When baby is poor at milk removal

[@llli*krystine]

Does it still increase supply to have baby nursing without removing much milk or is the actual removal what increases supply? My twins are not good at milk removal at all but I know the skin to skin stimulation should count for something. I am wondering if I'm mostly wasting my time to have the babies nursing if they are only removing 2-12 ccs and should mostly focus on pumping (I'm pumping at least 12x/day with a hospital grade pump).

[@llli*lllmeg]

Nursing at the breast itself has health benefits, even if the baby extracts nothing. So it is never a waste of time to have babies nursing at the breast.

Frequent milk removal is what increases milk production. My understanding is that skin to skin increases nursing frequency and that is why it increases milk production. However, I may be wrong on this last point.

An infant can take very little at the breast at a time and it can still be normal. That is why before and after nursing weight checks are useful but not in any way the last word on what is going on at the breast. According to IBCLC’s I have talked to, a single, normal nursing session in a well gaining newborn infant can result in anything from NO milk transfer to 3 ounces or more.

If a baby is truly unable to ever extract milk in a reasonable amount for their age, then the next question is WHY. Is there enough milk? Does baby need to achieve a better latch? Does baby need suck training? Is baby getting supplemented to the point they are simply not hungry enough to take more from the breast at a time? What? There is some reason.

Solving that is the key to being able to mostly or entirely nurse a baby as opposed to the much harder route of eping.

[@llli*krystine]

Thank you. I know the hospital promoted kangaroo care/ skin to skin as a way to improve milk production, among other things. It's just kind of interesting because by the time yesterday ended my production was up a couple of ounces, which is a big deal for me since I'm still working to increase my supply.

I'm guessing I am still dealing with prematurity although their due date is approaching (9 more days).

Do you have any suggestions on how to train a baby to open wide and keep his tongue down? One of my twins really struggles with that. I'm now using a nipple shield for him because even when he does latch he has a hard time maintaining the latch for more than a few sucks. The shield does seem to help him.

[@llli*lllmeg]

How large are your babies now? Because they are actually past term, as gestational age of 37 weeks is considered term. I think you can expect your babies to be able to latch normally at this point, premature or no. If they cannot, I suspect something requires tweaking. A painful or not effective enough latch is a common issue even in full term babies.

I do not know what you have tried so I am putting below several links to articles on latch and positioning (finding the right positioning for you and your baby often REALLY helps with latch.) Plus just some general info. I hope you will find some things to try. If you tried some of these ideas earlier on and it did not work, try again. Things change very rapidly in the early weeks.

But often the best help when it comes to fine tuning latch is a breastfeeding helper that you see in person. Someone experienced with helping mothers and babies overcome latch issues and who you can see for long enough at a time to work on it. This usually means an IBCLC although a local LLL Leader or similar volunteer may be helpful as well. An experienced IBCLC is also probably going to be helpful in figuring out if there is some physical issue causing baby to not be able to suck longer.


As the nipple shield is helping, that may provide a clue. The shield gives baby a firmer, harder, longer than your own nipple "tip" for baby to get onto. When it is working right, the tip is well into baby’s mouth, back behind the hard palate, triggering effective suckling. So this may indicate that breast shaping (like with the breast sandwich) or something to help your nipple protrude more may be helpful when latching.

This video shows where the nipple "should" be landing in the baby’s mouth for a deep latch. (I put "should" in quotation marks because some babies nurse just fine without this kind of a deep, asymmetric latch.) For me, the most effective part of the video is the animation showing that, so you get a nice idea of what you are 'aiming' for. http://www.ameda.com/healthcare-prof...ow-to-latch-on

When breast shaping, remember to keep your fingers well back and out of the way of babies lower jaw.


Karen Gromada-author of Mothering Multiples. Big nursing twins picture gallery on this site: http://www.karengromada.com/

Tips on latch and positioning http://www.llli.org/faq/positioning.html

Laid back position http://www.llli.org/docs/00000000000...astfeeding.pdf

laid back video http://www.biologicalnurturing.com/video/bn3clip.html

Here are two simple pictorials, one on latch, one on tongue tie http://cwgenna.com/quickhelp.html

latch and 'Breast sandwich' article http://www.llli.org/llleaderweb/lv/lvfebmar04p3.html

Additional info:

What is normal in the early weeks with a breastfed baby http://kellymom.com/bf/normal/newborn-nursing/


Help-my baby won’t nurse! http://kellymom.com/bf/concerns/child/back-to-breast/

Nipple shields http://kellymom.com/bf/concerns/child/wean-shield/

[@llli*krystine]

Baby A is 6 lbs 12 oz, Baby b is 6 lbs 0 oz. I just weighed them yesterday at our breastfeeding center. They are 38w5d now. They both can latch on and actually latched on when I first attempted at the hospital, about 1.5 hrs old (my first time seeing them since I was in recovery for my section and they were in NICU). Baby A latches and then slips off, though, which I think is why the nipple shield helps him. Baby b doesn't need the shield. It's weird because they can latch on but removing milk is hard. I don't understand that.

I struggled the entire first year with my daughter and I just want these little guys to get it sooner than that. I don't mind pumping, I mean, it takes a ton of time and I don't like it but I"ll do it if that is what they need but I just really want them to be able to get their nutrition straight from me and not have to deal with pumping and washing pump parts and bottles for forever.

I guess I have large nipples now. With DD they were flat and then with all the pumping and nursing they weren't flat any more, now just lg, and one of my LC's at the NICU said that might be hard for the babies to take. I will look at all of those links, I do the shaping and always hold my breast when I feed them (did that with DD too).

[@llli*lllmeg]

OK so both are now at normal newborn weight. So while yes, babies getting bigger and stronger of course helps, there is nothing about your babies size or weight that would necessarily interfere with latch or milk transfer ability.

Re: nipples are too large. Ok, yes, it happens, but we would be talking extremely large, thick nipples. And if the nipple shield is helping, that is making your nipple even larger! So I doubt this is a large nipple issue or much of one.

Laid back positioning often helps with "slippage". Gravity helps baby stay on the breast.

When was the last time you did a before and after nursing weight check?

How does nursing feel?

Since babies can latch, what about trying an at the breast supplementer?

[@llli*krystine]

I just attempted laid back with Baby B and I struggle with him bobbling around and me trying to hold my breast. We did try it but he was pretty upset and didn't end up really staying latched, mostly just screamed.

I did before/after nursing check yesterday and Baby A got 2 ccs and B got 6 ccs in spite of swallowing quite a bit.

Nursing feels comfortable. If they latch on too shallowly I break it and make them try again. I know how it should feel because of nursing DD and I don't put up with a bad latch because I know it's damaging to me and not the best way to get milk out.

I watched the Ameda video. My problem with finding them alert and about ready to nurse is they seem to be either fast asleep or awake and crying.

Do you mean like an SNS? I have never tried one...I can ask at my appointment on Wed (seeing another IBCLC).

[@llli*lllmeg]

Hmmm. Yeah, you need to have an IBCLC observe a nursing session. It does not make sense that you have milk, babies can latch, latch is comfortable (a good indicator latch is ok) and milk is not transfering better than that particularly if baby is swallowing! I assume these were nursing sessions of 10-15 or more minutes?

Laid back- usually feels awkward at first. Adjust as needed, this is a very adjustable positon. If a baby reacts like that it may mean you are TOO laid back. Mom need be only slightly reclined. Or, try latching baby however works best for you and then relaxing back slightly. Baby can be in any position. I know it can feel weird but I have seen this work well for so many really troublesome latch babies. Bobbing is (usually) normal rooting behavior. Baby is trying to bob right onto the nipple.

Yeah, like I said the best thing about the ameda video is the animation, that baby has got to be the most relaxed, alert, cooperative newborn I have ever seen. It's not usually like that!

BUT, it is very important to try to nurse when babies are as calm as possible. You said you were doing skin to skin. So, you can keep baby(ies) skin to skin (or just on you with very easy access) until baby(ies) start showing subtle rooting or cueing behavior. Then move them toward the nipple like in cw genna latch help pictoral. The biological nurturing video shows some early cues nicely, and I have linked an article on cues below. Or you can simply offer prior to any cue. Even if baby is asleep, baby may show rooting behavior and even be able to latch.

SNS is one brand of lactation aid. There is also the LactAid and there is a way you can fashion a homemade one. Here is an article about them and a video showing one being used: http://cwgenna.com/smartnothard.html (BTW this IBCLC-Catherine Watson Genna, wrote the book (literally) on supporting sucking skills in newborns. So your IBCLC should be familiar with her work.)

and video: http://www.breastfeedinginc.ca/conte...me=vid-lactaid (Newman has many other nursing videos fyi)

feeding cues http://www.llli.org/docs/00000000000...eding_cues.pdf

[@llli*krystine]

I nursed them both in bed this afternoon when we were napping together. We do co-sleep and I wear them in my Moby whenever I can (DH is wearing one of them right now while I pump). Since we were in bed and they had fallen lightly to sleep then woke up I was able to catch them in a fairly calm state but just now little guy just woke up in Moby with DH and he's crying with no stirring first...good grief they are confusing some times! I co-slept with DD for the primary purpose of improving our breastfeeding so I could catch her more during the night to nurse. Now during the night feeding is harder because right now I am just so incredibly exhausted it's hard to nurse them and pump and typically I've just been pumping in the middle of the night.

My little guy who was swallowing yesterday I had nursed for over 20 minutes. I was really hoping he had got more. The most either of them have ever gotten is 16 ccs when we've weighed them. I believe I have just about the right amount of milk for them - yesterday I pumped 1032 ccs and they drank 955. I let down in a pretty timely manner and this afternoon when I was nursing my bigger guy with the shield he did get a let down because the shield was full of milk. Why he doesn't easily just swallow the milk sitting in the shield is beyond me.

Most of the time when I've tried to nurse them sleepy they've been to sleepy to open their mouths even with me brushing their mouths with my nipple. I'll check out those videos, too, thanks!

[@llli*auderey]

krystine, i just want to say: you are doing a great job and you will figure this out!! hang in there