8 weeks, losing hope. Lazy,late nurser with TT, low milk

[@llli*daphnejanes.mom]

My 8 week old daughter and I have struggled with breastfeeding from the start. We've seen many specialists and LCs and I just wanted to get more help as I am losing hope with nursing. Most recently, at 6 weeks she had a posterior tongue tie corrected. It had to be re stretched twice but it did improve her ability to get suction. Prior to the TT clip, she had a latch that tore up my nipples and was painful. Nipples are now healing, slowly, but she makes them look like a lipstick tube after sucking sometimes. Also does a lot of clicking. But the reason I am tied to the breast pump after each feeding is that she just stops suckling after about a minute. Goes straight to comfort sucking. She doesn't transfer more than an ounce at each breast on a good session. So we supplement after feeding with a bottle of my expressed milk, have been doing so for pretty much her whole life as she wasn't able to gain weight without those supplements. We also need to give about 4 ounces a day of donor milk as my supply is low. I just don't know how to move forward with a sustainable feeding plan. Ideally breastfeeding only. Currently feeding takes 1 hour: 30 minutes at breasts, 15 min bottle feed, 15 minute pump. It's crazy! What would you recommend for getting her to focus on the breast?

[@llli*carm3]

I'm curious to know if anyone checked for an upper lip tie? Apparently posterior tongue ties and upper lip ties commonly occur together. Just in case this isn't something you've explored, this site has lots of good pics and info http://thefunnyshapedwoman.blogspot....-frenulum.html
Otherwise, I'm sure the other more experienced mamas will have some ideas

[@llli*daphnejanes.mom]

No one has said anything about a possible upper lip tie. I would think the doctor who did her TT release would have, but maybe not. I will ask her if she checked for that. Thank you for the response!

[@llli*lllmeg]

Starting wiht your question about baby Focusing on nursing: Comfort nursing does not usually mean there is no milk transfer. But to keep baby nursing more vigorously for longer, have you tried switch nursing (switching sides frequently during the feeding) and/or breast compressions?

How much milk (volume total) do you pump each day? How often do you pump and how often does baby nurse?

Are you continuing to work with a board certified lactation consultant that you like and feel confident in? Even after TT release, many babies take time to learn to efficiently latch and nurse. I know it feels as if you have been struggling forever but do not lose hope, this is actually still early days.

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.

But the reason I am tied to the breast pump after each feeding is that she just stops suckling after about a minute. Goes straight to comfort sucking. She doesn't transfer more than an ounce at each breast on a good session.

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? While they can be valuable information when added to everything else you know, a before and after nursing weight check only gives you a snapshot of the milk extraction for that one nursing session. Milk extraction varies. 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.

A normal feeding for this age would be anywhere between 2-4 ounces. Normal daily intake for this age is between 25-35 ounces. And a breastfed baby this age typically nurse at least 8-10 times a day, many nurse far more often than that. So you can see, feedings of 2-3 ounces would be fine assuming baby nursed often enough.


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.

[@llli*daphnejanes.mom]

Starting wiht your question about baby Focusing on nursing: Comfort nursing does not usually mean there is no milk transfer. But to keep baby nursing more vigorously for longer, have you tried switch nursing (switching sides frequently during the feeding) and/or breast compressions?

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.

Good suggestions - I ahve experimented with the finish at the breast technique. I couldn't tell if it worked better than the other way or not. But I will give it another go.

I am really so close to giving up. I just feel like there is no way to get her to use the right technique to nurse! How would you teach that? Is it just all the bottle feedings that have given her the wrong latch? Unless the tongue tie healed back together I think she should be physically able to do a good latch now.

[@llli*lllmeg]

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.

Well, it would be realy helpful if you saw an IBCLC (Board Certified lactation Consultant) who sits and watches a nursing session and works with you and baby on latch and sucking skills. This is what IBCLC's are trained to do, or at least, should have been trained to do. This may take 90 minutes or more. If the IBCLCs you have been seeing do not do this, What other local options do you have? A local LLL Leader may also be able to offer in person help but of course, they are not going to have the extensive education and clinical training as an IBCLC. On the other hand, we are free. You could also look into if there is a Breastfeeding USA chapter near you assuming you are in the US.

The nursing behavior you described is really not that far out of normal. Maybe she has gotten used to "finishing" with a bottle, so felt she was not done until bottle came. But the hitting, pulling etc. could be kneading behavior, which a baby does to get the milk to flow, or to flow faster. If your baby nursed ok at first, then she is capable of nursing well. Also I see that kind of behavior if baby is not thrilled with the nursing position. What other types of positioning have you tried? When you use the boppy, are you able to relax or do you tend to hunch over or have tension?

I suspect there may be some "flow confusion" going on which makes sense due to lifelong use of bottles for supplementing. I suggest, keep trying in these cases, maybe with some "instant reward" techniques to keep baby interested/trying at the breast.

Conditions do not have to be 'ideal' to encourage baby to nurse. this is a typical way of thinking when a mom is concerned baby is not getting enough at the breast. Mom starts to look at the breast as only a source of nourishment, interchangeable (or perhaps inferior to!) a bottle. Baby starts to look at it this way too, and before you know it, baby is exclusively bottle fed.

INstead, I suggest remember that, in the normal course of breastfeeding, the breast is a place for comfort sucking as well. So you could try Encouraging baby to latch and nurse for comfort as much as possible. If baby nursed more frequently, it might help make sessions not so long.

If I am really diligent and do 8 or more pumps a day I can get 24 ounces. Otherwise, maybe 20?

If you are pumping and nursing, and your pump output is 20-24 ounces per day, and baby is taking in even only 7-8 ounces a day at the breast, that is good milk production meaning it sounds like you make at least 25-35 ounces a day.

I understand wanting to give up, but wiht that kind of milk production, you are so close to actually exclusively breastfeeding! Can you try a little longer do you think? Can we at least try to get you some different help, locally?

[@llli*daphnejanes.mom]

Yes, I think getting more help with technique would be good for me now. Thank you for the encouragement!! It feels like I am miles away from success but maybe not so much. I am in Seattle. I know that there are LLL meetings and breastfeeding support groups as well as more IBCLCs. I have just felt like there are so many problems that I felt overwhelmed going to a group situation. But now maybe I could.

I had an appointment today and I did ask for help with the latch, as I felt that all previous efforts had been aimed at just maintaining my supply and getting her to gain weight. The IBCLC helped me a lot with latching. I felt like I actually got the hand position right with the cupping down below the breast and then tucking the nipple in. And we did a lot of nursing this afternoon and I am not in pain!! So that is a big success.

Ultimately, the IBCLC said, "just feed your baby." -- I should do whatever combination of feeding feels right. I am going to try to make nursing at the breast a bigger part of the picture. This afternoon we again did two sessions on each side during a feeding and she did pretty well on the right side. I would estimate she took about 1.5 ounces total on the right, but took less on the left, which is typical. I know this because after we nursed, I was able to pump and the output was lopsided. What if she continues to nurse better on the right side? It seems to be the way so far. Is there any problem with that?

I do think she is used to the habit of finishing with the bottle. I tried supplementing with the bottle first this afternoon, but in the end she still took a few more ounces from the bottle before seeming satisfied. In what I read about finishing at the breast, you try to estimate how much supplement is needed and give all of that first. Is that what you would recommend? I would just be afraid that she wouldn't be as hungry if I gave her three ounces or so beforehand.

I am committed to trying to breastfeed. I feel encouraged. However, I am thinking of switching to doing a bottle and simultaneously pumping at night, with minimal nursing, and focus the breastfeeding sessions on daytime. With feedings taking a long time, my patience at night is bad and I am also not getting great sleep. I don't have any nighttime help. I have my best supply at night, so it makes sense to me to get all that milk out. However, I am concerned with the bottle/breast interaction and my daughter's expectations. Any thoughts on that plan?

[@llli*lllmeg]

I am so glad you got good help with latch from an IBCLC!

I understand not wanting to go into a group situation. Do I ever! It took me 7 months to work up the nerve to attend my first LLL meeting. But I discovered that LLL meetings are a safe and supportive place moms can let their hair down and let the tears flow. I suggest, call a local Leader to chat before going, if they have a large and busy meeting they may be able to meet with you separately as well if that is possible. But do attend a meeting! You never know what mom is going to have the suggestion that helps you.

I do think she is used to the habit of finishing with the bottle. I tried supplementing with the bottle first this afternoon, but in the end she still took a few more ounces from the bottle before seeming satisfied. In what I read about finishing at the breast, you try to estimate how much supplement is needed and give all of that first. Is that what you would recommend? I would just be afraid that she wouldn't be as hungry if I gave her three ounces or so beforehand.

But yes, if you give your baby 3 ounces that would be a full feeding or very close to it for most babies this age. So supplementing that much before a feeding would probably not be a good way to encourage baby to nurse. Maybe look at it this way-your baby needs 30 ounces a day (approximately) which baby would normally get nursing 10 times a day (or more) so about 3 ounces per feeding should be all baby needs. Try offering an ounce or an ounce and a half and then nursing. Baby may well behave as if baby wants more, but what baby is wanting is to suckle, and that can be done at the breast. Also I suggest that it is normal for you baby to need to eat more frequently than your baby has been doing, so if baby does nto get a great feeding in, you can nurse again in just a short time. Yes I know feedings are taking a long time but that should start improving now with the better latch.

I am committed to trying to breastfeed. I feel encouraged. However, I am thinking of switching to doing a bottle and simultaneously pumping at night, with minimal nursing, and focus the breastfeeding sessions on daytime. With feedings taking a long time, my patience at night is bad and I am also not getting great sleep. I don't have any nighttime help. I have my best supply at night, so it makes sense to me to get all that milk out. However, I am concerned with the bottle/breast interaction and my daughter's expectations. Any thoughts on that plan?

well, ideally it would be better to avoid bottles as much as possible, including at night. Assuming the IBCLC found no physical barriers to your baby’s ability to transfer milk well, then what baby needs is to practice nursing and sucking and you need practice as well. Have you tried side lying to nurse? Laid back positioning? These positions could make nursing at night much easier on you than pumping. I guess I am saying if I was going to eliminate anything "at night" (by which I assume you mean some 6 to 8 hour period you (mom) are actually in bed trying to sleep) I would suggest eliminating pumping and just nurse. Especially if your production is better at night, as thaqt should keep baby more interested.

ON the other hand, if your plan wiht pumping at night really lets you get more sleep, then you could try it-because I think finding a way to put together a 4-6 hour block of sleep for a night or two can change an exhausted mom's whole outlook. I would also suggest, GET help at night. Do you have a friend, sister, mom, anything, who could sleep over for a couple of nights and help you?

Do you nap during the day?

[@llli*lllmeg]

Oh and do not worry about feeling lopsided. That is the least of your worries! All moms produce better on one side, some much more obviously than others. Some mothers also fully nurse thier babies with only one breast! it is just not a huge concern right now. I would also suggest not trying to estimate how much your baby took via nursing by how much you can pump after nursing. I have no idea if this would give you an accurate guestimate, even.

[@llli*daphnejanes.mom]

I will look again at the schedule of LLL meetings in my area. I like the idea of calling the leader ahead of time. That will eliminate some of the unknowns and some of my anxiety! I really could use the support, though.

I have to admit, I did the bottle/pumping thing at night, and it worked really well. Usually, by the time she completes a feeding (about an hour) she is wide awake and it has taken me another hour to get her to wind down & back to sleep. But with the faster feeding, she and I were back in bed by 45 minutes. I do think it would be best to get her to the breast at night, but I think I will focus on the daytime first.

My mom has, on occasion, come down and spent the night and when she does she gets up to help me. So I will see if she can do that sometime to give me a chance to work on the night feedings. I had tried the side-lying position and I wasn't able to get a good latch, although I could see from the position how great it would be for sleeping. I will practice with that during the day. I do like the laid-back position as well and have experimented with it. When nursing in bed I usually throw that into the mix as there tends to be a lot of popping on and off the breast so plenty of opportunity for position changes.

I do nap during the day but I've never been a great napper. I am of course getting better and better at falling asleep at any time, though.

Still working on the transition to the breast today. Seems like she still needs the bottle sometimes to "top off" and feel full, especially in the evening when my supply goes down a bit. I have been doing more frequent feedings for sure. With the bottle it was easy to give one big serving but with the breast it seems like many little servings, more often, is the way. So that is an adjustment for us.