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Thread: Last ditch effort, can a lact-aid improve suck?

  1. #1
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    Default Last ditch effort, can a lact-aid improve suck?

    I'll try to make this brief but would really like some opinions so please let me know if you need more info. My 7 week old daughter has been receiving pumped milk supplements since birth. She initially had jaundice and was not nursing well, then after the jaundice resolved she continued to fall asleep at the breast and not transfer milk effectively. At 1 week a weigh/feed/weigh session showed 3/4 ounce of milk transfer after 1 hour of nursing on both sides and doing breast compression. My production is great. At 5 weeks old she was able to transfer 1.5 ounces in about 30 minutes but that was when I skipped a pumping session and had pretty full breasts (not engorged just full). Since then I haven't felt that there is much improvement. She falls asleep while nursing, unless she's starving- then she pulls and fusses probably because she has gotten used to bottles a bit now. The IBCLC gave me a Medela sns, which works terribly (I have two of them now, because she thought the first one was malfunctioning but neither of them really work. They seem to have a problem venting air therefore a vacuum is created and no milk will come out... unless I unclamp the other tube and then milk comes out too easily. I was thinking a lact-aid might make her work more since she only gets milk when sucking. I am hoping if I can give her supplements at the breast that she will improve her suck and be able to nurse effectively. Any thoughts? Here is some additional info:

    -Born at 39 weeks, jaundice required 1 day on UV lights
    -Currently sleeping 6-8 hours at night and nursing 6-7 times a day
    -Takes 3 ounces of pumped milk at each feeding
    -I pump 5-6 times a day and get 22-24 ounces a day
    -Baby is gaining a little under an ounce a day (we have a scale at home)

    I can't keep up with the pumping and supplementing on a long-term basis. We have 3 older children and are a homeschooling family. It would break my heart not to nurse her but eventually I think I'd have to combo feed (and have my supply slowly dry up) or just go to bottles only and give her whatever I'm able to pump when I have time. She is our last baby so this prospect makes me very sad.

    Any advice or opinions are welcome. Thank you.

  2. #2
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Wow. your pump output is very high, considering baby also nurses- how much is baby supplemented each day? All of that? Because 22-24 ounces a day is very close to the total an infant typically needs daily, so my first thought is maybe baby is being over supplemented? When a baby is oversupplemented, even with a lactation aid, it may certainly create/exacerbate a situation where baby does not work hard nursing. Are you absolutely positive she is only gaining less than an ounce a day? That seems very odd with that much supplement. If you are weighing daily I wonder of the numbers indicate the same if you look at a longer period overall....

    I also homeschool my two elementary school age children and while I do not have an infant I do have a two year old, so I understand a bit about that challenge. I would suggest, Try to remember that exclusive breastfeeding is something measured in months. In 4 more months, and quite possibly sooner, your child can start solids and that may take some of the pressure off, depending on how your child takes to solids. Also, as baby gets bigger and stronger, nursing may quite possibly improve. Of course I have no idea what 'style' of homeschooler you are, or if you have to please some other entity other than yourself like a charter, or what particular learning challenges, if any, your other children may have...but no matter what style you usually follow, perhaps this school year is the time to experiment with the idea that less is more. I would also suggest that barring some special circumstnce, the benefits of these few months of exclusive breastfeeding for your baby will give you an incredible return on that investment of time that more intensive homeschooling for the same amount of time for your older kids is unlikely to, and unlike breastfeeding, in most circumstances, learning that does not happen in the next few months can be made up for at a later time. Sorry I hope I am making sense.

    Other thoughts- frankly am amazed at your pump output and really have to wonder if more is going on physically that baby cannot get enough breastfeeding considering that. Have you gotten any explanation for that?

    Sometimes what is needed is a tweaking of your 'plan' --What if you cut out a few pumping sessions, only supplemented at some but not all sessions, but nursed more often? Some time nursing with no worries about pumping after or using the sns during might help breastfeeding feel more normal and pleasurable as well. Baby is sleeping a long time at night for this age- maybe nurse once or twice overnight but JUST nursing, no pumping? Would that be more doable for you? Many, probably, most babies need to nurse much more often than 6-7 times a day to get enough milk overall.

    As far as whether a LactAid will "improve" suck, I have to say, I have no idea. However, it may work better overall for you than the sns, many folks who are supplementing more long term prefer the Lactaid. Perhaps call the company and talk to them?

    This article explains more about different supplementers- http://cwgenna.com/smartnothard.html

  3. #3
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Hi, I had some huge breastfeeding challenges with my LO (and he is my first so no other children to deal with so good job to you for managing the triple feeding for as long as you have so far, I know how draining it is.)

    A 6-8 hr sleep stretch is probably a bit too long for such a young baby especially if nursing/weight gain/supply issues are going on.

    How does nursing Feel? Latch issues generally go along with milk transfer issues but sometimes when suck is weak the pain might not seem that bad and a latch issue might not be sorted out early. (Mine was 6 or 7 weeks old before he really started hurting me and the tongue tie/lip ties didn't get corrected till 8 weeks. Unfortunately, we also needed some physical therapy for him to learn to use his mouth/tongue better for nursing which we didn't get till 3 months so I wasn't on the road to supplement free till almost 5 months since my supply also suffered early on because I was actually discouraged from pumping early on.) If baby isn't able to transfer milk effectively at the breast then there is some problem going on and that should be addressed since whatever the problem is could cause trouble with eating solid foods and speech later too so it isn't just about you and wanting to breastfeed! See the LC again or find another one to help you figure out the whole milk transfer issue. You might need an oral motor therapist to teach/work on exercises or if there is some illness/deficiency causing the continued sleepyness or suck weakness that should be looked at. Once you get that sorted out or even as you are working on sorting that you want to work with the LC on plans of how to wean off the supplements if you can since as you noted, the triple feeding routine with pumping is not sustainable long term for most moms even if it is the ONLY thing they are doing.

    Anyway, some tips for using the SNS (The LACTAID doesn't have the vacuum problem since it is a bag but it only has one tube so you have to move it to switch breasts so there are pros and cons.) The SNS can have a vacuum problem if you only open one tube and as you found out, if you wear the bottle too high up, when you open the other tube the milk flows out too fast. So you have to be able to wear it with the cap down pretty much between your breasts if you are going to open both tubes. I found it worked best when I was using football hold since I didn't wind up with the bottle top between us. However it was still tricky to use because my DS got into grabbing the tubes and stuff but we did manage.

    I was generally only putting 1 oz of supplement into the SNS at a time so didn't have quite as much trouble with the milk flowing out too fast even if I wore it a little bit high. I had switched to the smallest tube pretty early but the medium size tubes are recommended for starting out most of the time.

    Now I do agree with maddieb, nurse more often and reduce the size of the supplements is probably a better plan to weaning off the whole nurse/supplement/pump routine. 3 oz bottles are like a whole feeding for most breastfed babies so no wonder baby just wants to sleep/comfort suck at the breast. (FYI my LO normally nurses at least 15 times a day and most feedings are small. Even when he was occasionally given bottles via paced feeding, he generally wouldn't take much more than 2 oz and often only 1 oz. We have been totally off bottles and the SNS since before he turned 6 months and only occasionally (like maybe 1-2 oz every couple days between 5-6 months.)

  4. #4
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Thank you for your responses! My family went on a media fast the day after I wrote the post (I forgot we had planned on doing that) and although I would have made an exception to get breastfeeding help I was also very busy!

    MaddieB: Yes it is very frustrating to have such great supply and baby unable to nurse well. This evening I spent about 2 hours trying to nurse her off and on and she would pull and fuss and act like I have no milk to give- and once I finally gave up and gave her a bottle she drank a couple of ounces and passed out. I was then able to pump 4 ounces. Ugh. I think she has some nipple preference going on! I can't seem to get the SNS to work right. (Got the lact-aid in the mail and it is much easier to use but still can't seem to get her to use it successfully most of the time, so I ended up back on bottles while trying to use it off and on) She will nurse ok after her long sleep stretch (it's 4-6 hours now, with an occasional 8) when my breasts are very full, but any other time I try she cries and fusses after the first "easy" letdown" and doesn't suck hard enough or long enough to elicit another one.

    I like the idea of nursing more often and pumping less and am going to bring it up with the LC tomorrow. I'm confused as to what you mean by oversupplementing. If I supplement less and she is not able to transfer the milk she needs- won't she just become frantic and not nurse well? I am open to trying anything at this point though and I agree that 3 ounces is alot- but then she is only nursing 6 times a day right now, because of her long sleeps at night. I haven't weighed her daily but am fairly confident it's not more than an ounce a day. (Last week she was 8lb 4oz, then several days later she weighed in at 8lb 7oz, it had been 3-4 days.) If I nurse her BEFORE I give her any supplement, shouldn't she be hungry enough to put in a good effort at the breast? She used to fall asleep while nursing and then take 3oz from the bottle...which doesn't make sense to me. Unfortunately within the past week she's developed the nipple preference and cries/pulls/fusses instead of falling asleep. Argh.

    The homeschooling is an additional stress, to be sure. I have my son doing an independent type curriculum this year (switched on schoolhouse) and so the one whose education is suffering is my girl in kindergarten. I am trying to remember that kindergarten is so basic that we can easily get caught up when things settle. (I do one subject a day and some days no school at all with her)

    Tclynx: I think she might have a posterior tongue tie and a moderate lip tie. Those could contribute to transfer issues I know! My DS had a lip tie which was corrected but did not seem to help his milk transfer issues so I am not holding out much hope. I'm going to have her seen by an ENT. How did you get physical therapy for your DS? I will ask the LC about it tomorrow but she has not brought it up or even considered tongue tie as a problem so I think I'm on my own for finding alternative solutions. (her plan of action has been supplementing with an SNS until my daughter outgrows her high palate and gets stronger- which isn't a bad plan but I think she might have some suck problems that need addressing) Nursing feels like she doesn't suck hard enough, it always has. I can feel that I have milk and I know if she could just try a little harder she would get milk. She seems unable to do that- even before the bottle feeding affected her willingness to nurse.

    Thank you again for your encouragement and advice. I'm trying to hang in there because I do want this to be successful...but I'm having a hard time feeling hopeful about it.

  5. #5
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Quote Originally Posted by @llli*liamsmommy11 View Post
    Tclynx: I think she might have a posterior tongue tie and a moderate lip tie. Those could contribute to transfer issues I know! My DS had a lip tie which was corrected but did not seem to help his milk transfer issues so I am not holding out much hope. I'm going to have her seen by an ENT. How did you get physical therapy for your DS? I will ask the LC about it tomorrow but she has not brought it up or even considered tongue tie as a problem so I think I'm on my own for finding alternative solutions. (her plan of action has been supplementing with an SNS until my daughter outgrows her high palate and gets stronger- which isn't a bad plan but I think she might have some suck problems that need addressing) Nursing feels like she doesn't suck hard enough, it always has. I can feel that I have milk and I know if she could just try a little harder she would get milk. She seems unable to do that- even before the bottle feeding affected her willingness to nurse.

    Thank you again for your encouragement and advice. I'm trying to hang in there because I do want this to be successful...but I'm having a hard time feeling hopeful about it.
    I know it is HARD, I'm impressed that you have lasted this long with other children. I managed to find the names of a couple therapists through the LCs at WIC and they helped me find out that one of them actually also took my insurance so I took her name to the pediatrician's office and told them I needed at referral. Search for speech, or oral motor, or occupational therapists that work with children and deal with eating/swallowing issues. Call them up and find out if they work with infants and breastfeeding issues. For a posterior tongue tie, you may want to search for dentists that correct such issues.
    Here is a listing that might be of help http://www.lowmilksupply.org/frenotomy.shtml

    One thing I would definitely recommend trying is feeding way more often if you can get her to latch on. My LO is now gaining weight well without supplements and we nurse almost hourly during the day and lots at night. He will often only nurse for one let down though.

  6. #6
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Thanks for the encouragement. I saw the LC and we had a very good appointment where she took 3oz in one session. I was told to pump after every other feeding and cut back on the supplements. Yay! Then today was terrible, starting off with a tough feed at 5am (which is normally a good one because I'm full from not nursing overnight) and continuing downhill from there. She has sleeping issues as well and only cat naps during the day (15 minutes at a time) and then is overtired.

    So all day she refused to wait for a second letdown and my plan to nurse her more often failed because she was starving and didn't want to nurse smaller amounts more frequently. Because I've been doing such big supplements she is used to eating alot at once. I'm tempted to forgo pumping for a couple of days to see if her nipple preference (not wanting to wait for letdown) lessens. I often don't get a chance to pump immediately after I feed her so it ends up being too close to the next feeding and then I'm only half full. So it would be great just to quit pumping cold turkey and nurse every hour but I am afraid that it would affect my supply. I tried very hard to use the lact-aid SNS but for some reason I still can't get her to drink well with it (medela either). She gets a couple of swallows then starts pulling and fussing, unlatches, milk dripping from the tube, she pulls the tube out of the tape while crying and flailing, etc. Ugh! So it's a catch 22 because the bottles are making her resist nursing, the SNS is not working for us, and the supplement is still needed.

    I'm going to call an ENT tomorrow and am hoping that as she grows into her palate and if we get the tongue tie fixed things will improve. We took our older kids to the dentist Monday and she said my older daughter has a palate so high and narrow that she will need a dental appliance when she is older to help widen her palate so her adult teeth have room to come in. No wonder I struggled breastfeeding her! I think my baby girl has a similar shaped palate.

    Thanks again for the help and advice.

  7. #7
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Well, it is HUGE that your baby transferred 3 ounces! So she can do it. Why cant she do it always? It truly is a mystery. I hope you keep getting follow up with your IBCLC. With breastfeeding, things can change basically daily, so plans often need frequent adjustment. For what it's worth, I have frequently heard about a baby having a fantastic latch and/or nursing session during the lactation appointment and then it all fall apart the minute mom gets home. There is a study in there somewhere.

    I am not sure what you mean be baby "refused to wait for second letdown." Why does she need a second letdown? Maybe the first letdown is giving her all she needs at the moment. She might nurse more frequently (or take the other side after fussing for a while, or whatever) if she was not regularly being topped off possibly?

    I certainly do not believe in starving babies into submission. ON the other hand, you make plenty of milk and your baby is apparently capable of transferring milk normally, at least that is what the weighted feed indicated. So maybe it is time to be a bit more insistant about avoiding the bottle?

    ON the other hand, you should not need to be "full" in order for your child to latch and extract milk. That would seem to point to a physical issue. This is beyond my expertise but I think I have heard of this being an issue when a baby has a hard time getting a good 'seal' for some reason.
    We took our older kids to the dentist Monday and she said my older daughter has a palate so high and narrow that she will need a dental appliance when she is older to help widen her palate so her adult teeth have room to come in. No wonder I struggled breastfeeding her! I think my baby girl has a similar shaped palate.
    Breastfeeding can help to 'correct' issues of the oral cavity shape and also jaw alignment. Just another little reminder of why breastfeeding matters!
    Last edited by @llli*maddieb; October 15th, 2014 at 09:51 PM.

  8. #8
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    I know during the early days when I was having such challenges, if I was really full (nearly engorged) then when baby would latch on I could do breast compressions and basically squirt milk into him and about all he was doing was swallowing but if I wasn't that full the breast compressions were not nearly so effective and I still needed him to nurse to get the milk out. Unfortunately it isn't possible to be that full all the time for more than maybe a day since being that full is detrimental to milk production and supply will decrease if you try to maintain being engorged all the time.

    That said. There were some days where I did take a vacation from pumping. Sometimes it was just because I couldn't pump much due to going to appointments and then marathon nursing sessions to the point of hours on end and then needing some sleep.
    If you have some one to help by holding baby or giving the small supplement bottle while you pump right after nursing that totally helped me to be able to pump since my LO hated to be put down even for ten minutes for me to pump.

    When you give supplements, have you tried nursing for a bit then giving an ounce and then putting her back to finish at the breast?

  9. #9
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    Quote Originally Posted by @llli*maddieb View Post
    For what it's worth, I have frequently heard about a baby having a fantastic latch and/or nursing session during the lactation appointment and then it all fall apart the minute mom gets home. There is a study in there somewhere.
    Yes, I have experienced this. My LC was impressed and seems to think we are fine now, but I'm still struggling. I'm assuming she needs a second letdown because after getting the one letdown (on both sides) she is not content. I would be happy to nurse more frequently if that would enable me to wean off of pumping, but we will have to see if I can get her to adapt to that kind of feeding. She is used to big feedings less often, which I didn't want to do but was feeling pressured to supplement her alot and was unsure how much to give in the beginning, etc. She was weighed at the LC visit and has been gaining just under an ounce a day- so I'm not overfeeding her. (She's only eating 6-7 times a day due to sleeping through the night)

    I think you are right that there is something more going on here because I don't think I should have to be "full" for her to nurse effectively. I can't maintain an oversupply without pumping and if I pump then I'm not "full" enough by the next feeding for her to get enough. So I'm pumping to supplement and keep my supply up but the pumping is preventing her from getting enough at each feeding by just nursing alone so I have to give her a bottle, which is causing nipple preference. (she expects instant milk and pulls and fusses) I tried very hard to use the SNS again but without boring you with details I'll just say it prevents me from getting the latch I need to prevent nipple pain with the bubble palate. Does anyone know how to wean off of pumping once the baby is better at nursing? I'm sure if I cut it out suddenly that my supply would drop even if she was nursing well.

    I went the entire day without bottles and tried cup feeding and finger feeding for supplementing. It did not go overly well and I think I might have to continue to use bottles but only supplement when I think she really needs it (has not nursed well, or if I'm not very full because I pumped too recently) and hope that she gets better over time.

    I'm also going to look into seeing an ENT for tongue tie. I found this link that explains very clearly what to look for and I'm pretty convinced she has a posterior tie. It would be great if getting that clipped solved everything but I'm hesitant to be that hopeful.

    http://www.cwgenna.com/ttidentify.html
    Last edited by @llli*liamsmommy11; October 16th, 2014 at 08:18 PM.

  10. #10
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    Default Re: Last ditch effort, can a lact-aid improve suck?

    tclynx, how did you stop pumping? I have no idea how to wean off of it once I feel she is doing well enough to keep up my supply on her own. I agree that it's not possible to be "full" all the time. I had this same problem with my last baby and pumped for 13 months! (As he got older I did not need to pump as much but it still was taxing) I really really hope that is not the case this time because she is my last baby and I don't think I can do it for as long either.

    Thanks again.

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