This is a long story, so thanks in advance if you get all the way through it!
My little guy was born 7 weeks ago at 41 weeks, 7lbs 5oz. He had a strong suck and seemed to latch well within the first 2 hours of being born (with assistance from nurses for positioning). I had difficulty getting him positioned well and latching, asked for help from nurses fairly often in the 2 1/4 days in the hospital. My milk hadn't come in from what we could tell, I didn't have any changes after delivery. On the day we were going to check out, he had lost 10% of his weight and diaper output was slowed. The pediatrician advised supplementing with formula (via finger/dropper) with the idea that it would get us over the hump until my milk came in fully. At that point we also met with a IBCLC before checking out to work on latching and discuss pumping to stimulate my supply after every feeding. We bought a Medela Advanced Personal Double Electric Pump to take home.
Once home, his first diaper had some orange tinge so he was fairly dehydrated, but after the next dropper feeding and going forward his diapers got on track to where they should be. We had scheduled a follow up with the IBCLC at the hospital Tuesday (discharged Friday). In the meantime, we were nursing then supplementing with formula and pumping each feeding. On Monday, we saw the pediatrician and his weight was definitely improved but they also noticed an issue. He was quite severely tongue tied and the doctor said having it clipped should help with the latch, so we went ahead with that. We worked on the latch and positioning again with the LC but it was still difficult. He has a very short time between giving hunger cues and becoming frantic, so often times he is screaming bloody murder at the breast making latching all the more difficult. Once he did latch, he continued to be very sleepy at the breast and we were constantly needing to coax him into wakefulness to nurse.
In the next LC follow up, I had taken a break from nursing (this would be around week 2) because it was too emotionally taxing and I knew every nursing session ending in tears wasn't good for me or the baby. We continued to supplement but via bottle, and I kept pumping after every feeding. My pumping output did increase a bit, but it was still at half or less of what he needed.
We had two more follow ups with the LC, we found some methods to help with his latch on the right side (football position) and the frantic arm flailing (swaddling). He was still very sleepy at the breast and would nod off after at most a few minutes and become very hard to rouse. We did do weighing before and after feedings each visit, the most he was able to get in the last visit was 1 oz combined after 24 minutes; LC advised to basically assume that's the max he's getting. Our plan was to continue with nursing 1-2 times a day to help stimulate my supply and practice latching with the note that more nursing would help my supply. I was still at the 40% or so BM and 60% formula.
We've been in this rut ever since. With my husband going back to work, it's even more difficult to get in time to nurse every day and now bub is eating less frequently on top of it. It takes him usually a good hour plus to eat and settle down with the bottles, then I need to pump and wash up. Sometimes I'm barely finished with all of that and he's hungry again. During the day he's usually eating every 2-3 hours, going for longer stretches occasionally late afternoon or overnight. I think he's in the midst of a growth spurt right now so he's eating a ton and we've had a sleepless night (later figured out he was just a tad hungry which made him a touch fussy and couldn't sleep longer than 10 minutes but was giving minimal hunger cues).
When nursing right now, I try to give him 15 minutes on each side but he's usually to the very hard to rouse sleep level by about 7 minutes which is definitely an improvement. He is swallowing consistently for longer periods now, but he's still ravenous once he's done nursing. He is a little difficult to read as far as fullness, he screams/shows hunger cues for 5-10 minutes even after a fully supplemented meal. I've tried just letting him sleep on the second side until he wakes up (usually 10-15 minutes) and he's in full-on hunger cue/frantic mode. I am considering making another appointment with the LC to get an idea of how much he's transferring when he does have a good nursing session, but I feel like we're still seeing about that 1 oz at the breast.
I have a fast let down, my right side production is usually half to one quarter of the amount of the left side. I almost always put him to my right side first because it needs a lot more work to extract the milk and I want his best sucking there first. I don't know if that's the best plan to get him the most milk when nursing since he is definitely sleepier once he gets to the left (despite burping and undressing, etc). Currently I am pumping at the least .5oz combined (late evening when it's only been 2 hours between feedings) and at the most 2.25oz (overnight or when it's been ~5 hours between feedings). When I pump after nursing, I get about .25-.5oz on the left side and a similar amount on the right (which is close to what I normally would pump without nursing before). During the day I get about 1.5oz on average. Several times yesterday, I got all of 5mL out of the right side. I have increased my pumping to 20 minutes (previously did 15 based on the LC's advice) because I noticed my right side would give me almost a full third or half more in the last 5 minutes (of the 20). I do have hypothyroidism, fairly mild and my dosage was not adjusted during the pregnancy. My levels went up and down but since they were technically in the "normal" range the PCP didn't want to change it. I went to have it checked 3 weeks ago with the idea it may be affecting my supply but my TSH was quite low (they did not check T3/T4 for whatever reason). I am going to try to get to an endocrinologist in the near future just to make sure the treatment makes sense.
At this point, I am getting burnt out. The days I'm alone are quite arduous since he either needs to be held or wants to play (and I want to play with him!) after eating and it's very difficult to cram in time to pump - let alone nurse to begin with. I usually need to get in a nap or two as well so the time slots I do have some time, I should be sleeping. From what I can tell, the advice seems to be I need to nurse and pump more to increase supply (I did try Motherlove More Milk Plus with no real difference seen). My frustration with nursing is that we'll spend 45 minutes with all the coaxing and still only get a small portion of his feeding in, so we still need to do all of the bottles and settling down after. He has some reflux issues so we also spend about 30 minutes after eating before laying him down if he's going to sleep.
I want to keep giving him the breast milk, whatever I can provide - but it's wearing me down. I'm looking for some hope that there is a light at the end of the tunnel. I feel like the combination of inefficient nursing and low supply is a double whammy, and if we could at least resolve *one* of the issues it would make a big difference. I know his efficiency at nursing is related to supply/stimulation but is there some other way to get my supply up reliably? For the first month, I was pumping 8+ times a day with 1-2 nursing sessions added in and my supply barely crept up. Now I'm pumping around 6 times a day with 1-2 nursing sessions. One of the LCs did suggest renting a hospital grade pump to help with stimulation, I am a bit reluctant to go ahead with that because it would be kind of pricey over the long term - not sure how long I would need to give it to determine if it was going to help with the supply or not.
Thank you again for taking the time to read all of this and I'd appreciate any insight or comments.