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Thread: Sucking But Not Swallowing?

  1. #1

    Default Sucking But Not Swallowing?

    Hi there,

    I'm new to the forum and, well, to mommyhood. My baby girl is 8 weeks old and I've had my heart set on exclusively breastfeeding her even before I found out I was pregnant! Unfortunately I've been having trouble and am not sure how to get help. I worked with the various nurses and LCs at the hospital and also had 2 visits with 2 different LCs at the pediatrician's office, but I'm still having some trouble. I plan to see if I can talk with a LLL leader in my area, but I also wanted to check here to see if anyone has any advice. Sorry this is so long.

    Long story short, my baby takes in little to no milk when she nurses (as verified at one of my LC visits and also by the scale I have at home). The most I've seen her take in was 2oz, and sometimes she doesn't take in anything. I generally allow her to nurse as long as she wants (within reason), and frankly I think he would stay on my breast all day if I allowed her to. Because of this, she wasn't gaining well and I had to introduce supplemental formula/pumped milk (~2-3oz). In the meantime, my supply also went down. I'm still home so I've been feeding her on demand, giving her the supplemental milk or formula, and then pumping. I'm exhausted and frustrated, not to mention heartbroken that I'm not yet able to "effectively" feed my daughter.

    The LCs I visited said the latch seemed OK, and it doesn't hurt anymore, making me think that's not the problem. She doesn't have tongue tie or anything. I'm trying breast compressions, massage, and warm compresses pre-feeding. My supply is low, but I do still have milk, so I have no idea why she doesn't take much from me! Does anyone have any advice on how to encourage your little one to drink more and/or generally how to increase your supply?

    For some background, I came out of the hospital with some nasty nipple damage and a lot of confusion about how to heal and prevent future damage. I dreaded breastfeeding for the first few weeks since it hurt so badly, but I figured it out and healed. Everything at that point seemed to be going fine. Then, maybe a month in, something changed with her latch and it started to hurt again, and I think it was around then that I messed up my supply. I'm working on rebuilding it, if that's possible, but for now I can pump at most 5oz total overnight and 1-2oz during the day (without feeding her first). I've since been to see the LC at the pediatrician, and she suggested I use a nipple shield because I have pretty flat nipples. I'm sure there are other details I'm forgetting, but I feel like that's a pretty decent summary of my breastfeeding experience so far!

    Any advice wouldn't be very much appreciated! Thank you!!!

  2. #2
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    Default Re: Sucking But Not Swallowing?

    Hi hacouture. I am sorry you are having these difficulties. I know how exhausting it can be to be nursing, bottle feeding and pumping. I am going to ask some questions I hope that is ok.

    Are you still using a nipple shield and if so, for how long have you been?
    Have you tried latching baby without the shield again?
    Have you done a before and after nursing check using the shield?
    Do you do these checks on a professional digital infant scale, zeroed to the smallest measurement possible, with baby always naked?
    When doing these weighted feeds, Two ounce intake is normal transfer for an infant over 6 weeks. I understand sometimes there is no transfer, but actually, that is normal to, sometimes.
    Shields are known to prevent adequate milk transfer in some cases.

    Can you provide a complete weight check history with days of life?
    How many times a 24 hour day is baby given 2-3 ounces in a bottle? 2-3 ounces is a complete feeding for a newborn. If baby is possibly being oversupplemented, that will adversely affect your babies desire to take in more milk at the breast.
    How many times a day does baby nurse? Is baby taking any longer sleep stretches? any pacifier use?
    how many times a day do you pump?
    what kind of pump is it and is it new?
    How do you know you have low milk production?
    but for now I can pump at most 5oz total overnight and 1-2oz during the day (without feeding her first)
    Is this per session? or do you mean you pump 6-7 ounces total each day? Also, do you mean you pump prior to nursing rather than after?
    I'm working on rebuilding it, if that's possible,
    Usually, yes it is possible.
    I suggest the book Making More Milk
    Last edited by @llli*lllmeg; August 11th, 2014 at 01:07 AM.

  3. #3

    Default Re: Sucking But Not Swallowing?

    Thank you for responding so quickly and for the follow up questions! Below is more info...hopefully this is helpful and not too rambling! To summarize again, my concern is that she isn't able to take enough from me to sustain her growth despite frequent nursing. My goal is to eliminate the supplements altogether as long as it's in her best interest!

    Are you still using a nipple shield and if so, for how long have you been?
    Have you tried latching baby without the shield again?

    --Yes, I'm using the nipple shield most of the time. I started using it about 2 weeks ago when a lactation consultant at the pediatrician's office recommended it. I have tried latching without the shield and am somewhat successful (I'd really rather not use it!), although I do experience some pain, especially on my right nipple, which is more flat. I have a hard time getting my nipple to go all the way to the back of her mouth.
    --------------------------------

    Have you done a before and after nursing check using the shield?
    Do you do these checks on a professional digital infant scale, zeroed to the smallest measurement possible, with baby always naked?
    When doing these weighted feeds, Two ounce intake is normal transfer for an infant over 6 weeks. I understand sometimes there is no transfer, but actually, that is normal to, sometimes.
    Shields are known to prevent adequate milk transfer in some cases.

    Ah ok, I'm happy to hear 2 ounces or less can be normal. I thought she was supposed to take in about 4 ounces from me, which has never happened!

    --I did do one check with the LC using the shield during which she only took in about 1/2 ounce, according to the professional digital scale. I do attribute some of that low amount to the fact that I was nervous and uncomfortable in the office.
    --I also have a digital scale at home. I'm certain it isn't of the same quality as the one at the doctor's office, and it only rounds to the nearest 1/2 ounce.
    --During the weight checks in my home, my daughter isn't naked but in the same clothes in the before check as the after. And I'm sure to not change her diaper before doing the after check.

    Maybe the lesson here is that I shouldn't place too much importance on my at-home checks as they may not be accurate? I'm not sure whether the nipple shield is interfering with milk transfer, but I will say that since using it, I often notice milk in her mouth when she detaches, which I hadn't seen as much without the shield.
    -------------------------------

    Can you provide a complete weight check history with days of life?

    --Sure. She was born on 6/13 at 5 lbs 14 oz. She dropped to 5 lbs 7oz, which I think was taken one or two days after birth. She was actually 5 days "late," so we aren't sure why she was so tiny, but she was and still is otherwise healthy. Below are the weights recorded at her pediatrician.
    --6/17: 5 lbs 9.1 oz
    --6/19: 5 lbs 9.9 oz
    --6/23: 5 lbs 15 oz
    --6/30: 6 lbs 2.4 oz
    --7/14: 6 lbs 6.8 oz
    --7/24: 6 lbs 10.3 oz - started supplementation after this appointment
    --7/25: 6 lbs 15 oz

    On my scale this morning, she's now registering about 8 lbs 10 oz.
    -------------------------------

    How many times a 24 hour day is baby given 2-3 ounces in a bottle? 2-3 ounces is a complete feeding for a newborn. If baby is possibly being oversupplemented, that will adversely affect your babies desire to take in more milk at the breast.

    How many times a day does baby nurse? Is baby taking any longer sleep stretches? any pacifier use?

    --Oh ok, makes sense. I give her a bottle after every other feeding as per the lactation consultant I saw. Whenever possible, I give her expressed milk over formula, starting with 2 oz. I only give her 3 if she still seems hungry.
    --I nurse her roughly every 2 hours, give or take. I try to go by her cues but also try not to exceed 3 hours as per the pediatrician.
    -------------------------------

    How many times a day does baby nurse? Is baby taking any longer sleep stretches? any pacifier use?

    --She nurses quite a bit. Admittedly I'm not sure how many times per day (but can start counting again), but it ends up being about every 2-3 hours starting around 5am.
    --No current pacifier use.
    --She doesn't take long naps during the day - at most maybe 2 hours. I've been instructed to allow no more than 3 hours between feedings during the day. The pediatrician said she may have one 6 hour stretch overnight.
    -------------------------------

    how many times a day do you pump?
    what kind of pump is it and is it new?

    --Currently I pump after most feedings, at least after each feeding that is followed with the supplement. I've been doing this to help keep my milk production going.
    --I have a new Medela personal double breast pump.
    -------------------------------

    How do you know you have low milk production?
    --I guess I don't know for sure. I just assumed I do because she wasn't putting on enough weight from breastfeeding alone, she doesn't register much weight change before and after feeding, and because my pumping output is low (while I've gotten as much as 5 ounces, usually it's about 2 total without having breastfed her beforehand) compared to what I've read online. I'm not sure if this means anything, but I've also stopped leaking. I used to leak regularly, especially when nursing from the other breast. And my breasts rarely feel full.

    ---Quote---
    but for now I can pump at most 5oz total overnight and 1-2oz during the day (without feeding her first)
    ---End Quote---
    Is this per session? Also, do you mean you pump prior to nursing rather than after?

    --To clarify, while I generally breastfeed my daughter, I've occasionally pumped and given her a bottle during the day, for example when my mom was watching her while I was at the dentist. When I pump during the day without having fed her beforehand, my output is generally 1-2 oz total.
    --Since she is allowed a 6 hour stretch at night, I pump during that time, again to keep the milk production going. The most I've gotten during one of these nighttime sessions was 5 oz total, and the least was 2 oz total (this is more common).
    --When I pump after breastfeeding, I generally produce about an ounce between both breasts.

    ---Quote---
    I'm working on rebuilding it, if that's possible,
    ---End Quote---
    Usually, yes it is possible.
    I suggest the book Making More Milk

    Fantastic, thanks!!

    - Hilary

  4. #4
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    Default Re: Sucking But Not Swallowing?

    Ok Hilary, thanks.
    First you should know this is my last day on these forums. If you look at my thread in the "introductions" forum you will see why. I saw your post and had to respond because I know how hard what you are doing can be!
    So, based on your responses:
    Of course we cannot know what your milk production was earlier. But since baby appears to have difficulty latching without a shield, that indicates a latching and milk transfer problem, which can certainly cause poor weight gain, even if milk production is 100% normal.

    If latch and milk transfer is the issue, I think it is very important to see a breastfeeding helper in person who will HELP YOU FIGURE OUT LATCH AND MILK TRANSFER. Breastfeeding is normal so a baby should be able to get plenty of milk via nursing. If baby is not, that means something is wrong and figuring out what that is and getting strategies to help with that is why a mom would see an IBCLC. Sometimes it takes time to figure out an issue, of course. But in that case, follow up care is needed. If you are not getting the help you need from your IBCLCs with latch and sucking assistance, can you see someone else? Yes, contact your local LLL too. Call or e-mail, whatever your local Leaders do.

    Ok, baby's weight check history is interesting. Anytime a different scales is used that can make a weight check off, and human error occurs as well. So keep that in mind when looking at yuour infants gain.

    According to your doctors records, gain was entirely normal the first 10 days, (with baby being back to birth weight by 10 days.) Without supplement??? obviously weight gain between 6/23 and 7/24 was slow, good gain for that long a period of time at that age would be 20 to 30 ounces, and total gain was more like 10 ounces. How was output during that time, (poops) do you recall?

    Then, with supplement, baby gained almost 5 ounces overnight, between 7/24 and 7/25? This hardly seems possible. So I am going to take the 7/25 weight check out and just look at overall gain from 7/24 to now.
    In the 17 or 18 days, from 7/24 until today, using different scales, weight gain appears to be two pounds, or, 32 ounces, in 18 days. This is very rapid gain, normal averaged gain for this age (after 2 weeks but before 3 months) is *about* an ounce a day, or, 18 ounces for that period.

    Why the rapid gain? Well, scale error must be considered. But assuming accuracy, perhaps baby needed to catch up. On the other hand, when I see a supplemented baby gaining that rapidly, I think it is important to consider if baby is perhaps being oversupplemented. As I mentioned in my pp, oversupplementation may stop a baby from nursing efficiently, and may even stop baby from nursing at all. It is also very common.

    Your IBCLC told you to supplement after every other feeding. Well, that could rationally mean anything between 4 times a day or 8 times a day, depending on a baby's nursing frequency! This is only one reason why supplement instructions are often so confusing.
    How do you tell baby is "still hungry" after 2 ounces? Or one ounce? Or half an ounce? Do you try offering the breast again if baby indicates they want more? If your were exclusively nursing, that is what you would do. I suggest, even when giving bottles, keep "thinking" like an exclusively breastfeeding mom. Offer to nurse before and after bottles as much as you like.

    Did your IBCLC suggest an at the breast supplementer? A lactation aid, for giving supplements at the breast, rather than a bottle? These can be used with or without nipple shields. They can be very fiddly to use, BUT, they keep baby nursing more at the breast, and that cuts down on the time it takes to feed baby and also may well allow mom to pump less even when supplementing.

    Pump output can be very deceiving. A baby who is able to nurse normally is usually better at extracting milk than a pump. And many mothers do not respond well to pumping. The recommended pump for your situation is a rented hospital grade pump, but even with one of those pump output can be deceiving. Yet your pump output actually sounds pretty good! So this indicates to me that your milk production is possibly normal or at least, near normal. your dedicated pumping surely contributed to this.

    A newborn typically nurses a minimum of 10-12 times a day. In the very early weeks, some babies may nurse as much as 15 or even more times a day. That is considered normal nursing frequency.
    At 8 weeks, some newborns are nursing less often, maybe 8 times a day minimum. But many are still nursing 12 or even a little more.
    Milk production is increased with frequent milk removal.

    Very short sleep stretches night and day is the norm in the early months. Nursing sessions are typically very erratic in pattern. Sleeping one 6 hour stretch at night is fine if this is baby's normal sleep pattern and baby is gaining well breastfed. If baby is sucking on a pacifier or being swaddled, or being topped off at night with supplements, those are sleep lengthening techniques and may cause a baby to sleep longer than they would otherwise.

    Mom must sleep as well. But since you are getting up at night anyway to pump, I wonder if encouraging baby to nurse at night might be helpful. Who is helping you at night? imo it is more important to worry about mom getting enough sleep than baby, who needs to eat very frequently day and night and is thus biologically designed to get as much sleep as they need in short stretches.

    I do think weighted feeds should only be done on a very accurate scale. Even many digital scales are not sensitive enough for this. Really, when weight gain is a concern, ALL weight checks should be done on the SAME professional infant scale. With baby naked. Even Diapers and what is in the diaper changes this sensitive measurement.

    Kellymom has a good article on weaning off of formula supplements.
    Last edited by @llli*lllmeg; August 11th, 2014 at 09:20 AM.

  5. #5
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    Default Re: Sucking But Not Swallowing?


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