I had my 4th baby 3 weeks ago today. It was my 4th C-section. I have had issues with all my babies breastfeeding in the early days/weeks, but have overcome them and successfully nursed (#2 for 2.5 years and #3 for 3+ years). This time things are different and I am really struggling.
The baby was 8.15 at birth, which was considered large for gestational age- so we were slapped with needing blood sugars drawn before I could put him on the breast for 24+ hours (turned out being nearly 36 hours) (which takes out a lot of the spontaneity when you have to wait for a nurse to come and prick his heel before you are "allowed" to breastfeed). He latched well from the beginning and appeared to be sucking well, I had absolutely no concerns. The first night his blood sugars started to drop, one time he was at 35 and they told me 34 got him into the NICU. I had a ton of nurses in the room- passing him from one to the other. They said he needed formula and I said no, I would like donor milk. That really irritated them- like I was risking his life waiting for them to have to unthaw it. They bring it in a bottle and I said I would prefer a syringe. In the meantime I start trying to pump as much colostrum as I can. He really does not like the donor breastmilk and struggles taking it. At the next check his sugar was up to 48, but when I want to nurse him again and they check he is down to 32. At this point we have the NICU nurse, neonatal nurse practitioner, and charge nurse in our room telling us that we must give him formula by bottle, where he has to exert no energy (and they told me I would not be able to breastfeed him at that time because it burned too many calories/lowering his sugar), or they will take him to the NICU. He was refusing to swallow anything and they are forcing 30+ cc's down his throat. Anyway- it was a nightmare of a night- they didn't take him to NICU and our next shift nurse told us to just to skin to skin and not stress him out and his sugars came up beautifully, but they still had to be checked before he could latch.
We were discharged 3 days later. He had lost 10% of his weight and was down to 8.0 pounds. He was having some urate crystals in his diaper, which they were just calling concentrated urine and said it was normal until my milk was fully in. My milk came in on day 3/4 but it was not as dramatic as it usually is. I did have some engorgement, but not as long or as bad as I have had in the past. I just kept nursing, which was difficult because he was incredibly sleepy and hard to wake. Went to a check up at 5 days old and he was the same weight, 8.0. Called an IBCLC and she said to supplement (with expressed milk) after feeds. I was incredibly hesitant since my other babies had nursing troubles in the early days but I never had to supplement. But I did, and 2 days later at one week old he was 8.3. Dr. was happy. I still wasn't comfortable with the supplementing (bottles) so we were doing a few a day but I was really trying to just nurse. At 10 days old I noticed he did not seem to be any bigger and had my husband go out and buy a scale. On that scale he was back down to 8.0. So for the next 2 days we supplemented (again, breastmilk) and at his 12 day well child check he was 8.3 again, which was no weight gain in a week. (and my scale has proven to be within 1/2 oz of the Dr's scale every time)
At 13 days old the IBCLC came to my home to do before and after weights. She said he needed to be taking 2.5 oz per feed, and he only took 1.5oz from me during that session. (He was also dealing with some jaundice- was around 14 at this point) I rented a Medela Symphony and she wanted me pumping 20 minutes after every day time feed to boost my supply (which is 5-6 times a day) and supplement 2oz after every day time feed as well. She also had me start fenugreek and More Milk Plus. I started that and at his weight check 2 days ago (19 days old) he was up to 8.9. She didn't (and still doesn't) want me doing anything during the night other than nurse. Dr. was happy with the gain and is fine not seeing him until his 1 month appt.
I talked to the IBCLC after the appt. Monday (where he was 8.9) and she said great- we will start trying to slow down the supplements, maybe every other feed. She will come this Friday for another before/after weight to see if he is more efficient at removing the milk from the breast. I pump around 12 oz a day after feeds, which enough to cover all the supplements. He has received no formula since that first night in the hospital.
Well, it is now Wednesday and he has not pooped since very early Monday morning. I called the IBCLC yesterday and she said she is okay with that, that maybe I ate something that is constipating him or maybe he is absorbing it all and will have a big weight gain. I weighed him yesterday and today and he is exactly the same (on my scale) as he was on Monday. So, no weight gain in 2 days and no poop. I have still supplemented 5 times (10 oz) Monday and Tuesday.
What could be going on? He latches and I hear him suck and swallow, although there are times he doesn't. I have nursed for long enough to know the difference. But there are times he does really great.
Being on this schedule (and I have 3 other kids in the house, and my help has all gone) of nursing/pumping for 20 minutes/supplementing with a bottle (and I do have a SNS but find it very cumbersome and difficult to use) makes it very hard to just go with the flow and allow him to nurse and cluster feed. In the evenings I have been trying to just lay with him and allow him to just stay latched on, whether he is actively nursing or just sleeping, but honestly I feel like I am drowning and I don't know how to fix this. I have always dealt with oversupply in the past- and I have no clue if I have a supply issue or if it is okay- but he isn't gaining weight well, even being supplemented so I am leaning towards a supply issue. I have always had an overactive letdown- and this time I only feel the let down sometimes and it is very mild compared to what I am used to. I have shed so many tears over this and just want and need for this to work. But I cannot continue to be a slave to this schedule, where I feel I cannot leave the house for fear that it interrupts the nursing/pumping/supplement schedule.
Anyway- does anyone have any thoughts or advice? My biggest concern now is the lack of poop- he had been pooping in every diaper. He still tends to be a sleepy baby, but is awake more than he used to be. Most every night I am waking him in the night to nurse, although last night he did wake up himself. I would say that we are nursing 8-9 times a day, which I know is on the low end- but he is also getting 10 oz in supplements and I am pumping 100 minutes a day.
Thanks, and I apologize for the length of this!