Block feeding to correct foremilk/hindmilk imbalance

[@llli*chip]

I am the mother of a 9 week old boy. First time mom, first time breastfeeder. I went into my baby's 1 month well baby check with what I gathered was a normal breast feeding experience. He was eating a lot (10-14 hours a day at the breast) but I thought he was just a slow, leisurely eater. My pediatrician is also a lactation consultant and after a long Q and A session he put this together with a few other tidbits (baby is very gassy and we had just had a green poop, a little bit of irritation on his bottom as well). He concluded that I have a problem transitioning from foremilk to hindmilk and recommended that I block feed. He started me out at 4 hour blocks. I really tried but baby and I were miserable. I just couldn't satisfy him and my supply was taking a pretty big hit. I switched to 2 hour blocks. The situation seemed to improve to the point where 1 block equaled 1 feeding. He was still quite gassy though. At the 2 month check, I explained to doc that we abandoned the four hour blocks but things seemed slightly improved. Feedings were still long but a little less frequent. Baby was still gassy, but a little less so. No more green poops or irritation on his bottom. I explained that gassiness was still the number one issue as far as fussiness went. He insisted that I try block feeding again. 3 hour blocks this time. Well here I am five days in, no longer block feeding because I can't satisfy him with a single breast on any given feeding. Most feedings today he has not been satisfied after both breasts are emptied. I'm abandoning any thought of block feedings at this point and and doing the best I can to feed on demand and get my supply back up.

A few other notes...Baby burps well, does not spit up and poops 2-3 times a day. His weight gain has been a steady ounce a day. He's happy except when the gassiness is excessive. I am inclined to think that maybe his digestive system is just not firing on all cylinders yet. He might just need to grow out of this phase. Does anyone else have experience with correcting this issue with block feeding? Any other suggestions welcome. I just don't see it working for me and little guy. I just hope I haven't hurt my supply to the extent that it can't recover

[@llli*mommal]

If block feeding is making baby unhappy, don't do it! Gas and green poops are very minor irritations compared to a sad baby who doesn't seem to get enough from a single breast.

Aside from gassiness and some green poops and bottom irritation, what symptoms of oversupply are you seeing? Are you always or frequently feeling full or engorged? Seeing baby pull off the breast, cough, splutter, gag, or making a clicking noise while nursing? Seeing milk spray into the air when baby does pull off?

[@llli*chip]

Thank you for responding. Not seeing most of those other symptoms you mentioned. He gets fussy at the breast and pulls off, but this seems to be the result of not enough milk after a few days of block feeding. Also, I have heard a click while nursing before, but not with any consistency, and not lately. Only engorge when he sleeps for an especially long time (6 hour stretch is probably his record).

[@llli*chip]

To be fair, I should also mention that doc thinks baby is spending too much time on the breast. He is thinking that this is because he is primarily getting foremilk (less fatty and less filling, more lactose which leads to more intestinal gas). He feels that block feeding is the best way to encourage the transition to the fattier hindmilk over the course of a feeding.

I feel that less frequent more filling feedings would be great, but I'm just not seeing this as a solution to that issue or the gassiness. Not for us anyhow I'd rather not risk my supply any further. I hate to see baby uncomfortable, but as far as I know gassiness is not inherently dangerous. The benefits of maintaining my ability to breastfeed him far outweigh that concern.

[@llli*sonogirl]

Is the doc actually an IBCLC, or is he just calling himself a lactation consultant? This is an important distinction!

I feel that less frequent more filling feedings would be great, but I'm just not seeing this as a solution to that issue or the gassiness. Not for us anyhow I'd rather not risk my supply any further. I hate to see baby uncomfortable, but as far as I know gassiness is not inherently dangerous. The benefits of maintaining my ability to breastfeed him far outweigh that concern.

I would agree 100% with you. There are no health risks to being gassy, and no health risks to baby if he has a few weird poops, either! Based on your other responses, it really does not sound like you have oversupply at all, so pushing on with block feeding would likely be pretty detrimental to your long-term nursing relationship!

[@llli*mommal]

Yeah, I also wonder whether the doc is actually an IBCLC. His advice certainly isn't what most IBCLCs would give. Here's why:
- When a baby spends a long time nursing, that is not suggestive of oversupply. Oversupply usually causes fast letdowns, and fast letdowns mean that babies get full in a hurry. It's not uncommon for a baby to nurse in just 5-10 minutes when the mom has oversupply.
- There is no such thing as a baby "spending too much time on the breast". That's like saying a baby can spend too much time doing the most normal, most healthy activity in the world. Doesn't make sense when you put it that way, right?
- The doc is completely incorrect if he thinks that shorter feedings = greater "hindmilk" intake. Quite the reverse: most babies need to stay on the breast longer in order to reach the so-called hindmilk.
- The idea that a baby can be trained to take "less frequent, more filling" feedings is a total myth. Infant tummies are tiny, and breastmilk digests fast. Therefore, breastfed babies are designed to feed frequently. Some people imagine that you can make a baby take "meals" rather than "snacks", but they are ignoring the fact that infrequent feedings are bad for milk supply, and that snacking is the normal eating pattern for babies.

It sounds like you have already decided to shelve your doc's advice, which is excellent. You are absolutely correct that gas is a minor, minor concern when compared to your ability to nurse your baby for as long as you want.

[@llli*sassypants]

Some babies are just gassy and it isn't indicative of a problem that needs to be solved. Most babies will outgrow this in the 4-6 month range. I totally agree with you, don't risk your supply over a little gas. In the meantime you can try baby massage to relieve gas.

[@llli*chip]

Thank y'all for the helpful responses. I'm a noob to all things motherhood at age 37. It doesn't feel normal to ignore doc's orders, but in regards to breast feeding, I'm going to keep following my instincts. If I have a farting baby attached to my boob for 14 hours a day, I guess that will just have to be life for a while

[@llli*mommal]

I think that the noob stage of motherhood is a great time to stop thinking of yourself and your child as passive recipients of doctors' orders. Transition to thinking of yourself as a partner in and an advocate for your own health care, and your child's health care. I can't tell you how many women I know who have caught serious, life-threatening errors made by medical professionals!

Long story short: don't feel weird about ignoring bad advice when it's bad advice!!!