Originally Posted by @llli*lllmeg
Thank you so much for your thorough response! I really appreciate it. I have tried both of these. I do breast compressions regularly and they do result in a few good swallows, but no real change in sucking pattern. I had an experience just this afternoon which I think shows me the problem. My breasts were full and she was hungry, so it was an excellent condition for nursing. I relaxed and got comfy on the couch with my boppy. She nursed as usual on each side, then I took her off for a burp. She did, and then starting crying her cry that says, "I am not done eating." Usually we'd give her a bottle here. But instead, I put her back on the first side. This time she seemed to get that she needed to extract milk and her behavior was much different. She was vigorously pulling back on my nipple, repeatedly bopping me in the face with her fist, even sort of grunting, all while doing her usual suck which I believe must not be the correct kind of sucking to get the milk out. Anyhow, I think she really did get it that she needed to get her milk there, but she couldn't do it. We went on like this for awhile, and by the time we got to the second side, she was crying and I was about to, both from the pain and frustration. I think she is just not using good technique and none of the lactation consultants I have seen really address this. They might look at the latch or position I am holding her in, and of course the MD who did her frenotomy analyzed her anatomy in detail.
Right after the frenulum surgery, I felt and saw her do a better suckle for a few feedings (she still wasn't motivated at that time to get a lot out of the breast, and she needed to be kept on pain meds to mask the pain after the procedure) But I don't see that suckle any more. She sort of purses her lips and tries to suckle that way. They are still flanged, but I see tension at the side of her mouth where I think there should be just openness. I am convinced this is the problem, and it is also the way she suckles on the bottle. Is there any way to train or re-train her? I will ask the lactation consultant the same question tomorrow at an appt. I have.
How much milk (volume total) do you pump each day? How often do you pump and how often does baby nurse?
If I am really diligent and do 8 or more pumps a day I can get 24 ounces. Otherwise, maybe 20? This past weekend I was trying to pump extra to build up my supply but ordinarily I will pump about 5-6x a day, or after as many feedings as possible. Baby nurses 7-8x a day. I would do more but each feeding tends to last 45 minutes to an hour and I feel like I can't squeeze any more in!
Are you continuing to work with a board certified lactation consultant that you like and feel confident in?
Yes, I am working with a group practice at the hospital where I have my insurance. I have also seen an independent consultant shortly after birth, and the one at the MD's office who did the frenotomy. But I am sort of desperately searching for answers and I don't know that I have found the very person I trust to get me on the right track.
If you have been supplementing from the beginning, how do you know baby will not gain appropriately without the supplements? Weaning off supplementing and pumping is tricky and requires some leaps of faith and confidence. Your IBCLC should be there to guide you through that.
Well, we did supplement at the start because she didn't latch on at birth. So we did finger feedings until she latched. When she did, it was really painful, and I did for awhile just use my supply. But then she wasn't gaining well -- .2 oz a day -- and so it was recommended that I use supplements. She has not exclusively breastfed except for when she first started nursing and for a short period around 5 weeks. It has been too painful and my nipples needed to heal. Now they are 90% healed and if it werent for all the tugging and frustrated movements she makes while trying to nurse, I think they would be okay. But after the feeding this afternoon, they were really sore and painful. I can't imagine continuing to do feedings like that 8x daily.
First off, an ounce per breast is not all that terrible milk extraction, although of copurse by this age you would ideally want to see better. Also how many before and after nursing weight checks led to this conclusion?
Four separate office visits. Each time the transfer was typical of a feeding at home, and all were in the same ballpark of about an ounce transfer per breast.
If you have an infant scale and are doing your own befor and after mnursing weight checks, I suggest, stop doing that, or at least only do it once a day at most. Constant before and after nursing weight checks are needlessly stress inducing.
Yes, I can see how that would be. No, we don't have a scale here yet. Also stressful would be the change from seeing every ounce she eats vs. the breast where you don't really know how much she gets. I suppose I could just rely on her satiety to tell if she's had enough. This is of course if we can ever get her to transfer enough on a regular basis.
It sounds like your current schedule is feeling really burdensome to you. Hopefully you will be able to get baby nursing more efficiently so you can start weaning off the pump. But until then, What if you tried switching things up a bit? What about pumping at times other than feeding times? What about giving baby a small supplement PRIOR to nursing so baby is able to 'finish at the breast" for some feedings? It would be nice and probably helpful if you could have some feedings where both you and baby could relax and enjoy nursing and you not worry about having time to pump and baby not anticipating being topped off with a bottle.