Stuck in a rut, low supply/supplementing inefficient nurser

[@llli*rviolet]

Two hours after feeding overnight (5oz of breast milk and formula) baby was alert and active, he didn't get any sleep. He had spit up more than usual earlier then he started showing hunger cues (lip smacking, rooting, then escalated to some head shaking/hands around mouth) so I decided to give him a go at the breast. I figured he could eat if he was really hungry (was concerned he was trying to soothe a tummy ache or reflux) but it would be slow and we could spend some time before supplementing. We latched on the "easy" left side and he nursed actively for quite a while. I didn't need to coax him, there were a lot of pauses but he kept picking it back up himself. He nodded off a few times but roused and continued nursing. There was a lot of comfort sucking but I figured that would be okay. He broke the latch for good after about 45 minutes and slept a bit. He woke up and I burped him and he quickly became livid, screaming his hunger cry with lots of frantic arm flailing and head shaking. I tried to quickly ease him onto the right side but he had no interest in latching on. Usually I can get a latch even if he's mad but this was a struggle. He latched but never settled down, kept pulling off to scream and pushing my breast away. I tried moving from football to cross cradle then laid back, but he was just not having any of it. I prepared his bottles (1oz breast milk, 2oz formula; which was overly optimistic). I tried to add some pauses in but he was screaming any time we stopped eating. After the 3oz, I tried to pacify him to see if he was still really hungry or just wanting to comfort suck or his brain hadn't caught up with his tummy. He didn't calm down, so I prepared another 1oz of formula and then he was satisfied after eating and fell asleep.

[@llli*mommal]

He's 7 weeks, right? That's prime time for fussiness, especially in the evenings. Sometimes it's so bad that it can be termed colic- both my kids were like that. They'd wake up in great moods, eat and nap well throughout the day, but they would become progressively fussier as the afternoon wore on. By around 7-9 o'clock, they would go into full fuss mode- refusing to nurse, or latching on for a few seconds and then letting go and screaming. With my first daughter, a bottle would often defuse the fussy period (we were using supplemental bottles due to some latch and supply problems). We would give her a bottle and she would sometimes pass out for an hour or two. My second daughter didn't get any bottles, and I had to be a lot more creative with her when the evening breast refusal period struck. Some things that worked:
- White noise- radio static, vacuum cleaner noise, dryer sounds
- Calm house- lights, TV, and stereo down or off (my DH hated this- he always wants to BLAST music in the evenings!)
- Motion- swing, sling, stroller, rock, etc.
- Closeness- snuggle baby close in a sling or skin-to-skin
- Water- give baby a warm, soap-free bath in the sink or get in the tub with the baby
- Trip outside into the fresh air
- Nurse nurse nurse nurse nurse- if baby is willing!!!

Coping with colicky sessions is all about changing the baby's sensory inputs, and focusing on the things that are most soothing, most non-stimulating. Nothing is likely to work for long, so be ready with the next soothing technique when the first one fails.

I re-read your post above and it seems like your experience was in the morning, and probably not related to colic/fussiness- but I'm going to leave what I wrote above as is, just in case it's useful in other situations.

It sounds like this morning- when was this? Really early, I'm guessing- your baby woke up from a brief sleep and was really fussy. I,m wondering what would have happened had you offered the breast instead of trying to burp baby- often you can defuse fussiness by getting the baby latched on as fast as possible, before early hunger cues escalate into full-throttle franticness. Which is a long way of saying that when baby wakes up, offer the breast ASAP, even if it's been 5 minutes since baby ate and fell asleep.

[@llli*krystine]

Fussiness peaks at 6-7 weeks, mommal is right. With DD I was beyond wanting to pull all my hair out at that age and she had a ton of breastfeeding issues. I'll PM you a link to our story LLL published but it was a lot of work and I really really feel your pain and difficulty of your situation. Right now I'm breastfeeding twins and pumping and it's sort of similar but different and I can tell you one thing I am doing differently this time is using an at-breast lactation aid, and I do recommend it. It takes a little while to get used to it but it gets you more stimulation, thus increasing supply and also gets baby satisfied at breast so they're less likely to get a flow preference to bottles or start a nursing strike because they're so unhappy with breast (DD did that for 5 mos. It was very very emotionally draining on top of physically). You are doing a great job. I second the hospital grade pump. I use a medela symphony I rent. The double electric personal use pump is just fine when nursing is going fine and you just need to pump at work, for most women.

Take care. I know it's hard. Just nursing even a little will keep that relationship up that even though it's not easy now when Baby gets older and things smooth out, nursing is really a beautiful snuggly, bonding thing.

[@llli*rviolet]

Yeah, so we fed him the 5oz at 12:45am and he woke at 2:45am looking hungry. Spent about 45 minutes on the left side and zonked out for a bit. Spent some time trying to get him going on the right side and I wrote down the bottles with 4oz at 4:20am. He didn't wake this morning until 8:40am so I got a little sleep, just fed him 4.5oz (1oz breast milk) and he must have been super tired because he passed out while on his play mat (usually I have to keep a close eye on him so he doesn't get overstimulated and cranky, he hasn't fallen asleep there since he was probably a week or two old).

I do have to say though the only times he's extremely fussy and difficult to console (which I then later attribute to hunger) happens in this overnight time. It's not every night, thankfully, but 2 or 3 nights a week he will have trouble settling into sleep until 3am-7am. Our pediatrician attributed his fussing/colic overnight to being overfed/having a tummy ache so I became pretty paranoid about feeding him too much (his weight gain was above average but he's still pretty lanky looking). It's those times when I really want to be able to offer the breast since I know it's less of an issue then, but if he really is hungry I know we're going to spend a lot of time and not get much food out of it.

[@llli*rviolet]

Thank you Krystine. It really helps to hear some encouragement and stories of being able to overcome similar issues. I'm a problem solver type personality and I've looked up every issue we've had a million times it feels like now and this has to be one of the most frustrating things I've dealt with. There's so many variables and that I can't at least get my body in line can be really emotionally taxing. I'm going to try the SNS again today hopefully and see how it goes. It would be nice to be able to consolidate the bottle feeding into good nursing stimulation. I'll also look into the pump rental.

[@llli*lllmeg]

it sounds as if you are assuming that more food into baby = more (longer) sleep stretch, and not enough food into baby = shorter stretch and baby waking starving. Lots of people think this and it is completely incorrect.

A newborn baby (and yes your baby is still a newborn) is COMPELLED to nurse FREQUENTLY. That means baby is going to wake frequently, night and day, wanting to suckle. Biology set it up this way so 1) baby would get enough and 2) mom's milk production would be stimulated as needed.

All nursing is comfort to a baby. So called “Comfort nursing” is normal, needed and healthy! Your baby WILL NOT overeat at the breast. Only bottles can cause overeating.

5 ounces is an unusually large feeding for this age. Was this when doing paced bottle feeding, with a slow flow nipple, taking pauses? The problem with large feedings is 1) they are not healthy overall and 2) they interfere with baby’s normal cues and consequently, with breastfeeding. . If possible, it is best to keep all aspects of feeding as much like breastfeeding as possible, so that means that, when supplementing, to try to keep feedings frequent and small. 2-3 ounces at a time at most, maybe 4 on occasion, but also maybe 1 on occasion as well.

It sounds like your confidence has been really rocked from the beginning. You were even told in the hospital that your body made your baby overheated when it was probably because baby was swaddled! This just makes me crazy that someone said that to you. A baby’s natural place is right on top of mom, snuggled on her chest, as close to mom as baby can be, (NOT swaddled, but clothing optional as is most comfortable for you both.) Safe on momma is “home” to baby.

I can only suggest that 1) You know your baby best. Trust yourself and trust your baby. I suggest, stop thinking you are starving your baby. Try not to even think that word! As long as your baby continues to gain well, baby is doing fine. 2) A mom can only do what she can do. You are working REALLY hard, and that is all you can do. You deserve to get as much help as you can with everything else so you can concentrate on yourself and your baby. 3) Please try to find local breastfeeding SUPPORT and talk again to your LC about your plan if it needs tweaking to make it work better for you.

[@llli*rviolet]

Thanks. For the record, I am fine with him getting up every 2-3 hours to eat. We certainly don't want to push any more food on him than he wants in a feeding. It is easier for me if he eats frequently so I can keep up with pumping at the higher frequency. The only reason he's been getting the large volume is based on what we're seeing as far as crying/hunger cues. We do use a slow flow nipple and stop at intervals and try to pacify the crying to see if he's full but doesn't know it yet. It's quite rare for him to close his mouth and signal he's done feeding with these pauses. It's a great relief when he does! When what we perceive as him not getting enough happens, he doesn't stop crying or fussing and can't sleep. He might nod off with the pacifier, but as soon as he wakes up (a couple of minutes) he'll start crying again. The only thing I can figure is that he's sleeping through being hungry and gets to the point where he wants a lot to eat at once, I don't know if that makes sense. I've been trying to gently wake him during the day every 3 hours to see if he's hungry, most times he is. But he will stir and go back to sleep several times for another hour plus if I don't get him up.

[@llli*lllmeg]

I know you don’t mind feeding often, I am suggesting that you are thinking your baby is hungry all the time, and it may well be that baby simply wants to suckle more. Unlike bottles, nursing is for comfort AND food. So you can offer to nurse baby as much as you like.

It's quite rare for him to close his mouth and signal he's done feeding with these pauses

Think about how a baby nurses. They don’t close their mouth to pause. They stop actively sucking and the milk flow stops or slows as they wish. If they are actually unlatching, they actually have to open wider in order to unlatch.

With a bottle, even with a slow flow nipple, milk drips out of a bottle that is held wiht the milk angled above the bottle nipple. Even slow flow, even nipples that are supposedly "more like the breast" etc, will drip. Milk keeps coming, baby cannot stop it coming. If baby opened his mouth when milk is dripping into it, he might sputter. He might gag. So he does NOT open his mouth, even if he wants to pause.

I am not sure if you are doing paced feeding as described in the document I linked before. If you are, please just ignore this post. But if you are not, PLEASE read the document again. http://www.llli.org/docs/00000000000...astfedbaby.pdf And watch this video. http://www.youtube.com/watch?v=UH4T70OSzGs I don’t particularly like what she says about timing, either the time between pauses or the intervals between feedings, because that will be individual depending on baby. I would also say, she keeps the bottle in babies mouth, when angling the bottle down, and that is fine for the first part of the feeding, but then you can start trying totally removing the bottle to see if baby is truly done. But this shows you very well the right position to hold baby and bottle and how to allow baby to take pauses.

[@llli*rviolet]

I have tried to use the paced feeding, but seeing the video did clarify some things about moving the bottle. When doing the tilt forward, he just kept sucking air until we got the milk back in the nipple. I'm curious if using the tilt down she shows will be any different. We've been removing the bottle to check for fullness all along, but it's pretty unusual that he shows he's done. We've just tried to decide how much we should be feeding him, remove bottle and give him something else to suck for several minutes and then see if he's satisfied or still acting hungry. I wonder if we can work in more pauses without him going crazy that he'll have time to realize he's hungry during the feeding so we won't have to do the guesswork. That would be a great help! Before these recent ravenous few days, he'd been taking about 3.5oz but he'd been sleeping more so was down to only 6 feedings a day.

[@llli*krystine]

I know this is controversial, but we finally introduced pacifiers to get my boys to take smaller meals more often. Their wt gain was good and they were 2 mos old. My LC suggested it and I know it's better to just nurse when ever they want to suck. Since I have twins I have to do some things that might not be textbook ideal for nursing, I feel, in order to keep everyone fed and everything. I don't know, but with bottles I think they drink faster than they can meet sucking needs whereas exclusively nursing at breast babies can just nurse a ton and life is good.

http://www.breastfeedinginc.ca/conte...me=vid-lactaid

Good video on inserting a lactation aid. I can't say enough good things about Dr Newman and the use of a lactation aid.

http://www.breastfeedinginc.ca/conte...vid-reallygood

video of really good drinking. This helped me recognize how a baby looks while really removing milk. Also, if you get the lactation aid, you can see your baby really take in milk and see the jaw movements. It was quite a learning experience even for me after nursing my daughter over 3 yrs!