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Thread: bottle supplementing w/ 36-weeker

  1. #1

    Default bottle supplementing w/ 36-weeker

    Can anyone tell me their experience with this, or offer some perspective?

    My baby (boy) was born at 36w0d, and would now be 38 weeks. He can latch and suck using a nipple shield, but gets tired easily. He gets bottles (pumped breastmilk) after most breastfeeding sessions, because without them he gets cumulatively ravenous and becomes irate after a few feeds, so hungry that he refuses to eat and will only cry. He also gets bottles at night, because I have to take a prescription to sleep and can't be awake to breastfeed him.

    I'm afraid he's just learned to wait for the bottle to arrive, and that he's not learning to breastfeed effectively. On the other hand, without the bottle, he suffers from being too hungry to be content enough to try breastfeeding.

    On top of this dilemma, he seems to have chosen nighttime to really get his belly full. He'll sleep most of the day, then become alert in the evening and into the night (when I can't breastfeed, because that's when I have to take my prescription). This makes him even more dependent on the bottle, because his most alert hours are the ones where he's being exclusively bottle fed.

    I don't know whether I should 1) try to get him to be more alert in the mornings somehow, so he has more energy to breastfeed during the day 2) try to eliminate the bottles, though I can't see how, given that it seems to starve him 3) continue supplementing, and hope he gets stronger at breastfeeding through the attempts he makes, and that by the time he's 40 weeks, he's able to breastfeed successfully or 4) something I haven't thought of yet.

    Can anyone help?

  2. #2
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    Default Re: bottle supplementing w/ 36-weeker

    Hi and congratulations. I hope we can help.

    First I would suggest do not let anyone tell you to wait until baby is 40 weeks. There is no general reason that a 36 week gestation baby (and even earlier) cannot nurse just fine. The time to address issues like baby refusing to nurse or not nursing effectively is immediately.

    You have a very major challenge aside from anything else with not being able to nurse baby at night. Are you not nursing due to concerns about baby getting your milk with the medication, or because you are sleeping? Have you investigated alternatives to this arrangement? Because in the normal course of things, baby nurses frequently both day and night, because they must do this in order to get enough milk overall and to stimulate mom's milk production to normal levels. In other words eating lots at night is not something baby decided to do, it is something he has to do.

    Supplements during the hours you can nurse are not needed unless baby is not getting enough milk without them, and you generally can tell that pretty well from output (poops) and weight gain. It is entirely normal for a baby to want to nurse almost constantly for long periods and to be upset if that does not happen, so behavior can be misleading.

    Supplementing when it is not necessary is a fast way to kill the breastfeeding relationship. Even when supplements are needed, it is important they are given in a breastfeeding supportive way...supplements can be given with something aside a bottle, and these alternative methods may cause less issues. If bottles are used, bottles can be given in a special way where they will cause less issues. But the most important thing is to be sure baby is only getting the amount of supplements baby needs.

    So the first thing to figure out is if baby needs any supplements during the day, and if they can possibly be at least reduced at night.

    What is baby's complete weight history?
    How many times a day does baby poop and what does it look like (size)
    How many ounces in a bottle is baby given at each feeding (day and night)
    How many ounces in a bottle overall daily?
    How are the supplements given?
    How many times in 24 hours does baby nurse?
    How many times in 24 hours do you pump?
    How long a stretch at night is there no nursing? Any pumping at that time?
    Is nursing comfortable for you?
    How long does baby nurse when he nurses?
    Can you explain what time of day it is that baby becomes "irate" and what happens exactly?
    Where does baby "hang out?" or sleep? (day and night?) Is baby typically held by you & held by someone else while you pump, or laying down in a crib or similar? Who is watching over baby at night and is baby in the same room they are?
    Last edited by @llli*maddieb; June 28th, 2015 at 09:51 PM. Reason: meant to say hi not ho!

  3. #3

    Default Re: bottle supplementing w/ 36-weeker

    Thanks for this very thoughtful reply! I'll answer your question about Trazodone first, then your other questions in-text, below (and may I say again how grateful I am for your advice? I'm so thankful!!!)

    When I take Trazodone, I'm not completely knocked unconscious, but I'm incapacitated for 8-9 hours. I have a serious sleep disorder, and I have to take it to function, so I can't take less or stop taking it. I can wake up enough to have a conversation, but can't lift my head for more than a minute without becoming dizzy and passing out. My husband and I have talked about side-lying nursing, when the baby can latch without a nipple shield and pull milk effectively, but I'm not sure if this is really an option, because I really can't "help" with the nursing. My husband would have to do everything for me, and I might feel very sick during the nursing from being woken during the drugged period when I'm not supposed to be woken.

    What is baby's complete weight history? he was born at 5,7 and has been gaining like a champ. He's now 5,10 at 2.5 weeks.
    How many times a day does baby poop and what does it look like (size) He poops constantly, and it's healthy looking. I estimate one million poops per day, I can't even count them! Every time I change him, he has pooped and peed. It looks seedy/mealy and mustard/orange colored.
    How many ounces in a bottle is baby given at each feeding (day and night) He's eating about 4 ounces at a time during the night, every 2-3 hours. He also sometimes seems to ask for "snacks" in between. He breastfeeds in the morning, and will feed for 30 minutes at 5am, then maybe 15 minutes at 6:30, then maybe 10 minutes at 7:30, then he sleeps for a while. He gets progressively frustrated over the course of the day, I think because he doesn't get enough calories from the breastfeeding? Sometimes by the afternoon he seems too tired (read: enraged) to breastfeed and pushes away the breast, but will down 4oz from a bottle in just a couple of minutes.
    How many ounces in a bottle overall daily? I've never tracked this...I'm going to estimate 20 ounces?
    How are the supplements given? My husband or I bottle feed him. When it's me, I usually breastfeed first and follow up with a bottle to see if he's still hungry. During the night, my husband feeds him bottles when he wakes up and shows feeding cues.
    How many times in 24 hours does baby nurse? 5-7 times.
    How many times in 24 hours do you pump? about 7 times.
    How long a stretch at night is there no nursing? Any pumping at that time? There are about 10 hours between my last night pump and first morning pump, and maybe 12 for baby with nursing. I get about 16 ounces at my first morning pump, and then 5-6 ounces at each remaining pump.
    Is nursing comfortable for you? Comfortable would be a stretch. he latches well, but I'm always worried he's not sucking very much. He swallows, but I don't feel much pull on the nipple (and we use a nipple shield).
    How long does baby nurse when he nurses? He nurses for 35 minutes on a really great session, or 5 minutes on a particularly sleepy or angry one.
    Can you explain what time of day it is that baby becomes "irate" and what happens exactly? he gets upset in the evening. He'll breastfeed or bottle feed, and then I'll put him skin-to-skin, and he'll root and root. I'll try to put him back to breast, and he doesn't seem to want to latch (he's always just eaten). This just kills me, that he's not peaceful when we're skin-to-skin at night. In the morning, he's so calm after he nurses, he'll unlatch at the end and fall asleep on my breast, and it's wonderful.
    Where does baby "hang out?" or sleep? (day and night?) Is baby typically held by you & held by someone else while you pump, or laying down in a crib or similar? Who is watching over baby at night and is baby in the same room they are?He's in a rock-n-play sleeper or a pack-n-play during the day while I pump. I can't manage to pump hands-free, thought I've tried the pumping bra tricks, etc. The flanges just don't stay positioned right, and then milk doesn't come out right. It's torture to be separated from the baby for so many hours while I pump. From about 8pm to 4am, he's in a crib in the same room as my husband. My husband stays up until about 1am with him, and will feed him until 4 as needed. I wake up at 4 and take over. We've started having me sleep in the spare room so I'm not woken up every time the baby wakes at night. When I get up, I take the baby from the bedroom into the living room, where he's in the pack-n-play while I pump. We'll start doing baby-wearing once he meets the weight requirement for our Baby K'Tan, though the design of it still won't let me pump and wear him simultaneously.

    One more problem is that I've often just pumped when baby wants to nurse, and then I'm empty. This leads to more bottles, and less nursing...

    Thanks SOOOO much for your reply, I'm looking forward to hearing from you!

  4. #4
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    Default Re: bottle supplementing w/ 36-weeker

    When I take Trazodone, I'm not completely knocked unconscious, but I'm incapacitated for 8-9 hours. I have a serious sleep disorder, and I have to take it to function, so I can't take less or stop taking it. I can wake up enough to have a conversation, but can't lift my head for more than a minute without becoming dizzy and passing out. My husband and I have talked about side-lying nursing, when the baby can latch without a nipple shield and pull milk effectively, but I'm not sure if this is really an option, because I really can't "help" with the nursing. My husband would have to do everything for me, and I might feel very sick during the nursing from being woken during the drugged period when I'm not supposed to be woken
    Ok, unfortunately this leaves you with a real problem I am not sure how to solve. The lactating body must have milk removed from the breasts every few hours night and day, or milk production will reduce. (or never get where it needs to get in the first place.)

    This may be from a pump or from baby, or even hand expression, but something has to be removing the milk every 2-3 hours. If milk is not removed, Aside from production reducing, (or never getting where it needs to get in the first place) mom may be come engorged, get plugs, get mastitis...the milk sitting in the breasts for long periods will make you ill, in other words. So, I wonder how this has been working, going 8-9 hours with no milk removal? How are you feeling? How are your breasts feeling?


    I can tell you for sure that from a safety pov, Sidelying nursing with baby next to you when on meds that are this strong is not safe unless another responsible adult is right there, watching and entirely awake every time you nursed for the whole time baby was beside you. This is entirely aside from whether the medication levels in your milk at this point when they are affecting you so strongly are safe, which I am not sure about...

    Pumping actually might be doable. There are cases of ill, comatose new mothers "being pumped" while they were unconscious. But of course this is extreme and I have no idea how you feel about this or whether you and your husband could get you into a position where this is possible.

    Would you be able to hand express...even if you did not keep the milk? If you were not trying to collect the milk, and were just expressing to keep milk production normal and avoid the milk stasis issues, then both pumping and hand expressing could be done more easily.

    But bottom line, not having milk removed overnight, there is every likely hood you will not make enough for your baby during the day, either now or in the near future.

    The situation of medicated sleep for 8-9 hours daily is so unusual from a lactation standpoint I feel it is an area you really should be talking to a professional about- a board certified lactation consultant. (IBCLC) or a physician with breastfeeding expertise. One with lots of experience.

    But if I may, I can approach some of your other concerns, and what I am going to do is approach them as if you worked at night, and were not there to nurse your baby. That way, I have a reference point I am familiar with to go by.

    Newborn babies of 2 weeks of age need an average of 20-25 ounces per 24 hour day to thrive and gain normally. (Earlier than 2 weeks it is slightly less.) After 2 weeks, this amount goes up slowly and gradually for the next 2-4 weeks, leveling off at about 5 weeks for an average of 25 -35 ounces per day, and it stays somewhere around there from then on...it does not keep going up. A 6 month old needs the same amount daily as a 6 week old, in other words.

    Average means that some babies do fine on the lower amount and some need the higher amount. There are also outliers who need more or less than this average range and thrive and gain fine.

    And breastfed newborns get this daily amount nursing 10-12 times in 24 hours. This means feedings average about 2-3 ounces at once. If course when a baby is nursing, it is entirely normal for some feedings to be tiny- less than an ounce, as well. It is all over the map.

    So, I think you know where I am going- 4 ounce bottles are really big for a two week old. And if baby is getting 20 ounces from bottles daily, baby is getting all or almost all baby needs from bottles.

    When a baby is fed large amounts at once in a bottle, they tend to get used to that idea, and thus become frustrated at the breast where the normal feeding is much less and they have to work for the milk in a way they do not have to with bottles. When a baby is over fed over the course of a day, baby becomes much less interested in nursing, because baby has more than enough from bottles.

    Also, a baby this age will suck on whatever baby is offered. If baby is offered a bottle with 4 ounces in it, that is what baby will drink, even if baby has no need for that amount.

    I imagine that right now, there is lots of milk in your breasts in the mornings. Night times are times of peak milk production, so even if a baby is nursing normally overnight, the breasts are usually fuller in the morning. If milk is not being removed, there must be even more. So the flow rate in the morning must seem just fine to baby. But it is entirely normal for milk production to reduce over the course of the day, normally causing a baby to nurse more and more frequently, culminating in a longish period of cluster feeding and attendant fussiness in the late afternoons and evenings.

    So, the immediate issue is that baby is being overfed at night. The frequency is fine, its the size of the bottles and how they are given that is a problem.

    For during the day, I would suggest, try to resist any supplementing. Your baby is gaining well with lots of poops. This means baby is getting plenty of milk. His behavior is normal and thus not an indication he actually needs supplements during the evening when you are "there" to nurse. This is a time of fussiness and upset for well fed babies around the globe.

    So that would be my suggestion to the night shift mom- reduce the size of bottles, teach husband how to give bottles so they are not over feeding baby, and stop supplements when she is there to nurse and just nurse, and comfort baby other ways, as baby needs.

    But your situation is not quite the same, as the night shift mom with a newborn would be expressing milk at least 3 times over the 8-9 hour separation in order to have normal milk production. (Later when milk production was established, she might be able to reduce this to 2 times.)

    IN other words, I am not entirely sure of where your milk production is or where it is going...due to the many hours of no milk removal. again, I would strongly suggest talking to a professional about your unique situation.

    What you can safely do right now is change the way baby is given bottles. Whether a baby is breast or bottle fed, small, frequent feedings that baby controls the flow and amount of are closer to the biological normal. If you figure out a way to safely nurse baby at night (safe for you both) then of course night bottles can be reduced or even eliminated. But eliminating bottles will have to be done gradually, as baby is getting so much in the bottles at this point, you of course want to know baby is still getting enough overall as they are reduced.

    As long as baby continues to gain normally, you can also stop giving supplements during the day and evening when you are awake and can nurse. But you will have to watch your milk production closely because or your unique situation if you continue to be unable to nurse, pump or hand express overnight. Since milk production is not able to be accurately measured from pump output or infant behavior, keep watching the weight gain and the poop output closely.

    Here is info, remember most of this is written for when a mom is back at work, so it is assumed baby is at least a couple months old. Paced feeding can be safely done at any age, but a two week old will nurse/eat more often than an older baby, typically: http://www.llli.org/docs/00000000000...astfedbaby.pdf
    Video demo with doll https://www.youtube.com/watch?v=UH4T70OSzGs
    Video demo with newborn IGNORE the comments from people saying this is wrong. They are wrong. See top comment from the babe's mom. https://www.youtube.com/watch?v=ykdFuEOIdeE
    Supplementing alternatives well explained: https://www.youtube.com/watch?v=vrrrC5NyNnQ
    Last edited by @llli*maddieb; July 2nd, 2015 at 11:02 PM. Reason: Added stuff

  5. #5
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    Default Re: bottle supplementing w/ 36-weeker

    Ok I thought more about you last night and I wonder if I am being overly pessimistic about your milk production. I wonder if you might be ok milk production wise if you can increase nursing frequency and lesson/eliminate supplements when you are awake, nurse right before sleep and right after, and expressing milk and/or nursing very well ONCE over the night- in the middle of the night between the before and after nursing sessions.

    I don't know. Some moms do make plenty of milk even if newborn baby sleeps without nursing for a couple longish periods of about 4 hours each day, so it is possible. But this is something that would depend on your personal capacity of milk production and also your personal milk storage capacity- and these are factors outside your control. They differ mom to mom. So I think it would depend on how your body is responding to the overnight period of no milk expression or nursing.

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