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Thread: Not getting enough when breastfeeding

  1. #1

    Default Not getting enough when breastfeeding

    My daughter was born at 27 weeks, and after 3 months in the hospital we finally brought her home a little over 3 weeks ago. We started breastfeeding when she was 33 weeks old in which I was able to breastfeed her once a day (I am a student and am now on summer break). We did start right away with a nipple shield. As my daughter began eating more, my production wasn't growing as much with her. When I exclusively pumped right before we brought her home, I would produce roughly 300-350 milliliters and now her goal is to consume somewhere between 480-720 mililiters. It is a challenge to know how much I pump now because I have the breastfeeding thrown in the mix as well.

    I'm having several problems now that she is home and I have been working towards exclusively breastfeeding for the summer. The first issue is that my milk supply is still less than she needs to consume. I have done the 8 pumpings per day, and power pumping. It seems like each session takes forever! I usually have to pump for 40 minutes each time and I still don't feel like I get everything out. I don't believe my suction is too low. I set it to just a step below there is any kind of pain. I have had a hospital grade pump for the first 3 months but didn't notice that much of a difference to justify the rental. I am using a medela in style. I also try to express after each session which I could sit there for another 20 minutes trying to drain everything. Again, it doesn't feel like I quite get everything out. Its exhausting and then I get sore if I do too much!

    The other problem is when I can get her to breastfeed, she does not completely drain each breast even if she eats for an hour. She also does not want to breastfeed more than 4 or 5 times per day, and each session usually lasts anywhere from 10 minutes to 45 minutes. She prefers a bottle as I think it is easier and she can have her fill more quickly.

    We are also still using a nipple shield. I try to get her to breastfeed without the shield each time. Whenever I don't use the shield, she continues to root around like she is looking for a larger nipple like what would be used on a bottle or the shield. I have tried to express milk and have also used a syringe with expressed milk while trying to breastfeed without a shield. She just keeps her mouth open and won't latch in these instances and gets fussy quickly! It is quite frustrating because when I breastfeed, I still have to supplement with a bottle afterwards as she is still hungry but won't breastfeed anymore, and then I have to pump. The whole process can be anywhere from an hour to two hours. Since my supply is less we also have to supplement with formula. It seems like a never ending event!

    I feel like the most important thing is to get her to drain the breast each time she feeds and I don't understand why she is not getting enough milk when she breastfeeds. It seems like she is old enough. Her adjusted age would be 3 weeks 5 days. And we have been breastfeeding for about 10 weeks.

    I would also like to breastfeed without a shield. I hope my supply will increase if she is able to drain each breast without a nipple shield. I can tell she gets frustrated and I'm not sure why she is not able to get enough milk each time we breastfeed. This feels like a never ending battle for almost 4 months and I am so frustrated. I want this to work but I don't know how much more of this I can take. Any advise would be greatly appreciated!

  2. #2
    Join Date
    May 2006
    Posts
    21,259

    Default Re: Not getting enough when breastfeeding

    Welcome to the forum!

    I think the first thing to concentrate on is just how far you have come! Your baby was born so early, and yet she is home, able to nurse, and getting a lot of her nutritional needs met by you. Those are huge achievements, really!

    At 3 weeks, many term babies are still struggling to master breastfeeding. And they may not be ready to nurse without the shield if their moms have been using one. I think right now you should probably resign yourself to the shield. Keep offering the bare breast, of course, but don't feel like it's some sort of huge failure if your baby isn't ready to nurse that way yet. Just put the shield back on and try again later.

    Shields are great for babies who have difficulty latching without them. The big problem with shields is that they can reduce stimulation to and milk removal from the breast, and that can result in lowered supply. It's possible that the shield is all or part of the reason you have been unable to get a full supply, or to meet your baby's need solely by nursing.

    Another possible complication is that babies who get lots of bottles from very early on often become rather lazy at the breast. They know they can nurse without too much effort, and yet still get their needs met by the bottle. The way to deal with this is to either eliminate the bottles. You can slowly decrease the amount you supplement, watch diaper output and weight gain carefully, and hope that a hungrier baby will nurse more and more enthusiastically, bringing your supply up. Or you can choose to supplement without using a bottle- using a Lact-Aid or Supplemental Nursing System might be really helpful to you.

    Since your baby is currently nursing so infrequently, pumping is going to be part of your life if you want to meet more of her nutritional needs with the breast. Pumping shouldn't make you sore, so I would make sure that you have the right size of breast shields. Improperly sized shields might also explain why you're having trouble producing enough, and why it takes so long to get enough milk. I'd definitely consider going back to the hospital-grade pump for now, as well- you never know if it might help.

    How often are you currently pumping?
    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

    Default Re: Not getting enough when breastfeeding

    Thank you so much for your response! I know it's been a while since I posted, but I wanted to get the SNS system before I checked back in. Thank you for the encouragement. I appreciate the reminder to be proud of how far we have come! I really need to keep that in mind through our struggles. I had never heard about one of these nursing training systems and wish I would have tried this sooner. However, I'm hoping it's not too late.

    We didn't have a very successful first try with the SNS today. I think our next attempt should be before she is too hungry. She was hungrier then I thought when we started!
    I tried the SNS without a nipple shield first. That didn't go so well. Even if there is milk flowing slowly or quickly out of the tube, she still does not want to latch and gets quite frustrated. I then tried the tube with the nipple shield. It's very hard to position the tube in the center of her mouth with the nipple shield. Plastic on plastic is just slippery. So I had a hard time with placement. Since that didn't work, I tried putting the tube inside the nipple shield. I think by this time we were both so frustrated that she didn't have the patience for breastfeeding. Is this ok if I put the tube in the nipple shield? This seems so complicated with all of the extra pieces. Do you have any suggestions? Are there any nipple shields that are shorter than the Madella brand? My nipple is so much shorter (LC at the NICU sized me with a small) than the actual shield and it seems that might be why she is so confused.

  4. #4
    Join Date
    May 2006
    Posts
    21,259

    Default Re: Not getting enough when breastfeeding

    The SNS is tricky. I found it very frustrating to use- getting it properly positioned and getting the baby on the breast at the same time... I found that using a piece of masking tape was helpful, because I could tape the tube down in the vicinity of the nipple and that made it easier to get baby to get a mouthful of breast AND tube. I know other people have luck latching the baby on and then slipping the tube into the baby's mouth while the baby is already latched, but I have no idea how they do that without a second pair of hands!

    I would definitely try putting the tube inside the shield. Worst thing that happens is that it doesn't work, and then you try something else.

    IDK if there are shorter shields- I would call the LC and find out.
    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!"

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