Here is our background but at the end are my questions...
My daughter will be four months old this week. She is my first child and we live in a rural area that does have a lactation consultant at the pediatrician’s office (not internationally certified) and I do not have any friends who breastfeed their babies. This is my last hope to find out what’s really going on and what I can do. I really want to exclusively breastfeed my baby for at least her first year of life. Please help us!
Here is a little background regarding my question. For the first couple of weeks after she was born, she ate and slept frequently, but I still was engorged often (so much so that it was difficult getting her to latch sometimes). Once she got to be two weeks old, though, it was as if a light switch was turned on as she suddenly was fussy/crying all the time and the only way she could be soothed was to put her to the breast. At her two week Dr. appointment she was gaining weight and her bilirubin was improving. I called the Lactation consultant at my pediatrician’s office several times, who attributed the constant crying/fussiness to either a growth spurt, then eventually to colic (even though she would cry around the clock every day, not just at one particular time frame during the day). Her crying would range from slight crying to loud, piercing crying. From day one, I’ve always tried to feed her as soon as I saw early hunger cues. During this difficult timeframe of her crying, sometimes she would fall asleep at the breast but then would wake up if I tried to lay her down and start crying all over again, or she wouldn’t stay latched on and acted frustrated/angry and would fight against me. This went on for about three weeks until I finally said “this has got to be something aside from colic” and went into my pediatrician’s office again to have her examined, weighed, and to ask the Doctor about her behavior. She was still gaining weight and nothing appeared to be wrong. My doctor asked about signs/symptoms of possible gas/colic and of reflux. She never arched her back or spit up large amounts when nursing. Sometimes she would have audible rumbling in her tummy and sometimes would bring her legs up to her abdomen like she was having gas, but that was only sometimes and I’d already tried Gripe Water as often as I could give it to her. The Doctor recommended I try colic calm and mylicon drops and then to start on reflux meds if those didn’t help. I did try the colic calm and mylicon drops, which didn’t make any significant difference. Desperate to find an answer not only because I was returning to work at 6 weeks postpartum but also to give my little one some relief, I finally supplemented with the little breast milk that I was able to pump and store in the freezer. This made a dramatic difference in her behavior, so it was then that I realized that, despite frequent and complete drainage from my breasts over the previous few weeks, I wasn’t making enough milk for her. This led to the last thing in the world that I would want to do- supplementation with formula. I only supplemented when she got so upset and wouldn’t possibly take my breast anymore and also gave her formula and expressed breast milk while I was away at work.
I’ve read “The Breastfeeding Mothers Guide To Making More Milk” and I wonder now if where I messed up was not completely draining my breasts in those first two weeks (as I went from engorged to seemingly starving baby within a matter of days!). This is my first baby and I thought frequent nursing was enough. I didn’t know I should have pumped in those first couple of weeks and I was afraid to pump because I was afraid my baby wouldn’t have any milk when she would wake next to nurse. After reading “...Making More Milk” I realize that I may have inadvertently gotten rid of some prolactin receptors by doing this and it sounds like those aren’t something that you can get back. While pumping, I can get anywhere from 0.5-1 ounce if I nurse and then pump. I can get 2-3 ounces if I pump within 3 hours after nursing. My daughter has ‘slept through the night’ (8p-4 or 5 am) since about 6 weeks old and about a month ago or so I started waking up at least once during the night around 12 or 12:30 to pump, when I can get the most milk (4-5 ounces).
The Lactation consultant told me that by 6 weeks when I went back to work, she should be eating between 4 and 6 ounces at a time. I also did not know about paced bottle feeding, so while I was away at work, I was aiming to pump 12-18 ounces per 24 hours, which I could not keep up with. I then read about Reglan and some herbal supplements, so I took Reglan 10mg three times daily with weekly tapering dosage. I drank (and still do) Mother’s Milk Tea three times daily after steeping for at least 10 minutes. I’ve tried Fenugreek three tabs three times daily along with blessed thistle three tabs three times daily. All of these don’t seem to have helped, perhaps marginally. I eat a large bowl of oatmeal every morning for breakfast. I’ve tried spending a weekend nursing as much as she wants with pumping after every nursing session. I’ve tried having her co-sleep some nights. Just yesterday, I stopped taking the fenugreek and blessed thistle and switched to Mother Love’s special blend capsules four times daily. I have had breast augmentation surgery in the past (under the muscle, incision under the fold of the breast) and had very small breasts prior to the surgery.
About a week ago, I read in a LLL forum that babies need 1.5 ounces of milk per hour of separation http://forums.llli.org/showthread.ph...being-over-fed. I’m gone from 7:15-5:45 so let’s say 7am-6pm, but I do come home for 30 minutes to nurse her. According to the forum, I should pump 16.5 ounces! I read in “The Breastfeeding Mothers Guide To Making More Milk” that infants between 1-6 months should be receiving 2.5 ounces per pound in 24 hours, divided by the number of times they eat in 24 hours, which would tell you about how much she should be getting per session. My baby is 13 pounds at almost 4 months old, so that would mean she would need 32.5 ounces. Usually she nurses 9-10 times in 24 hours but even if I conservatitely divide 32.5 by 8, that would mean she would need 4 ounces per session. I asked a nutritionist I work with and she said that breasted babies need approximately 2 ounces per pound in 24 hours, with the average being about 25 ounces in 24 hours once they start taking in solids regularly. This would mean she would need 3.25 ounces at a time now (since she is not yet on solids). I called the Lactation consultant at my pediatrician’s office two days ago, and she said that my daughter should be taking between 4-6 ounces at a time now and she may get up to 8 ounces before she starts having solids!! She said she even checked with a pediatrician who verified these numbers. What she said is totally against what I’ve read both in the book mentioned and in the forums.
So I either need to be able to pump 3-3.25 ounce bottles, 3-4 ounce bottles, or 3-6 to 8 ounce bottles. Right now, I pump once during my morning break, nurse during lunch then pump for ten minutes, and pump once during my afternoon break, then nurse on demand as much as she wants while I’m at home (and I pump once during the night). With this, I can pump between 10 and 11 ounces in 24 hours. I don’t know if I truly still have an insufficient supply because my baby seems pretty content now. She cluster feeds every evening, which I read was normal, but I can’t pump more than 10 or 11 ounces in 24 hours. I’m using a Medela Symphony 2.0 double electric hospital-grade pump.
So how many bottles and how large of bottles do I need to be preparing while I’m away at work? I have Nuk slow-flow nipples/bottles that flow slower than the bottles I was initially using (The First Years, which have an inner and outer nipple). Is there any way I can increase how much I pump? I try doing breast massage and compression while I pump and try to relax. How will this amount increase as she gets older and how will it compare when she starts eating solids regularly? I’d start solids before 6 months if it meant keeping her off of formula. Thank you so much for taking the time to read my post and to help me and my baby girl. God bless you.