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Thread: Lazy nurser or poor milk supply or something else?

  1. #1

    Default Lazy nurser or poor milk supply or something else?

    DD2 (kidlet #4) was born 9 days ago at 37w5d. The birth was pretty ho-hum and we were discharged the next day with a pretty decent latch, positioning, etc. The following day we had a home visit from a postpartum nurse (standard practice here). She helped again with better positioning and making sure everything was chugging along, but noted that DD was jaundiced and had lost a bit over 10% of her birth weight. She also noticed that DD had a tongue tie and suggested some minor supplementing with equal amount of pumping, but was not insistent.

    Next day we went to a weigh in and jaundice recheck. Both were worse than the previous day. The nurse that day was more insistent we supplement and pump. We did a tiny amount of formula that day and I pumped really effectively (manual pump, but I get good output).

    Next day was another recheck and some mild improvement on the weight gain (first day to see an increase) but worse on the jaundice. I was sure that the underlying issue was the tongue tie and once we got it clipped the rest would get better.

    Finally on Wednesday (day 5) we began to see the jaundice plateau, the weight gain make another tiny improvement and we had the tongue tie clipped. Thursday things were not better, but that was not unheard of. Friday finally felt like a good day. DD was latching beautifully, I got an amazing output on the pump and really cut out the formula.

    Then Saturday came and everything went to pot DD started screaming whenever I tried to nurse her and was not really working at getting any milk. Nursing started to take nearly 2 hours start to finish, with multiple re latches, lost of crying (both of us), and whenever I think she is done she starts rooting again. I nursed on demand as much as possible but really the end result is that she is still hungry. We pulled out the formula for an ounce or two to top off and she would snarf it down and look peaceful and contented.

    Today she wasn't nearly as angry, but she also didn't get any more sated from nursing. She still sucks a bit, stops, sucks, stops and nursing takes 1-1.5 hours. I started to take fenugreek, drink way more water and I pumped twice, with pretty meager output (though the milk is really creamy looking). At dinner time I nursed for 1.5 hours, she was still rooting and I was sure there was nothing left to feed her. I gave her 1.5 oz of FF and she went to town on it. She fell asleep within seconds of finishing (it was nearly impossible to get a burp out). Also, today she is really not having poopy diapers. Yesterday wasn't too bad for poopy diapers but today is really not good.

    I'm stumped. I realize that I could opt to stop supplementing and that is probably the answer I will get if I want to make BFing work long term, but it is so hard to stop feeding DD the one thing that makes her finally settle contentedly. I had similar issues with DD1. Ultimately we ended up on formula after she hardly gained any weight in 2 months. I know that FF was a lifesaver with DD1 so I am not opposed to it at all, but I don't want to go to 100% formula unnecessarily if I can make BFing work in some capacity. FTR, I over produced with my older boys and nursing went really well, go figure!

    The other thing worth noting is that I never really felt engorged is time around. I haven't had the whole leaking, breast pads galore, let down at random times, etc. this time around. I know DD had a pretty lousy suck before the TT was corrected which may have crossed the signals with how much she was needing to eat. I don't know...

  2. #2
    Join Date
    Feb 2014
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    Default Re: Lazy nurser or poor milk supply or something else?

    It kind of sounds like she is trying to re-establish your supply since there was a little trouble in the beginning. I don't think you'll have to be supplementing for long. Just make sure to keep putting her to the breast and I believe things will start getting better.

  3. #3
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    Default Re: Lazy nurser or poor milk supply or something else?

    Actually the first few days sounded entirely normal to me. It is very typical for a breast-fed newborn to lose weight the first three days or so and it is also very typical for breast-fed newborn to have jaundice during that period. You do not mention what the actual bilirubins levels were, however you may want to read up on jaundice in the breast-fed newborn. I think that Jack Newman has a good article.
    As far as what is going on now, it is entirely normal for breast-feeding sessions to take long periods in the newborn days and it Is entirely normal for a baby to pop on and off. It is also normal to not feel engorged. Engorgement is actually a sign that things may not be going entirely well with nursing. Yes of course it is very common, however it is not a necessary part of normal breast-feeding. If the baby is nursing frequently enough and effectively enough, then a mother with normal milk production should not get engorged.

    The question now would be is baby continuing to gain weight? Does baby appear to be on track to regain back to birthweight by 10 to 14 days? If not I would suggest seeing a board certified lactation consultant to assess breast-feeding if that is possible.

    If you think the problem is low milk production, usually the best thing for low milk production is to allow baby to nurse very frequently for as long as baby wishes, switching sides at least once or more often each session as you and baby like. But if baby is having difficulty removing milk from the breasts adequately, then pumping may need to be part of the picture. Also of course if you are supplementing, pumping is probably necessary. But this is why it would help be helpful to see a lactation consultant to see if such interventions are actually needed and to make sure they are done in such a way that does not further undermine your milk production or your baby's ability to nurse effectively.

    You're not on hormonal birth control by chance are you? This can harm milk production and is particularly harmful if given shortly after birth. Also if there is any chance you are retaining part of your placenta, that will certainly cause issues with milk production. I mention these because it is a bit puzzling if your milk production was very good with your older children that it would be less with this one even with the tongue-tie and supplement interventions in those first few days.
    Last edited by @llli*lllmeg; March 31st, 2014 at 11:40 AM.

  4. #4

    Default Re: Lazy nurser or poor milk supply or something else?

    Quote Originally Posted by @llli*lllmeg View Post
    Actually the first few days sounded entirely normal to me. It is very typical for a breast-fed newborn to lose weight the first three days or so and it is also very typical for breast-fed newborn to have jaundice during that period. You do not mention what the actual bilirubins levels were, however you may want to read up on jaundice in the breast-fed newborn. I think that Jack Newman has a good article.
    As far as what is going on now, it is entirely normal for breast-feeding sessions to take long periods in the newborn days and it Is entirely normal for a baby to pop on and off. It is also normal to not feel engorged. Engorgement is actually a sign that things may not be going entirely well with nursing. Yes of course it is very common, however it is not a necessary part of normal breast-feeding. If the baby is nursing frequently enough and effectively enough, then a mother with normal milk production should not get engorged.

    The question now would be is baby continuing to gain weight? Does baby appear to be on track to regain back to birthweight by 10 to 14 days? If not I would suggest seeing a board certified lactation consultant to assess breast-feeding if that is possible.

    If you think the problem is low milk production, usually the best thing for low milk production is to allow baby to nurse very frequently for as long as baby wishes, switching sides at least once or more often each session as you and baby like. But if baby is having difficulty removing milk from the breasts adequately, then pumping may need to be part of the picture. Also of course if you are supplementing, pumping is probably necessary. But this is why it would help be helpful to see a lactation consultant to see if such interventions are actually needed and to make sure they are done in such a way that does not further undermine your milk production or your baby's ability to nurse effectively.

    You're not on hormonal birth control by chance are you? This can harm milk production and is particularly harmful if given shortly after birth. Also if there is any chance you are retaining part of your placenta, that will certainly cause issues with milk production. I mention these because it is a bit puzzling if your milk production was very good with your older children that it would be less with this one even with the tongue-tie and supplement interventions in those first few days.
    Thanks. I made an appointment with an LC but only later in the week. I also am getting a hospital grade pump tonight. I'm not on BC, but totally intrigued by the retained placenta concern. I did have a manual removal, and there were issues getting it all out. I left a message with my OB re: getting an U/S to rule it out. I plan to go weigh DD tomorrow.

    Unfortunately today is worse than yesterday. DD just doesn't make any swallowing sounds/pauses on the breast. She is naked and I am doing compressions. She just licks and does these small sucks that don't seem to do much.

  5. #5
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    Default Re: Lazy nurser or poor milk supply or something else?

    Okay well if you can move that lactation appointment up that might be a good idea.
    But I would also say that baby taking formula and then going to sleep may or may not mean anything. I understand you wanting baby to settle while nursing, and yes it is possible that this behavior indicates that baby is not getting enough milk. But not necessarily.
    Again wait gain is the way to tell baby is getting enough. Poops are a good sign, but diapers don't necessarily tell the whole story. Also as long as baby is pooping about three to 4 times per 24 hours or more that is considered to be reasonable poop output. Every poop that is about enough to be scooped up like with a teaspoon, rather than just a streak would count when you're counting poops.

  6. #6
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    Default Re: Lazy nurser or poor milk supply or something else?

    Weight gain. Not wait. Sorry.

  7. #7
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    Default Re: Lazy nurser or poor milk supply or something else?

    Also great you are getting a hospital grade pump. Even if baby is not nursing effectively, pumping with a good pump will help keep/get your milk production where it should be while you figure out what is going on. Try not to stress out about how much you pump each time. Remember not all moms respond really well to pumps, normal feedings at the breast are pretty small (1-3 ounces at this age) and that if mom is pumping as well as nursing, normal pump output each time is ~ from 1/2 to 2 ounces. If you feel that the pump alone (on top of nursing) is not quite doing the job, you might try adding hand expression to your routine.

  8. #8

    Default Re: Lazy nurser or poor milk supply or something else?

    Quote Originally Posted by @llli*lllmeg View Post
    Also great you are getting a hospital grade pump. Even if baby is not nursing effectively, pumping with a good pump will help keep/get your milk production where it should be while you figure out what is going on. Try not to stress out about how much you pump each time. Remember not all moms respond really well to pumps, normal feedings at the breast are pretty small (1-3 ounces at this age) and that if mom is pumping as well as nursing, normal pump output each time is ~ from 1/2 to 2 ounces. If you feel that the pump alone (on top of nursing) is not quite doing the job, you might try adding hand expression to your routine.
    An update of sorts. Good news is that my supply has improved somewhat. I'm feeling more letdown type feelings and my pumping output per session has doubled! Bad news is baby is still under birthweight and we are still supplementing at each feed. I met with an LC yesterday and she agreed dd has a weak suck (and a high palate) with an awkward latch. She showed me a few positions to try.

    Is there anything I can do to help dd suck more effectively? Currently even with the increased supply I have to do compressions to get dd to suck somewhat and she tapers off quickly. She also really scoots off a deeper latch and will only suck with a shallow latch.

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