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Thread: Oversupply? Late engorgement?

  1. #1

    Default Oversupply? Late engorgement?

    Hi,
    My little one is a little over 2 weeks old. We got off to a difficult start with breastfeeding. After a c-section, my baby lost 10% of his birth weight by the time he was 2 days old. We had a hard time finding a latch and my milk was late to come in. He was tongue tied and this was fixed when he was two days old. In the hospital they gave him donor breastmilk until I was able to get my hands on a clinical grade pump. When we went home when he was 4 days old I could not get him to latch for the first week or more. My milk started to come in by day 4 and I did not experience engorgement. I was exclusively pumping and supplementing until about 5 days ago. During this time I broke down and used a bottle and paced feeding because the SNS system and using our finger to feed him was leaving me exhausted and overwhelmed.

    Thankfully I have a solid milk supply and some good guidance from a LC. He has been steadily gaining weight and as of 2 days ago he was back to his birth weight.

    Starting 5 days ago my LC felt that his latch was good and my milk was strong and she wanted us to start exclusively breastfeeding, using a nipple shield when needed. At this point I am able to get him to latch 50% of the time without the nipple shield. I also experience quite a bit of discomfort when he latches but as he feeds the discomfort goes away. My LC said this initial latch pain is normal for some women and will hopefully go away at some point. Has anyone experienced this?

    The first couple days of trying to exclusively BF I did pump a couple times in the first couple days to relieve the pressure in my breasts but I realize now I was increasing my supply. I have not pumped in the last 3 days.

    I think I have an oversupply because my baby often coughs, gasps and seems to be choking on the amount of milk that he is receiving. He often has to feed in 5 minute periods at a time because he will pull off my breast and need to be burped and often falls asleep. But I will generally get in 10-20 minutes on one breast over a one hour period of time. Now I am experiencing what seems to be engorgement 2 weeks postpartum.

    Is that normal given my BF experience? I have been trying to do block feeding to decrease my supply and drain my breast more fully sticking with one breast for 3-4 hours. But by the time I get to the other breast if is aching and feels like it is about to burst. I am reaching out to see if anyone has experienced this kind of late engorgement and oversupply. What worked for you? Is there hope at the end of the tunnel? It has been a long two weeks with my BF challenges and I am trying to remain optimistic is will all balance out eventually.

  2. #2
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    Default Re: Oversupply? Late engorgement?

    Hang in there Momma, there is light at the end of the tunnel. The newborn period is always hard even if everything is going perfect so when dealing with some challenges don't feel bad if you need to call for some extra support.
    Did your LC recommend the block feeding? If so definitely call and talk to her for extra support since balancing it is an art. If you are getting painfully engorged then you should probably shorten the length of time you are blocking that breast. Though I'm not really sure you should be block feeding at this point.
    Engorgement is not that uncommon early on, you should take steps to avoid it (hand expression or nurse more often). I would caution about the block feeding unless your supply is so abundant that your baby is gaining weight extraordinarily fast (as in gaining around a pound a week.)
    Block feeding can really reduce your supply too much if you are not careful.
    Also, the fussing/coughing/choking at the breast during let down can be from an OALD that is not always associated with over supply AND that forceful letdown will actually be exasperated when you first feed on the blocked breast.

    What might be better for you to do is feed very frequently. Finish one breast and only offer the other if baby seems to want it. If let down is still really forceful (as in spraying out if you unlatch baby during let down) then let that spray go into a towel till it slows enough that baby can latch back on without choking.

    Feeding frequently won't cause over production the way pumping can. If you must pump to relieve engorgement, only pump or better yet hand express just enough for comfort but don't try to drain the breast.

    Hopefully some of the other ladies who know the links will provide the articles about block feeding since it is quite possible to harm your supply and wind up having to pump again to bring it back up.

    Your supply should regulate naturally over time.

    Now if your LO is still having some issues with milk transfer and latch, it may be worth getting the tongue tie checked again (also check for lip ties) and some babies also need some physical therapy (oral motor therapy) to help the muscles involved in nursing especially if they had a tongue/lip tie (Mine did but his wasn't corrected till 8 weeks.)

  3. #3
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    Default Re: Oversupply? Late engorgement?

    Hi! Sounds as if you are doing really well after a very challenging start. I do agree with pp- 2 weeks is rather early to be block nursing.

    First I am not sure what you mean by 'late' engorgement. Engorgement can happen any time that the amount of milk being made is more than that which is taken out. Both nursing frequency and effectiveness (milk transfer) are important for avoiding engorgement. But this does not mean baby must EMPTY the breast, as that is actually not typically needed and taking pains to have baby 'empty' the breast will increase milk production. Rather, engorgement is avoided (hopefully) when baby nurses effectively enough and often enough to keep the breasts soft (not overfull) and of course for baby to get enough to eat overall. Yes this is sometimes easier said than done, and that is why engorgement happens. And it is very common to occur for the first several weeks. This does not mean it is always normal or not a problem- it just means it is common. Milk production typically increases for the first 4-6 weeks, although much, much more slowly after two weeks than it does prior to 1 or 2 weeks of age.

    Also, milk "coming in" -the transition from small amounts of colostrum to much greater amount of mature milk at 4 day is not all that slow, and is pretty good for after a C-section especially if this is your first baby. This is just an FYI for others who may be reading this.

    OK I have a few questions- Are you exclusively nursing now? or are you also pumping and/or does baby get any bottles?

    How is baby's weight gain? Poop output?

    How many times in 24 hours does baby nurse? Get a bottle? Do you pump? (if the latter two are still happening)

    Are you using a nipple shield most or all of the time, or sometimes? When you are using it, does the shield help with the fast flow at all? Does the breast feel softened after baby nurses with the shield the same as when not using it? Better? Worse?

    What ideas have you tried for helping baby get a more comfortable latch? There are many latch and positioning techniques that might help. Pain at this age is almost always a sign something is off with latch. Of course it is true that sometimes pain goes away simply with baby getting bigger and mom and baby learning/practicing nursing. But it is also true that pain is a warning sign of a more severe issue and should be paid attention to. Since you are ALSO having issues with engorgement, I wonder if there is more to the latch issue.

    Also, engorgement itself can cause it to be much more difficult for baby to latch or to latch comfortably. Did your LC show you how to do reverse pressure softening? This can help if that is going on. Frequent nursing (so the breast is less full the next time) also helps.

    Yes nursing frequently will not increase your milk production beyond normal. Nursing very frequently is a tried and true technique for handling issues of fast flow and overproduction and probably helps with most breastfeeding issues. But assuming gain is good, no reason to have baby nurse both sides each time. One breast at a time is often fine at this age especially for when there is fast flow/op.

    Nursing in a laid back position is also very helpful for fast flow. More info below, and adjust the amount if lean and baby's position to whatever works for you. Sidelying nursing also seems to help with fast flow.

    Block feeding: One does not block nurse in order to empty one side with multiple feedings on that side in a row. In fact, taking pains to "empty' the breast WILL increase milk production. Block nursing is done to make the "blocked" breast- the breast that is not nursed from for the block of time baby is nursing only on the other side- get very full in order to signal to the body to make less milk. And it works very well, which is why it is very tricky and not typically recommended at this age especially, and also not when there are also latch issues going on, although of course there are exceptions. And yes, when blocking, if you are getting painfully engorged on the 'blocked' side, then it is important to switch sides or hand express or pump just enough to soften the breast. But again, it may be that block nursing at all at this point is not a great idea.

    More: Block feeding do's and don'ts http://www.nancymohrbacher.com/blog/tag/block-feeding

    Handling fast flow: http://www.nancymohrbacher.com/blog/...-breastfeeding (read down the page for more info on laid back nursing)

    More on positions and getting a comfortable latch: http://feedthebabyllc.com/latch-and-positioning/

    Engorgement and RPS http://www.llli.org/faq/engorgement.html
    Last edited by @llli*maddieb; November 16th, 2014 at 03:03 PM.

  4. #4

    Default Re: Oversupply? Late engorgement?

    Thanks for both replies, resources and encouragement. I had not begun block feeding for very long (less than 12 hours) and will stop for now and rotate between my breasts for each feeding until I can meet with my LC. No one recommended it - it was something I read about online regarding oversupply. I am glad I posted and you both advised me to stop until I can get professional advice. I did not realize that draining on breast fully could increase production. He seems to be doing a better job today of softening my breast with one feeding so I think this will work well for us.

    I think I thought of my engorgement as late because all the books refer to engorgement as the time when your milk first comes in and I did not experience the full, aching breasts until a couple days after I began to EBF without pumping and supplementing with my milk at 14+days postpartum.

    LegendaryLLady - to answer your questions:
    OK I have a few questions- Are you exclusively nursing now? or are you also pumping and/or does baby get any bottles? Last 5 days are all nursing, no pumping or bottles

    How is baby's weight gain? Poop output? - weight gain is good so I don't think milk transfer is an issue. After 10% weight loss he is up to his birth weight. He put on 5 ounces in the 5 days I began to EBF. He poops at east 5 times a day (yellow) with 8+wet cloth diapers.

    How many times in 24 hours does baby nurse? Get a bottle? Do you pump? (if the latter two are still happening) I feed on demand---so anywhere from 10-12 feedings. Some are really short vigorous sessions (5 minutes) to 20 minutes. Today there seems to be longer sessions with less sputtering and coughing at the breast. He has not had any bottles in the last 5 days and I have not pumped in the last 4 days. He is a sleepy baby so I often have to wake him to feed or he would go longer than I would like between feedings.

    Are you using a nipple shield most or all of the time, or sometimes? When you are using it, does the shield help with the fast flow at all? Does the breast feel softened after baby nurses with the shield the same as when not using it? Better? Worse? I am using the nipple shield when I have a hard time getting him to latch or when I have been really engorged. I think he gets lots of milk either way and if he nurses long enough my breast gets soft.

    The main latch I have been using is across the front of my body supporting my breast with one hand and his neck and shoulder with my other - I forget what is is called - cross latch? This is the main one I can do well. I cannot seem to get laid back right but I want to keep trying. I did start experimenting with side lying which went well except he had large spit up sessions after these feedings, the kind that seem like his whole meal came up - and my friend advised feeding him more upright and keeping him upright for at least a half hour after feeding and the large spitups have stopped.

    I will keep working with my LC on the painful latch. One LC thought it was possible he has a tongue tie at the back of his tongue in addition to the one in his front that was already cut. The other LC felt that his suck was strong and that it might not be necessary to have additional procedures. He has the classic heart shaped tongue. I do think that with the daily stretches his tongue is regaining mobility. I am taking him for craniosacral bodywork next week.

  5. #5
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    Default Re: Oversupply? Late engorgement?

    It sounds to me as if things are going better and, except for the owie latch, everything sounds pretty normal for this age. Great baby is exclusively nursing at this point- this will probably help things 'normalize' more quickly.

    Nurse in whatever position(s) work best for you, and no harm in experimenting with others as you like. Maybe Look at the tips in the article I linked for helping baby get a deeper, more comfortable latch. Spit up is usually not really a problem, it looks like it all came up but trust me, it did not. However, I agree with your friend that holding baby upright both during and after nursing can help baby handle the flow especially when there is fast letdown.

    After 10% weight loss he is up to his birth weight. He put on 5 ounces in the 5 days I began to EBF. He poops at east 5 times a day (yellow) with 8+wet cloth diapers.
    This is wonderful and spot on normal! But normal gain (rather than overly fast gain) is probably a clue that block nursing is not needed or no longer needed.

    weight gain is good so I don't think milk transfer is an issue.
    Yes it is clear baby is getting enough milk and that is what is most important. But, if it is true that you have an overabundant production and fast letdown going on, normal gain at that point does not necessarily indicate baby will continue to gain normally if milk production decreases. In other words, there may still be a latch issue even though baby is getting plenty of milk. This is why block nursing this early is tricky and it is important to be sure latch is in good shape. So I am glad you are seeing LC again.

    He has the classic heart shaped tongue.
    So, the heart shape that indicates tie? I thought that indicated a tip tie (not a back tie?)

    But at this point, all sounds really good and it is great baby is feeling a bit more settled when nursing. What may have happened is that pumping on top of nursing brought in a big supply, (common) and the couple days of block nursing then helped calm it down just enough. In other words, no harm done and may have helped!

  6. #6
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    Default Re: Oversupply? Late engorgement?

    Sounds like you are doing well now.
    If the pain on latching doesn't improve and quickly, definitely get baby checked for a posterior tongue tie and/or see about getting some oral motor therapy since weak jaw muscles or fatiguing muscles can cause baby to clamp down or have difficulty opening wide enough to make getting a good deep latch possible.

    The heart shape tip of the tongue can be a sign of posterior tongue tie. Also, if top lip isn't flanging out, check for lip tie.

    Getting ties fixed is far easier the younger you get them done, my LO didn't get his done till 8 weeks and it was a long time before we got all our nursing issues sorted out.

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