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Thread: bottle to breast problems

  1. #1

    Default bottle to breast problems

    My son was born at 32.5 weeks as a result of HELLP syndrome and spent 4 weeks in the NICU and has been home for a little over 3 weeks. Today is his due date! I have been pumping the entire time and built up a bit of an oversupply (I was pumping 30 oz a day).

    Over the past two weeks I've had help from a lactation consultant and we were able to get my son to latch and then to feed. It felt great. At first I tried to do away with bottles entirely and that went really well, but I found the first night to be exhausting since each feeding took a long time and it could be difficult to get him to find a good latch. I couldn't get a good side-lying position which is how I handled nights with my first son. I was still pumping just to relieve discomfort and my LC wanted me to try to bring my supply down.

    So we decided to give him bottles at night so that I could get some sleep and then I would breastfeed during the day. We noticed that his milk intake increased quite a bit on the second night and he was very lethargic on the following day. I couldn't wake him to feed despite doing all the tricks the LC had taught me. I maybe got in only one good feeding on that day. That night he took even more milk- 4 ounces a feeding (it had been 2.5/ 3 previously). The following morning he was lethargic again so we decided to start offering him bottles during the day because I had a feeling he wasn't really getting enough from me. I start each feed by offering the breast, but now he cries and sometimes bites down so now we are back to bottle feeding and pumping.

    The only problem is that apparently I lost a lot of my supply in those few days- I was pumping 5-6 ounces every 4-5 hrs and now I'm pumping 2-3. I'm trying to go back to every 3 hours and pump for longer to increase my supply but I'm feeling very discouraged. Because of the holiday I wasn't able to see my lactation consultant this week- we talked over the phone but she just said to keep doing what we're doing. I wonder if anyone has any other ideas. I should mention that I breastfed my first (full term) son with no issues.

  2. #2
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    Default Re: bottle to breast problems

    If your plan is to continue to pump and give baby bottles part of the day, rather than nursing, it is important to understand the drawbacks and how to try to avoid them.
    Over time, bottle feeding increases the chance that a baby will begin to lose interest in nursing. The more bottles, and the longer bottles are given, the more likely this is to occur.
    Over time, the more breastfeeding sessions are replaced with pumping, the more likely it is that milk production will not be stimulated appropriately, leading to less milk production over time.

    So the first thing to consider is whether the daily amount of bottles and pumping replacing nursing sessions can be reduced, so that nursing at the breast can be increased.

    The next thing to consider is whether the pump is working efficiently enough. Even good pumps malfunction, need a part replaced, don't fit right, etc. Some mothers need to pump twice to replace one nursing session. Some moms need to add hand expression or breast compressions to pump sessions to make them efficient. Frankly your pump output sounds normal or high to me, but it always makes sense to make sure pump is working well.

    The next thing to consider is how the bottles are given. To decrease the risk of breast refusal, it is vital that baby not be over fed with bottles. Unfortunately, it is very easy to do this. So you could consider using an alternative feeding method, or learn paced bottle feeding. Also, be aware of how large a typical meal is and don't put too much in the bottle. 2-3 ounces would be the most you would want to do typically if the bottle is replacing an entire meal at the breast. Babies suckle for comfort and will eat from bottles much more than they need consequently. I am not surprised that after a night of bottles, baby was not interested in nursing. Isn't it possible baby was simply full? What you describe with baby nursing less after bottles, and needing more bottles and more in the bottles the next day is the classic snowball effect that occurs when babies are supplemented. This will lead to no more nursing if it is not halted.

    The only problem is that apparently I lost a lot of my supply in those few days- I was pumping 5-6 ounces every 4-5 hrs and now I'm pumping 2-3.
    How much you pump is not a good indication of how much you make, aside from showing you the minimum milk available. 5-6 ounces per pump session is very high, and 2-3 is normal. However, I do agree that unless you can get baby nursing better and more often, you will need to pump more often in order to continue to have a normal milk production.

    You have worked hard to get your baby nursing again after such a difficult start. You must have worked very hard to have such a good milk production as well. Given that, I wonder if you could go back to more nursing, less pumping, less bottles, and try to turn this around, while getting help to maximize your rest. I have multiple children, I know it is difficult, but you are so close to success I hate to see that undermined with too many bottles. If baby is truly unable to latch and nurse normally, and is consequently unable to gain normally without bottles, can you see lc again for more assistance? Also are you still actively trying to decrease milk production and how?
    Last edited by @llli*maddieb; November 26th, 2015 at 12:30 PM.

  3. #3

    Default Re: bottle to breast problems

    Thank you so so much for taking the time to respond. I should have clarified that my plan is to eventually exclusively breastfeed and stop pumping.

    Yes I think my pump is working properly. The reason for the drop off in supply has to do with the fact that I was really focused on breastfeeding and didn't pump much for a few days in a row. Our breastfeeding sessions over the past few days hadn't been as productive as they should have been for me to drop so many pumping sessions. I went from 5/6 sessions to 2/3 but my supply was so high I didn't think it would have such a drastic effect.

    I definitely agree with you that we are probably over feeding our son with bottles. My husband does most of the bottle feedings so I'm trying to get this through to him. I'm very interested in alternative feeding methods. Are there any that you would suggest in my situation?

    I'm not sure we can really replace nursing sessions with bottles at this point. Right now my son doesn't continually suck enough to bring about a let down. He either starts crying or falls asleep. When I was overproducing I could do breast compressions and keep him at the breast this way but now with my supply down my breasts feel empty and I'm not having much luck.

    I'm planning to see my LC this upcoming week but we missed a session this week due to the thanksgiving holiday so I appreciate this forum.

  4. #4

    Default Re: bottle to breast problems

    I just want to add that my supply did not drop as drastically as I had thought. I pumped about 18 oz yesterday- maybe only an ounce under what baby is taking in a bottle. My LC wanted me to get closer to baby's intake so perhaps it's okay. My breasts just feel very empty and it feels like breastfeeding has gotten less productive as a result.

  5. #5
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    Default Re: bottle to breast problems

    So you pumped 18 ounces during a day with no nursing sessions? Or were there also nursing sessions? You do not mention if any steps were taken to reduce milk production as it seems was suggested by your LC. Were there? I am wondering why you think milk production has been negatively impacted. I know it is hard to trust the transfer from pumping to baby nursing, but if baby is nursing normally at this point there really should be no reason to pump, unless you are giving supplements. Even supplements of mom's own milk means pumping must continue.

    Anyway if the plan is to exclusively nurse, then I think the direction you want to keep going in is to nurse as much as possible and only pump and supplement as necessary for baby to get enough milk to gain normally. In your first post, you said bottles were being given so you could sleep at night. So this is different than supplements given because they are literally needed for baby to get enough milk. I certainly understand the need for more sleep for mom, I was just suggesting that there might be a way for you to get enough sleep while still nursing more and pumping and giving bottles less. Of course if baby is still unable to transfer milk normally, that complicates the issue. But in the newborn stage, a baby can be transferring milk normally and mom still does not get much sleep because a baby simply needs to nurse night and day.

    Sometimes supplements can accompany a breastfeeding session and sometimes replace it. What works best in each situation is going to vary. There are few rules to this, you do what works best for you. The only hard and fast rules are that Mom's milk production must be stimulated by very frequent milk removal via either nursing, pumping or hand expression, and that if baby cannot get enough milk when nursing, baby must be given enough supplements to gain normally but not so much at a time or overall that baby does not nurse with normal frequency.

    Alternative methods for supplements:
    Paced bottle feeding: https://www.youtube.com/watch?v=UH4T70OSzGs and https://www.youtube.com/watch?v=ykdFuEOIdeE
    Cup feeding: http://www.breastfeedinginc.ca/conte...me=vid-cupfeed
    Syringe feeding: https://www.youtube.com/watch?v=vrrrC5NyNnQ

  6. #6

    Default Re: bottle to breast problems

    As an update, my supply seems to have regulated itself. That's what my LC thinks since I have been pumping exclusively for 2 months, it would make sense that around this time I would have less of an oversupply. I didn't take any purposeful steps to reduce milk production, but with all the nursing attempts, I did not always take the time to pump and instead would sometimes use cabbage leaves to reduce the discomfort. My LC was worried that my oversupply would cause an infection and thought I should try to slowly reduce how much I pump so I thought it would be fine. Now I am pumping almost exactly what my son takes in. The problem is that my let down is really slow and in some ways we're having even more trouble breastfeeding as a result. I know that babies are more efficient than a pump, but to give you an idea of the difference, it now takes sometimes an hour to empty both breasts using a pump whereas it used to take 20 minutes. I have to do breast compressions almost the entire time and I had my first brush with mastitis because it has become so difficult and time consuming to fully empty my breasts by pump. I've changed pump parts and tried different pumps, but the pump does not seem to be the problem.

    Also he didn't have great weight gain during the time that I was trying really hard to breastfeed so I am now focused on just making sure he is getting enough and have not been trying so hard to breastfeed. His weight was back up by the end of last week so I am starting to think about how to get back to breastfeeding. Right now I am exclusively pumping and we have 2-3 nursing sessions a day usually after he has a bottle so that he's calm. He is much easier to latch but does not seem to be getting much from me (don't hear swallows). My LC did a weighed feeding last week and he had no change in weight. When we did a weighed feeding a few weeks ago when I had my oversupply he gained 2 ounces.

    Here are some ideas I had to try to get back on track:

    - domperidone- My midwife suggested this. I've tried eating oatmeal every day, drinking teas, adding pumping sessions, drinking more water, etc. Nothing seems to be able to bring back the supply I had a few weeks ago. I am nervous about taking this when I just recently dealt with blood pressure issues but I will check with my doctor first.

    -cranio-sacral therapy- this is the most expensive option but my pediatrician thinks it might be a good idea and another LC recommended it.

    -SNS system- my LC tried a version of this with the syringe but milk just got everywhere and baby did not seem to care for it maybe I should keep trying? This is probably my least favorite option. It's expensive and sounds like a lot of work.

    Any thoughts on these options or any others? My LC thinks he just needs time to get bigger and stronger and that he'll get it but I'm starting to lose it with all the pumping I have been doing to keep my supply up.
    Last edited by @llli*yellowcat; December 9th, 2015 at 01:26 AM.

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