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Thread: Nursing taking a turn for the worse, doubting myself...

  1. #11
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Sorry to reply so late - I really do appreciate your advice.

    Unfortunately things got even worse. Baby is refusing to nurse almost entirely (occasionally middle of the night works) and we've had to move to bottles for almost all feeds. I would try the cup or spoon, but I am so overwhelmed with pumping full time and bottles that I just can't work up the energy. It's gotten to the point where just being near the breast makes him scream. I am following the tips here:http://kellymom.com/ages/newborn/nb-...ack-to-breast/ but so far no luck. This is so incredibly depressing. I cry every feed watching him get so upset when he used to spend so long at the breast. However, I am not giving up yet. If you have any additional suggestions I am very open to anything! I desperately want this to work.

    Edit: There is one specific question I have. According to the Kellymom instructions I should pump whenever I offer expressed milk. My question is how much to pump? Just enough to cover what he drank? Longer? For example this morning he ate a small amount at the breast and then finished with 2oz on the bottle. Pumping for 10 minutes after he ate I got 6 oz. He is now finishing again on the bottle after 5ish minutes on the breast, but I don't know if I should pump more since he did not eat as much as I pumped last time. I want to keep my supply as tied to his needs as possible.
    Last edited by @llli*moredonuts; December 26th, 2015 at 05:02 PM. Reason: added a question

  2. #12
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Hi! Sorry things are so stressful, I hope we can help. Here are some thoughts.
    Pumping for 10 minutes after he ate I got 6 oz
    So, that is an incredible amount of milk to get for pumping 10 minutes...even if baby has not just nursed. I really have to think that there may be overproduction going on, causing a very forceful letdown, and that is perhaps what is causing baby to not want to nurse. What do you think?

    Other than that, about baby refusing to nurse.... This is so unusual- for breastfeeding to go well for months and baby all on their own to start refusing to nurse- that my best suggestion is to see a board certified lactation consultant (IBCLC) without delay. I have to think there is something going on we are completely missing and that in person help is required. Babies can be inadvertently "trained" away from the breast if they are given bottles, pacifiers, fed on a schedule, sleep trained, or any other practice that discourages normal nursing behavior. THAT is not so unusual, in fact, it is pretty common, and the "cure" in that case is to stop those things (or reduce them, sometimes a baby needs bottles due to separations of course) and follow those kellymom suggestions until nursing gets back on track. But a baby nursing fine and gaining well for weeks and then refusing without those practices is unusual. Especially since you are already trying everything suggested in the best article on the subject without any luck, I think there may be something going on that we are missing in online communication that is making baby unwilling- or even perhaps unable- to nurse.

    My question is how much to pump?
    So you already know I think you have over production. If that IS indeed the case, what you may want to do is to GRADUALLY reduce your milk production. So it may not be possible yet to tie your pumping exactly to what baby needs, because you may make way more than your baby needs right now, and suddenly reducing that may cause you to get engorged or worse. So how much you should pump will depend on several things. Yes, you want to pump at least as often and as long as needed to be sure you pump at least about as much as baby drinks each day. If you are finding that you are making far more than baby needs, you can gradually reduce pump session time and/or frequency to slowly teach your body to make less milk. Does that make sense?

    An average healthy gaining baby needs an average total of between 25-35 ounces a day to gain normally. Please note the use of the word average! Some babies never actually need that much or anything like it, ever. Some might take 35 ounces one day and 20 the next. Intake is going to vary. We already know your baby has been gaining faster than average breastfed. There is nothing wrong with this if baby is breastfed, but if baby is partly bottle fed, that kind of rapid growth may mean baby is being overfed with the bottle, as is easy to do. So it is important to be mindful of when and why baby gets a bottle, how baby gets it, and how much it is each time.

    So here is what I wonder. If baby has just nursed, why is he then given 2 ounces in the bottle? I understand the bottle if baby refused to nurse at all, and 2 ounces would be a reasonably sized total feeding. But if baby just nursed, I am unclear why baby was then given a bottle.
    Second, how are bottles given? You do not have to use a cup or a spoon, but if you do not, it is very important to use paced bottle feeding. I will attach info on this method of feeding a baby.

    So generally, here is what I would suggest, but of course you will have to tweak it to fit with what is going on.
    First, if baby nurses, don't give baby a bottle or pump.
    If baby refuses to nurse, and takes a bottle, try to pump "around" the same time. It does not have to be the same exact time. A few hours one way or the other is probably ok when needed. Think of it this way, Moms who are back at work do not pump the exact times their baby is fed and it's fine. On the other hand, if it is easier to pump at about the same time, that is of course fine. Do what works for you.
    Since you are clearly making enough milk to do so, I suggest, pump at least as much volume as baby took in the bottle, and then also pump as much as you need to feel comfortable. You want to be careful to not become overfull or engorged. On the other hand, if it is true that you make much more than enough milk, as I suspect, there is no need to pump until you feel "empty" either. This is a milk production increasing technique, and if you already make too much you do not want to tell the body to produce even more.

    I also suggest, Think about what is typical and think about what may be happening if what is typical is far off from you and your baby.

    Typically, a baby this age will need to eat 8 to 12 times total in 24 hours. A few babies are fine with eating as little as 6 times. Also, a baby may want to NURSE much more often than this, and that is fine, and some will not, and that is also fine.
    A typical nursing session will result in intake of something between one half and four ounces of milk. This is why "2-3 ounces" is the typical recommendation for bottles that are REPLACING a nursing session- that is the average. If baby is nursing and then getting a bottle, they probably will not need that much.

    Overall, milk should be taken out of the breast about as many times as baby eats. If baby nurses and gets no supplement, there is no need to pump unless a mother has low milk production or for some reason baby is unable to take a normal amount when baby nurses. Your baby's gain would not suggest either problem, but of course we do not know what is going on right now with baby refusing to nurse, that might be harming baby's ability to transfer milk. This is another reason to see an IBCLC without delay.

    Here is info on bottle feeding the breastfed baby: http://www.llli.org/docs/00000000000...astfedbaby.pdf and video: https://www.youtube.com/watch?v=UH4T70OSzGs

    More info on OP and fast letdown: http://kellymom.com/bf/got-milk/supp.../fast-letdown/
    Last edited by @llli*maddieb; December 26th, 2015 at 07:56 PM.

  3. #13
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    with everything MaddieB posted!

  4. #14
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Thank you again! Sorry for the sporadic communication.

    Quote Originally Posted by @llli*maddieb View Post
    Hi! Sorry things are so stressful, I hope we can help. Here are some thoughts. So, that is an incredible amount of milk to get for pumping 10 minutes...even if baby has not just nursed. I really have to think that there may be overproduction going on, causing a very forceful letdown, and that is perhaps what is causing baby to not want to nurse. What do you think?
    I think you are right - he does seem frustrated with the letdown. His fussing often coincides with the letdown (although not always) and it is hard to get him back on track after that.

    Quote Originally Posted by @llli*maddieb View Post
    Other than that, about baby refusing to nurse.... This is so unusual- for breastfeeding to go well for months and baby all on their own to start refusing to nurse- that my best suggestion is to see a board certified lactation consultant (IBCLC) without delay. I have to think there is something going on we are completely missing and that in person help is required. Babies can be inadvertently "trained" away from the breast if they are given bottles, pacifiers, fed on a schedule, sleep trained, or any other practice that discourages normal nursing behavior. THAT is not so unusual, in fact, it is pretty common, and the "cure" in that case is to stop those things (or reduce them, sometimes a baby needs bottles due to separations of course) and follow those kellymom suggestions until nursing gets back on track. But a baby nursing fine and gaining well for weeks and then refusing without those practices is unusual. Especially since you are already trying everything suggested in the best article on the subject without any luck, I think there may be something going on that we are missing in online communication that is making baby unwilling- or even perhaps unable- to nurse.
    So he has gotten a bottle before, although not with great regularity (maybe 1x/week?). We coached everyone who might be giving a bottle on paced feeding and for a while it did not seem to be a problem. I find it puzzling that it suddenly became a problem, but my guess is that either caregivers are not using the techniques we showed or even with the techniques he still finds the bottle easier. For now I am only offering the bottle unless he absolutely refuses to nurse at all. I am seeing an IBCLC next week to get our situation assessed.

    Quote Originally Posted by @llli*maddieb View Post
    So you already know I think you have over production. If that IS indeed the case, what you may want to do is to GRADUALLY reduce your milk production. So it may not be possible yet to tie your pumping exactly to what baby needs, because you may make way more than your baby needs right now, and suddenly reducing that may cause you to get engorged or worse. So how much you should pump will depend on several things. Yes, you want to pump at least as often and as long as needed to be sure you pump at least about as much as baby drinks each day. If you are finding that you are making far more than baby needs, you can gradually reduce pump session time and/or frequency to slowly teach your body to make less milk. Does that make sense?
    Makes sense - thanks!

    Quote Originally Posted by @llli*maddieb View Post
    So here is what I wonder. If baby has just nursed, why is he then given 2 ounces in the bottle? I understand the bottle if baby refused to nurse at all, and 2 ounces would be a reasonably sized total feeding. But if baby just nursed, I am unclear why baby was then given a bottle.
    Second, how are bottles given? You do not have to use a cup or a spoon, but if you do not, it is very important to use paced bottle feeding. I will attach info on this method of feeding a baby.
    I offered a bottle after 1 minute of nursing because he did not seem to be getting more than a few swallows. We use the paced bottle techniques to feed him if he gets a bottle. I suspect that my husband and I are more careful about the pacing since I figure having more opportunities to nurse is key, I am not leaving him with other caregivers for now. That way I can make sure the paced feedings are happening if he gets a bottle. Since that day I've modified my approach a bit (no bottle if baby has nursed at all. If he does not nurse well, try again later - but not too much later) so I do not offer the bottle as often. In fact, he has not been offered a bottle for the past couple of days.

    Quote Originally Posted by @llli*maddieb View Post
    Typically, a baby this age will need to eat 8 to 12 times total in 24 hours. A few babies are fine with eating as little as 6 times. Also, a baby may want to NURSE much more often than this, and that is fine, and some will not, and that is also fine.
    A typical nursing session will result in intake of something between one half and four ounces of milk. This is why "2-3 ounces" is the typical recommendation for bottles that are REPLACING a nursing session- that is the average. If baby is nursing and then getting a bottle, they probably will not need that much.
    Thanks for the guidelines. Based on your advice here and previously, I am attempting to increase the number of sessions by offering the breast as much as possible (but not forcing). I basically stay topless at home so I don't miss any opportunities. We've increased sessions to about 12 or so per day, but only lasting a few minutes each. Since I offer so often now, I don't bring out the bottle unless it has been a few hours since he last ate and he is acting hungry but refusing the breast entirely. With all the mini feeds I have not felt the need to offer the bottle because he rarely goes more than an hour or two without a "snack."

    Again, thank you for your advice. I really appreciate all your help.

  5. #15
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Well assuming baby is gaining ok it sounds like things are going much better...would you agree? Have you tried different positioning ideas for helping baby handle a fast flow?

    I am seeing an IBCLC next week to get our situation assessed
    Great!

    So he has gotten a bottle before, although not with great regularity (maybe 1x/week?). We coached everyone who might be giving a bottle on paced feeding and for a while it did not seem to be a problem. I find it puzzling that it suddenly became a problem, but my guess is that either caregivers are not using the techniques we showed or even with the techniques he still finds the bottle easier.
    I have no idea if the bottles caused the problem or not. I think maybe the fast letdown is what made nursing sessions short- baby was/is forgoing comfort nursing. And again, there may be some not obvious issue, which is why it is good you are seeing an IBCLC.

    But the correlation between bottles and nursing problems is complicated, and is about more than baby finding the bottle easier. Here are some of the things that are known or suspected about bottle use.
    Some babies really do "switch back and forth" from the breast to the bottle with no issues ever. Others have issues, up to and including breast refusal. And those issues are not always immediate, in fact, they are typically NOT immediate. It is impossible to say what babies might have a problem and when.
    Things that increase the likelihood bottles may cause a problem: Very early bottles (under 4-6 weeks) number of bottles given (frequency) and the length of time bottles are given (problems can occur many weeks and even months after bottles were initiated) how much is in each bottle (or more precisely, how much baby drinks) and how bottles are given. Also if baby is also getting a pacifier, that increases the likelihood of eventual breast refusal issues.
    Part of why bottles are problematic are because they reduce the frequency that baby nurses. This is of course an issue when milk production might be too low, but it is also a potential problem if milk production is too high. Say for example a mom has some overproduction and fast letdown. The more often a baby nurses, the less forceful the letdown. If baby gets a bottle, that increases the time between nursing sessions, worsening the letdown when baby nurses. Since babies so often take MORE at the bottle than they would at the breast, it may create an even longer stretch- in other words, a single bottle may replace one and a half or 2 nursing sessions. Also, since pumping is required if a baby is getting supplements, and often a mom may pump more milk out than baby would take at a session, this will stimulate the body to make more milk and can also exacerbate or prolong issues of overproduction.

  6. #16
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    Nov 2015
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Hi,

    I jut wanted to give an update since this forum has been so helpful.

    We saw an IBCLC this week who was also puzzled. We tried several positions, but it did not make much of a difference. The best guess is that now that he's older he is more aware and picky. She also pointed out something I missed - he gets squirmy even without a forceful letdown, as if anticipating it. He also latches and unlatches constantly, even if the milk flow is not particularly fast. Frequent nursing and time seem to have settled my production so I am hoping he will learn to relax.

    I'd say things are livable, but not great. He eats mostly from the breast, albeit reluctantly, and his weight is good (15lb 12oz, so about 2lb, 11 oz in 4 weeks) so if this is as good as it gets I can deal with that. This turn for the worse also coincided with more frequent night wakings and despite increasing the daytime feedings he is firmly in the 1-2 hour schedule at night. Previously he was getting up to 4 hours, sometimes 5 at a stretch. Totally exhausting! I am going back to work soon so I am not sure how I will manage with him waking every hour, but for now we can get by.

    Again, appreciate all the advice and encouragement!

  7. #17
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    Default Re: Nursing taking a turn for the worse, doubting myself...

    Sometimes I think one breastfeeding issue goes on long enough that it morphs into another issue. The first issue is getting better, but there is a new issue, and It looks like the same issue, but is different.

    Many 3-4 month olds start to nurse "weird." Squirmy, fussy, popping on and off, distracted, not wanting to comfort to sleep, refusing to nurse at times, nursing shorter periods, nursing more frequently, nursing less frequently, etc.- these are all behaviors that commonly pop up around this age even when nursing has been going perfectly up until then. In the Womanly Art of Breastfeeding (8th edition) they call this the "4 month fussies." If baby was having nursing issues that created similar behavior early on, it can look like the same thing. But the (hopefully) good news is that at this age, such nursing behavior is actually very common and usually temporary. Of course exactly 'how' a baby nurses does normally change over time, and some changes will be permanent while others cycle in and out.

    Also sleep consolidation is not a linear process, and it is entirely normal for a 3-6 month old to start waking to nurse more often at night than they did when younger. Gonzalez discusses this in his book Kiss Me on pages 67-69.

    I would also suggest the baby gaining over 2.5 pounds in a month indicates that gain continues to be rapid gain-slightly above average. So while fast letdown may not still be a problem, it does sound like there may still be some op going on. Around 3- 4 months, gain rate typically begins to slow down noticeably so be prepared for that, it is normal and not a sign there is a problem.

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