Hello, and thanks in advance for your suggestions - you all deserve medals for being here waiting to help people like me. (Sorry this turned out so long!)
First, my prior history with bf is my 6 year old son, who nursed like a champ in the hospital and my milk came in by day 3 even though I'd had a c-section (failure to progress induction for gestational diabetes which was managed by diet well.) He was 7lbs,13oz, and we were on the fast track but then he developed jaundice. We took him home on Day 4 and that day he was an almost lifeless, floppy, sleepy baby who would not wake up at all to eat even after 6 hours, so we took him back and were re-admitted to the hospital where he spent the night supplementing with formula and under the billi lights. It was more than 24 hours since his last successful nursing before a pediatric nurse suggested I pump, which I did, but we never recovered from nipple preference and dwindling supply. He never latched on after 8 weeks, and I pumped for 5 months but by the last 2 months I was getting less that 2 ounces total for the day.
Current problem - I had a baby girl 4 weeks ago, c-section (breach, big baby b/c of difficult to control gestational diabetes - diagnosed at 13 weeks, insulin by 26 weeks, insulin dose had to be adjusted every single week because my numbers were never in line. 10 pound, 3 ounce baby girl born at 39 weeks. Nursed like a champ, milk came in even earlier than before. I begged and pleaded with the pediatrician to put her under the lights as a precautionary measure but just wasn't able to make my concerns understood. I knew it was coming for us because this second time around we had even MORE risk factors for jaundice than the first time! He kept saying nursing wouldn't take a hit because he wouldn't order me to stop nursing if the baby had to be re-admitted to the hospital. I couldn't explain well enough that it was NOT the Day 4 or 5 billirubin count of 19 and a re-admit that I was worried about - I agreed with him that it was run-of-the-mill jaundice that would correct itself - but it was the Day 3 billirubin count of 13 that I was sure would make her too sleepy to nurse and start the whole vicious cycle again. In the end we were discharged and had to go back to the hospital three times for jaundice checks, though she was never re-admitted. She did get too sleepy and unenthusiastic to nurse, and went down to 9 lbs, 1/2 oz before we left the hospital. About 11.5% weight loss.
We went to see our pediatrician (a different doctor in the group) and they have their own board-cert LCs who are fantastic. We saw the LC on Day 4, 5, 7, 14 and 21 to monitor the jaundice/weight. During the last night in the hospital and our first day home, she had been so sleepy that I would try to latch her and maybe get a few sucks, even with all the info I could read about getting a sleepy baby to wake up and nurse. She'd latch, suck a bit, then sleep. We'd switch nurse, turn on all the lights, change her diaper, poke at her and tickle her feet - everything - she just wouldn't wake up to eat enough. I pumped a few times that first day home because this time, I knew what was coming for us. I left for the first LC appt with 4 oz in the fridge. The LC tried her best to help us with latch and waking her up - her chin is set way back so we had to reach down and manually pull her bottom lip out, which helped a bit, and I have nipples that point in different directions so my positioning needed help. She suggested that if she wouldn't wake up to nurse effectively, we'd have to feed her somehow - the Kellymom 2 step, feed the baby, empty the breast route. We tried cup feeding, it was a disaster, so we went and bought the bottles she recommended and started 'supplementing' with expressed breastmilk after every feeding and taking Motherlove More Milk Plus because of the previous supply issues with my son. In the beginning, she'd nurse and have a *few* swallows, then all of a sudden be too frantic to latch or nurse or console, and then frantically take 2 oz from the bottle. We tried supplementing with 1/2 oz before to calm the frantic-ness, but she was still frantic. It was a 2 steps forward, 1 step back roller coaster since then. Some times she'd refused the breast entirely and drink 3oz. The bottles have, I think, helped her figure out how to stick her bottom lip out fish-style like she's supposed to. We had to pry her lips out around the bottle nipple too in the beginning, but now she does that herself and latches nicely on the breast too.
Her weight gain has been sluggish, but consistent, so the Dr. and LC are not concerned but keep having us come back to check. She's gained about 1/2 oz per day I think, and weighed 9lbs, 14oz at her 3 week checkup. They agree with me that the birth weight is very inflated.
This past few days we've seen a marked improvement. She latches well and nurses well every time for the last 2 days, but still drinks 1-2 oz. of expressed milk after most every feeding. I tried doing the bottle first but then she wouldn't latch. We tried to do a nursing vacation, thinking that since it's all my breastmilk, we just have to force her to take it all from the breast rather than give up and take her last 'easy' ounce from the bottle. We even made it 9 hours of EBF one day, and we can usually get at least 1 feeding in the night without the top-off. After the 9 hours, though, she was angry and frustrated, wouldn't cooperate or latch at all, screamed bloody murder, and frantically sucked back 3.25 ounces from the bottle. That was last week. Since then I've only done the once per night and maybe 1 daytime feed where I try to see if I can skip the top-off, and that has worked out ok, and she wakes up to eat again in 2.5-3 hours (this is the night time feeding) rather than 4-6 hours later. The LC has said that instead of trying to get rid of the bottle right now, we should wait to see her get back to her birth weight before changing anything drastically like that. It's going well, she said, it would be terrible to come in here in 7-10 days time and have slid backwards into a rut even bigger to climb out of.
I would like advice on how to eventually get rid of the top-offs, since it is right now an incredibly onerous 3-step process to feed her. First breastfeed, then hand her off to the husband to top her off while I go pump (or do all the steps myself during his workdays.) I don't pump every time she tops off anymore (I did 8-10x per day in the beginning, but supply doesn't seem an issue this time around so far and I already have 90+ ounces in the freezer) but I do pump at least 4 times a day, usually whenever she has a large top-off and then before going to bed because she sleeps so long. (When I pump I get 2-5 oz each time, around 10-15 ounces total per day, and the past two days she's had less than 8 ounces per day by bottle, so I am freezing the excess.) Sometime she seems to nurse well, and take less than an ounce afterwards, but then I still get 3 or more ounces pumping.
My biggest concern is that she seems to be on her own ill-advised schedule of nursing. She only eats 6x per day. Even in the hospital she would only eat 7-8x per day, and sleep 4+ hours at night - and she's never increased her feeding frequency since then. During our longer stretches trying to go without the top-off she does nurse every 2 or 1.5 hours, rather than her usual 3-4 hours stretches, but then at the end she's starving and angry. When I try to wake her up to feed at shorter intervals, she does nothing. If she's not hungry, she won't latch at all, she just sleeps. Even when she wakes up to eat, she doesn't do much until about 30-45 minutes after she wakes up. Like she needs a rumbly tummy before she'll nurse enthusiastically. She still nurses with her eyes closed almost all the time too, like she's still a sleepy baby 4 weeks out! She sleeps up to 6 hours stretches at night, even though she's never had a drop of formula.
Also, should I continue taking the More Milk Plus, or do you discontinue it once supply has been established?
Thanks again! Sorry for any typos, this is long and I am a terrible proofreader.