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Thread: Oversupply/allergy problem, nipple shield frustration (long)

  1. #1

    Default Oversupply/allergy problem, nipple shield frustration (long)

    Hi there,

    I am beyond frustrated right now. This is going to be a really long post and I apologize. There are just so many things happening as far as feeding my LO is concerned, and I don't know how to sort them out.

    My LO is 7 weeks old tomorrow. The good news is that she seems quite healthy and happy and has been gaining really, really well. Her doctor says she looks great.

    However, last Sunday there was blood in her stool. Needless to say, I called to talk to an advice nurse. While waiting for a callback, I researched and found info on oversupply and milk protein intolerance. Nurse I talked to totally dismissed the oversupply idea and said, "give up dairy and see a doctor tomorrow." So I did.

    Monday we saw a nurse practitioner at the pediatric clinic. She also dismissed the oversupply idea so I have continued to be dairy free since then. I also returned to work Monday and am now pumping so my husband, who is a stay at home dad, can feed her while I'm gone. I get about 20 ounces a day pumping 3 times while at work.

    Before I went back to work, I fed her at the breast all the time. Now, I feed her about 3 times a day (once when I get home, once in the middle of the night and in the morning before I go to work, unless middle of the night feedings continue into morning feeding, which happens about half the time) and the rest of the time my husband feeds her.

    When I breastfeed, my daughter gulps/splutters and pulls back and milk is pouring from nipple (though the milk pouring out has lessened in the last couple weeks). What's really frustrating, though, is that she spits up insanely copious amounts, I am talking rivers and fountains of watery milk spit up that soaks her front and back. It looks like she spits up everything she just drank. Then she wants to eat again. Most feedings last an hour and a half-ish. Sometimes when she gets in the eat/spit up cycle especially badly it feels like I am chained to the recliner for hours on end with breaks just to change the diaper. (That happened this afternoon). In addition, I noticed green frothy poop this afternoon. Most of her diapers are green. I also leak like crazy when I wake up in the morning.

    I figured out a few weeks ago that one breast completely sates her, and I started block feeding sometimes before I knew what it was because I had a feeling she just wasn't making it all the way to the hindmilk in one feeding and that's why she wanted to feed again. Also, I wonder if she has to spit up a bunch of foremilk to get rid of it so she has room for hindmilk. But people keep telling me to stop worrying about foremilk and hindmilk and quitting dairy is enough.

    In addition, she has pretty much always had a diaper rash. We cloth diaper and change the diaper all the time, and we wash with Country Save and two full wash cycles with extra rinses. Docs keep pointing the finger at the cloth diapers. I have tried multiple cloth diaper safe balms but nothing helped, not even switching to disposables and using A&D ointment. Eventually the doc told me to switch to disposables and use desitin. That finally helped, but it is obviously treating the symptom, not the cause. We're back to the cloth and I think a tiny bit of the rash is still there, but better.

    Several weeks ago, at a lactation consultant's suggestion, I tried a nipple shield to slow the flow down for her. Now she won't take the breast without it. This is a huge hassle in the middle of the night. Ladies, I have mammoth breasts. My bras are specially made to order in Mexico and once my milk was in, I had to order the largest size they will make. My nipples hang down past my waist when I'm seated. Getting her into a decent position so she's at least a little bit upright and I'm not just flat out dumping milk down her throat is difficult to begin with, but the nipple shield complicates everything. When I'm dead tired in the middle of the night it is next to impossible to manage. I'm falling asleep out of exhaustion, she's falling asleep because she can't get the nipple shield to stay on, and we drift in and out for hours trying to get her fed till it's time for me to go to work and that's not even mentioning the spitting up issue, which continues. At my wit's end on this one -- any ideas?

    Docs seem to think these issues are not connected -- my oversupply (aren't I lucky to have so much milk, just use the nipple shield and try laidback positioning), the blood in the diaper (milk protein intolerance), the rash (cloth diaper not wicking away enough moisture), the spitting up (immature stomach valve).

    Maybe there is an intolerance issue. I'm not taking any chances and have stayed very carefully dairy free since last Sunday. Nobody mentioned to me that it will take 2-3 weeks for dairy to leave my system, so I got concerned when I saw blood last night and called an advice nurse again. This one said dairy should be out of my system by now (wrong) and told me to see the doc again, so back we went this morning. Lactation consultant/NP yet again told me there was no way oversupply would cause blood in the stool, but said there was only a little bit of blood and she was "fine with continuing to breastfeed for a few more days at least until we get this sorted out."

    Pardon me? She's obviously healthy and gaining well. I'll give up more things she can be intolerant to if necessary, but switching to formula never even crossed my mind. I am shocked that a lactation consultant would say something like this.

    I have an appointment with the pediatrician who is a breastfeeding medicine specialist Wednesday, so I am hoping she will help me figure out what to do.

    So here's my main question (sorry it took so long): now that I am pumping and she is eating from a bottle for over half her feeding times, she must be getting foremilk and hindmilk all mixed together. Could the blood be just because she hasn't healed yet from the imbalance she experienced till I went back to work a week ago? Will this resolve on its own? Or is the fact that she is still BFing for part of her feedings and on the weekend sufficient to continue causing a secondary lactose intolerance problem?

    OR is the fact that she still has blood in her stool proof that it is not related to oversupply and is in fact a milk protein or some other intolerance?

    I worry about decreasing my supply because I do need to pump at work and want to make sure I have plenty. I am so committed to BFing! It is deeply important to me. But I feel like doctors and nurses, even lactation consultants, aren't listening to me about legitimate concerns.

    Because of the nipple shield/night feeding thing and the possible foremilk/hindmilk imbalance, I am tempted to just pump to bottle all the time... but I have a feeling that while that might simplify things now, it will only cause me more headaches and needless effort down the road when she'll be able to finish a feeding in 10 minutes instead of an hour and a half. (This will happen someday, right?)

    Thoughts? Suggestions? I promise I won't give up, but I could sure use some help.

  2. #2
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Welcome to the forum!

    I think the first thing to focus on is this:

    She's obviously healthy and gaining well.
    When that is the case, blood in the baby's stool is something to watch but NOT something to freak out about or to switch to formula over. The Academy of Breastfeeding Medicine has a protocol on managing allergic proctocolitis in exclusively breastfed infants (available here: http://www.bfmed.org/Media/Files/Pro...ish_120211.pdf). This is the gold standard for managing bloody poops caused by allergy and if you read it carefully, you will find that an immediate switch to formula is not recommended even when the baby has received a failure to thrive diagnosis. In a baby who is otherwise healthy and gaining, continued breastfeeding, sometimes coupled with an elimination diet, is recommended.

    So, should you do an elimination diet? I'm thinking that you might, but that it makes sense to get any oversupply issues under control first. I don't care what the doc and nurse said, the truth is that oversupply can cause bloody poops. And it is vastly more common than allergy. So if you see bloody poops and you know you have oversupply, odds are good that oversupply and not allergy caused the intestinal irritation which lead to the bleeding.

    Can you give us some sense of how pumping is going for you? When you pump, how much milk do you get per breast? Do you think you could get more if you pumped longer? Ordinarily you shouldn't judge supply by pump output, but in this case it might give us a sense of how severe your oversupply situation is.

  3. #3
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    I believe she said 20 oz in three pumping sessions at work but that doesn't tell us how long those are or how much per breast.

    Have you tried side lying nursing in bed? This might be a way to manage your large breasts while baby doesn't have to be below them getting drown by milk because of gravity dropping it into her.

    Mommal's suggestions sound good, I believe she has experienced both extremes of milk production with her different babies.

    Keep in mind that milk production often peaks at around 6 weeks so you may be on your way to regulating naturally over the next six weeks. To help deal with forceful let down another common thing is to try to nurse more frequently since a breast that is over full is more likely to spray. Unlatching and letting spray go into a towel during let down and then re-latching baby may help with the "getting overfull" and spitting up.

    What happens when you don't bother with the nipple shield? It is meant to be a tool to help but if it isn't really helping then don't bother with it and try to get creative with positions without it. (This will also get easier as baby grows and gains more head control for herself.)

  4. #4
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Tclynx obviously has better reading comprehension than I do! 20 oz in just 3 pump sessions is a lot of milk. Average daily intake for a breastfed baby, per the reliable kellymom.com, is 19-30 oz, and that would generally be spread out over 8-12 nursing sessions per day. You're getting 20 oz in just 3 sessions, maybe 6-8 hours of separation? Definitely suggestive of oversupply.

  5. #5

    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Thank you ladies SO MUCH for reading my ridiculously long post and replying!

    OK, so yes... I feed DD right before and after work (or as close as I can come), but I'm gone a total of 10 1/2 hours with my commute and the extra time I have to stay to make up for pumping. At work, I pump the first time at 11:30, again at 3 and then again at 5:30. At 11:30 I get about 5-6 oz from each breast, at 3 and 5:30 I get 2-3 oz from each breast, but I'm pumping for 10-15 mins max for 2 of the 3 sessions, maybe 20-25 max at 3. I could get more, especially during the first session. (My work is pretty strict on scheduling.)

    I'm pretty sure DD can get more out of me than that, too... part of the problem, I think, is that I have a lot of storage capacity. If it's been a few hours, there's just a lot there. Feeding more often may be part of the solution, at least on the weekends, but would that increase my supply?

    I think I had a little bit of a breakthrough today -- I was always BFing on a recliner and I think maybe the positions I was taking there, no matter how much I was trying to keep DD more vertical to prevent spit-up, were actually causing more spit-up because of the way she was curled around/under my breast and sort of propped up on the recliner arm. I tried today with a boppy pillow and nursing stool on our couch and things went much better. I got her to take the nipple without the nipple shield, even!

    I also followed the suggestion about letting the milk spray into a towel during letdown and then relatching once it's done. Now that the nipple shield isn't there I can see that I'm going like a fountain just as much as I ever was. I think letting it go into a towel is definitely reducing spit-up and generally making things more pleasant for DD, who spit up MUCH, MUCH less. Now she stops, then wants to eat again within 30 mins to an hour and this happens 2-3 times before she is fully sated, but we've seemed to broken the feed/spit-up/feed cycle.

    Now that I know what block feeding is, I am sticking to feeding with one breast for 4-6 hours at a time and I feel like things are going better. It's obvious that DD is getting plenty of milk every time. Her swallowing is slowing down toward the end of the feeding the second or third time I put her to breast. We actually had a yellowish orange poop today (everything else has been green and frothy/mucousy at least when I am feeding her myself). I take that as a positive sign.

    I still think DD is getting too much foremilk before she can get to the hindmilk, but since she is fed 4-5 times a day from pumped milk on weekdays, and I'm taking action now, things should get better. I'm hoping the specialist I see on Wednesday can confirm this for me. I'll stay off the dairy just in case till a doc says otherwise... I miss cheese, but it's not been as horrible as I feared.

    How long does it take to reverse intestinal irritation in this kind of situation? (In other words, when will bloody poop disappear? Any idea? I'm sure it varies.)

    One other thing -- is there a chance block feeding might reduce my supply too much? I do want to make sure I'm not shooting myself in the foot here.

  6. #6
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Your baby is healthy and gaining. So the blood in the stool is almost certainly not a sign of a severe medical issue and is in no way a reason to stop nursing!= or give your baby anything besides your milk (although one study suggests probiotics may help.)

    You are only a few days into the dairy elimination. Since the ONLY sign of any issue that is not entirely explained by overproduction and forceful letdown is the bloody stool, I would suggest, keep up the dairy elimination for at least two weeks total before eliminating anything else- and put dairy BACK in your diet before eliminating anything else! Also, be aware that even if they DO stop, that does not prove the blood was caused by dairy or anything else you eat!

    From Breastfeeding Answers Made Simple, lactation textbook, Nancy Mohrbacher, 2010. On bloody stool:

    "If a baby has bloody stools and eliminating dairy from the mother's diet does not resolve them, they will most likely clear in time with continued breastfeeding." p. 520 (Italics mine)

    After description of a study of both breast and formula fed infants with bloody stool the results of which are too complicated to explain here:

    "If the baby's healthcare provider recommends suspending breastfeeding during a trial of hypoallergenic formula, suggest the mother discuss the possibility of continuing to breastfeed, as NO NEGATIVE OUTCOMES HAVE BEEN ASSOCIATED WITH THIS. P 521 (caps mine)

    Anyone who calls themselves an "LC" or gives breastfeeding advice should have this book on their shelf and be able to read these pages to you. If You wish to PM me to arrange to speak to me I am happy to read them to you over the phone.

    Rash: If you are using any type of commercial wipes, stop. Instead, using soft washcloths or soft paper towels and a bowl of warm water, gently SOAK babies bottom clean at each poop change. If need be, put a drop of very mild infant soap in the water if you like. I have seen and experienced personally that it is the constant WIPING, not the poops and certainly not the diapers that cause bad rashes in breastfed newborns.

    I also cloth diaper, I use cotton prefolds. Maybe check with your diaper maker about using a LITTLE bleach in wash AS NEEDED (not every wash-like once every several months probably.) And look into wool covers, which are amazingly absorbent yet very breathable. Whenever my baby starts getting a little red, I pop her in one of her wool covers and it clears right up. Great for overnight too.

    If you have ruled out yeast, get the thickest, most protective diaper cream you can find to protect bottom. I suggest Calmoseptine, which is so effective as a barrier cream it is used for incontinent adults with severe diaper rash issues. You may need to ask pharmacist for a tube but it is not prescription or anything.

    Other thoughts: Don't think you cannot get off the shield. You can. It will take some persistence and patience but you have to try as it will really help you feel more positive about nursing. Article below.

    I think you are not nursing your baby often enough. 3 times a day is not enough to reliably maintain a breastfeeding relationship after the return to work. Also such infrequent feeds will make any forceful letdown issues much worse. Encourage baby to nurse more often when you are home.

    bottles- fed by dad only while you are at work using cue feeding and paced feeding techniques to avoid overfeeding and breast refusal. See more info below.

    While I think it is pretty clear there is some overabundant milk production going on, I agree with you about not being super proactive about reducing your milk production...instead, maybe try to not inadvertently increase your production by overpumping, and help baby handle flow by nursing more often and nursing in reclined (laid back) and/or sidelying position. Remember, these are adjustable positions, and finding what will work best for your body type will take fiddling around. See links below for positioning tips. When pumping, Pump ONLY during separations, pump as often as you can, but maybe don't pump so MUCH each time(?)

    For very large pendulous breasts, have you tried putting a rolled up towel under the breast to change the position/angle of the breast? Also, a very large breasted mom I know propped baby beside her with pillows-mom leaned back, (reclined but NOT flat on back) baby was placed next to her, and baby came at the breast from the side.... sorry, it is hard to explain. I would also suggest have your husband help you and baby get positioned at night.

    You are doing fine. Your baby is, almost certainly, just fine. It's really stressful returning to work and you don't need all this extra stress! I hope the person you see on Wednesday is helpful. Make sure they watch a nursing session, examine baby's mouth, and discuss the nipple shield use with you. They should have ideas for helping baby get a good latch without the shield.

    ok links:
    Nipple shields and weaning off: http://kellymom.com/bf/concerns/child/wean-shield/

    Paced bottle feeding article: http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Paced bottle feeding video: http://www.bing.com/videos/search?q=...36403D3FC35D6E

    Laid back nursing: http://www.nancymohrbacher.com/

    tips for large breasted breastfeeding: http://www.lalecheleague.org/llleade...yjun89p35.html

  7. #7
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    As far as:
    here's my main question (sorry it took so long): now that I am pumping and she is eating from a bottle for over half her feeding times, she must be getting foremilk and hindmilk all mixed together. Could the blood be just because she hasn't healed yet from the imbalance she experienced till I went back to work a week ago? Will this resolve on its own? Or is the fact that she is still BFing for part of her feedings and on the weekend sufficient to continue causing a secondary lactose intolerance problem
    I don't know the answer to this. I DO think you without a doubt have some overproduction and forceful letdown going on. But need you DO anything about it, even if the blood in stool IS caused by baby getting an abundance of foremilk? I don't really think so. As pp says, your production should begin to calm down on its own soon assuming you are not overpumping. I do think you and your baby will be happier while actually nursing if you keep doing things that seem to help calm down the fast letdown- and what seems to work best for that, typically, IS to nurse more often, let baby take one side at a time if baby prefers, nurse sidelying or laid back or in any position you can figure out where you are letting gravity hold back the flow a bit... and (when needed only) hand express a little milk before offering the breast and/or take baby off the breast right at letdown to help baby avoid the fastest flow.

  8. #8
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Feeding more often may be part of the solution, at least on the weekends, but would that increase my supply?
    It might increase your supply, but high supply really isn't the worst problem you can have when you're back at work. And since you're back at work, having your baby nurse more is good practice for her and therefore worth doing.

    I think I had a little bit of a breakthrough today -- I was always BFing on a recliner and I think maybe the positions I was taking there, no matter how much I was trying to keep DD more vertical to prevent spit-up, were actually causing more spit-up because of the way she was curled around/under my breast and sort of propped up on the recliner arm. I tried today with a boppy pillow and nursing stool on our couch and things went much better. I got her to take the nipple without the nipple shield, even!
    Wonderful!

    I also followed the suggestion about letting the milk spray into a towel during letdown and then relatching once it's done. Now that the nipple shield isn't there I can see that I'm going like a fountain just as much as I ever was. I think letting it go into a towel is definitely reducing spit-up and generally making things more pleasant for DD, who spit up MUCH, MUCH less. Now she stops, then wants to eat again within 30 mins to an hour and this happens 2-3 times before she is fully sated, but we've seemed to broken the feed/spit-up/feed cycle.
    Even better!!!

    Now that I know what block feeding is, I am sticking to feeding with one breast for 4-6 hours at a time and I feel like things are going better. It's obvious that DD is getting plenty of milk every time. Her swallowing is slowing down toward the end of the feeding the second or third time I put her to breast. We actually had a yellowish orange poop today (everything else has been green and frothy/mucousy at least when I am feeding her myself). I take that as a positive sign.
    Excellent! Just please do be cautious with block feeding. Block feeding is designed to reduce supply and it is possible to go too far with it. Think of it more as an art than a science, and do it in a flexible way. A lot of moms are scared to adjust things if it's not "time" to offer the blocked breast. But I think it's best to be prepared to offer the second breast at some feedings, if the baby is giving you signs that one breast wasn't enough for her. Or to block feed for only part of the day, when supply is highest, and offer both breasts when supply is lower.

    Also remember that dealing with oversupply is a "2 steps forward, 1 step back" process. Sometimes you'll think you have the oversupply beat only to see it come roaring back for absolutely no reason. If this happens, it is not a sign of failure. Just a sign to go back and work the blocks again.

    I still think DD is getting too much foremilk before she can get to the hindmilk
    Just FTR, foremilk and hindmilk don't actually exist. They are convenient terms for the end members of the milk composition spectrum, but we don't actually make 2 distinct types of milk. The first milk to come out of the breast, when it is more full, is more watery, lower in fat, and higher in lactose (milk sugar). As time goes on and the breast gets progressively emptier, the milk becomes gradually less watery, less sugary, and higher in fat. But there's no abrupt change from one type of milk to the other, and all your milk is good for your baby and contains all the components necessary for healthy growth and development.

    How long does it take to reverse intestinal irritation in this kind of situation? (In other words, when will bloody poop disappear? Any idea? I'm sure it varies.)
    In my experience, it took several months. My pediatrician told me that proctitis peaks around 3-5 months, and 3-4 months was certainly when I saw the most bloody poops. By that time, my oversupply was pretty much beat- but the intestinal irritation was clearly hanging around.

  9. #9

    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    Wow! Thank you Mommal and Maddieb for all the responses and excellent info. I am being pretty cautious with the block feeding especially until I talk to the doc.

    Regarding feeding more often when I am at home... During the week, I leave for work at 8:30 AM and am home by 7:45 PM or so. She usually is sleeping for longer stretches after I feed her when I get home (4 to 5 1/2 hours). When we were in the feed/spit up/feed cycle, it took at least an hour and a half for one feeding and sometimes 3+ hours of on and off feeding, so it really wasn't three times.

    This morning, she fed for about an hour at midnight, then woke up to eat at 5:30 for about 30 minutes, then slept for maybe a half hour before BFing for another 30 minutes, then she slept again but woke up a bit before 8 and wanted more so I gave her another 15 before I had to go and then turned her over to Dad. Still much less spit up.

    Do you think I should be waking her more at night to eat?

  10. #10
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    Default Re: Oversupply/allergy problem, nipple shield frustration (l

    With the new/less spit up development things might change a lot here for you so you may just want to roll with it and do what seems right to you at the time.

    However, what time do you go to bed? Maybe you want to try a dream feed before you go to bed if you are not going to bed at the same time as baby.

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