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Thread: Tongue-tie, low supply, and pumping (oh my!)

  1. #1

    Default Tongue-tie, low supply, and pumping (oh my!)

    Hello! This is my first post, so please forgive me for any etiquette gaffes. I have what feels like a saga, so here goes:

    My daughter, Lucy, is 3 1/2 weeks old and was born just smidge early at 36w6d. I had an unremarkable, unmedicated labor, and Lucy nursed within an hour of birth. For the next several days, I nursed her on demand. She would nurse for 15-20 minutes every 2-3 hours and unlatch herself to fall back to sleep.

    However, at her 2 day checkup, she had lost 10% of her birthweight (7.0 lbs to 6 lbs 2 oz). We rechecked at 4 days and she had lost another ounce, but the pediatrician was confident that this was her low point, breastfeeding sounded like it was going fine, and she'd be back to her birth weight by 2 weeks. At 2 weeks, she had not gained any weight back and was even down to 6 lbs 0 oz. At that appointment, the pediatrician found a tongue tie. We had it fixed that day at the ENT, who also found an upper lip tie.

    The pediatrician, who has been very supportive of breastfeeding, and I suspected that Lucy's ties prevented her from nursing effectively, which was not only getting her not enough calories, but not sufficiently stimulating my supply. For about 3 days before her 2 week checkup, Lucy was feeding for 2-3 hours straight. (I never did feel my milk "come in," and I rarely feel let down or even engorged.) Pedi asked me to pump after nursing to stimulate my supply and to begin supplementing with formula so that she could gain weight.

    So, our new feeding regime of the past week is this: every 2-3 hours, she breastfeeds first. I try to get her to feed for 30 minutes on each breast. She is rarely satisfied - less than 1x per day - on only one breast. If she's still hungry after feeding on both breasts, I give her pumped breast milk, but I rarely have much to feed. If she's still hungry after that (and she usually is), she gets formula - of which she usually consumes ~2 oz. If she only fed from one breast, I pump the other. This whole routine takes 2 hours (1 hour of BF, 20-30 minutes formula, 20-30 minutes of dozing off between BF and formula - "is she ASLEEPasleep or will she be hungry again in 15 minutes?"). Happily, Lucy has gained 12 oz this week!

    SO, my concerns/questions are these.
    1) Should I be pumping more? When I do pump after a double-sided feeding, I rarely get more than a few drops and aggravated nipples.
    2) Does this seem like a bona fide low supply issue? Will my breasts ever catch up to the 2 oz of formula she takes at most (but not all) feedings?
    3) Has anyone else had a tongue or lip-tied baby whose latch eventually improved? She does have a shallow latch in the majority of feedings. They start off promising, and over the course of a feeding, she sort of slides off the breast until she's just on the nipple. The latch hasn't really changed dramatically since getting the ties clipped, despite seeing a lactation consultant.

    Any tips or sympathy? Supplementing with formula is certainly not how I envisioned our breastfeeding relationship, but it's something I'm happy to do for her healthy. I'd just like to know whether I can expect my milk to ever fully cover her needs.

  2. #2
    Join Date
    May 2006
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    20,607

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Welcome to the forum and congratulations on the new baby! I'm sorry you had such a rough start with her.

    It's still very early days, and I think there is every reason to expect that you will eventually get a full supply and be able to drop the formula supplements. The fact that you're working so hard already suggests that you have what it takes in order to make that happen- and that's dedication and drive!

    Some questions for you:
    - How does nursing feel? Was it ever painful? Is it painful now, post tongue tie revision?
    - What sort of pump are you using?
    - When you pump, do you find that your niples are rubbing against the sides of the collection tubes?
    - Any health problems for you- e.g. thyroid issues, PCOS?
    - Do you know if your placenta came out in one piece? Any possibility of a retained placenta fragment?

    Sorry to answer your questions with more questions, but your answers may help us know how to give you better advice.
    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!"

  3. #3

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Quote Originally Posted by @llli*mommal View Post

    Some questions for you:
    - How does nursing feel? Was it ever painful? Is it painful now, post tongue tie revision?
    - What sort of pump are you using?
    - When you pump, do you find that your niples are rubbing against the sides of the collection tubes?
    - Any health problems for you- e.g. thyroid issues, PCOS?
    - Do you know if your placenta came out in one piece? Any possibility of a retained placenta fragment?

    Sorry to answer your questions with more questions, but your answers may help us know how to give you better advice.
    Thanks for your response, and your optimism!
    -Nursing is fairly painful. I can get a decent latch at first, but she always seems to work her way down the nipple. At the end of a nursing session, my nipple will be pointed at the end and practically creased at either side, like she's been chomping it flat. The right one in particular is sometimes white afterwards, as if blood flow has been cut off.
    -I'm using my health insurance-issued Ameda Purely Yours.
    -My nipples don't rub against the flanges of the pump, but part of my areola does. It looked, according to the user manual, like the standard 25 mm flanges were too large (I have pencil eraser nipples but large-ish areolas), but after buying the smaller, 21 mm flange and the 21 mm "areola stimulator," neither provided a more comfortable pumping session, or yielded more milk. I have stuck with the 25 mm flanges for simplicity's sake.
    -No other health problems.
    -My placenta was intact, as far as I know. Her birth was at a birth center, so I remember being shown the placenta, but I didn't examine it closely myself.

    Thanks again for your feedback!

  4. #4
    Join Date
    May 2006
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    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Thanks for answering those questions!

    Okay, since nursing has always been painful for you and you have evidence of compression, my guess is that the poor latch is the root cause of your problems with supply and also the baby's problems with weight gain. To fix this problem, I would take the following approach:
    1. See a lactation consultant- preferably an IBCLC- for assistance with latching, positioning, and pumping.
    2. Get yourself a very good pump with correctly sized shields. The Ameda Purely Yours is probably not the machine you want to be using- it's a lighter machine made for working moms with nursing babies and well-established milk supplies, who are pumping just a few times a day. It's not made for women who are really relying on the pump to build supply. I would strongly suggest using a hospital-grade rental pump.
    3. Pump frequently, aiming for a pump session after every nursing session if possible. (I know this is exhausting- I did it with my first baby.)
    4. Take supply-building herbs (fenugreek, oatmeal). They can't hurt (unless you're diabetic) and may help- just don't expect them to take the place of hard work with the hospital-grade pump.
    5. Call your midwife or doctor and discuss prescription drugs which can help increase supply. Reglan and Domperidone are both Rx drugs which are used off-label to increase serum prolactin levels and milk supply. Both have additional side-effects and are not right for all moms, so do not take either one without talking to your care provider first.

    I would also call your midwife and/or obstetrician and discuss the following:
    1. Your placenta. Retained placenta fragments can inhibit milk production.
    2. Blood tests for thyroid function. Postpartum thyroiditis affects about 5% of all women in the postpartum year! and poor thyroid function can impact milk supply.
    These are more long-shot explanations for your difficulties, but IMO you want to take an "all of the above" approach in this situation.

    Don't give up, mama!!! A lot of the problems you're having could be related to your baby and her tiny mouth and tongue tie. But even the worst tongue ties tend to stretch with time, and babies and their mouths grow fast. A deeper, better latch is almost undoubtedly in your future.
    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!"

  5. #5

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    I agree with mommal. Are you able to see an IBCLC for a professional consult? Health insurance may cover.

  6. #6

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Thanks again! After you mentioned compression, I looked it up and that is absolutely what is happening. It makes me wish I had larger nipples - she doesn't chomp my finger or bottle nipples, which reach the roof of her mouth, but she will chomp my nipples in the majority of latch attempts.

    I did get a bit of good luck 2 nights ago: I usually nurse cross-cradle, but in desperation 2 nights ago tried football for the umpteenth time and actually got a great, comfortable latch. I was amazed at how good it could feel! Unfortunately, we still have to get through about 7 bad latches to get a good one, and the good ones only last about 5 minutes and usually cannot be replicated in the same nursing session... but I know we're both learning how to do this.

    I have a few questions I've developed since writing the post, and I will definitely be pursuing your other suggestions during business hours on Monday!
    -Because we can achieve a good latch, but usually only once and for a short period, should I keep trying to re-latch her to make a nursing session last more than 5-10 minutes? This is what I currently do, aiming for at least 15 minutes (depending on her interest and my soreness), but results in several bad latches that I interrupt, and probably a just "OK" one that I settle for. Would she benefit more in terms of training her little muscles from just one good latch and not getting to revisit the bad habit of bad latches?
    -Would a SNS be a good option for us?
    -Aside from the general tips for achieving a good latch, is there anything specific to compression and chomping at the nip that I can work on with her?

    Thanks!!

  7. #7
    Join Date
    May 2006
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    20,607

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Nipple size doesn't really matter, but nipple length can definitely be an issue, particularly in cases where the mom's nipples are short, flat, or inverted. The good news for women with short/flat/inverted nipples is that lots of nursing and/or pumping often breaks the adhesions under the skin that hold the nipple down. And babies and their mouths grow- a larger mouth can achieve a deeper latch, and that generally means less of a problem for moms who have short nipples.

    One thing that can really help get the nipple deep into the baby's mouth, past the point where compression is an issue, is something called the sandwich technique. You can look it up online, but it's best if you have someone show it to you. Is hands-on help from an IBCLC a possibility for you?

    It's tough to say whether or not it's a good idea to relatch your baby in an attempt to get a good latch. I think you'd need to balance the baby's frustration and willingness to nurse against the benefits of a perfect latch. On the one hand, a better latch would mean less pain for you and probably more stimulation to your milk supply. But if relatching your baby very frequently makes her so frustrated that she nurses less, then it might not be a good trade-off. I would at least try relatching. Of it's not too frustrating for you or baby, it's probably worth doing.

    A SNS definitely sounds like a good option for you, because you currently must supplement. If all baby's food comes at the breast, there's less chance of nipple confusion, and more nursing should result in better supply even if the nursing is done with the SNS in place for some of the feeding. Just don't expect SNS use to substitute for work with the pump. The SNS is a tool, not a cure-all.

    Regarding your baby's chompy latch, I think hands-on help is your best bet. And I think I would talk to the pediatrician and the ENT again, and make 100% sure that the tongue and lip ties are completely gone! and have not reattached.
    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!"

  8. #8
    Join Date
    Oct 2009
    Posts
    2,609

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    I will put in a good word for a lactation aid although the SNS brand is very expensive. You can make one your self for a few dollars. I just posted and it's further down on this pg "if you need to use a lactation aid" with a link for inexpensive tubing if you are interested.
    Nursed my sweet daughter 3 years, 3 mos.

  9. #9

    Default Re: Tongue-tie, low supply, and pumping (oh my!)

    Good news! My insurance does cover a hospital grade pump rental. The medical supply company they work with actually sends a SNS with the pump, so I'll be killing two birds with one stone. Naturally, today (New Year's Day) is the first day I can use my health insurance, but offices are all closed... I'll get it ordered tomorrow though.

    I had a (free!) phone consult with an IBCLC at a local hospital, and she reiterated that I needed to be pumping every 2 hours like clockwork to get my supply up. When I did the math, because I pumped after every breast feeding, I was actually pumping every 4 hours. She said an in-person consultation wouldn't be super helpful for me right now since my supply is low, but offered to meet in a week or so if it responds to the more rigorous pumping routine.

    After hearing about exercises that many doctors prescribe after tongue tie-snipping, I called the ENT who did Lucy's frenotomy to inquire about them and to tell him she was still not nursing properly. We're seeing him again tomorrow - hopefully he can shed some light on re-training her little mouth.

    Thank you again for all of your help! I'll update if/when we have improvements, for the posterity of the internet.

    P.S. Krystine, I will look up your DIY SNS. Sounds clever!

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