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Thread: Overwhelmed

  1. #1
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    Default Overwhelmed

    I'm currently struggling a bit with breastfeeding my son. He's now 7 weeks and 3 days old. Unfortunately, I'm not able to breastfeed exclusively at this point in time. We just finished our first can of formula last night. =\ I desperately want to continue with breastfeeding (and hopefully someday go back to exclusive breastfeeding), but I've been told several aspects of my lifestyle - which I cannot immediately change - may cause problems with supply. In addition, we're supplementing a feeding before bed with a bottle of formula and rice. His pediatrician recommended this and I'm only using formula because after the first few weeks of his life, I've been unable to pump more than one half oz - and usually not even that much.

    My son had a little bit of a rough start due to Neonatal Abstinence Syndrome caused by medication I took throughout pregnancy and will continue taking for the next 3 months, if not longer. I'm only going into this because I feel it is relevant. While my son's NAS was relatively mild, he still suffered from several of the more common symptoms, the most worrisome has been poor feeding. We are completely past this now, but it presented complications during the first weeks of his life. I put him on the breast within a half hour after delivery. We were discharged because he seemed to be doing very well. However, after a quick check-up two days later, it was determined that he had lost too much weight. He weighed 8 pounds 1 ounce when he was born, and had lost around 9 ounces within the first three or four days. This worried his doctors due to NAS babies being notoriously poor feeders. He was admitted into the hospital and given IV fluids and supplemental formula. After about 24 hours, I had my mother bring in a pump and was able to give him expressed milk instead of the formula. After he was discharged, five terrible days later, I continued pumping but had given up on nursing because he just didn't seem to be able to latch on correctly. (He was still quite uncomfortable, as if the shock of being born isn't enough in and of itself.) I was terribly sore and just couldn't cope with it anymore. (It should be noted that I tried to breastfeed my first two babies, but only managed to stick to with it for about two weeks with each of them. With the first, I was very young. The second was quite sick and so was I.) After more than a week of giving him only bottles, I decided to try again because I had been forced to give him more and more formula as the amount I was able to pump decreased. I tried very hard to pump every two hours, but being a single mother with a toddler and an 8 year old, it was extremely difficult. By this time I had done loads of research about latching on, and with some practice, we managed to get it down pretty good. The hospital I delivered at does not have a lactation consultant, but I was able to track one down a few days after my first attempts to begin nursing again. She told me his latch was good and that he was gaining an adequate amount of weight. So although I felt apprehensive about weight gain, I continued exclusively breastfeeding. Everything seemed to be going well, until I took him to see his pediatrician about two weeks ago. He wasn't overly concerned, but recommended supplementing. So, I'm now very concerned about supply and nipple confusion. He has only one bottle at night, before we go to bed - but his latch isn't as deep as it was before so I'm somewhat sore. I've always been told there should be no soreness if baby is latching on correctly. Yet the lactation consultant I have met with insisted his latch was appropriate - despite the fact that I was feeling intense pain up until two weeks ago. Right around the time his pediatrician recommended supplementing! I was thrilled when the pain faded away, but now it seems we're having issues with latching on yet again and I'm becoming more sore with each feeding. I have noticed a clicking sound, which I read about but hadn't had to deal with up until these past few days. I break suction and have him latch on again, but the clicking usually continues. My main concern with his latch is poor milk transfer, which I worry will lead to low supply and then drying up completely. Two others concerns regarding supply: I'm trying to quit smoking and I'm tapering off of Subutex (for opiod dependence) after many years in treatment. I only smoke five to ten cigarettes a day, but I'm having real difficulty with reducing my intake further. I'm tapering off of Subutex, but this is not something that can be done quickly. I can't just stop taking it or I'll have terrible withdrawal, and he might have some mild symptoms himself - though I doubt it. The amount reaching him is said to be miniscule. So, I'm not really sure what to do. I don't really have time to research these things as much as I'd like to, so I joined this community. I live in a very backward area. People here generally react to breastfeeding somewhat negatively. There is only one lactation consultant nearby, that I know of, and while she's quite nice and very supportive, I'm not too thrilled with her. Aside from family, I have very little support. Even most doctors seem to feel like it's no big deal whether or not I'm able to continue with breastfeeding. I disagree. It's very upsetting. I'm far more committed to it this time around. Any advice anyone has to offer will be greatly appreciated!

    A few more questions...

    I've used Fenugreek to boost my supply and it has worked wonderfully! Yet now I'm wanting to stop taking it because I'm concerned my body will build up tolerance and quit responding to it altogether. Is this likely? It may just be paranoia, but I feel without the Fenugreek, I'm not producing enough. I stopped taking it for a few days, and he began kicking and tugging at the breast (without removing his mouth from the nipple). I read this was likely due to the milk not flowing quickly enough, that he was becoming irritated with the slow flow. With the Fenugreek, I have oversupply. But... I can't help but feel oversupply is better than no supply. I'm wondering, what are some other signs that milk supply is low and beginning to dry up? I know the more often baby nurses, the more milk my body produces. Which brings me to my other big concern... How long and how often should he be nursing?? Sometimes he seems to be satisfied after only five minutes! But I was told in the hospital he should nurse for 10 minutes on each side every two to three hours?? I've come to the conclusion that the nurses I encountered were wellmeaning, but completely clueless about breastfeeding. It's a very small hospital. At first, I tried timing every feeding and writing it down. It sounds silly, but this just added to the stress I was already feeling. So now I'm not as intent upon the clock. I just glance at the time at the beginning of most feedings, and within 10 minutes he often falls asleep or loses interest. I'm just so frustrated by this. My mom has insisted that he is just very efficient, but I'm not convinced. He doesn't poop as often as he should, though he seems happy and healthy. I'm not sure if this pooping issue has to do with the fact that he's drinking formula also, or if it means he's not getting enough breastmilk. Plenty of wet diapers... But still, I'm concerned he isn't taking in as much milk as he should, which will affect supply, and so on. I'm very confused about how to tell when the breast is completely drained because unless I'm taking Fenugreek, my breasts never feel hard. Also, if I'm not taking Fenugreek, I stop feeling letdown reflex.

    I have many, many other questions, but for now, just one more. When I started putting him to the breast again, I used a shield. I thought it was wonderful! The pain was not nearly as intense! Then I did some research and realized it wasn't such a wonderful thing after all. So, the next feeding, I didn't use the shield and it was unbelievable how much his latch had improved! Suddenly he was latching on deeply, more so than ever before. The soreness lingered a while longer, but faded soon enough. I use NUK nipples, which are supposed to be more like mother's breast and so reduce chances of nipple confusion. But like I said, his latch isn't as deep as it was before we began supplementing this second time. I'm wondering if maybe it might be okay to use the shield just once in a while? I used it only two days, and when I quit using it, the improvement in his latch was almost miraculous. The shield is also NUK - BarelyThere Nipple Shield. Yet it is there, and I know it's going to affect milk transfer if I use it. I can't quite bring myself to drop the supplemental feeding simply because he is thriving now and he while he wasn't doing poorly, he wasn't quite thriving before.

    I'm sorry this is so long! I've never been very good at getting straight to the point. I felt like sharing our history might give anyone wanting to offer advice a better idea of why we're struggling right now. I never dreamed breastfeeding would be so stressful. So complicated! Maybe it's just me, but it's been an endless stream of questions and googling for the past 7 weeks!

  2. #2
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    Default Re: Overwhelmed

    Hi mamaisaw, welcome to the forum.

    I am not sure I understand all your questions but I am going to try answering- but I have a few questions myself if that is ok.

    Are you hoping to exclusively nurse, or do you want to keep giving nighttime bottle?
    How much formula/breastmilk in bottles is baby getting –one a day every day and in what amount each time?
    Do you pump for every time baby gets a supplement? What kind of pump? How is output when you pump?
    Are you using paced bottle feeding for the bottles?
    How many times in 24 hours does baby nurse?
    how often does baby poop and what does it look like? It is common for poop frequently to go down after around 6 weeks fyi. And yes formula can affect poop patterns.

    Any local lll or other breastfeesding support group?


    I continued exclusively breastfeeding. Everything seemed to be going well, until I took him to see his pediatrician about two weeks ago. He wasn't overly concerned, but recommended supplementing.
    Do YOU think supplementing is required at this point? You say your doctor was not very concern, but recommended supplementing. Why? What did he see? poor weight gain? Something else? because this is odd, as supplementing is a major medical intervention and should only be done (medically speaking) if baby is not gaining normally due to not getting enough milk and there is no way to increase the breast milk baby gets. A baby might not get enough milk for 3 reasons-not nursing often enough, cannot extract the milk properly, or low milk production. SO the first thing to figure out is 1) is/was supplementing actually necessary and 2) WHY. If you know the why, you know how to target the problem.
    I'm wondering if maybe it might be okay to use the shield just once in a while?
    Nipple shields can cause problems and they can be great tools. As long as they are used correctly and when actually needed, I have no problem with them. The ‘correct’ reason to use a shield is if baby is unable to physically latch without one. However, some mothers find them helpful for other reasons and I am not one to argue with success. Be aware some moms have to pump when using shields in order to keep milk production up. And some moms find it very difficult to wean baby off the shield later. Others do not have these problems, it varies.

    Clicking is not a problem on its own. It may or may indicate a problem, but stopping baby from nursing & relatching due to clicking is probably not needed unless the clicking is hurting you. .
    I'm very confused about how to tell when the breast is completely drained because unless I'm taking Fenugreek, my breasts never feel hard. Also, if I'm not taking Fenugreek, I stop feeling letdown reflex.
    You don't need to think about whether the breast is fully drained, and breasts feeling hard is not a good thing. If baby is nursing frequently and normally, your breasts will not feel full because the milk is regularly removed. Not feeling letdown is also entirely normal. That said,
    I've used Fenugreek to boost my supply and it has worked wonderfully! Yet now I'm wanting to stop taking it because I'm concerned my body will build up tolerance and quit responding to it altogether. Is this likely?
    OK. If the fenugreek is working, why would you stop taking it because you are afraid your body will build up a tolerance? If this DID happen, then you could take more, up to a point. Or even if the fenugreek stopped working entirely down the line, is that a reason to stop taking it now when it was helping? I just do not understand this reasoning. I have no idea if you need fenugreek or not, and some moms do not like how it makes them feel (tummy issues) and stop taking it. But if you are doing well on it I have no idea why you would want to stop taking it.

    I know nothing about neonatal abstinence syndrome or the medication you are on. If you have questions there, I suggest you call www.infantrisk.org and ask them about that, they have studied all drugs and how they do or do not affect breastfeeding. They are very nice and your call is anonymous.

    One problem with smoking is it is not considered safe to share a sleep space (bedshare) with your infant if you smoke, in fact, even a mom smokes in pregnancy and quit when baby is born that would still be the recommendation. And obviously you know it is safer overall for both you and your baby if you are not smoking. But experts do believe that if mom is a smoker, it is much healthier for baby to be breastfed than not. So definitely keep breastfeeding!

    I also strongly suggest stop googling and get a good breastfeeding manual. The Womanly Art of Breastfeeding 8th edition is the best.

    Good reliable websites are us & kellymom.com
    Last edited by @llli*lllmeg; December 19th, 2013 at 01:41 AM.

  3. #3
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    May 2006
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    Default Re: Overwhelmed

    More questions/comments- sorry if they repeat LLLMeg's

    I've been told several aspects of my lifestyle - which I cannot immediately change - may cause problems with supply.
    Can you tell us what they are? Maybe we can suggest ways to ameliorate them.

    In addition, we're supplementing a feeding before bed with a bottle of formula and rice. His pediatrician recommended this
    This seems like dubious advice to me- rice in a bottle is a choking hazard and thickened feeds are really only recommended for babies with reflux. What is the pediatrician thinking the advantage of rice in a bottle would be?

    I've been unable to pump more than one half oz - and usually not even that much.
    What sort of pump do you have, how often are you pumping, and how does pumping feel?


    He weighed 8 pounds 1 ounce when he was born, and had lost around 9 ounces within the first three or four days.
    I can understand why your doctors were worried, but the weight loss was within the normal range. Breastfed babies sometimes lose as much as 10% of birth weight before beginning to regain. This is particularly true of babies whose moms had IV fluids at birth, since fluids from the IV can artificially inflate birth weight.

    He wasn't overly concerned, but recommended supplementing.
    Why? If weight gain was adequate, there should be no need for supplementing.

    Soreness: potentially problematic. It might help to do a weigh-feed-weigh measurement using a professional scale. The LC should have one, or the doctor's office might allow you to use one there. A weigh-feed-weigh measurement allows you to gain a very accurate picture of how much milk your baby takes in at a feeding.
    Clicking: not a problem in and of itself- more of an indicator. Babies click for a variety of reasons, and you should only be concerned by it if it is happening in concert with severe pain and/or poor weight gain. One thing that can cause pain and clicking is oversupply- baby may click (break suction) and clamp down on the nipple (causing pain) in order to control a fast flow of milk.
    Fenugreek: if it works, just keep taking it.
    Oversupply being better than no supply: yes, but it's best of all if supply and demand are well-matched. Perpetual oversupply is not something you want!

    How long and how often should he be nursing??
    As long and as often as it takes for him to get his needs met. I know that sounds arch, but truly there is too much variation in normal nursing patterns to give a mom an exact figure for either feeding length or frequency. However, most new babies nurse a minimum of 10-12 times a day and some nurse more often than that, and it is rare for babies who are less than a year and still dependent on mom's milk to nurse less than 8 times a day. If you're concerned, there is nothing wrong with increasing the number of times you offer the breast. Feeding times are even more variable than number of feedings- some babies get all they need in just 5-10 minutes, others will nurse for close to an hour.

    Sometimes he seems to be satisfied after only five minutes! But I was told in the hospital he should nurse for 10 minutes on each side every two to three hours??
    Completely incorrect. This is exactly the sort of advice that derails breastfeeding for many moms.

    He doesn't poop as often as he should,
    This may be an effect of the formula supplements, which are notorious for causing constipation. But how often does he poop?

    I'm very confused about how to tell when the breast is completely drained because unless I'm taking Fenugreek, my breasts never feel hard. Also, if I'm not taking Fenugreek, I stop feeling letdown reflex.
    It is not necessary for a baby to completely drain the breast. If your breasts feel softer after nursing, that's a good indicator that baby got enough to eat, but there's no need for them to be "completely drained"- if that were even possible. Milk is always being made, and the faster it is removed, the faster it is being replaced.

    There's also no need for your breasts to feel "hard"- that is generally an indicator of overproduction. The average feeding is just 2-4 oz, and if you feel engorged you probably have a lot more than 2-4 oz sitting in the breast. Feeling letdown means nothing- I have nursed 2 kids and never felt a letdown. Many moms only feel letdowns when they are overproducing. Once supply and demand are well-matched, the letdown sensation often diminishes or vanishes. It's often easier to judge letdowns by watching the baby- if he suddenly starts gulping away, he's getting a letdown.

    Shields: as LLLMeg said, they're a good tool for some moms. I wouldn't be afraid to use them, particularly if you are using them in a limited fashion.

  4. #4
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    May 2013
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    Oregon
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    Default Re: Overwhelmed

    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004566/

    There is a link about NAS. I work with mothers who are working on being in recovery from substances and just wanted to throw in that successful breastfeeding can occur in instances even when baby has been exposed to prescriptions or illicit substances in the womb. And to give you encouragement and support for continuing to work so hard at this!!!
    , , , , ,

  5. #5
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    Default Re: Overwhelmed

    I am hoping to exclusively breastfeed at some point. Currently, he has one bottle before bed. I prepare 4 ounces of Similac Sensitive for Fussiness and Gas and add two teaspoons of rice, as his pediatrician recommended. He usually drinks about 3 and a half ounces. Sometimes he will nurse again for a few minutes about a half hour later. It seems like a lot? But if he seems to be wanting to nurse, I always let him. I offer him the breast every time he seems the least little bit unhappy, but I do sometimes worry that he will get too full and end up feeling uncomfortable. We have no problems with reflux. The rice is, I assume, just to get weight on him quickly? At the time, he was weighing in at about 8 and a half pounds. The pediatrician wanted him to weigh at least 10 pounds... So... It's unfortunate, but doctors in this area really do not seem at all inclined to support breastfeeding. Nonetheless, I'm apprehensive about weight gain.

    I'm not familiar with paced bottle feeding, but I'll check into it.

    I stopped pumping altogether several weeks. I was only getting a few drops. At one point I pumped exclusively, but since our latch issues have been worked out, I haven't pumped. At first I used a single side electric pump made by Evenflo. That one messed up and the next one I bought was single side electric made by NUK. Honestly, both make me kind of sore, but the NUK seems a bit better. I haven't tried to pump at all recently because I end up sore at dread nursing. I have insurance that will become effective the first of the year, and I'm hoping to be able to get a hospital grade pump - if necessary. Working with what I've got now, I think the pumping causes more harm than good. Is it really necessary to pump if I'm supplementing? I just dread the thought right now. I've been told it's very important for maintaining supply, even without the supplementing. If I were to stick with pumping would I eventually see some results? Ending up with just a few drops in the bottle is discouraging.

    I don't know how often he nurses over one 24 hour period. I stopped timing and counting a while ago because it was just stressing me out worrying about trying to make sure he was conforming to standards set forth while in the hospital. I took this all very seriously in the beginning, but it started to seem a bit ridiculous. Not one of the nurses we encountered had ever breastfed and the doctors were all male. It just seems to me that babies are all so different from one another... Feeding patterns are bound to vary greatly. The one size fits all approach they pushed on us almost lead me to give up entirely. He wasn't doing as they said he should, so I was sure he was starving. In reality, I'm pretty certain he was doing just fine. So now I just feed him whenever he seems hungry. I often offer the breast even if he isn't acting hungry. He very rarely cries. He's normally very smiley and happy.
    He usually poops every other day, but sometimes two days will pass with no pooping. He never seems to have belly aches, so I really don't think he's constipated. My two year old was on formula only at this age, and he did have problems with constipation. I'm thinking I'd probably recognize it if it were an issue with this baby. When he does poop, he poops a lot. He does not seem to be straining particularly hard. He grunts, but all of my babies have done that. Consistency is somewhat gooey and it's yellowish/brownish, kind of a funky looking tan color. Hard to describe. It has some characteristics of breastfed baby poop - looks "seedy" - but texture seems to be more like that of a formula fed baby.
    We have absolutely no LLL or anything similar within about 60 miles of my hometown. It isn't practical for me to travel that distance. I live in West Virginia. It's very rural. Breastfeeding is generally frowned upon... As ridiculous as this seems, it's true. Aside from my mother, I am the only person I know who has breastfed even for a limited time. We have high rates of SIDS. I know many parents who smoke in homes and cars and can't seem to understand why this isn't okay. If I mention breastfeeding, I often get this response, "Ain't no baby suckin' on my titties!!" This is not an exaggeration. A new mother said this to me last week. Just to give you an idea of what I'm up against.

    I don't know what to think about whether or not the Fenugreek is really needed now. Because I smoke and also take medication that is said to cause low supply, I'm really worried. I had low supply with my two year old and I figured it was mostly due to those two factors. I drink plenty of water and I'm not particularly sleep deprived or stressed out. Right now I'm taking 6 Fenugreek tablets throughout the day. When I wake up in the morning, my breasts feel firm and full. After the first two feedings, they're soft. I do worry a lot about whether or not he's able to extract milk properly. But the lactation consultant said he was latching on correctly. I'm not sure what might indicate low supply. Sometimes he'll get a bit fussy with while nursing, tugging and whining while at the beast. Lactation consultant said this is due to milk not flowing quickly enough. So when this happens, I switch him to the other side and he settles down. I always figured if supply was low, he would continue fussing even after I've switched him to the other side. He seems happy and content, so I take that to mean my supply is alright for the time being.

    The clicking is gone now. I still feel like the latch could be deeper, but I'm not experiencing any pain.

    I worry that my body will quit responding to Fenugreek because I'm not sure I can maintain my supply without it. I haven't tried any of the other herbal supplement, but I plan to order some to have on hand just in case. I have worried about my supply since day one. When I saw the lactation consultant, she said I should be able to squirt milk by squeezing just behind areola and pressing inward. This has -never- worked for me. I've never even been able to even express a few drops by doing that. So that worried me. I can express by placing a finger or two beneath my nipple and pushing upward. I one time expressed an ounce doing this, but it took a long time. I'd like to become more efficent at hand expressing. But I've not been able to really get the hang of it.

    I'm trying to quit smoking. I'm confused about why I shouldn't cosleep? I've read this several times, but I'm not sure I understand. Right now I'm not sharing a bed with the baby. I have shared a bed with my 2 year old since he was about 2 months old. I was planning to transition him to his own bed soon to be able to safely share a bed with the baby. It would make our nights so much easier. I know how to provide a safe sleep space, but I'm concerned about the whole smoking thing. I don't smoke in the house or any car, and ever since my first son was born, I've covered my clothes and hair whenever I go out to smoke and keep those articles of clothing away from all of my kids.
    I mentioned not knowing when my breasts are "drained" because I'm trying to do the whole blocked feeding thing. I'm not sure if I'm doing it right. I'm pretty sure he has an imbalance because he is super gassy. I don't think it's the formula/rice. I feel pretty sure it's an imbalance of foremilk and hindmilk, which I'd never heard of up until reading through this forum. He already seems less gassy.

    I recently read that encouraging a baby to sleep through the night too early can affect milk supply. I woke him to nurse the first several weeks, but now I let him sleep unless I wake up to him making noises. Then, I feed him. He never cries in the night and would probably go back to sleep without nursing if I held him a while. Is it going to be harmful to my supply if I don't start waking him up to nurse at night?

    I have some questions about herbal teas. I ordered the manual you recommended, but it will probably be a week before I receive it. So, I'm wondering if it's okay to drink herbal tea that contains peppermint once a day? Or will this affect supply too much? I've been drinking tea that contains peppermint all along, but recently read that peppermint will reduce supply. I'm also wondering if spearmint will dry up supply. It's listed on some sites, but not on KellyMom. It also seems that some teas meant to increase supply contain licorice, but I've read also that licorice isn't good for lactating mothers and breastfeeding infants?

    I don't really have any questions about NAS - but that is an informative link. I've had two babies on Subutex and done loads of research. It can be scary. But I was in treatment and did not use any illicit drugs, only prescribed medication. I only did that because my doctors insisted detoxing would've presented a high risk of miscarriage. I wish all mothers with babies suffering from NAS could be informed, but it's difficult for many of them. They lack the resources. So thanks for the link - and for the work you're doing.

    If this is difficult to follow, I'm so sorry. It's just that I've been writing this on and off for several days now because I don't have enough time to sit down and complete a post all at once. It would've been shorter and easier to follow if I'd been able to write it all at once.

  6. #6
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    May 2006
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    Default Re: Overwhelmed

    If your baby doesn't have reflux, there is ZERO reason to put rice in the bottle. It's a choking hazard. It substitutes a low-nutrition food for some amount of breastmilk or formula in your baby's diet. And, of course, it lacks the immunoprotective components of human milk. It will not help your child gain weight more quickly, because rice is an extremely low-calorie food compared to breastmilk or formula. Think about it this way: if you wanted to gain weight, what would you eat- a rice cracker or a milkshake?

    Is it really necessary to pump if I'm supplementing?
    Yes and no. If you are supplementing and you want your supply to stay equal to your baby's needs, then pumping is important because it will make up for whatever stimulation your baby isn't giving you, and because you will be able to supplement with breastmilk rather than formula. But if you are supplementing and you are okay with your supply not being entirely equal to the baby's needs, then you don't have to pump.

    It sounds like pumping is a real problem for you because you've been using some not-so-great machines. Pumping shouldn't hurt, and your pump shouldn't break after light use. Are you eligible for WIC? They may be able to provide you with a better pump, even before your new insurance kicks in.


    I don't know how often he nurses over one 24 hour period. I stopped timing and counting a while ago because it was just stressing me out worrying about trying to make sure he was conforming to standards set forth while in the hospital... It just seems to me that babies are all so different from one another... Feeding patterns are bound to vary greatly.
    Feeding patterns do vary. But when there's a concern about weight gain, we always want to look at nursing frequency. Sometimes we'll have a mama come through with a baby who isn't gaining weight, and we'll find out that the baby is nursing really infrequently. In general, newborns nurse a minimum of 10-12 times a day, and older babies nurse a minimum of 8 times a day. If you find your baby is nursing less than this, even when he's being nursed on demand, it's probably a good idea to offer the breast more often.

    When he does poop, he poops a lot. He does not seem to be straining particularly hard. He grunts, but all of my babies have done that. Consistency is somewhat gooey and it's yellowish/brownish, kind of a funky looking tan color
    This seems normal for a baby who is getting formula.

    If I mention breastfeeding, I often get this response, "Ain't no baby suckin' on my titties!!" This is not an exaggeration. A new mother said this to me last week. Just to give you an idea of what I'm up against.
    It's tough to be in an area with no support, much less one where people are actively negative. It sounds like you have a lot on your plate right now, but maybe in the future you'd think about starting some sort of breastfeeding group? Becoming a La Leche League leader is something you can do long distance. And I bet that there are women in your community- women you don't know about, don't see, don't hear from- who ARE nursing their babies and wish that someone, anyone, was there to provide them with help and support.

    I don't know what to think about whether or not the Fenugreek is really needed now.
    It doesn't hurt, and might help, so why not? I kept a bag of fenugreek seed in my closet and I drank a cup of tea whenever I felt low- and I had no supply problems at all.

    When I wake up in the morning, my breasts feel firm and full. After the first two feedings, they're soft.
    This is entirely normal. Most moms produce more prolactin (the milk-making hormone) at night, which means that milk supply tends to peak in the wee hours of the morning. Result: moms often wake up feeling pretty full, and babies get to start out their day with a couple really big meals in a row. After that point, milk supply tends to settle down and match the baby's needs more exactly, which means that mom is going to feel light/floppy/empty for the rest of the day. One mistake many moms make is equating feeling full with having enough, when the truth is that when you feel full, you actually have significantly more milk than the baby needs.

    I'm not sure what might indicate low supply
    Indicators of low supply:
    - baby not gaining weight at a normal rate
    - baby not producing normal diaper output- low pm number of pee diapers, or poops infrequent, greenish-brown and very scanty
    - evidence of dehydration- sunken fontanelle (soft spot), "brick dust" urine, skin "tenting" when pinched
    - baby feeds almost constantly but never seems satiated

    The way you describe your baby's nursing- latch feels good, baby may tug and grouse a bit but is happy once switched to the other breast, baby is satisfied after nursing, etc.- this sounds like nursing is going fine.

    When I saw the lactation consultant, she said I should be able to squirt milk by squeezing just behind areola and pressing inward.
    No. Just- no. This might be true if you were a COW. But very few human women will be able to shoot jets of milk into the air with the maneuver described by the LC. Hand expression is something that doesn't work for every woman, and every woman has to experiment with trying to get milk from the breast in order to find the motion that works for her. The fact that you once got an ounce by hand expressing suggests that you're able to do it- it's just laborious. That's why you'd probably do far better with a good pump with correctly fitting shields.

    I'm trying to quit smoking.
    AWESOME!

    I'm confused about why I shouldn't cosleep?
    I know you're doing a lot of great things to mitigate the risk from tobacco use- covering your hair and clothes, not smoking in the house or car, etc.- but the current thinking is that any level of tobacco use just isn't compatible with bed-sharing. It's a SIDS risk and I don't know that anyone knows exactly why.

    I mentioned not knowing when my breasts are "drained" because I'm trying to do the whole blocked feeding thing. I'm not sure if I'm doing it right. I'm pretty sure he has an imbalance because he is super gassy. I don't think it's the formula/rice. I feel pretty sure it's an imbalance of foremilk and hindmilk, which I'd never heard of up until reading through this forum. He already seems less gassy
    .

    Block feeding is something you want to do ONLY when you have a problematic oversupply, and you seem convinced that you have borderline undersupply. The way block feeding "fixes" foremilk/hindmilk imbalance is by reducing supply. I really don't understand why you would be block feeding and simultaneously taking fenugreek in order to increase supply.

    I recently read that encouraging a baby to sleep through the night too early can affect milk supply. I woke him to nurse the first several weeks, but now I let him sleep unless I wake up to him making noises. Then, I feed him. He never cries in the night and would probably go back to sleep without nursing if I held him a while. Is it going to be harmful to my supply if I don't start waking him up to nurse at night?
    When nursing is going great and the baby is gaining weight well, a mom can feel free to allow the baby to sleep. When nursing isn't going well, or the baby is having trouble gaining weight, waking the baby at night in order to nurse is one of the best ways to increase weight gain, and also supply if supply is a problem. Nursing at night never hurts and may help, so when there are nursing problems it's definitely something you want to do.

    So, I'm wondering if it's okay to drink herbal tea that contains peppermint once a day?
    Probably fine, since it's a very small amount.

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