lower milk supply, but fenugreek, lots of fluids, and getting her to latch with pumping should put me back on track. If not, I will still have to supplement. I do find it is better when I can get her to latch and then pump, as long as she is on longer than five minutes-- I end up producing more the next day.

Since we do have to supplement, I asked the lactation consultant about how to supplement at the breast. She gave me the equipment to do it and took the time to show me, but it really is a four-handed job for me right now. We just started getting her to latch more consistently, but my fiance intends to help me with the supplementation at the breast to help keep her latched longer.

I am pumping more frequently to get those extra times in and certainly exhausted, but easier with the electric pump. I got my pump provided by WIC (they have been so helpful and wonderful and were the ones who referred me here as well). I do think I have trouble letting down while using it because I do get more with the hand pump, but that hurts my hands with excessive use. I did find a much more comfortable setting, but it seems like it takes longer to empty my breast. I was told to only pump for 15-20 minutes each session, but then I read about how you should pump for five minutes after the milk stops flowing. I am still usually flowing at the end of those sessions on the electric pump-- though the flow is very slow. Should I extend sessions or still keep them at that length and keep doing them more frequently? I also have the breast gel packs that you can heat and cool. I just heat them before a session and leave them on for a few minutes and sometimes while pumping. It seems to help a bit (much better with the hand pump though). I don't know if this one is a hospital grade pump. It is the EnJoye TM model from Hygeia. It is the only one they had available and I needed it stat so they were nice enough to supply me with it.

Since we have given it some time and keeping her up-right, the sandifer's syndrome episodes have decreased. We also noticed a difference with the bottles. Avent make the episodes worse and the playtex nursers seem to cause no problem.

So I will just keep trying in the mean time!