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Thread: "Re-lactating" with a 1mo old

  1. #11
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    Default Re: "Re-lactating" with a 1mo old

    Ok, thanks for the additional info.
    Yes, I have seen both an MD / certified lactation consultant, and a lactation consultant found through the LLL website. Both saw a questionable tongue tie, but baby was able to extract milk pretty efficiently (we did a weigh in).
    WHEN was this and WHY, If baby took in a normal amount of milk at a nursing session, and baby is gaining normally, (as I presume baby is, more on that in later) are you still supplementing and pumping? Did the LC give you a plan for weaning off the supplements and pumping? Did they tell you you still need to pump every three hours? And why? Because I do not understand that.

    I still feel as if you are still operating under incorrect assumptions and this is undermining your sense of progress. My understanding is baby is both nursing and being supplemented, and gaining well(?) Maybe I am just misunderstanding the situation.

    When you posted originally, you were pumping one ounce at a time. You have doubled (and possibly tripled, at times) that in 2 weeks. That sounds like pretty obvious and good improvement to me! Please do not expect to get the same amount of time every time you pump, also, how long it has been since the last pumping session is not very relevant in what you can expect to "get" as you seem to believe (this is a common misconception.)

    You were told early on to pump every three hours, and you have been doing this. Correct? But have you had a follow up consult to see if this can be or should be adjusted? You had a before and after nursing weight check done to see how much milk your baby can transfer, so, if baby can now transfer milk normally, couldn't you stop pumping (or at least, start cutting back gradually) wit the goal being to get to only nursing?

    If a mother is nursing AND pumping, an output of 2 ounces is 100% normal. Less, even much less, would be normal as well.

    What a mother can pump is not an accurate indication of her milk production- it can only tell her the minimum possible number, especially if baby is also nursing and thus taking milk at the breast.

    A baby nursing and then immediately rooting and wanting to nurse more is 100% normal and does not mean a mother does not make enough milk!

    2 ounces or so is a "complete" feeding for a 6 week old who is nursing with normal frequency- 10 or 12 times a day or more is normal nursing frequency. If baby took 2 ounces each time, that would be about 20- 24 ounces per day of intake (or more.) No this may not be enough for all babies to gain normally, but it would be plenty for many and very close for all others.

    I do not know birth weight so can not say for sure, but a 6 week old baby weighing 12 pounds sounds like baby is gaining on the fast side. As I mentioned above, IF this is happening, it may well indicate over-supplementing, and over supplementing is a big problem when a mom is trying to increase her milk production and wean off supplements and pumping. I will illustrate this with an example. Say a baby had a birth weight of 9 pounds, and then lost half a pound in the first week, (well within normal loss) and then starts gaining at about one week of age after a lowest weight of 8 and a half pounds. Over the next 5 weeks, if baby is gaining very well, you could expect that baby to gain about a pound every 2 weeks, or 2 and a half pounds total. Since the start was 8.5 pounds (after the normal initial loss) that baby would weight about 11 pounds by 6 weeks.

    IF your baby is being over-supplemented, baby is not going to nurse as actively and effectively nor as frequently as baby normally would, further harming milk production.

    Also,
    and a lactation consultant found through the LLL website
    As far as I am aware, there is not an IBCLC lookup on this website. This website lists local LLL Groups and Leaders.
    Last edited by @llli*maddieb; September 19th, 2015 at 06:16 PM.

  2. #12
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    Default Re: "Re-lactating" with a 1mo old

    Quote Originally Posted by @llli*maddieb View Post

    2 ounces or so is a "complete" feeding for a 6 week old who is nursing with normal frequency- 10 or 12 times a day or more is normal nursing frequency. If baby took 2 ounces each time, that would be about 20- 24 ounces per day of intake (or more.) No this may not be enough for all babies to gain normally, but it would be plenty for many and very close for all others.

    I do not know birth weight so can not say for sure, but a 6 week old baby weighing 12 pounds sounds like baby is gaining on the fast side. As I mentioned above, IF this is happening, it may well indicate over-supplementing, and over supplementing is a big problem when a mom is trying to increase her milk production and wean off supplements and pumping. I will illustrate this with an example. Say a baby had a birth weight of 9 pounds, and then lost half a pound in the first week, (well within normal loss) and then starts gaining at about one week of age after a lowest weight of 8 and a half pounds. Over the next 5 weeks, if baby is gaining very well, you could expect that baby to gain about a pound every 2 weeks, or 2 and a half pounds total. Since the start was 8.5 pounds (after the normal initial loss) that baby would weight about 11 pounds by 6 weeks.
    Yes, I know. Would be enough for most... had I not had such a LARGE baby. He weighed in at 10.7 at birth. So he is gaining fairly normally. I am being very cautious about over-feeding. I am told (by several pediatricians) that at his age 3.5-4 oz per feeding is normal (obviously this is not for a breastfed baby). I do not generally feed him more than 3 oz every three hours.

    So, while you are correct, 24 oz would be enough for most, it seems I would still need to produce 6 oz for sufficient intake.

    The thing I am confused about is that while we are talking overall oz per day, each consultant has approached the issue as a per feeding deficit. That is to say, they are operating on the idea that i don't have enough milk since he has only consumed 60ml per feeding -- instead of the min average 88ml for a child this age / weight to fill his belly.

    Do you have experience that shows this is an incorrect approach? It seems accurate to me that I would need to build from 2oz since the baby would likely still be hungry at each feeding.

    Also, the numbers i am getting per pumping do not reflect sessions where i have nursed immediately beforehand. I occasionally pump in between feeding or before nursing to "see where i am" in terms of increases in production.

  3. #13
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    Default Re: "Re-lactating" with a 1mo old

    If you would please comment also on how --if I am not able to get to a point where I am nursing exclusively -- I can keep my supply as long as possible? (Short of pumping 8 times a day) Is this do able?

  4. #14
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    Default Re: "Re-lactating" with a 1mo old

    I am sorry I know of no evidence that a larger baby needs more milk than a smaller baby to gain normally. I am more confused than ever ad need to get some facts if you do not mind.

    Can you explain
    1) how many ounces in bottles baby is getting each 24 hours and how many bottles over 24 hours baby gets?
    2) and how many times each 24 hours baby nurses
    3) what babies lowest weight was, when that was taken,
    4) and how long it was Days or weeks) between that check and the most recent, and what that check showed?
    5) Right now you are pumping 8 times a day, correct? And can you tell me how much milk overall you pump out in 24 hours?

    That is to say, they are operating on the idea that i don't have enough milk since he has only consumed 60ml per feeding -- instead of the min average 88ml for a child this age / weight to fill his belly.
    According to Breastfeeding Answers Made Simple, a respected lactation textbook written in 2010, 2 ounces (60 ml) intake during a session at which there is a before and after nursing weight check indicates normal milk transfer. If a lactation consultant it telling you your baby needs to take in 3 ounces at a before and after nursing weight check to indicate normal intake, I do not know what to tell you.

    Per feeding intake is important, but it has to be considered along with feeding frequency. Right? A baby who is eating 6 times a day and eating 4 ounces at a time is getting less milk overall daily (20 ounces) than the baby who is eating 12 times a day getting 2 ounces at a time. (24.) We know that a normal feeding frequency for a baby is around 12 times in 24 hours. Some nurse less often and get enough, and some nurse more often. If that baby who eats exactly 12 times gets 2 ounces at a time, that baby is getting 24 ounces per day. If that baby gets 3 ounces per time, that baby is getting 36 ounces. The average daily intake for a baby one month and older is between 25 and 35 ounces, and we know that babies most typically take in small amounts at some feedings and more at others, and that daily intake fluctuates as well.

    Right now, it sounds like you are feeding your baby 8 times in 24 hours. That is what "every three hours" adds up to. That just not often enough for many babies.

    So, while you are correct, 24 oz would be enough for most, it seems I would still need to produce 6 oz for sufficient intake
    ....
    I do not generally feed him more than 3 oz every three hours.
    Then why do you have to make 6 ounces? If baby is getting 3 at a feeding and doing fine?

    Please note I am not saying your baby could not possibly need more than 24 ounces per day to gain normally. It is possible. But it would not be MUCH more... Also, The way to tell gain is to look at lowest known weight, when that was taken, (Typically sometimes during the week after baby was born) and compare it to the most recent check, and see how much was gained in how many weeks. So knowing only birth weight I cannot draw any conclusions about the rate of your baby's growth.

    I am told (by several pediatricians) that at his age 3.5-4 oz per feeding is normal (obviously this is not for a breastfed baby).
    Ok, so there is no difference between a breastfed baby and a formula fed baby. The biologically normal way for an infant to eat is at the breast, nursing 8-12+ times in 24 hours. Formula fed babies are fed large amounts less frequently for convenience. Many formula fed babies are placed on feeding schedules that reduce their eating frequency to even less than 8 times in 24 hours by this age, and those babies obviously need larger individual feedings. This is not healthy, it is not normal biologically- but it certainly is normal in the sense that is how many babies are fed.
    Last edited by @llli*maddieb; September 20th, 2015 at 04:31 PM.

  5. #15
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    Default Re: "Re-lactating" with a 1mo old

    If you would please comment also on how --if I am not able to get to a point where I am nursing exclusively -- I can keep my supply as long as possible? (Short of pumping 8 times a day) Is this do able?
    I am not even convinced you have to pump 8 times a day now. I really do not see why you could not start encouraging baby to nurse more often overall so you can start weaning off supplements. The less your baby is supplemented, the less you will need to pump. EDIT: But I am basing this on the fact your baby has shown they can transfer milk normally and your pump output has increased to a normal or near normal per pump session output...I am not at all clear on what the differential is between what your baby needs to gain normally and how much milk you are currently producing overall. That is why I added the questions at the top of previous post. That said, there is no reason to increase milk production to total needed before starting to wean off supplements. Starting to wean baby supplements is the first step toward the eventual ability to stop pumping.

    Your question is:
    If you would please comment also on how --if I am not able to get to a point where I am nursing exclusively -- I can keep my supply as long as possible? (Short of pumping 8 times a day) Is this do able?
    How often a mom will need to pump depends mostly on how much baby is being supplemented and how often and how effectively baby is nursing. To a lesser extent, needed pumping frequency depends on how mom responds to pumping and her breast storage capacity (how much milk her breasts "hold" at a time before she starts feeling full- this varies considerably mom to mom and makes a difference in nursing and pumping frequency, but not a difference in overall how much milk mom makes.) If a mom is nursing her baby 10 times a day, and her baby is needing 6 ounces of supplement per day to gain normally, that mom usually does not need to pump as often as the mom whose baby is nursing 4 times a day and needing 20 ounces of supplement.

    Also there is a subtle difference between pumping in order to increase milk production when a mom does not make enough, and pumping in order to maintain milk production when a baby is getting supplements. When a mom is needing to increase milk production, if her baby is nursing, it is usually suggested mom pump after most or all nursing sessions (depending on how often baby nurses and what works for her.) She can also pump "in between" sessions, but if baby will nurse more frequently, that is usually the easier option. Again the overall idea is to increase the frequency and efficiency with which milk is removed from the breasts.

    When a mom is trying to maintain her milk production at whatever level it is, and baby gets supplements, it is generally suggested mom pump whenever baby is getting supplements. If a baby does not require supplements 8 times a day, that mom is probably not going to need to pump 8 times a day.

    Also, the direction to pump 8 times in 24 hours is a compromise to reality, not a magic number. 8 is what is suggested so moms do not lose their minds trying to pump as much as a baby would normally nurse, which would usually be more than 8 times in 24 hours. Pumping more often (sometimes called power pumping or cluster pumping) part of the day is an effective way to increase milk production, but few mom will do that for any duration of time or the idea panics them, so it is not suggested as much as it might be. Also, some moms need to pump more often than others in order to increase or maintain milk production. Some moms can pump less often. And it will usually vary for the same mom during the time she is lactating.

    Here are a couple articles I think may help: http://kellymom.com/hot-topics/pumping_decrease/ and http://kellymom.com/bf/got-milk/supp...es/low-supply/ and http://kellymom.com/bf/got-milk/perc...fficient-milk/
    Last edited by @llli*maddieb; September 20th, 2015 at 11:33 PM. Reason: Added some things

  6. #16
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    Default Re: "Re-lactating" with a 1mo old

    Quote Originally Posted by @llli*maddieb View Post
    I am sorry I know of no evidence that a larger baby needs more milk than a smaller baby to gain normally. I am more confused than ever ad need to get some facts if you do not mind.

    Can you explain
    1) how many ounces in bottles baby is getting each 24 hours and how many bottles over 24 hours baby gets?
    2) and how many times each 24 hours baby nurses
    3) what babies lowest weight was, when that was taken,
    4) and how long it was Days or weeks) between that check and the most recent, and what that check showed?
    5) Right now you are pumping 8 times a day, correct? And can you tell me how much milk overall you pump out in 24 hours?
    I don't think I can answer all of these questions. I would need to call the pediatrician to check on the lowest weight (which was 3 days post delivery). I can't recall at this point.

    1) The amount of oz baby gets fluctuates each day, but it hovers somewhere around 18oz in bottles that he is getting (it has been a number of days since I have tracked this very strictly). Last time I checked I was making around 8oz of those 18 myself (i.e., 8oz of those bottles were expressed milk from multiple pumping sessions). Again, it has been about 5 days since I have been strictly tracking this so I believe the supplementation by formula has decreased. I will begin tracking again today.

    2) Baby has been nursing / feeding around 9 to 10 times a day.

    3) ?
    4) ?

    5) I have pumped up to 13oz of milk a day (this is in addition to nursing the baby, but not always right after nursing him).



    Quote Originally Posted by @llli*maddieb View Post
    .... Then why do you have to make 6 ounces? If baby is getting 3 at a feeding and doing fine?
    I don't have to make 6 oz. The doctor/lactation consultant said he should be having around 3oz each feeding. This means -- if he has 2oz of breastmilk, then another oz should be formula.
    Last edited by @llli*magdatay; September 22nd, 2015 at 08:56 AM.

  7. #17
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    Default Re: "Re-lactating" with a 1mo old

    Thanks for all of the additional information. I have a follow up appointment with the lactation clinic today and will discuss some of what you've put forth. Looking back at the first post I see what kind of progress I've made in these 3 weeks. I was initially only able to pump 1oz of milk without baby nursing... and I have gotten to the point where I have pumped up to 3oz during a night session *after* the baby has nursed!

    I have gone a number of nights now (around 3 or 4) where the baby is able to nurse through the night without the need for supplementation.

    I wonder if it is possible to get baby to be satisfied with the every 1.5 to 2 hour feed (with 2oz) instead of the every 3 hour (with 3oz of formula or supplement). He has been angry about that before and seemed to be incredibly hungry after just my milk... though sometimes I have noticed he doesn't completely empty me (I figure this out if I pump after nursing him and am able to get more than usual). He is likely starting to realize that he will get a bottle soon even if he doesn't do the work.

  8. #18
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    Default Re: "Re-lactating" with a 1mo old

    I asked the questions because I am trying to get a handle on the situation. I feel I must be missing something, because it sounds as if 1) Baby is gaining normally (or better than normal, but it is unclear) 2) You are (now) pumping over 2 ounces per pump session which is very good pump output and 3) your baby has shown they are capable if transferring milk normally. Given all that, I just do not understand why you are not feeling as if you can start weaning off the pumps and supplements. (this will of course be a process, not something you do in a short period of time if baby has been getting lots in supplements.) Of course it is important to know exactly how much formula baby is getting so you can track progress and to be sure there is no overfeeding.

    2) Baby has been nursing / feeding around 9 to 10 times a day
    Ok I am assuming this means baby is NURSING that many times a day. Even if baby gets supplements at the same feeding, that still counts as nursing. Of course if baby is being fed only supplements and does not nurse, that will not count as nursing. So for nursing, that is pretty good frequency. But many breastfed babies need to nurse 12 times a day or even more sometimes to get enough milk. Right now with all the pumping you are doing, you are probably not even able to think about nursing more often. But think about it- even if you nursed two more times a day, that would be 4-6 ounces more into baby at the breast that you would not have to give baby via supplement.
    5) I have pumped up to 13oz of milk a day (this is in addition to nursing the baby, but not always right after nursing him).
    The reason you pump right after nursing is to more completely "empty" the breast, so it gets the message to make more milk. You may get very little milk when pumping right after baby nurses, that would be entirely normal. So do not worry that this was what you pumped on a day you did some pumping instead of nursing. It still counts for me to get a better idea of what is going on.

    If your body is able to pump 13 ounces of milk in a day, (or something close to it) when baby is also nursing over the same day, and your baby is being supplemented 18 ounces, you are very close to closing the gap...just nursing a couple more times as I suggested about would possibly close the gap!

    I think you have been a little mislead by the idea baby needs x number of ounces per feeding. It is just not the reality of how infants nurse...this has been studied, and per nursing session intake in a normally gaining baby over about a month old can vary from very little - less than an ounce, to 3-4 ounces.

    Also,
    He has been angry about that before and seemed to be incredibly hungry after just my milk
    Because everyone recognizes that breastmilk is the biologically appropriate food for infants, formula is manufactured to be as much like breastmilk as possible, and this means your milk has just as many calories, fat, etc, as formula. So if you mean there might be something wanting about your actual milk (rather than how much baby gets total) please do not worry about that.

    The reason it is vital to keep a record of weight gain in this situation is because that is what will tell you how you are doing. A baby needs supplements if they cannot gain weight normally without them. They do not need supplements ever for any other reason- not because they seem "hungry" or "angry" after nursing, or want to nurse more often or less often, not because moms pump output is not what she thinks it should be, etc. I have had op with all three children, so they all gained rapidly, and they still would often act hungry and angry after nursing, want to nurse non-stop periods of time, root to nurse again shortly after nursing, become fussy and refuse to nurse for no apparent reason, or nurse for short periods and then stop and fuss. This is all part of normal infant behavior, and as long as baby is nursing well enough to keep gaining normally, does not indicate a breastfeeding problem in most cases.

    Looking at your second post it sounds like you are making good progress and just as importantly, recognizing that progress. Try not to be upset if there is some backsliding or a feeling of a stop in progress, this is common. Remember this is a process, and some backsliding and regaining ground is part of the process in many cases. I think you are doing really well. I hope the lactation appointment goes well.

    This is a good, cautious article about weaning off formula supplements. http://kellymom.com/ages/newborn/nb-...rease-formula/

    Of course, if baby is getting moms own milk that she is pumping daily (essentially) you can probably move more quickly off the supplements than if baby is formula fed. I would suggest, work on weaning off the formula top offs first, and once that has happened and gain is still normal, you can start weaning off the breastmilk supplements and as they can be reduced, the pumping can be reduced.
    Last edited by @llli*maddieb; September 23rd, 2015 at 12:59 AM.

  9. #19
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    Default Re: "Re-lactating" with a 1mo old

    I am happy to say that the MD was pretty much 100% with what you presented. She advised me to go ahead and stop pumping and start feeding the baby -- weaning off of the formula slowly this week. She advised me not to give him more than 6 oz a day (1oz at each feeding) and to look out at whether he actually needs this.

    One discrepancy I see between her approach and what I am seeing in the forums here is that she does not advise feeding "small amounts" around the clock (which is why she's asking me to give 1oz at each of the daytime feedings). That this equates to snacking all day and is not natural.

    HOWEVER , I am having trouble with both messages. On the one hand, after not producing enough milk I am finding it difficult to "trust my body" and not read babies fussiness as hunger. On the other hand, I don't mind nursing him frequently if this will allow me to close the gap faster... but how do I know HOW frequently?

    Last night he did wonderfully and did not need his "top offs" again. This morning it was hard to get him down for longer than 20-30 min! Sometimes even less. It didn't seem like hunger so I held off until 12 with a "top off" of 1oz, but still then he continued to want to nurse VERY frequently. This'll total way more then 12x a day.

    Is this normal at 7 weeks? Or is he hungry? After I gave him the 1oz, he spit it up... possibly because he didn't need it? I'm so confused... Its been 6years since I've had a baby and I feel like a first time mom!
    Last edited by @llli*magdatay; September 23rd, 2015 at 12:09 PM.

  10. #20
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    Default Re: "Re-lactating" with a 1mo old

    I forgot to mention that his weight last week went from 11.9 to 12.5 (with top offs)

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