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Thread: Supplemental Nursing System

  1. #1

    Default Supplemental Nursing System

    Hello.

    I have just ordered a Medela supplemental nursing system at the advice of my baby's pediatrician. The breastfeeding issues we've been having are almost too long to explain, but in sum: my daughter is not quite 4 weeks old yet and we're having just one successful nurse each day and the rest of the day I'm pumping as often as possible (which can't be sustained much longer) and bottle-feeding her (breastmilk but also formula due to low-ish supply).

    Does anyone have experience with the SNS and/or some advice for me as I begin to use it and hope that it works to increase supply and increase the number of successful/happy nursing sessions? The ideal, of course, is that we can use the SNS for a while but over time figure out how to make it fix all problems and lead us into the full nursing relationship I always imagined/wanted. Any advice and guidance is welcome!

    Thanks,
    Emily

  2. #2
    Join Date
    May 2006
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    Default Re: Supplemental Nursing System

    Welcome to the forum!

    The SNS can be a useful tool for getting a baby to nurse, and can also help with supply. But the SNS isn't a magic bullet; it can be tricky to use, and usually the SNS alone isn't enough to boost supply all the way up. You're probably looking at a continued relationship with pumping.

    One thing that helped me with the SNS was tape. It can be really hard to hold that little tube near your nipple while also maneuvering the baby, but tape can get the tube more or less into position. I think some people also become adept at latching baby onto the breast and then slipping the tube into baby's mouth.

    Another thing that can happen with the SNS is that the baby can learn how to feed predominantly from the SNS, and not suck very hard on the breast. Once the baby is latched and feeding, it helps to periodically crimp the tube. That will force the baby to nurse more enthusiastically, and will also accustom her to the natural ebb and flow rhythm of milk flow.

    I know you said that your story is too long to explain, but a full rendition might help us help you! I'm especially curious about what sort of pump you're using, how often you're pumping, how you discovered the low supply, how nursing feels when baby does nurse, and what baby does when nursing (e.g. does she have trouble latching, does she resist the breast, does she fall asleep very rapidly, etc.).
    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!"

  3. #3
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    Jun 2009
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    Default Re: Supplemental Nursing System

    Mommal I had forgotten you used an SNS. I wonder what you think of the jack newman video on using a lactation aid. Also if there are any lactation aid videos online you think are good?

  4. #4
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    Default Re: Supplemental Nursing System

    Is it this one: http://m.youtube.com/#/watch?v=ezGIk...3DezGIkIkhC_o? If so, I do like the way the tube gets slipped into the baby's mouth. Definitely better than what I was doing, which was trying to latch baby onto tube and breast at the same time. But it looks like it requires 2 people to make it work?

    Wsh I had a more informed perspective on SNS/Lact-aid use. I always found it exceedingly tricky and didn't use it for long.

    OP, has anyone suggested the "finish at the breast" technique? That can be helpful when you're supplementing via bottle. What you do is to nurse (if baby will nurse), then offer a small supplement (maybe 1-2 oz), and then relatch the baby onto the breast for unlimited nursing. That way the baby associates the breast with comfort, satisfaction, feelings of satiation...
    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!"

  5. #5

    Default Re: Supplemental Nursing System

    Hi!

    Thanks for your responses! I thought I would get an email notifying me of any responses, so I didn't check back until now. Maybe I can figure out how to change my settings so I will get an email.

    Anyway, I can definitely share details of my situation. I will try to remember everything important so I apologize ahead of time if I go on and on. Feel free to ask any specific questions if you think it'll help you understand and give feedback. I've been overwhelmed with support and opinions but I'm still thirsty for any and all advice I can get!

    BIRTH: I was 11 days late and was induced. I knew that my baby just wasn't ready to come out, so I was conflicted about agreeing to the induction, but I hadn't been feeling her move much and they said they were afraid the placenta was just wearing out. After about 24 hours of labor and LOTS of pitocin, I had dilated 4cm but the baby had not moved down into the pelvis - in fact she had not descended at all. We knew before labor that she was occiput posterior (facing forward), and afterwards the midwife and doula both thought maybe she had not only been OP but also that her neck might have been turned so that she was looking sort of up and a little off to one side. This might have meant that during all those contractions for 24 hours, her head was being pushed agains some part of the pelvic bone (or something) and she might have alignment issues because of it. That positioning would explain why she was never able to descend even a little bit. So she was eventually born by c-section, which went fine. But this does mean that she received a ton of fluids, as I was getting IV fluids the whole time I was in labor, and it meant that I had to get an epidural and she may have been affected by that too.

    FIRST FEW DAYS: In the hospital, she wasn't eating much but I didn't really have a real way of knowing. She came out pooping, so we weren't worried about that, and she was having wet diapers (but maybe because of getting rid of all that extra fluid). At around 6pm on her second day of life (though she was born the previous afternoon, so she was really only about 27 hours old), she nursed for a while. That was the last nurse until 9:30am the next day. We had a horrible night of me getting so nervous and her getting very upset every time I offered her my breast. The next morning a nurse got her to latch and eat, but it didn't last long. During my time in the hospital, I saw a total of 6 lactation consultants (4 came in at the same time on one day) and attended a breastfeeding workshop/class. Various things were tried/discovered. We started using a nipple shield because it seemed like she didn't suck unless something was put way back far into her mouth. By now (weeks later) a couple of people have mentioned that it looks like she has a high palate. The LCs in the hospital worked on my positioning and making sure I was relaxed. Things sort of maybe improved. But my milk hadn't come in yet and she was latching for short periods of time (though I didn't really realize it at the time - I'd never done this before!) and then still seeming hungry. So we started supplementing her with formula and I would pump at the same time (though nothing was actually being extracted). In her first couple of days, my daughter, Indigo, had lost weight (I think about a pound - though she was born at 9lbs, 6oz), but by the last day had gained a little bit back again so they were ok with us leaving (thank goodness).

    HOME: The day after coming home we went to see the new pediatrician. Indigo had lost weight again. We talked a long time with the pediatrician about our feeding plan and she said we should be offering her much more each time (the hospital nurses had been unclear but sort of discouraged us from letting her eat too much - not that we ever denied her food when she was eating). We laid out a plan to offer to her nurse and see how long she would nurse, and then my husband would supplement while I pumped for the remainder of a half hour. That's sort of the plan we've had going for a while, and she's been gaining weight so the worry is no longer on her health but just on breastfeeding.

    GENERAL FEEDING ISSUES: Someone in the hospital thought that she had tongue-tie, so we decided to have that clipped while we were in the hospital. A week or so later the pediatrician saw scar tissue that had complicated the tongue-tie again, and so we had to go see an ENT, who agreed and then re-clipped the frenulum. For a while after coming home from the hospital she was very difficult eating from a bottle as well. Sometimes feedings would take an hour and she would only have taken 1/2 ounce. She seems to have gotten better with that lately, though she still sometimes has little fits at the bottle and gets upset or frustrated, or just plan lazy with eating. Maybe her high palate causes her issues, maybe frenulum issues, maybe nipple confusion, maybe even neck muscle tightness because of her womb positioning or labor pressure. I just don't know. I've only been able to weigh her before and after a feeding one time. It seemed like a pretty good nursing session to me (as compared), and yet she had only taken in 0.2oz!

    SUPPLY: We've been doing that plan above (developed in combination with the hospital lactation consultants and the pediatrician) for the most part, although my husband is back to work so while I'm home alone with Indigo I can't feed her and pump at the same time. My pumping has been hard to time, but I've been able to pump between 5 and 10 times a day. I'm only pumping between 8 and 14 ounces a day. She eats that (from bottles) as well as formula. About a week ago I was prescribed reglan (suggested by the pediatrician and prescribed by my midwife). Until this morning I would have said that it hasn't made any difference at all, but this morning (right after using the supplementer and nursing her) I pumped a larger amount than normal in one pumping (about 3 ounces) - which could have just been about the fact that it was morning but I'm hopeful that maybe the reglan has kicked in.

    WEIGHT: She was born 9lb. 6oz. (but remember about the fluids she was taking in during labor). I don't remember what she weighed the next day or two, but on the morning that we left the hospital she was 8lb. 9.5oz (3 days old). At 17 days old she weighed 9lbs 0.5oz. We had a lactation consultant come to our house when she was 19 days old, and she weighed 9lbs 1.6oz. That's the day that we weighed her before and after a nursing session and she had only taken in 2 tenths of an ounce. Her most recent weight was last friday, at 25 days old, and she was 9lb 7oz. Finally above her birth weight! She'll be weighed again at her one month appointment tomorrow (she'll be 4 weeks and 4 days old). So now she's steadily gaining, but not entirely on breastmilk (I produce less than half of what she eats) and not without a lot of effort to make sure she eats enough each day.

    SUPPLEMENTER: This morning was the first time I was able to try to supplemental nursing system. It was just cumbersome and difficult. I'd love to try it again later, but with my husband at work I think it'll be completely impossible. Indigo nursed and was taking formula from the supplementer. But the instant gratification didn't magically fix all of our problems. She latched for a while but then later on in the feeding she wouldn't latch or would get it in her mouth but then lose it right away. She was falling asleep (I would say that half of our nursing sessions end in her falling asleep and half end in her very agitated), but if my husband took her she would wake up and so eventually he offered her a bottle of formula which she took. I pumped for half and hour and got quite a bit, as mentioned above.

    So I guess my lingering questions are . . . everything. Any advice on using the supplementer? Any thoughts/advice about the situation I've described above? Overall, I need to figure out a way to either (ideally) get to a complete breastfeeding relationship, or at least feed her as much breastmilk as possible. And I'm very afraid that I won't be able to sustain (or ideally improve) my milk supply if she's not feeding, and that the amount that I'm pumping (and just the amount of time that me and my husband both spend on her feedings) is just not sustainable either - especially when I go back to work, but even before then.

    I've consulted with a total of 8 lactation consultants (9 if you count my pediatrician, who doesn't work as an LC but is very experienced and passionate about breastfeeding) and read a ton of books, articles, and online forums about all of this. I've gotten conflicting advice (for example, one LC told me not to pump for longer than 10 minutes, but the pediatrician told me to keep going for up to half an hour based on how much the baby nursed successfully, for another example, lots of what I read says that to increase milk supply you need to attempt to completely empty the breast as often as possible, but one LC told me to just pump as many times per day as possible, even if it's just very brief to get the stimulation and not to worry about completely emptying the breast). I just need to figure out the specifics of my current situation. So any and all advice/insight is more than welcome!

    I'm so sorry for this super long post!

    Thanks!!!
    -Emily (& husband Dan & baby Indigo)

  6. #6
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    May 2006
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    Default Re: Supplemental Nursing System

    I wish I had more advice on how to use the supplementer. I myself found it extraordinarily tricky, and often resorted to bottles. The fact that your baby will latch and will nurse is awesome, and puts you way ahead in the game. I personally would fight this battle primarily with the pump- if you can use the pump to create a great supply, hopefully baby will be more willing to nurse and better able to extract the more ample milk.

    I think the advice you've gotten about pumping is both good and bad- on the one hand, pumping for just 10 minutes probably isn't enough, but if shorter pump sessions result in you using the pump more often, then they are preferable to longer pump sessions. Emptying the breast is great, but all pumping you do is good and useful. Basically, when you're trying to boost supply with the pump, you want to max out as many variables as you can: you want to pump as often as possible, for as long as possible, emptying the breast as much as possible.
    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!"

  7. #7
    Join Date
    Feb 2007
    Posts
    1,709

    Default Re: Supplemental Nursing System

    I'm also someone who gave up on the SNS, so I can't help there. But I also know someone who used it for 2 years, so I know it can be done. I guess you just have to use your judgment about whether it's worth the effort to learn (it definitely does help with keeping baby at the breast and giving your breasts the stimulation they need), or is just causing you/baby too much stress.

    My best advice is to hang in there. Having a breastfeeding-friendly doctor is a big plus. Sounds like you have seen a lot of LCs, mostly in the hospital, but perhaps not had much total time with any of them? Have you had a good hour-long appointment with a board-certified LC (IBCLC)?

  8. #8
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    Default Re: Supplemental Nursing System

    I'm sorry if you already said this but how many times the day does baby nurse? Any?
    And breast milk and formula combined what is the total ounces baby gets in a 24-hour day?

    As far as conflicting advice. None of it is necessarily wrong. The problem is finding what will work for a particular mom. some mothers pumping for a half an hour is too stressful and painful. A mother may pump that long but she can't do it very frequently. In general we do know that when the issue is low milk production it is the frequency of milk removal that is most important and 15 or 20 minutes each breast seems to be a manageable length of time for most mothers. Some mothers can pump for an hour and still be having letdowns other mothers will pump for 10 minutes and that's all there going to get. It's very individual. it is impossible to actually empty a breast because your body is always making milk. But certainly especially when pumping there will appear to be no more milk remember the pumping is a very different way of removing milk from the breast than a baby. Basically when trying to increase milk production via pumping you have to just figure out what's going to work best for you.

    Also I agree with previous post about lactation consultants Don't be defeated thinking that you saw every body and got all these opinion but still can't do it. first off forget everyone you saw in the hospital that was under a completely different situation, you were recovering from surgery and you were probably so swollen yourself with edema it was almost impossible for your baby to latch who knows what was going on things are different now. Also any lactation consultant you spoke with on the phone or briefly can be taken off the list. They did not see you baby and so they cannot assess the situation entirely accurately. What may help now if it is possible would be to see a board-certified lactation consultant who is experienced with helping post op tounge tie or other very difficult latch situations to work with you on latch and suck training assuming that the before and after weight check was correct and baby has a very difficult time transferring milk. I think you're doing really good with a difficult set of circumstances.
    Last edited by @llli*lllmeg; March 21st, 2013 at 04:13 PM.

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