Continuation of weight gain/supply struggle

[@llli*tclynx]

continuation from http://forums.llli.org/showthread.ph...te-milk-supply

Babe reaches 12 weeks in a few days so I figured it was time to start the next thread.

QUICK refresher
I'm 40, this is my first pregnancy. Easy pregnancy, no complications.
Natural birth, kinda long labor, extensive tearing/repairs but blood loss not extreme enough to require transfusion or anything like that.

Baby born March 12
8 lb 14.5oz
discharge 2 days 8 lb 5 oz
ped apt day 5, 7 lb 11 oz, started supplementing 1oz formula per feeding at breast with tube feeder.
Day 8 Dr said to only supplement every other feed for a couple days then stop supplementing.
Day 10 Obvious to me that babe not getting enough milk to stop supplementing.
Day 11 Dr apt weight not good
Day 14 WIC apt 8 lb 9.5oz
Got Medela SNS and started pumping to increase supply.
Day 19 dr apt 8 lb 15.5oz
started trying to wean off using the supplement slowly
Realized pump was hurting me.
By 4 weeks we were down to only supplementing 4-6 oz per day
day 33 dr apt 9 lb 7 oz
40 days rented good pump
44 days, able to pump 4oz when pumping after feedings.
tried to reduce supplement again.
baby starts to really compress/crease nipples bad (before most latch discomfort being blamed on trying to get latched with the tubes or from nipples being bruised from old pump.)
Day 48 See Hospital LC for help
Day 49 Ped office for evaluation of Tongue/Lip tie 9 lb 12oz
Supplementing more while trying to get tongue/lip tie revised
day 55 Tongue and Lip tie laser surgery
62 days dr apt 10 lb 2 oz
70 days dr apt 10 lb 7.5 oz and tongue tie re-cut
Supplementing only about 2 oz most days
78 days visit from LC more experienced with tongue/lip tie issues
80 days aprox 10 lb 14 oz
81 days 10 lb 14.5 oz dr office confirming an inguinal hernia.

It seems difficult to get him to eat enough. He will nurse for a very long time but much of that time he is not very actively nursing. I have to do breast compressions to get him to take in much during a feeding and compressions only seem really effective when I'm quite full.

We are not quite to 3 months but not far from it.

82 days Surgeon says NOT a hernia, at least not yet, just a Hydrocele? Not an emergency so will check again in 6 weeks.
85 days Aprox 11 lb 3 oz according to home scale.
88 days Aprox 11 lb 5 oz according to home scale
(future) 89 Days WIC Appointment
(Future) 91 Days Dr appointment for Weight Check.

[@llli*tclynx]

I'm starting to feel a bit defeated about getting off the supplements entirely so posted the following over in increasing milk supply

What is the best way to cope with having to give supplements long term to have it impact milk supply the least?

I'm starting to fear that I may be stuck with supplementing long term. I've gotten my supply up enough but it still doesn't seem to help, baby only gains weight when we give that extra expressed milk to him via SNS and/or bottle.
It seems to be a milk transfer issue.

So, if I must continue supplementing long term, I would like some advice on how to handle giving 3-5 ounces per day.

I can use the SNS for up to two feedings per day (usually only about 1-1 1/2 oz max at a time) but more than that and he starts trying to latch onto the tube instead of the breast and feedings get really fussy and tricky. Also it is difficult to get a good latch when using the SNS so I would really rather avoid using it more than absolutely necessary.

When DH is home I will sometimes let him give one or two 2 oz bottles per day either right before or right after a breast feeding in the afternoon when my supply is lowest and I will pump extra but DH travels for work and is out of town for a week at a time often so that is not a daily answer.

I have not yet given DS any bottles myself so I'm not even sure if he would take a bottle from me. I haven't really wanted to try with bottles for fear of it causing more problems with breastfeeding. Is it ok for me to use a bottle for him once per day? If so, suggestions?

So that leaves me wondering how best to deal with giving another 1-3 oz to DS.

I suppose I could finger feed using the SNS but does anyone have any other suggestions? DS is only 12 weeks old.

[@llli*bsua65]

Hey there!

I may easily have missed some key information in all that you have written... But the main thing I want to say is in effect there are only 2 reasons for you to supplement... The first is if your milk supply is off; the second is if a baby has inefficient milk transfer.

From what you have posted it sounds like your best chance of coming off the supplements is working with your new LC.

From a personal point of view we had weight gain issues for the first 4 months... For us this was firstly a tongue tie revision; but the alone was not enough... We then did gentle suck training and the 'tongue walk' to teach my lo to use her now freed tongue properly... We had to work on a confused latch which was shallow/bottle like... This was done with input from the LC, using the 'flipple' and breast sandwiches to latch and then breast compressions to keep her on and teach her to encourage my let downs and not just wait for them... (she fed forever during this stage).

I post all of this in case there is something in my story that can help you. I had a meltdown at 4 months thinking I couldn't go on with feeding but after a 2 hour LC session and a cranial osteopathy session it only took a few days for my LO's latch to improve.

It is now 6 weeks on and her weight gain is so good we are looking to stop the 2 50ml suoplements of EBM that she has via SNS. I appreciate the faff of the system and yes my now 6 month old drinks from the tube like a straw... but for us it was better than reintroducing bottles with her dodgy latch.

It sounds like you have your milk supply sorted so I won't comment on that!

Good luck with it all and hang on in there; if you can get her milk transfer sorted you can come off the supplements!

[@llli*tclynx]

Hey there!

From what you have posted it sounds like your best chance of coming off the supplements is working with your new LC.

From a personal point of view we had weight gain issues for the first 4 months... For us this was firstly a tongue tie revision; but the alone was not enough... We then did gentle suck training and the 'tongue walk' to teach my lo to use her now freed tongue properly... We had to work on a confused latch which was shallow/bottle like... This was done with input from the LC, using the 'flipple' and breast sandwiches to latch and then breast compressions to keep her on and teach her to encourage my let downs and not just wait for them... (she fed forever during this stage).

I post all of this in case there is something in my story that can help you. I had a meltdown at 4 months thinking I couldn't go on with feeding but after a 2 hour LC session and a cranial osteopathy session it only took a few days for my LO's latch to improve.

It is now 6 weeks on and her weight gain is so good we are looking to stop the 2 50ml suoplements of EBM that she has via SNS. I appreciate the faff of the system and yes my now 6 month old drinks from the tube like a straw... but for us it was better than reintroducing bottles with her dodgy latch.

It sounds like you have your milk supply sorted so I won't comment on that!

Good luck with it all and hang on in there; if you can get her milk transfer sorted you can come off the supplements!

Thanks for your comments, I've been getting a bit discouraged.

Can you tell me more about the gentle suck training?
And the "tongue walk" you mention?

I'm not sure where to find some one for cranial osteopathy or if I can afford it.
I grew up with osteopathic doctors but they seem hard to find where I live now.

[@llli*tclynx]

have the WIC appointment today. Looks like my county is finally getting an IBCLC.
And I'm picking up the PISA they have since in order for my baby to remain 100% Breastmilk fed, I need to pump about 6 times a day minimum and have often been pumping 8-10 times a day.
I can't afford to keep renting the Symphony long term.

[@llli*tclynx]

ok,
consultants at the WIC office have put me in touch with an Oral Motor Therapist.
Hopefully I can get in to see them This week.

[@llli*tclynx]

last couple days have been difficult for pumping as DS keeps falling to sleep on the breast but I've had trouble getting him to stay asleep when I try to put him down.

[@llli*bsua65]

http://www.justbreastfeeding.com/sor...reastfed-baby/

[@llli*bsua65]

For the tongue walk if you stick tongue walk breastfeeding into Google the 2nd hit is a LLLI pdf. I have no idea how else to link it. Sorry it took so kong to reply

Am glad you are getting support; let us know how it works out! Osteo wise I got a recommendation from my health visitor as woykd never have thought of it!

[@llli*bfwmomof3]

Here's the PDF:
http://www.llli.org/docs/92.pdf