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Thread: 2.5-week old, breastfeeding challenges, would love support

  1. #1

    Unhappy 2.5-week old, breastfeeding challenges, would love support

    Hello,
    My daughter was born on 12/12 and we have had a lot of challenges with feeding since she had severe jaundice and went to the NICU. There, we had to supplement with formula in order for her to get the high levels of bilirubin out, and since then breastfeeding has been challenging. Because pre- and post-feeding weighs indicated she gets only about 1.5 oz from me, we have been advised to supplement each feeding with 1oz of formula or pumped milk, but I have not had success with an electric pump and am only able to hand express 10ml at a time. We give her the supplement through an SNS now since I am convinced the bottle was contributing to her not being able to transfer milk effectively (e.g, doesn't suck long enough or effectively enough). That is helping, but I would really like any insights above and beyond what I've learned from our lactation consultants. I am wondering (a) how to stimulate more production beyond mother's milk tea and fenugreek supplements + hand expressing after feeding; (b) why, if I can express by hand, I am not having success with the pump (hand expressing + SNS means feeds take 1-1.5 hours ; and c) if there are people who have had success transitioning to breast only after experiences like this. I feel that feedings are getting better, and the lactation consultants are optimistic that soon I'll produce and transfer enough to cut out the supplement, but I don't really feel that production is increasing (for one, I'm not expressing more after each feeding - just a consistent 5-10ml). Any thoughts, advice, or support/encouragement would be much appreciated! I have almost lost hope so many times as this has been such a tough few weeks. I hate that she is getting formula and want nothing more than to be able to give my daughter all she needs from the breast. Thank you!

  2. #2
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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    How many times a day does baby nurse? Perhaps if that is increased total daily intake will increase. You cna expect a newborn to nurse a minimum of 10-15 times per day. (this does not mean increase times you pump or hand express or supplement btw!

    When was the last before and after nursing weight check done, and how many have been done? 1.5 ounces seems like pretty good intake to me, but several of these need to be done in order to get a true picture because per session intake esp. in these early days can normally vary from almost nothing on up. According to my research, 2 ounces per nursing session would be considrered normal intake at a b4 and after nursing session for a baby 2 weeks old or older. A baby less than 2 weeks could normally take in less.
    (a) how to stimulate more production beyond mother's milk tea and fenugreek supplements + hand expressing after feeding
    I do not have specific suggestions because it depends a bit on why your production is low and if indeed it IS low, which I am not convinced of. But the best course of info for how to increse milk production would be the book Making More Milk. It is written for the mother (so easy to understand) and pretty chepa, but you might need to order it online or one of your LC's copuld loan it to you. If you have a local LLL they may have it in thier library as well. meanwhile, www.kellymom.com has good info on increasing milk production techniques

    (b) why, if I can express by hand, I am not having success with the pump (hand expressing + SNS means feeds take 1-1.5 hours ;
    What kind of a pump are you using? have you tried different pumps? has an LC watched you pump with it? the pump may not be working correctly, it may be improperly sized for you....some issue with the pump should be ruled out first.

    c) if there are people who have had success transitioning to breast only after experiences like this. I feel that feedings are getting better, and the lactation consultants are optimistic that soon I'll produce and transfer enough to cut out the supplement, but I don't really feel that production is increasing (for one, I'm not expressing more after each feeding - just a consistent 5-10ml).
    Many moms have succesfully nursed after low production concerns early on, including me. every story is different but I can tell you that from my perspective, all the work and sweat of those early weeks has been worth it 1000 times over. I also do not like to see a mom disheartned by how much (or little) she can express via hand OR pump after nursing. This is NOT a good indicator of overall milk production.
    Last edited by @llli*lllmeg; December 29th, 2013 at 04:18 PM.

  3. #3
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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    sorry cannot fix typos super fussy sick toddler calling.

  4. #4

    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Thank you for this great response. We feed 8-10 times in 24 hours - I want to do more but it's very hard since we have been told to do the supplement - she's not really interested in eating more, and it's VERY hard to wake her up to eat even as is. Many of our feedings are very sleepy with her not sucking vigorously. So it's kind of a vicious cycle of not frequent enough feeding and not vigorous enough feeding when we do, contributing (maybe) to production issues, which then in turn makes her unwilling to suck since milk doesn't seem forthcoming. She does well with the SNS but when it stops flowing she loses interest in sucking. I will try breastfeeding more often without upping # of pumps and supplements - good idea.

    Last before and after weight was a few days ago, when she was 2 weeks, and it was the second time in a row she received 44ml, then sometimes I can hand express 5-10 which almost gets us to the 2oz per feeding that is recommended, but not quite. Plus, the before and after weights were after long feedings, lasting 45-60 minutes, and she won't often feed that long - which makes me think she may not normally get that amount. But maybe if my production has gone up in the past few days she is getting enough - I just don't know.

    I have tried a Medela double electric pump - both my personal one and the hospital grade one, as well as a manual pump, all with VERY limited success. LCs and nurses have seen me pump with hospital grade one and didn't have concerns, plus the suction on mine has been tested by LC. So I do not know what the problem is. Again, hand expressing gets me about 5-10 ml after each feeding but is a pain and very time consuming. Does hand expression stimulate supply the same way an electric pump does? Good to know that how much I pump (or do not) doesn't indicate production issues. What may indicate production issues is the difficulty my daughter has in transferring milk - 44 mls isn't bad, but she sleeps or cries through so many of our feedings--and readily wakes for the SNS or a bottle--which makes me think she is still having trouble getting enough from me.

    Thank you again for your kind and very helpful response.

  5. #5
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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Hi I am back husband took kids out lol.

    When do you see an LC again? Do you have a plan for weaning off the formula? How much formula is baby given each day anyway?

    I am sure your LC's explained normal milk production to you. According to Breastfeeding Answers Made Simple, typical DAILY intake for a normal healthy newborn goes from basically ZERO day one to ~19 ounces by day 7 or so. It then continues to increase but more slowly over the next 4-5 weeks of life, topping out at around 25-30 ounces per day by 5-6 weeks of age. (And stays around that amount until very gradually over many months or years breastmilk is replaced by solid food.

    All this time, normal nursing frequency is, again, a MINIMUM of 10 times a day for about the first 3 months and sometimes longer. Usually babies nurse more often and some much more often. This is why intake can and does vary so much per nursing session and still be ok. It also means that unless something is interfering with normal milk production in your case, your milk production IS going up. Maybe your milk production is taking a bit longer to get ‘going’ because of the jaundice, hospitalization, and supplementing that happened early on.

    IN any case, what can interfere with production increasing normally NOW is if milk is not removed from the breasts with high FREQUENCY. So as far as milk production goes, it does not matter if it is hand expressing, or a pump that is removing the milk. Whatever gets milk coming out of the breasts best is the right thing to use. Usually, baby is best at milk extraction, and so both pumps and hand expressions are second best and needed only if baby cannot or will not nurse well or frequently enough or production needs a boost for some reason.

    So if hand expressing is working best for you, ok, because the point is to get as much milk as possible out and however you can do that, do that. However, the fatigue of hand expressing gets to many moms. And in some cases that fatigue makes it hard to really get the milk out effectively. In most cases, a hospital grade rented pump is the best choice for when frequent milk removal is needed. But not always because we are all different. But I would suggest keep trying the pump. many moms find that a pump will not work well in early days and then works better as milk production increases. (I know, it's kind of a a paradox.)

    When was the last time you pumped and with which pump? How does it feel-comfortable? Does the suction pull only your nipple in and out of the tunnel, and does your nipple move freely? Have you looked into Pumpin Pal angled flanges? These supposedly help moms for whom pumping is not working well.

    Also I think that you may be focusing too much on how much milk comes out when pumping or hand expressing. First off, remember that your milk production is slowly increasing over time, and it was a very small amount to begin with. (Everyone's is.) So you would not expect to get much. Second, no one can accurately measure milk production by how much milk moms pumps or hand expresses, and certainly not by adding that amount to 1.5 thinking that is what baby took in. For one thing, you have no idea how much your baby took or if it was 1.5 ounces each time-almost certainly, it was not, normally it may be more or less, and since baby is also being supplemented at the breast, that makes a difference as well. A newborn baby can only hold so much at a time and it’s about 2 to 3 ounces tops and often, less. For another, what a mom can pump or hand express each time simply does not correlate to milk production because pumps and hand expression just do not work all that well for some moms, and almost never as well as a normally nursing baby.


    So one problem is that nursing sessions are taking a VERY long time. I had similar issues with my oldest son. It took him forever to latch, then to keep him nursing, and then I had to pump. Many a night I repeatedly nodded off while pumping to find milk dripping on the floor. So while my issues were not exactly the same I get it. But I will also say that a baby nursing for an hour at a time is not all that unusual for this age! I think it is all the extras that are making this already normally intense time even more difficult for you. It gets better!

    So it sounds to me as if the problem is maybe more one of babies latch and sucking not being as effective as it can be, and not (necessarily) your milk production? (Of course it could be both, or the first could lead to the second) What latch/positioning techniques have you tried? Any favorites? Have breast compressions been suggested? Stroking baby, squeezing/"pumping' babies hand or foot to keep baby sucking actively, stimulated? kwim? I used to tickle/jiggle my sons chin to get him "revved up' and actively nursing again. Not all of this will necc. work while using the lactation aid, so while I think you are very smart to use that for supplementing, it might really help to get some nursing sessions in where there is no lactation aid and no worrying about finding time to pump right after.
    Last edited by @llli*lllmeg; December 29th, 2013 at 06:32 PM.

  6. #6
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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Hi mama. Congratulations on your new squish! Our LOs are close in age: my youngest son was born a day before your daughter, so like you I'm in the midst of trying to build my milk supply, nursing around the clock, etc. In fact he's currently latched on as I'm typing this. I wanted to respond because I have in fact shared some of your experiences with my older son (who is now almost 3). He was a jaundiced baby, so we were advised to supplement, and consequently we had trouble with bottles, so we transitioned to an SNS, etc. In fact I just posted something about my experience in this forum under a thread titled "3 days old, one poop..." if you want to read about it. I wrote about my experience with my older son later in the thread, I think on page 3. Anyway, I bet you'll find some similarities in our experiences.

    I wanted to share with you that I think many of my BFing troubles with my olde son stemmed from early supplementation. I believe that because we supplemented so much in the early weeks, my body's supply never correctly calibrated to my son's demand, and we ended up having to supplement until he started solid foods around 5 months. Not trying to scare you...but more trying to reiterate what Meg is saying about the importance of removing as much milk as possible in these early days to simulate baby's demand, because pretty soon here, your production may cap out based on the demand in these early weeks. At least that's my understanding of how it works, and that's why I believe my supply never caught up with my baby's demand...just not enough milk removal due to supplementing. And I pumped like crazy, but pumping just didn't do the trick. (Even this time around, I don't pump much milk...I jump for joy if I can get 2 ounces in the morning, though it's often less, but then I'll bring my baby to the breast after pumping and he'll happily drink and drink a bunch of milk that the pump failed to remove.)

    So, when I read your post, I automatically wondered if you might be able to safely wean baby from the SNS ASAP. I'm sure that's your goal and the reason you're seeking advice on increasing your supply, but my concern is that you could be like me and unable to stimulate enough production as long as you're supplementing. Of course, lots of women can...but I wonder if closely monitoring baby's weight gain would be a safe way to more aggressively wean her from the supplement? I don't know...I'd stick with expert advice on that...but that was a question I had as soon as I read your post.

    I will never know if I had the ability to produce enough milk for my older son, which is why I'm so paranoid about my supply this time around, but I will always wonder if things would have been different if I'd allowed my body to do what it's designed to do, which is meet a real-live baby's demand (not a pump's). But I know how hard it is when your newborn is jaundiced, sleepy, and acts like she is starving because your supply is low...such a catch 22.

    The other thing is that ANY amount of BFing you can do is good for baby, and like everyone on here will tell you, BFing is about so much more than milk. I'm so glad that I stuck it out with my older son despite our supply woes because he went on to nurse for 2.5 years, and some of our most precious BFing moments occurred when he was a toddler.

    I wish you the best of luck, mama!
    DS#1: Aidan, born 1/7/11 - 9 lbs. 5 oz. 22 in. (a difficult induced labor), BFed for 2.5 years after a VERY rocky start (indebted to LLL for the support)!
    DS#2: Amiel, born 12/11/13 - 9lbs, 22 in., 8 days "late," spontaneously, naturally & unmedicated after resisting pressure to induce.
    :

  7. #7

    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Thank you both for your wonderful responses. We have a weight check on Friday, and I am hoping that then we'll get the green light to start weaning off the supplement, though we've already started doing that to some degree--I'm spending the mornings just nursing her on and off for hours, on demand, then doing supplements about every other feed (we were told to do 1oz at each feed). On LC's advice I started pumping again (rather than just hand expression) to boost supply, even though I don't get much (max 15ml, usually much less, as little as 1ml) and I think that's helping; daughter has been sucking better and more vigorously since I started pumping again last night. I am also trying to de-stress as much as possible since obviously that can hinder supply, but I am very paranoid about messing up supply irrevocably in these early weeks, as you both mention. I think the only thing I can do is continue to nurse as much as possible, pump a fair amount, and supplement at least every other feed with SNS so she's sure to be getting enough until our weight check. At least with SNS she is stimulating nipples while getting supplement (vs. a bottle). I also ordered Pumpin Pals - thank you for the suggestion! 27 mm flanges seem to fit ok, but I'm willing to try anything. I have long nipples so they do get sucked up pretty far into the tunnel of the flange when I pump. I have to hand express with a lot of force to get anything, so I'm wondering if the pump just doesn't suck hard enough…but I had same results with hospital grade pump, so I'm not sure. I do breast compressions with every feed and massage breasts prior to pumping/hand expressions. We do everything we can to keep her awake but that is particularly hard after formula supplement - she really does NOT want to eat for 4 hours after that, which is the conundrum. So I think with less formula things will continue to get better…or so I hope. To wean her would you recommend putting less formula in the SNS each time or just doing the SNS less frequently? I can ask pediatrician, too.
    Thank you both for your support!

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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Please talk to LC or pediatrician for specifics about weaning off supplements, but I think either of these
    To wean her would you recommend putting less formula in the SNS each time or just doing the SNS less frequently
    would be fine, or some combo. This is not an exact science.

    and supplement at least every other feed with SNS so she's sure to be getting enough until our weight check.
    I do think the fact baby will not eat for 4 hours after formula is a potential problem, (and it also suggests baby does not need that much formula) but you have to do what you have to do. When is the next weight check?

    but I am very paranoid about messing up supply irrevocably in these early weeks,
    please try to relax, it is unlikely you would mess up supply irrevocably. It is not as if you were not nursing or pumping nearly enough, (in terms of frequency) then you might have a big problem. But it sounds as if you are pumping and nursing as often as you can. This is good.
    Milk production can, in may cases ,be increased at any time a mother is nursing. But yes, due to the hormonal factor working FOR you at this point, it is always best if it is possible to get milk production established normally in the early weeks.
    Please keep us updated!
    Last edited by @llli*lllmeg; December 31st, 2013 at 04:12 PM.

  9. #9

    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    The weight check is on Friday, so she'll be 3 weeks and 1 day by then. This AM we did just breastmilk and one SNS with breastmilk (finally saved enough to do so) and she was awake & fussy for a few hours (tried to nurse as frequently as I could in this time), but then again slept for several hours and woke up pretty uninterested in sucking. My mother tells me that as a baby I only liked to feed every 4-5 hours, so I wonder if this is hereditary and maybe not even just because of the formula…She definitely does better at the breast when I let her wake on her own, but again, this is often 3-4 hours. I don't know if I should pump in that time b/c I don't want her to wake up ready and then be empty!

    I am trying to relax, and am feeling optimistic - I am still concerned about supply mostly because I never feel fully drained - she won't suck for sustained periods (is this b/c my supply isn't there and she gets frustrated/uninterested? or is she used to easy intake via SNS? or is she just a sleepy baby who needs to learn to suck better? all questions on my mind…) and the pump doesn't work for me, so I can only express 1-10ml at a time - I can only imagine there is milk left in there that is telling my body it's not needed. Oh well - I can only do what I'm doing, feeding as often as possible, pumping, hand expressing, and trying to take it easy…

    Again, thanks for the support.

  10. #10
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    Default Re: 2.5-week old, breastfeeding challenges, would love suppo

    Were you breastfed? A baby eating every 4-5 hours as a regular thing is eating about 6 times a 24 hour day. We know now that this is not nearly often enough for most newborns or for normal milk production. But for a long time, it was recommended that both formula AND breastfed babies should only eat this often, in fact, mothers were strictly told not to feed baby more frequently, to the great detriment of breastfeeding overall. Now we know that even formula fed babies do better if fed smaller amounts more often-more like the breastfed babies.

    ON the other hand, your baby is very young. I forgot that. In ~ the first two weeks babies often DO need to be awoken to nurse at regular intervals to nurse, at least, that is a typical recommendation.

    (For a sleepy baby, you can also try holding baby lots, skin to skin if that is comfortable for you, as baby may very well both cue and nurse in sleep. I am linking a video below is actually about laid back nursing but shows these early 'sleep cues' nicely.)

    Then around 2-3 weeks typically, babies kind of 'wake up' and request to nurse much more often. So I would not draw any conclusions yet. And yes, since there is a concern about milk production and weight gain, certainly you can pump during that time. I guess try to pump as close to the last feeding as possible, but the fact is, you can nurse right after pumping if necessary. Your body is always making milk.

    As far as feeling drained. oh my gosh, I wish no one would ever again tell a mom baby should 'drain' her breasts. Very often, especially in the early weeks, there is simply more milk readily available in the breasts than baby wants at the moment, and baby is not going to be able to 'drain' them. And, again, your body is always making milk. If baby nurses a long time and gets lots of milk out, mom has another letdown and there is more milk.

    For good milk production, What we want to see optimally, is milk being removed from the breasts FREQUENTLY so mom does not too often feel uncomfortably full, and baby is getting enough milk. Either those two things are happening or they are not. If they are not, that is the problem, not whether or not breasts are getting completely drained. Please do not worry about that. I hope I am making sense.

    she won't suck for sustained periods (is this b/c my supply isn't there and she gets frustrated/uninterested? or is she used to easy intake via SNS?
    ?? What do you think? will she nurse longer without the sns? And what do you mean be sustained? Nursing sessions can be both quite long or short at this age. Again, breast compressions and switching sides, (even repeatedly) and stroking, rubbing, squeezing baby, can often help baby nurse more actively for longer.

    I can only imagine there is milk left in there that is telling my body it's not needed.
    Again I strongly urge you to think about frequency of milk removal, not that every drop of milk is removed each time. If milk is being removed frequently, your body is going to get the message.

    video of baby cueing in sleep (also of laid back nursing) laid back video http://www.biologicalnurturing.com/video/bn3clip.html

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