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Thread: Major Trouble Breastfeeding - Baby 6 Weeks Old...

  1. #1

    Default Major Trouble Breastfeeding - Baby 6 Weeks Old...

    My little boy is 6 weeks old. From the start we've had all sorts of troubles with feeding. I'm going to write down everything as I'm not even sure what the real problem is any more or where to go from here...

    At the very start, he slept 7 hours straight after the birth, couldn't wake him at all and wasn't interested in feeding.. so we had a late start. Then my nipples got sore and were bleeding, so painful but kept feeding him on demand (every hour or so the first few days with a few longer breaks). My milk came in, had tons of it, fed well but baby was only going poop every 3 or 4 days (a big poop nonetheless!) and it was green! I read it could be a foremilk/hindmilk imbalance and tried to block feed. Big mistake - yes, his poop when yellow, although still only went every 3-4 days, but my supply dropped and I didn't realise until one day I thought I felt a bit empty. Friends assured me this is normal once the supply regulates. I was nervous and called in an IBCLC who told me not to block feed, and to pump after every feed and finger feed it back. The baby also had a weak suck and needed practice, plus the latch was a little shallow. His weight gain was good though (a mystery, as he for sure wasn't getting what he needed from me).

    Here's one problem with the latch. I have very small (almost flat) breasts with small areolas. A comfortable latch for me and the baby takes in all the areola but baby's mouth is still quite small. The latch the LC showed me was far deeper, but only works on a full breast, after a few mins of sucking baby starts to slip off the breast repeatedly as there's no curve to hold on to...is there an alternative way of latching on?

    That's the other thing, he sucks for maybe 5 minutes, then starts to nibble, and I feel quite empty. Pumping after gives me maybe 10ml on each side at the most. He feeds for up to 40 mins, although I'd say 30 mins of that is without hearing swallowing. He does spit up after every feed, and has a lot of wet diapers, so not sure how much he is getting really.

    Oh, and then last week I got mastitis and I think my supply dropped more. After the mastitis, baby's weight gain had only been 100g in a week. So me, the attachment parenting, babywearing new mom, started giving a bottle of formula spread out amongst all the feeds each day... say 40 ml x 3 supplementing 3 feeds... and he still seems hungry (rooting etc.) all the time. I feel terrible So scared I won't be able to get a good supply. I need to go back to work in 1.5 months and can't pump more than 60ml in one go (that's instead of a feed, like I said, after a feed I can pump max 20 ml, usually around 10ml). Plus, I think my baby is starving! I'm taking 9 fenugreek tablets a day, drinking a big glass of water before every feed, pumping between or right after feeds, and getting as much rest as I can. No improvement yet!

    And seeing my little boy trying to latch again and again on an apparently empty breast is breaking my heart...

    Any advice? Will I ever be able to feed him properly??? Feel like a failure...

  2. #2
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    So how many times a 24 hour days is baby nursing now? Also, how many times do you pump each day? what type of pump?

    Pump output is not an accurate measure of production.

    I don't know metric, so mils and grams, I really can't follow. So if anyone can convert to ounces I would appreciate it.

    Basically, this is what I see. What am I missing?
    Baby gained fine and all was well until you started block nursing.
    Block nursing reduced your production. But baby continued to gain well even so.
    You got mastitis. Any idea what led to the mastitis?
    there was ONE week, post your illness, of slower gain. If 100 g is about 3.5 ounces, yes, that is slower than average gain for this age. But not CRAZY slow, especially assuming gain was better prior. Was it? What is babes overall gain since birth? normal? Babies do not always gain steadlily, So one off week here or there is not neccesarily an indicator anything is amiss.
    after this week of slow gain, you started supplementing about s
    ay 40 ml x 3 supplementing 3 feeds...
    so what is that total each day? about 4-5 ounces? That would be about a 5th of total daily intake for an average 6 week old. (fyi) And are you continuing to carefully monitor gain since starting supplements?

    As far as milk intake by baby while nursing, did the IBCLC do a before and after nursing weight check? This is a much better measure than pump output, but still only gives you the info for one session, and intake normally varies session to session.

    A comfortable latch for me and the baby takes in all the areola but baby's mouth is still quite small. The latch the LC showed me was far deeper, but only works on a full breast, after a few mins of sucking baby starts to slip off the breast repeatedly as there's no curve to hold on to...is there an alternative way of latching on?
    A deeper latch does not always equal more comfortable nursing or better transfer than a more 'shallow" latch. If what the IBCLC showed you ONLY works on a full breast, I don't think that is going to work. Most mothers begin to experience a less full breast over time and this should not affect latch at all. If anything, a "too full" breast usually leads to more latch issues.
    What positions have you tried? Is the latch technique the IBCLC showed you the 'breast sandwich?'
    How are the supplements given? Paced bottle feeding?
    Last edited by @llli*lllmeg; July 30th, 2014 at 09:33 AM.

  3. #3
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    Meg,
    Aprox 1 oz = 30 ml

  4. #4
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    http://kellymom.com/bf/normal/newborn-nursing/
    http://kellymom.com/bf/got-milk/supp...es/low-supply/
    http://kellymom.com/bf/got-milk/perc...fficient-milk/
    My lo is 16 weeks now. I remember thinking several times in the first two months that if I were a less experienced mother I'd be convinced something was wrong with my supply. I didn't pump until this month but the constant nursing and fussing and ' empty ' breasts surely gave me that my baby is starving feeling. We just kept switching sides repeatedly and doing breast compressions. On and off for hours. He gained 4 lbs the first month and two the second so he was clearly taking in plenty of milk. I'm delighted to be on the far side of the newborn stage. I think with some faith in yourself, you could easily wean back off the supplements. One question I don't see mentioned in your post. How many times does he nurse overnight? Any long stretches of sleep with swaddling or a pacifier?

  5. #5

    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    Thanks so much for your replies - sorry about the grams/ml/oz thing!

    Quote Originally Posted by @llli*lllmeg View Post
    So how many times a 24 hour days is baby nursing now? Also, how many times do you pump each day? what type of pump?
    I nurse about 8 or 9 times a day, usually it's every 3 hours, an occasionally 'snack' type feed in between, and then one four hour stretch at night, and the first 2 morning feeds are usually about 2 hours apart... I pump after usually at least 6 of the feeds (not the first morning one), with a medela lactina hospital grade pump.

    Quote Originally Posted by @llli*lllmeg View Post
    You got mastitis. Any idea what led to the mastitis?
    The first night I swaddled the baby was when I got mastitis. He slept four hours straight (Before that he used to wake up 5 or 6 times a night to feed and/or refuse to settle hours when we tried to put him down for the night.) and I woke up in pain, with chills and a fever, and really engorged. I guess the mastitis must have been brewing beforehand but that was when I noticed it.

    Quote Originally Posted by @llli*lllmeg View Post
    there was ONE week, post your illness, of slower gain. If 100 g is about 3.5 ounces, yes, that is slower than average gain for this age. But not CRAZY slow, especially assuming gain was better prior. Was it? What is babes overall gain since birth? normal? Babies do not always gain steadlily, So one off week here or there is not neccesarily an indicator anything is amiss.
    Weight gain was very good prior. And this week, at 5 weeks 2 days, he had gained 2.6lb since birth.

    Quote Originally Posted by @llli*lllmeg View Post
    after this week of slow gain, you started supplementing about s so what is that total each day? about 4-5 ounces? That would be about a 5th of total daily intake for an average 6 week old. (fyi) And are you continuing to carefully monitor gain since starting supplements?
    I give him about 4oz formula a day. I have tried to monitor the weight gain and it was good again this week after a few days of supplementing (he gained about 10oz this week).

    Quote Originally Posted by @llli*lllmeg View Post
    As far as milk intake by baby while nursing, did the IBCLC do a before and after nursing weight check? This is a much better measure than pump output, but still only gives you the info for one session, and intake normally varies session to session.
    Yes, he nursed for 15-20 mins and took in about 40ml (1.4 oz). He was 3 weeks old then, but that was before the mastitis. I then pumped directly after and got my usualy 20 ml (0.8oz) before it 'dried up'.

    Quote Originally Posted by @llli*lllmeg View Post
    A deeper latch does not always equal more comfortable nursing or better transfer than a more 'shallow" latch. If what the IBCLC showed you ONLY works on a full breast, I don't think that is going to work. Most mothers begin to experience a less full breast over time and this should not affect latch at all. If anything, a "too full" breast usually leads to more latch issues.
    What positions have you tried? Is the latch technique the IBCLC showed you the 'breast sandwich?'
    How are the supplements given? Paced bottle feeding?
    She just showed me a normal latch, pulling the baby closer, quicker with chin pressed in. But the more breast I get in, the less he seems to want to nurse. He does always have more than the nipple though. I've tried normal cradle hold, and also the football hold which was good earlier when my baby was very very sleepy, it kept him more awake. I don't find it helped with the latch.

    I'm feeding him with a feeding tube, either with my finger or at the breast. The last few days I've been leaving the formula until last, trying to express as much as I can to fill the gaps. Especially at night when my supply is much better, I can sometimes get a good 2oz spare for use during the day.

  6. #6

    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    Quote Originally Posted by @llli*zaynethepain View Post
    http://kellymom.com/bf/normal/newborn-nursing/
    http://kellymom.com/bf/got-milk/supp...es/low-supply/
    http://kellymom.com/bf/got-milk/perc...fficient-milk/
    My lo is 16 weeks now. I remember thinking several times in the first two months that if I were a less experienced mother I'd be convinced something was wrong with my supply. I didn't pump until this month but the constant nursing and fussing and ' empty ' breasts surely gave me that my baby is starving feeling. We just kept switching sides repeatedly and doing breast compressions. On and off for hours. He gained 4 lbs the first month and two the second so he was clearly taking in plenty of milk. I'm delighted to be on the far side of the newborn stage. I think with some faith in yourself, you could easily wean back off the supplements. One question I don't see mentioned in your post. How many times does he nurse overnight? Any long stretches of sleep with swaddling or a pacifier?
    He nurses at about 7pm, 10pm, 2am, 6am, 8am...(his natural routine - not my doing! I'm nursing on demand!) he is swaddled and sleeping between feeds between 10 and 6. He does use a paci to go to sleep at these times (we tried without it but that was a disaster!)

    Maybe he is getting enough... just sometimes literally after 5 minutes he stops swallowing...

  7. #7
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    10 oz of weight gain in a week is actually really good weight gain. Average of 7-8 oz of weight gain in a week is actually really good.

    Remember to measure weight gain from the lowest weight (not birth weight, only thing to really take note of for birth weight is when baby regains to birth weight, if it takes longer than 3 or 4 weeks to regain birth weight then they worry, most babies manage it in 10-14 days.)

    Gaining 2 lb per month is really good weight gain, don't panic too much, I think you are probably still doing better than you think.

    Now something to know about nursing on demand, YOU are allowed to have some input on this. Just because he isn't demanding doesn't mean you shouldn't offer if you feel like it. Granted, if he doesn't want to nurse you can't force it but you could offer a little more often and that might make a big difference in supply and weight gain.

    As to the swaddling and paci, if weight gain is an issue, these things can tend to extend sleep or stretch the time between feeds which can be a problem so if using them you need to make sure the sleep stretch doesn't stretch too long. (My LO didn't much like swaddling and never took a paci, he requires cuddling to sleep so we have to co sleep.)

    When I started pumping to increase my supply, I only ever got drops, pumping actually takes practice and some people never respond well to the pumps. I eventually got to the point where I could get anywhere from 10 ml to 50 ml when pumping but it often depends on time of day and how much baby just nursed. Massage and compressions help when pumping. But as noted, pumping isn't really a good indication of how much milk supply there is.

    Breast compressions can help when feeding. To really get an idea of how much milk baby is getting, doing a weigh/feed/weigh several times can help you get an idea there.

  8. #8
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    no, I am sorry I am stuck in the 50 years in the past when it comes to measurements. I guess I am starting to get it though, my conversions were not to bad.

    So please go over anything I say with your IBCLC. She is there and knows the situation. I don't. But here are my thoughts.

    ok. I think you are doing really well! as pp notes, Baby is gaining wonderfully. So while I certainly agree block nursing was probably not a great idea, obviously any damage done was not to bad plus, is getting reversed. You can usually reverse low production of this type (the type brought on by breastfeeding management rather than some underlying condition that causes low production) by nursing lots and lots. Pumping as well, as you are doing gave you a jump start, but you may be able to back off on that now, which will make life far easier for you.

    to respond specifically to each of your answers:

    I nurse about 8 or 9 times a day, usually it's every 3 hours, an occasionally 'snack' type feed in between, and then one four hour stretch at night, and the first 2 morning feeds are usually about 2 hours apart... I pump after usually at least 6 of the feeds (not the first morning one), with a medela lactina hospital grade pump.
    I would strongly suggest seeing if baby will nurse more often. 8-9 times a day is on the low end of normal for a baby this age. Just bumping this up two more times a day would almost surely make up for what you are supplementing.
    Well you are using an excellent pump. Great. BUT I doubt you need to keep pumping that often. For sure, definitely pump if you are still supplementing. But once you stop supplementing, you can almost surely quickly wean off the pump sessions entirely.

    The first night I swaddled the baby was when I got mastitis. He slept four hours straight (Before that he used to wake up 5 or 6 times a night to feed and/or refuse to settle hours when we tried to put him down for the night.) and I woke up in pain, with chills and a fever, and really engorged. I guess the mastitis must have been brewing beforehand but that was when I noticed it.
    Thank you very much for pointing out one of the dangers of swaddling. Like pacifiers, swaddling is a sleep lengthening technique. That works. This means, it can make a baby sleep longer than they would NORMALLY. This is not always a good thing. It is potentially bad for milk production and baby gain, and also vcan most certainly lead to mastitis. Absolutely. Baby nursing frequently night and day is normal and needed in the newborn period.

    Weight gain was very good prior. And this week, at 5 weeks 2 days, he had gained 2.6lb since birth.
    So your baby is gaining wonderfully. Average gain for this period is about an ounce a day-averaged out. This does NOT mean baby will always gain an ounce a day! Some of the time it will be more, some less-but, If the overall gain is that much, there is almost surely nothing much wrong with milk intake. 37 days = 37 ounces or about 2 lbs 5 ounces. Also, your babies gain is even better than those numbers indicate probably, as baby surely lost a little weight after birth(?)

    I give him about 4oz formula a day. I have tried to monitor the weight gain and it was good again this week after a few days of supplementing (he gained about 10oz this week).
    So going by the most recent weight checks, baby is gaining MORE than the average gain with a small amount of supplements. That suggests to me that the supplements may be unneeded. 4 ounces would equal about 1-3 average nursing sessions. So again, even if baby did need that extra, that may very well be available to baby via nursing a bit more often.

    She just showed me a normal latch, pulling the baby closer, quicker with chin pressed in.
    Ok. If you mean she showed you a quick movement with your arm that rams the baby onto the breast, this is a very outdated approach to latch. Yes it works sometimes, sure. It was the accepted method of latch for a long time. but more recent research indicates this is not a helpful latch technique for many moms. If you mean an asymetric latch, yes, there is wide acceptance this is helpful when a latch is painful and baby is not getting enough milk. But it is not always needed, and it certainly is no more 'normal' than any other latch. And it is not always going to work well.

    Now latch on is considered a more subtle and individual art, and positioning is wide open, with laid back positioning being the idea that has really caught on in the last several years, because it often works so well and is so comfortable. BUT, each mom and baby pair will find their own way to latch and position. Each pair is too individual for any one size fits all latch or positioning ideas. I am linking some info on latch and positioning ideas below.

    http://feedthebabyllc.com/latch-and-positioning/

    LLL positions ideas http://www.llli.org/faq/positioning.html

    Laid back http://www.llli.org/docs/00000000000...astfeeding.pdf

    nice simple pictorial http://cwgenna.com/quickhelp.html http://www.nancymohrbacher.com/blog/...-breastfeeding

  9. #9

    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    Thank you for the useful links.

    I find it very confusing to follow the latch advice when all the diagrams/pictures are of much bigger breasts! Mine look nothing like that and when following their advice baby ends up latched on with a much smaller mouth than is shown in the pictures... maybe that's just the best way for us?

    I tried the laid back thing. I like it, not sure if it's practical for all the time though.

    I do think more weigh, feed, weighs would be useful.

    I just want to describe the two main types of feed that we have - to know what I should be changing.

    Non-fussy feed:
    Baby acts hungry (rooting etc.), I put baby to breast. Baby sucks hard after letdown, for anywhere between 30 seconds to 5 minutes.... then he starts sucking with little sucks. He may fall aslep, and I'll wake him by doing breast compressions or switching sides, burping him etc. Even if he isn't falling asleep, he'll suck with tiny little sucks and no audible swallowing for ages...none of the above helps for more than 2 or 3 sucks. Is he taking milk in this time? When am I meant to stop him from feeding? I've tried not stopping him and he can do these tiny sucks for 2 hours (that's the longest I've let him before taking him off). And even after that, he will root either right away or 5 minutes later, and act hungry. Surely this means I don't have enough milk? Now, I tend to take him off after 40 minutes or so, but like I said, sometimes he wants more not long after. I do want to feed on demand - but I need to be able to get dressed, go to the bathroom, tidy the house, go out to the grocery store etc.! What's going wrong???

    Fussy feed: When I put him to the breast, he only sucks right after the letdown, once the fast flow has stopped, he detaches, bobs his head back and forward, re-attaches, sucks a bit, slips off, fusses around, goes back on etc. It's like he only likes the fast flowing milk... and breast compressions etc. don't help here either. Is this also a sign of not enough milk???

    I would love to stop the formula and the pumping... but I don't know how to if I can't tell when he's hungry and how much he has had...

  10. #10
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    Default Re: Major Trouble Breastfeeding - Baby 6 Weeks Old...

    If you can, I would recommend getting at least temporarily a baby scale so you can weigh before and after feedings for a bit to get an idea of how much baby manages to take in. Look for a scale that reads down to a tenth of an ounce or at least 1/2 an oz or the equivalent in grams.

    I actually got one just this week for about $50 USD. You might also be able to rent a good one.

    You might also want to look into using a lactation aid so you can supplement right at the breast and maybe get him to fill up at the breast and get his supplement all at the same time.

    In nursing comfortable or is he hurting your nipples?
    Saddly, this does sound like a low supply issue, there may be herbs or medications that might help and there are some medical issues you want to check for since some conditions can be treated which can help improve supply issues.

    As to marathon nursing sessions. Do the compressions and switch sides a couple times and then let him comfort suck as long as you are comfortable but yes eventually you do have to detach him on occasion even if it is just for a few minutes. This is where the at the breast supplementer really helps since you can put into it as much as you expect him to take at a feeding and you get to breast feed and supplement all at the same time and if he gets full and falls to sleep you don't have to wonder if he is really still hungry.

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