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Thread: EBFing 5wk old...getting diff opinions from LCs + ped

  1. #1

    Default EBFing 5wk old...getting diff opinions from LCs + ped

    I have been EBFing my 5 wk old daughter and have been starting to have some difficulty the past week or so. I am getting different opinions on what is happening and what to do about it from the two LCs I've been seeing and my ped. I'm confused, worried, and having a hard time emotionally thinking that my daughter and I won't get the hang of this, or that she is not getting enough to eat. Here's what has been happening - apologies for a long post but want to be thorough!

    I will start by saying that her weight gain is good (born Sept. 8 at 9.7 lbs and weighed 11.2 lbs on Oct. 11) and she is having plenty of wet and dirty diapers. Dirty diapers have become more orange than yellow, and are mucous-y. She was 8 days overdue.

    -At birth, she was given to me immediately and I nursed her. Over the next few days (before milk cam in), my nipples became sore and scabbed. She was either screaming or trying to nurse. The home nurse that visited us recommended a supplementary feeding of formula based on her weight loss (9.7 at birth and 8.3 three days later) and we did this twice out of sheer exasperation - I had a long and difficult labor and was discharged from the hospital just 24 hours after her birth. Neither my husband or I had slept more than an hour or so in days. I also pumped a few times so that if supplements were needed we would not need to use formula.

    -Day 4 or 5, my milk came in very strong and I became engorged. In the next few days it became clear that I had a very abundant supply and a forceful letdown. The primary issue now became that my daughter was choking, sputtering and gulping for air at the breast as it was like drinking from a fire hose! Her latch was not textbook - she seemed to clamp down with her gums (I assume to control the fast flow) and thrust her tongue more than actually suck. I tried to work to get her gums to flare, pull chin down, etc. which sometimes helped. She rarely nursed more than 10 minutes per session and on one side only, pulling off frequently to breathe with her mouth. Nipples healed fully and I did not experience any more pain while nursing.

    -October 1 (3 wks old) I saw an IBCLC at our peds office to discuss how to manage the oversupply/OALD. She watched us nurse with minimal difficulty. Baby was weighed before and after, and she had taken in 4 oz. on one breast in less than 10 minutes. She gave me some tips about nursing with the OALD - all things I'd already been doing (moderate block feeding, reclined positioning, pull baby off when letdown occurs and catch spray with cloth, etc.). She reassured me that some of these kinks would work themselves out with time as my body adjusted to my daughter's needs. I felt good and we went on our way. Shortly after, assuming that nursing was well established, we did introduce a pacifier to help with my daughter's constant need for non-nutritive sucking (if suckling for comfort at breast and milk came out, she was very mad). She happily sucked the paci and continued to nurse well (or so I thought). It was a godsend for our fussy evenings where she wailed from 4 or 6 pm to 10 or midnight.

    -October 10 (5 wks old) I saw another IBCLC independent from my peds office. The newest development in the past few days was that my daughter had begun fussing, bobbing, and clawing at my breast during feedings - particularly at night - although sometimes during the day. I was in tears most feedings seeing how upset my daughter was and worried that she was hungry but not eating. She also began spacing feedings out to about 6x per day from 10-12x previously. I was worried about how long between feedings she was going. The LC was not able to get baby to suck on her finger or latch correctly at my breast for the entire visit. Her assessment was that baby does not know how to suck and just gums the breast. With my oversupply issue beginning to correct itself, baby is having to work to eat and thus the fussing and angry feedings. She recommended suck training with tube and syringe, pumping 8x per day, and nursing when possible. I was devastated and overwhelmed. Here I thought that my issue was *too* much milk and now was being told my baby doesn't know how to eat. I was also told she has a high arched palate. The LC also instructed me to have cranio-sacral work done to help with mild torticolis (sp?) on one side of her neck. I left the appointment and cried and cried. I want desperately to EBF my daughter but knew the regimen was too intensive for me to maintain for any length of time, particularly given my fragile emotional state and lack of sleep.

    -October 11, I saw our pediatrician for a weight check and to discuss the advice I had been given by the lactation consultant(s). She was pleased by baby's weight gain pattern. Her assessment was that baby *does* know how to suck, or her weight would be suffering. (Baby was born at and is still above 90th percentile.) She watched me nurse and noted baby was coming off breast frequently, did not have the best latch but was still doing relatively well. She sucked on the ped's finger right away but then started gumming it after a bit. She felt baby is a lazy eater given how easily she was able to get milk due to my OALD, and that as she continues to develop, her suck/swallow will get better and we'll do just fine though it might be a bit fussy in the meantime. She told me to continue nursing my baby when she is hungry, work on practicing sucking with my finger when baby is willing, and to return for a weight check in 10 days. She also told me to not get hung up on how long baby nurses, or how frequently (within reason). We discussed that I might have been upsetting baby by trying to force feedings when she was not truly hungry or during times when she was just simply upset (fussy evenings). Finally, she reminded me that baby is only 5 weeks old and BFing takes time to perfect for both mama and baby so not to get discouraged. I left the appointment feeling much better about my ability and baby's to work through this in a way that is healthy / manageable for both of us.

    But....I am still second-guessing myself and confused by all the conflicting advice I've been given. She definitely is NOT a good sucker, though we are getting by. Feedings are hit or miss. I do think there are times she is hungry and gets frustrated because she can't immediately latch. I try to catch her as she wakes up from a nap since she seems to do best then. I'm worried about how much she is actually getting, and what that means for my milk supply. She still does not eat for more than 10 minutes (often less) and I'm already worried about her ability to suck on a bottle when she goes to daycare in 7 weeks. The few bottles she's been offered have taken her an hour to do 1-2 oz.

    Has anyone had a similar experience? Did it work itself out? Based on my situation, do you have any advice for me?

    Again, sorry for the super long post. I really, really want to BF my daughter but not at the risk of my emotional health. I subscribe to the theory of happy mama, happy family...and BFing is anything but happy for us right now.

    Thanks in advance for your words of wisdom!

  2. #2
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Wow I can see why you are frustrated! That really is conflicting advice. I have not been in this exact situation, but I have certainly gotten conflicting advice on breastfeeding issues. What worked for me was to gather the evidence/info/suggestions from respected (by me) sources and then do what made the most sense to me. Remember, you are the expert on your baby.

    The newest development in the past few days was that my daughter had begun fussing, bobbing, and clawing at my breast during feedings - particularly at night - although sometimes during the day.
    is this still happening? Did you block nurse or start hormonal birth control do anything erlse that would dramatically lower production? This sounds to me like normal kneading behavior made frantic because baby is overly hungry (due to not eating very frequently) and/or baby is uncomfortable or in an awkward (for baby) nursing position. It could also be due to low production or forceful letdown. Did the lc who told you to pump offer any other suggestions- hand expressing a few drops to give baby instant reward? Laid back nursing position? Sidelying position?

    You do not give exact weights. If you average it out, between the last two weight checks, did baby gain about an ounce a day? Or significantly more or significantly less?

    Is nursing painful or uncomfortable for you?

    Do you know the typical early cue signals and offer to nurse at those times? And if baby does not want to, try again shortly?

    As far as the second lc's advice to pump 8 times a day and basically fit in nursing sessions around pumping-why would this be needed, if weight gain was normal? Are you certain she wanted you to pump instead of nursing? I find that unusual. Limiting nursing at the breast is something that is almost never helpful and is usually only considered if mom has extreme nipple injury and needs time to heal. Suck training, if needed, can occur while baby nurses a normal amount. Pumping, if needed for low production, should ideally occur along with a normal amount of nursing. And supplementing, even with your own pumped milk, is only warranted if baby is not gaining appropriately at the breast.

    On the other hand, if your baby truly has difficulty latching and suckling that cannot be ignored, as even if baby is gaining fine now it will catch up and probably cause issues with weight gain and milk production down the line. These two lc's work together. Right? So they should be working together on your case...can you see the first one again? Get clarity on the plan from the second?

  3. #3
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    how frustrating! I agree with everything meg says/asks, including wondering whether you might have actually switched to LOW supply. dr jack newman posted on facebook about a week ago a scenario a lot like this - going from huge oversupply to undersupply, and mom/health care people assumed OS was still the problem. but if she's still gaining well even in the last week or so, that's less likely. has she been weighed that recently? same scale etc?

    and as far as daycare and bottles - don't borrow trouble. 7 weeks means more than double her lifetime, so what she'll be doing then is totally different from now. for now, focus on making the breastfeeding work. and i agree about not worrying about how long feedings are - 10 mins can definitely be enough! watch the baby, make sure she's swallowing at the breast, get weekly weights, and gauge by that instead.
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  4. #4

    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Thank you so much for the quick responses!

    I think low (or lower?) supply is possible, especially with the emotional stress I've been under and baby's latch/sucking issues. As the day has gone on I am no longer feeling the strong letdown reflex though I can express milk and I still have milk spraying when she nurses. When I pump, I'm getting about 5 oz between both breasts. I'm not sure if that's a good amount or not.

    To answer the questions above...

    -No pain when feeding. Nipples are not sore at all. The head bobbing and thrashing continues for feedings in evening or when I do not catch her at just the right moment to attempt to latch. Often she will latch, suck 1-2x and then unlatch and cry. I have tried compressions, expressing milk to give her instant reward...did not seem to make much of a difference.
    -As far as positioning is concerned, we have tried every position. She does best with cross cradle so that has been my go-to. When she is upset in the evenings it doesn't matter what position I try, she starts screaming as soon as I even begin moving her toward breast. I do hold her topless while she is calm to see if she will latch on her own. Never happens.
    -The second LC recommended nursing when possible *in addition* to pumping 8x daily. Sorry if I wasn't clear!
    -The two LCs do not work together. One is in my Peds office and the other came recommended by my doula. She works as a midwife out of a local hospital (though not where I delivered). I just thought it would be good to see more than one in case they had different opinions (and of course they did!)
    -Last two weight checks were 10/1 (10 lbs 12 oz) and 10/11 (11 lbs 2 oz). If I am doing my math correctly that seems to average to less than 1 oz per day...again, ped told me her gain "looked great."?? She was weighed on the same scale in a clean diaper both times.
    -I know hunger cues and try to catch them very early since I will have a very short window to try to get her to nurse. I do offer whenever she acts hungry but am getting very anxiety-ridden about it, since she gets so upset so quickly if I try to make her nurse (whether it's because I'm forcing it or because she is frustrated in not being able to latch right away, I'm not sure.) she has had very fussy evenings since birth and this makes it even harder to tell if it's hunger making her upset or if it's just the stage she's in. Today she nursed 3x between 8 am and 1 pm just fine, and then when our 4 pm feeding rolled around she was irate (maybe I should have woken her sooner?) and we resorted to giving her 1.5 oz by bottle to ensure she had something in her tummy.

    I know I am probably overreacting, but I'm on the verge of throwing in the towel and just asking for help in getting her to take bottle and then EPing or doing some combination. Every evening is a struggle with me crying hopelessly because she won't take breast or bottle well (or at all) for several hours. I know she must be hungry and it's killing me to see her cry with what I assume is great hunger. It's not good for me, baby or husband to go through this daily and I just want to know she is getting enough. I am willing to try whatever we can within reason but if I took the advice of the second LC to nurse, pump 8x a day, and then also finger feed I would literally not have any time to take care of myself which is hard enough right now the way it is!

  5. #5
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Two things jump out at me. The first is the timing. It seems like you had fussy evenings starting at 3 weeks, and then the fussiness intensified at around 5 weeks, am I correct? The second thing that stands out is that the baby's fussy behavior intensities as the day goes on. These two things together- they are very suggestive of what people call "evenings-only colic". As far as I can tell, this is a subspecies of colic that occurs primarily in the later parts of the day. Both my girls had it- they were evening screamers from around 3 weeks to around 3 months, and the worst of it was definitely around the 6 week mark. It was just so upsetting- there was nothing that would calm them for more than a few minutes at a time. Here are some of the things that worked:
    - Nurse- if baby is willing!
    - Calm house. TV, lights, and stereo down or off
    - White noise (e.g. radio static, dryer sounds)
    - Motion- stroller ride, sling, swing, bounce on exercise ball, rock in a rocking chair, etc.
    - Closeness- snuggle baby close in a sling, or skin-to-skin
    - Water- give baby a warm bath in the sink, no soap.
    - Trip outside into the fresh air.
    It's all about changing the baby's sensory inputs and making everything as calm as possible. When one trick stops working, you try another.

    Don't throw in the towel over this mama. Colicky evenings are AWFUL- trust me, I know!!! But they are also temporary.
    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!"

  6. #6
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Can you get to a LLL meeting?

    You have tried every position-I have nursed three babies and I have not tried every nursing position. Because there are an infinite number of nursing positions. Have you tried leaning back and pulling baby to the breast from over your shoulder? Have you lain baby on a blanket on the floor and leaned over baby? Have you nursed baby while standing up and walking around? These are all nursing positions and there are many more. In another post I am going to link some info below on positioning but the key is to play around and find what works for you and your baby.

    The weight gain of 6 ounces in 10 days (were these on the same scale? This is vital) suggests neither over or under production. It is slightly lower than average, but certainly not unduly alarming. (of course this is a small time sample as well.) Plus your baby was only nursing about 6 times a day during this period, correct? That is not typically frequent enough for a newborn. Your ability to pump 5 ounces at a time indicates very good production.

    I suggest
    Try comfort measures mommal suggests.
    forget about long feeds. Offer frequently. OFFER. do not force or pressure. Maybe your baby prefers short nursing sessions.
    Stop all bottles until if and when supplementation is necessary. Your baby is gaining ok with breastfeeding. As long as that is happening, bottles can only cause problems.

    If you are not supplementing and baby gains normally and nurses at least 8-10 times a day, there should be no need to pump. But since this was so strongly suggested to you I think you need to talk to that ibclc again. Maybe she wants you pumping after nursing sessions to ensure adequate milk removal. That is not an unusual recommendation, but if it is causing you to much stress, it may be counterproductive. plans can always be tweaked as needed.

    Sometimes giving an upset baby a very small amount of expressed milk in the bottle or syringe helps baby calm down and nurse. This is another of those instant reward ideas I suggested above. There are more in the kellymom article below.

    I am confused by why you are thinking these are problems that warrant not breastfeeding when in general that is your preference. I mean, obviously, I personally think the benefits of nursing are enough to keep trying even when there really big challenges. But you seem to think breastfeeding is making you and or your baby unhappy and life would be better if you were not breastfeeding. Life with a newborn is pretty challenging no matter how baby is fed. Many moms here can attest that as far as breastfeeding goes, in most cases, when it starts out rough, over time, it gets better, then it gets ok, then it gets easy, then it becomes so much a part of your life you wonder how you ever considered not nursing. This is the experience of many (of course not all but many) breastfeeding mothers.

  7. #7
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

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

    Tips with pictures on latch and different positioning ideas (includes side lying) 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, you want the one on latch. Notice that the mother is in a “slightly” laid back position, looks like on a couch? This is a very “adjustable” position, play around to find how you and your baby are most comfortable. http://cwgenna.com/quickhelp.html

    This video is not in English but it does not matter. Shows the versatility of laid back nursing: http://www.youtube.com/watch?v=7SZ3zb5OYMA

    latch and 'Breast sandwich' article http://www.llli.org/llleaderweb/lv/lvfebmar04p3.html (probably only needed if baby cannot latch or latch is hurting mom)

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

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

  8. #8
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Hi I wanted to try to clarify a couple things as I was rushed last night. -
    The second LC recommended nursing when possible *in addition* to pumping 8x daily. Sorry if I wasn't clear!
    You were clear. I would interpret that as, nurse if you can, but pumping is more important. And I question that in your situation. Babies learn to nurse by nursing. Maybe I am interpreting the words incorrectly of course, but to me that sounded as if limiting nursing was being encouraged.

    The problem is that even with clearly needed pumping (mom has low milk production low and/or baby cannot nurse efficiently) pumping and nursing and supplementing can be very overwhelming for a mom. This alone can cause a mom to feel hopeless and exhausted and stop nursing, so what is gained? So any suggestion to pump & supplement without clear(er) indications of one of those two issues, it may be best, imo, to revisit.

    The two major issues when breastfeeding is if a baby is NOT gaining normally at the breast and/or, if nursing hurts mom. If a baby IS gaining normally and nursing is comfortable for mom, in most cases, any other concerns are a matter of practice, confidence, and fine tuning.

    Without knowing more of the exact weight history, (and I know I did not ask) your baby does appear to be gaining normally(?) via nursing at the breast. Your pediatrician seems to think so and that is a good indication it is ok.

    And at the first visit with an IBCLC, baby transferred 4 ounces at a before and after nursing weight check. Which is excellent transfer. Milk transfer at typical feedings after about two weeks of age varies from less than 1 to about 4 ounces, with 2 ounces being the minimum that typically makes IBCLC’s happy when doing a before and after nursing weight check.

    The weight gain and that milk transfer plus your pump output are all evidence that you make enough milk and baby IS able to nurse efficiently. So unless something very dramatic changed between the two IBCLC sessions, I wonder if you just had a really difficult session (as far as baby cooperating) with the second IBCLC and she became understandably alarmed due to what she observed-a baby who would not nurse and seemed disordered with sucking.

    Did she give you suck training exercises that do not involve finger feeding? Have you tried them? Do they make sense to you?

  9. #9

    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    Thanks for all of the thoughts and helpful links. I have spent a lot of time on Kellymom and Dr. Jack Newman's site in the past few weeks. They are excellent resources. Regarding a LLL meeting, I'm fortunate to have one in my neighborhood and will be going this evening. I'm also going back to LC #1 tomorrow morning to get help with latching and to discuss the situation, since when I originally saw her we primarily discussed OALD/oversupply which seems like it is no longer the issue.

    I realize that we are at the peak of newborn fussiness, and that could be a major factor here. We are using / have used many comfort measures...bouncing on the exercise ball and wearing her in the sling have been the most effective but we also mix it up with baths, rocking, walks outside, white noise, swaddling, walking and bouncing, soft music, etc. Many evenings she is alternating screaming and dozing from 4 pm to 10 pm. Regarding nursing positions, I should have said that I have tried all of the positions I was aware of / could think of Baby has very little patience for trying something new when she is upset so I'll try some of the others during the day when she might be more receptive.

    I guess what I'm most concerned about is her lack of intake during these long fussy stretches. I do offer frequently, and I don't force. But this often means she is going 6+ hours in the evening without much more than a few minutes of nursing. Yesterday, for example, she nursed 8x in 24 hours (all under 10 minutes on one breast, she always refuses the other breast) but only nursed for a few minutes between 2 pm and 10:45 - and they were not a very productive few minutes. I'm not worried about the short nursing sessions - she has always done that. I'm worried about the short nursing sessions combined with their decreased frequency and increased fussiness.

    As I mentioned before, we resorted to offering a bottle during this time as she was giving very clear hunger cues but not willing to nurse. The bottle did not calm her down much, so I suppose the behavior could be attributed to fussiness but that seems like way too long for such a young baby to go without a substantial feeding? I think this is the part that is causing me so much distress. I really think there's nothing worse than seeing my child root and smack her lips or stick out tongue and then when I try to (gently) move her to breast to nurse she becomes even more upset and we start the screaming/calming cycle all over again. I feel like I'm failing as her mom if she is hungry and I cannot help her get the nutrition she needs. I agree breast is best and that it's worth working to overcome challenges but I guess I was desperate last night! While she's upset it is easy for me to rule out things like whether she has a dirty diaper, is too hot or cold, wants to be held or worn, etc. but no way to know how much she has eaten if at all or how hungry she is.

    --

    I just saw the latest reply after I finished typing this. I think the change between the two LC visits was 1) baby did not latch at all during second visit and 2) milk supply was greater (or at least I think it was) when I visited the first LC. My breasts have since become much smaller and softer - no longer leaking, either, which I have read is normal as your body adjusts to baby's needs but it has been such a dramatic change.

    Weight history so far is:

    Sept 8 (birth) - 9.7
    Sept 11 - 8.3
    Sept 13 - 9.0
    Sept 19 - 9.11
    Oct 1 - 10.12
    Oct 11 - 11.2

    I was given a French tube and syringe to do suck training but baby was not cooperative to this at all - and then my ped told me to just use a finger without syringe or tube to practice since her weight gain was fine and she was transferring milk albeit with a sloppy latch.

    And I will get another weight tomorrow. I am hoping baby will be willing to nurse when we see the LC because I'd really like to know how much I am transferring.

  10. #10
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    Default Re: EBFing 5wk old...getting diff opinions from LCs + ped

    OK I think it is very good you are seeing the first LC again. The only thing I find alarming in your last post is the baby's refusal of one side, I would definitely discuss this with your LC. Are you expressing milk from that side? If baby is truly refusing to nurse on one side, that would be a reason to pump or hand express on that side.

    As I believe someone mentioned above, when a mom has op early on, it can feel very dramatic to both mom and baby when it levels off. So p[erhaps this is contributing to baby’s issues at the breast.

    Weight gain from lowest known weight is 3 lbs in about one month. Excellent weight gain.

    ONE 6 hour stretch without nursing per 24 day is fine at this age as long as baby is gaining well and nursing with good frequency overall. Weight gain is good, but frequency is still a tad on the low side. But more importantly, I (and I am sure you) would be happier if baby was sleeping rather than fussing during that 6 hour stretch. So figuring out how to get upset baby to calm down enough to nurse would be helpful. I think you are dealing a bit with colic AND a baby who has difficulty latching. Colic will go away on its own and latch issues are solvable. Hang in there!

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