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Thread: Help For My Wife

  1. #1

    Default Help For My Wife

    I could really use some advice to try to help out my wife who is having a very hard time with breastfeeding. I apologize as this is a very long post but I wanted to provide adequate background information.

    Background:

    Our son is currently 10 days old. My wife was induced on August 15th as a result of high blood pressure. I believe she was officially diagnosed as pre-eclamptic. She had a successful delivery that day. We had some initial problems with breast feeding and getting a successful latch but the nurse practitioner at the hospital really helped us out. We went home on the 17th feeling confident that everything was going well.

    By the 19th we realized he had not had any stool in his diaper for almost 24 hours and no urine for 12 hours. We called the pediatrician which we had not met yet and they told us to take him straight to the emergency room where we discovered his bilirubin level was approaching dangerous levels and my wife and sone were readmitted to the hospital. In the hospital, they connected my wife up to a breast pump and we discovered that her milk had not yet come in and she was barely producing anything (3 days old at this point). They told us we needed to begin supplementing with formula immediately to help bring his bilirubin levels down. They also had my wife begin pumping regularly.

    We returned home on the 20th and began seeking advice on how to increase her milk supply. Her supply has come in at this point but is still not enough to sustain our son without heavy supplementing. Last Thursday, after we finally got out of the hospital and had a chance to meet with our pediatrician for the first time, he made the recommendation that we go 24 hours without breastfeeding to make sure our son was not experiencing breast milk induced jaundice. This was day 7 and while pumping every 3 hours, my wife was only producing around 10 - 15 mL (both breasts). Our pediatrician told us we should be trying to get him 40 - 60 mL worth of milk/formula per feeding at this time.

    Last Friday we met with one of the other pediatricians in the practice who verified our son was growing great on formula. We spoke with her about the fact that we really wanted to get back to exclusive breastfeeding and how should we go about doing that. We were given the recommendation to spend the weekend doing exclusive breastfeeding (with pumping after every feeding) every 2.5 - 3 hours with a follow on appointment for today. By Friday night (Saturday 3AM) and being completely unable to put our son down without constant wailing, we realized this wasn't working and that he was starving. We called our pediatrician on call and were advised to supplement with no more than 30mL of formula and only if the baby was inconsolable. We supplemented once and continued to try to make it through the weekend with little success. By today we were back to supplementing at every meal so he would actually be able to sleep afterwards.

    Today, we met with the pediatrician again who proposed a new plan. 15 minutes on one breast every 1.5 hours. Supplement with 25 - 50 mL of formula every 3 hours. Pump 3 times a day. When we got home from the visit, we heard back from a lactation consultant my wife found (through this website I believe), who recommended modifying the pediatrician's plan to feed (one breast) every 3 hours, pump (both breasts) after every feeding, and supplement after every feeding.

    We implemented this plan and at first were very excited. After feeding for 15 minutes, my wife pumped and got almost 20mL total (with the fed breast contributing very little). This left us very hopeful that we were increasing our supply.

    Since then, things have gone downhill. My wife's last pumping about an hour ago produced about 2 mL total of milk despite the fact that one breast had not been fed from in over 3 hours.

    My wife is exhausted after 2 hospital stays, attempting to feed on demand while not producing enough for several days, and rapidly growing discouraged. We are on Reglan, taking fenugreek tablets, and trying to do everything we've been advised to do. Our son's latch is steadily getting worse every time we use the bottle (he won't open his mouth wide enough to get the nipple in far enough). My wife's breasts are getting increasingly sore and its not even clear that he's actually get anything of real substance from her.

    My wife had her 1 week follow up due to the pre-eclampsia today and her blood pressure was so high, she has to have blood work done and begin taking her blood pressure 3 times a day (with a possible hospital stay if it gets much worse). Not only are we now contending with a poor milk supply but we are also rapidly becoming concerned for my wife's health if she can't get more rest.

    We are on the verge of giving up on breastfeeding completely and going strictly formula if we cannot get relief soon. Can anyone please help?

    Note: We do have the lactation consultant my wife found through this website coming for a home visit tomorrow. This may completely obviate the need for this post but I did not want to wait any longer before seeking additional advice.

  2. #2
    Join Date
    Jun 2009
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    Default Re: Help For My Wife

    It sounds as if your wife is ill. Might this not explain low milk production?

    It is good a lactation consultant is coming over. You do not say what their expertise is. There are different kinds of lactation consultants, and while any level of expertise might be very helpful, and indeed there are many very experience and gifted breastfeeding helpers who are not credentialed in any way. But when there is a serious and slightly unusual issue of ill mom, jaundiced baby, and very low milk production, I do think it best (when possible) if mom can see an international board certified lactation consultant. (IBCLC.) This may or may not be needed I just wanted to explain that the term 'lactation consultant" is rather fluid.

    Some thoughts.
    Breastfeeding is not only about the milk. There are proven physiological and psychological benefits to nursing at the breast for both mother and baby even if baby must have supplements, or in fact even if baby is entirely formula fed. Supplements of both expressed breastmilk and formula can be given using a lactation aid or "at the breast" supplementer. I posted links about these in another thread earlier today, I will look for that.

    Even if breastfeeding must temporarily stop or be pulled back from while mom is stabilized, that does not mean it must stop entirely or forever. By pumping as much as she can, mom can keep up some milk production even if baby is not nursing. Even if baby is getting supplements, baby can be allowed/encouraged to nurse as much as baby wishes and mom can handle.

    "Plans" have to be realistically doable for the mom, or they are pointless. When your wife sees the lactation consultant, she may want to talk to her about what she feels capable of doing at this point. Plans also can and should change as needed, day to day.

    Plans with strict time schedules are very often far to exhausting, unnecessarily so. Instead of thinking "I have to pump every 3 hours" many moms find it more doable to think "I am going to try to pump 8 times today." Babies do not nurse on such and such hours schedules so there is no reason to pump on a set schedule either.

    Any plan that limits time at the breast seems backwards to me. Yes it can help in some cases in order to help mom not spend so much time nursing/pumping/supplementing. But there are other ways of cutting down on that time, like using a lactation aid. Of course mom is going to pump a little more if she limits her baby to a very short nursing session. But what is gained? If baby is nursing effectively, why not let baby nurse longer and mom pump some other time, rather than right after nursing? Or, if baby is allowed to nurse longer, baby may get enough and mom need not pump at all at that time?

    Pump output is a very tricky thing to measure milk production with. Often a normally nursing baby is more effective at milk removal than the best pumps. It is very hard, but many moms find it helpful to NOT focus on "how much" is going out. I know a mom who kept her pump covered so she never could see how much was coming out.
    When pumping in this type of situation, a hospital grade rental pump is the appropriate tool. And it is very important that the pump flanges fit mom correctly. It is probably a good idea for the LC to check out the pump fit.

    Good books : Making More Milk and The Womanly Art of Breastfeeding
    Good website for all pumping and low milk production issues: www.kellymom.com

    ok here is the info I posted recently:

    Also be sure caregiver is using the proper techniques for bottles. This is vital! Video: http://www.bing.com/videos/search?q=...ttle&FORM=VDRE and article: http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Here is info on what to expect at a lactation consultant (Ideally.) http://cwgenna.com/lconsult.html

    the same IBCLC on the whys and hows of using a lactation aid: http://cwgenna.com/smartnothard.html

    Jack Newman video, shows tubing being inserted after baby starts sucking (this is one way to do it) you can see this lactation aid is "home made" http://www.breastfeedinginc.ca/conte...me=vid-lactaid

    Newman on lactation aids: http://www.breastfeedinginc.ca/conte...agename=doc-LA

    Info on purchasing lactation aids:
    Lact -aid http://www.lact-aid.com/ Anecdotally, This is the one typically preferred by moms who have to use one for a long time. See more about differences of each in the CW genna article above.
    sns: http://www.medelabreastfeedingus.com...ing-system-sns

    hope this helps you guys!

  3. #3
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    Sep 2012
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    Default Re: Help For My Wife

    Excellent advice above! Kudos to you for helping your wife so much. Marital support is a key to a good breastfeeding relationship. I hope your wife recovers very soon!
    Please let us know how things continue to go for you. It's very early days yet. My oldest didn't even latch until three weeks yet is still nursing at three years.

  4. #4
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    Mar 2014
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    Central FL
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    Default Re: Help For My Wife

    Quote Originally Posted by @llli*zaynethepain View Post
    Excellent advice above! Kudos to you for helping your wife so much. Marital support is a key to a good breastfeeding relationship. I hope your wife recovers very soon!
    Definitely, your support in whatever your wife wants to do at this point is SOOOO important.

    Also, make sure baby is checked for tongue/lip ties.

    Here is a site to search for IBCLC's since sometimes you need to try more than one breastfeeding helper http://www.ilca.org/i4a/pages/index.cfm?pageid=3901

    And a site I found very helpful (I've had issues with low supply and needing to supplement) http://www.lowmilksupply.org/index.shtml

    Hang in there. I also highly recommend getting a lactation aid giving supplements right at the breast.

    Remember that breastfeeding is NOT all or nothing. Exclusive breastfeeding may be the goal but even if that doesn't work out, any breastfeeding is beneficial.

  5. #5
    Join Date
    May 2006
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    21,117

    Default Re: Help For My Wife

    Excellent advice above.

    I especially agree that illness may be a factor here. If she had pre-e then she was probably given magnesium sulfate and there are some reports- anecdotal ones- of mag sulf being a factor in delayed/depressed milk production. But that doesn't mean that she should not have taken it of continue to take it! Her health has to take precedence here!

    What sort of pump does she have? As the PP said, a mom in her situation should be using a very good double electric, like a Hygeia Enjoye or Medela Pump in Style, at the very least. And ideally, she should be using a hospital-grade rental with correctly sized shields.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6

    Default Re: Help For My Wife

    Thank you for the advice everyone.

    The lactation consultant was a huge help and we now have a new plan and are once again hopeful. We are going to be feeding from the breast much more often (no pumping) and supplementing through finger feeding instead of the bottle only if he is still fussy after both breasts. We tried using a lactation aide but had a lot of trouble threading the end into his mouth and getting it to work. So far it has gone pretty well but we will need to see how things go overnight.

    We have a pretty good pump based on my understanding (Ameda I believe).

  7. #7
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    Jun 2009
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    Default Re: Help For My Wife

    Wonderful! Sounds good.
    The whole pump issue is very confusing.

    There are basically two kinds of double sided electric pumps, and all the major pump companies sell at least one version of each.

    Those that are bought at the store or online by individuals, are called "personal use" pumps, and are basically designed for the mom with an established milk production, who is pumping at most 3 or 4 times a day, perhaps because she is back at work.

    The other is the hospital or rented pump (also called a multi-user pump) that is far to expensive to buy, so instead individuals RENT these by the week or month. These are designed for a mom who has low milk production and is trying to increase it, and/or whose baby cannot nurse effectively or cannot nurse at all.

    To further confuse the issue, you have a situation where perhaps baby is nursing well and often but mom still needs to pump for an extra production boost. In that case, either type of pump might be fine depending on the amount of time mom has to pump and how often she needs to pump, as well as how well that particular mom responds to the pump.

    Ameda posts this simple guide you can check out to see if your wife's pump is the "ideal" pump for her situation. Even if it is not (if, for example, she is using a purely yours when a platinum or elite is recommended) she can continue to use what she has until you find out if you are able to get the other pump and decide if it is needed.

    Of course, once milk production is established and baby is getting what baby needs at the breast, no pump or pumping is required. http://www.ameda.com/breastfeeding-p...ump-comparison
    Adding hand expression as needed is helpful as well, many moms find. Especially in the early days.

  8. #8
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    May 2006
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    Default Re: Help For My Wife

    There is likely to be a HUGE difference between a personal use pump and a hospital-grade rental. If mom isn't using a hospital-grade pump, then she's not going to be getting maximum stimulation and milk removal.

    I am not sure I understand why your wife is being told not to pump if supplements are going to be part of the picture. When a mom uses a supplement, she should pump- otherwise her supply will not stay equal to baby's demand.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  9. #9
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    Default Re: Help For My Wife

    Quote Originally Posted by @llli*minute View Post
    We are going to be feeding from the breast much more often (no pumping) and supplementing through finger feeding instead of the bottle only if he is still fussy after both breasts.
    Feeding much more often and offering both breasts is good. Even offering the first breast again and second breast again if baby is still hungry. However, I have to agree with Mommal, if supplement is then given, pumping should happen whenever supplements are given no matter how or what. Even if supplement is previously expressed milk. This pumping isn't necessarily to get any particular quantity out but to stimulate greater milk production. Pumping in this case is just simulating baby sucking demanding more milk even if none is coming out. Stimulating nipples extra is helpful too.

  10. #10
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    Default Re: Help For My Wife

    Maybe at this point mom needs rest and that is why pumping is not being suggested right at the moment? Yes ideally pumping is recommended whenever a baby is supplemented. ON the other hand, sometimes the ideal is not realistic and a plan needs to meet what mom can do. This plan has baby nursing a lot, which is good. Assuming normal or near normal latch and milk transfer, Bringing baby to the breast often is going to be good for breastfeeding overall even if baby also needs supplements.

    Finger feeding when done correctly is probably less likely to result in OVER supplementation than bottles, so that is a plus.

    Just remember babies tend to be fussy a lot of the time. So baby being fussy after nursing does not always mean baby needs a supplement. Try other comforting measures as well. The most accurate way to make sure a baby is getting enough to eat is by weight gain and the second most accurate is output (poops, specifically.)

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