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Thread: What to do next?

  1. #1

    Default What to do next?

    Hello.

    I am a mother of a 3Y old DD which I breastfed for 15 months and on 15th of July I gave birth (with s.c.) to a 28W gestation old preemie DD Now she is 36W. We are home for 2 weeks. I am pumping BM from the start and I pump about 150ml in one session - 50ml from L side and 100-150ml from R side. I stopped adding fortifier last week. DD is bottlefed and about 3 times a day I breastfeed her now. She can manage from about 25ml to 50ml in one feeding. I have a scale and she drinks about 15ml on the breast and then I give her the bottle. She latches on OK (sometimes she has trouble opening her mouth...) and then suckles until she gets tired. I pump a bit first to get the milk flowing so that she doesn't get tired doing this as well. Especially the left breast has a slow flow and it takes time for the milk to come out.

    My question is how to go on from here. Do I have to change this pattern? I really don't know what is the right way to get to exclusive breastfeeding from here. I am getting sick and tired of pumping milk. It is really frustrating...
    And also what is the best way to wean off pumping? I don't know what is the right amount of pumping to avoid mastitis and producing more milk... I know it is said to pump only to release pressure but how much is this?

    Thank you very much for your answers and pardon my English - I am from Slovenia

  2. #2
    Join Date
    Jun 2009
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    10,754

    Default Re: What to do next?

    Hi, congratulations on your baby it sounds like you are doing really well!

    I think the immediate issue is that your baby is not latching or nursing as well as baby could. I would suggest that working on that would allow baby to transfer more milk more quickly, and this will allow you to ease off the bottles and eventually the pumping more quickly. Have you received help with this from someone who can work with you and baby? Is that possible? Do you have lactation consultants, professional or volunteer where you are?

    I think the basic answer to the question of how to move from where you are now to only nursing is to gradually increase time at the breast and decrease supplemental feeds in bottles. This can be done while you work on latch, but of course will go far better if baby can transfer milk efficiently. Once you have made significant progress with reducing the supplementation, you can start cutting back on pumping sessions. Once baby is able to get enough milk at the breast and needs no more bottles, pumping can stop completely. But as long as baby gets any supplemnts, whether it is your milk or formula, pumping should continue because otherwise milk production will be compromised

    Of course, exclusive nursing is not the only option as far as goals go. You could plan to pump and supplement and nurse in some combination for as long as you nurse. You could decide to drop the pumping and supplement as needed with formula while still nursing, and many other variations. There are benefits and drawbacks to each possibility, so you just want to know what those are.

    The book The Womanly Art of Breastfeeding (8th edition) is available in many languages and may be very helpful, as may the book Making More Milk.

    Some moms find a lactation aid very helpful for situations where they need to supplement. See: http://www.breastfeedinginc.ca/conte...agename=doc-LA and http://cwgenna.com/smartnothard.html

  3. #3

    Default Re: What to do next?

    maddieb thank you for replying!

    My baby is doing quite OK as far as breastfeeding progression is concearned. She gets more milk this way. I try to latch her on for every feeding and then I offer the bottle. But if she eats very small amount in one feeding I skip BF the next one and give her just the bottle. She can manage to BF longer now and drinks about 20-30ml.

    But I have some other issues that I would like to ask about. She has liquid green stools for about two weeks now. The doctor said that the color is green because of iron she is taking. But she is taking it from the start and the stools have been yellow before. I am guessing it is maybe due to my high milk production. Maybe she gets a lot of foremilk - especially from the R breast. If I make 150ml on this side and she drinks only 20-30ml that means she gets a lot of foremilk! And she is also having colic for a few days now. What should I do about it?? I almost always pump some milk in order for her not to get tired but that is only about 5-10ml...

    We have LLL in Slovenia and I will contact them but on our website there are only volunteers and the nurse that has IBCLC was not very helpful with my first daughter when I asked her about some issues that we had... Come to think about it my first daughter also cried during BF in the first month or so and latched off and sometimes had greenish stools. Maybe I had overenthusiastic breast even then but I didn't know because I wasn't pumping...
    Last edited by @llli*lollipop86; September 13th, 2015 at 07:43 AM.

  4. #4
    Join Date
    Jun 2009
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    10,754

    Default Re: What to do next?

    My advice is do not worry about green poops. First, how iron supplements might affect the look of your baby's poops may certainly change- in other words, if your doctor says it is from the iron, I see no reason to question that. Maybe you can ask doctor if iron supplements can be reduced at this point.
    Second, If you have a high milk production, that is not really a bad thing in most cases, and is probably a good thing in a case where baby needs to improve how well she transfers milk so she no longer needs supplements. "Too much foremilk" will not hurt your baby, and all of your milk has what baby needs, nutritionally. If the only problem it is causing is green poops, it is really not a problem at all. Fussyness/colic are also normal and not necessarily the result of "too much foremilk."
    If you want to reduce the amount of "foremilk" baby gets, the best method is to encourage baby to nurse more often. Luckily the more often a baby nurses, the better anyway. The shorter the amount of time between nursing sessions, the less time milk has to sit in the breast, and the less foremilk there will be. Also, try a leaning back nursing position to help baby deal with a fast flow. See: http://www.nancymohrbacher.com/blog?tag=Fast+Milk+Flow

    But if she eats very small amount in one feeding I skip BF the next one and give her just the bottle. She can manage to BF longer now and drinks about 20-30ml.
    I am unclear on why you would skip the nursing part of the feeding session ever? Assuming weight gain is going well, I would suggest, encourage baby to nurse as often as you can, and give supplements as needed around that. The more often baby nurses, the less supplements baby will need, and the less often you will need to pump. Also, do you usually nurse before baby gets a supplement or after? It may help to mix this up a little.

    Yes all LLL Leaders are volunteers, the entire organization is almost entirely volunteer. They do have training, rather good training usually, but their training is in "normal" breastfeeding, so a LLL Leader may not be able to help much with unusual issues, although can still provide plenty of support for mothers. Aside from your baby being premature and consequently needing supplements, I do not think there is anything all that unusual here, so I am hopeful your LLL will be able to help you.

    LCs are just like any other professional- there are good ones and not so good ones, and there are many who might be good for one person but not the next. If you did not have a good experience with one LC, try to not let that color your perception of the entire profession.

    DO ask about the training and experience the LC has. I live in the US, and anyone can call themselves an "LC" and we have a real problem with nurses being given a course of a few hours in lactation and then they are called "LC"s by the hospital when in fact, their training in the area of lactation assistance is very inadequate. Try to find an IBCLC (board Certified Lactation Consultant) or someone with a strong history of education and clinical experience in lactation issues.

    You may not need to see an IBCLC, of course. It depends on what you are able to do on your own or with the help of your local LLL. You are an experienced nursing mom and are already doing quite well on your own.

  5. #5

    Default Re: What to do next?

    Hi again.

    Firstly I would like to answer about my high milk production. This is what I found about foremilk/hindmilk on LLL International:
    "A further problem may also result from this unintentional mismanagement. Foremilk is high in lactose, a normal and necessary milk sugar that in large volumes causes gassiness and discomfort, frequently with green, watery or foamy stools. Over a period of time, undigested lactose can irritate the lining of the intestines, causing temporary secondary lactose intolerance and possibly small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Adjusting breastfeeding to increase the amount of fat the baby receives ("finishing" the breast before switching) usually corrects the problem."
    So I started pumping some milk before BF and after 2 days she didn't cry as much and stools are getting lighter color and right smell. So I really think and feel I was right...

    About BF and bottle feedings. If she drank 15ml during BF and she got so tired that she couldn't manage the bottle after then I was worried that she would do the same again with the next feeding. This would not be enough for her to gain weight so I did the next feeding only with the bottle so she would drink more. I also was advised to start BF every other feeding just because of that reason by medical staff.

    Now I am trying to BF every feeding and after BF I offer her the bottle. She usually won't drink anything because she fally asleep... But she is stronger now and she drinks 20-40ml on the breast. At night I give her the bottle 2 times because I am just so tired from all the pumping. I really hope she will start to only BF soon

  6. #6
    Join Date
    Feb 2015
    Location
    California, USA
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    460

    Default Re: What to do next?

    It might be worth whike to try giving a small bottle of 15 ml or so before nursing. This way, baby gets some milk so she has energy to suckle and she gets to finish her meal at the breast and likely fall asleep after getting what she needs. This is just a suggestion I'm glad that your sweet baby has been having better looking diapers.

  7. #7

    Default Re: What to do next?

    Hi again.

    Thank you for your answers.
    I am replying so late because my LO was in the hospital this past week... She had an infection - non defined - and the antibiotics helped so she is back home from yesterday. I noticed that she was getting sleepy through the night she stopped breastfeeding. As if she forgot how to do it. So I took her to the doctor and the blood work showed an infection... We went to the hospital and in a few hours she started having breathing problems so they took her to intensive care. She was on CPAP and had to get a transfusion... So we didn't BF for a week. But yesterday when we got home I started BF again and I was so happy that she took the breast and ate 50ml! Now we are just BF, without bottles... She is BF every 1,5-2 hours today, drinking for about 20 minutes. Just on one side. I also called an IBCLC consultatn to ask her about pumping. She advised me to keep the R breast full as long as I can, to BF just on R side a few times and if necessary to pump after BF to make the breast soft. I hope this will work! I've BF on R side in the morning and at first I pumped about 25ml out so that it wasn't too much flow for her and that she wouldn't get just the foremilk. Then she drank (or do you say ate??) 40ml and then I pumped another 140ml! I wanted to empty it. So I hope this plan will work for me. And that I will avoid complications.

  8. #8

    Default Re: What to do next?

    Hi. I have another problem - too much milk in the R breast. I read Strategies to Slow Down the Rate of Milk Production on LLLI and asked a consultant about it. I am a little confused now about what is the best strategy for me because I have only one "overenthusiastic" breast. I've BF baby on this one (right breast) only two times today. the rest of the time I just left it to be very full. I pumped a few times to releave pressure and massaged it. I pumped about 40ml because if I would pump less there would be no relief. I also put cold compresses on. But I feel quite sore and I have some redness near the armpit. I don't know if it is from massage or something else.

  9. #9
    Join Date
    Jun 2006
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    COUGARTOWN Baby! From here on in!
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    Default Re: What to do next?

    Are you wearing a bra with a wire in it? That sounds like it could be the start of mastitus. I would actually move the milk out of that breast more thoroughly than that if you could. That probably too large a reduction for one days time! Like try moving from 150 ml back to 100 ml. You want to move much more gradually and you still want abundant milk. Just not an over supply if it can be helped.

    Way too lazy for formula

  10. #10

    Default Re: What to do next?

    Thank you. It seems this was really too much for my breast. The redness is gone. It was on the upper side of the breast where I have full lumps every time the breast is full and I massage it very much there. I am not wearing a wire bra - actually I am used to sleeping without it but now I have to wear it and it's not comfy at all
    I am thinking if maybe it would help if every other feeding I pumped 25ml on the R side and then BF there? Would this be enough to lower the supply there and be safe enough to avoid mastitis? I tried this once and DD drank enough for the breast to feel comfortably soft. Would this be too much stimulation for the breast?

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