Happy Mothers Breastfed Babies
Results 1 to 8 of 8

Thread: 4m - emptier breasts = better nursing?

  1. #1

    Default 4m - emptier breasts = better nursing?

    Hi Folks,
    My 4 month old (but 3w early) baby just had the longest and most peaceful nursing session in about a week, after I'd just finished pumping about 20 min before he latched on. Why would he be nursing better when my breasts are practically empty than when they are fuller? Is this a latch issue? A let-down issue? Normal? Something else?

    *when breasts are full (haven't been emptied in 4+ hours-- I know I should be pumping but the logistics are complicated) he will suck once, swallow once, and pull off the breast. Repeating this for 2-5 minutes before refusing breast all together. He does this long enough to cause a let down that sprays all over the place when he pulls off.

    Some background on us:
    - we've been working with an IBCLC since a few days after birth because he couldn't latch at all when he was born. Lack of latch was attributed to him being born 3w early and by c-section (I had pre-e).
    - for his first few weeks he was exclusively bottle fed a combination of pumped milk and formula (I couldn't pump enough for him)
    - from 3w to 3.5m he was fed through a combination of nursing with nipple shield, pumped breast milk, and formula. He still wasn't nursing great with the nipple shield and we guessed I had low supply because I couldn't pump enough to keep up with him, still.
    - at 3m we had lip and tongue tie released by laser. He quickly got RSV and we weren't able to do all of the exercises after. IBCLC is sending us back to dentist to see if ties need to be released again
    - at 3.5m he was finally able to nurse without the nipple shield. He nursed great, although frequently (about every 2 hours). Lots of wet diapers and very little supplement seemed to be needed.
    - last week i got anxious about whether or not he was getting enough at the breast and started offering lots of supplement. I was probably over feeding him and he started spitting up a lot and became a bit adverse to eating.
    - in the past few days I've been paying more attention to hunger cues and he's gone 3-6 hours between feedings (got shots on Monday so he's been out of sorts). When I offer a full breast he'll suck, swallow, and pull off. Repeating this pattern for just a few minutes before refusing the breast all together. I've been manually pumping and hand expressing to reduce the pressure between feeding attempts but tonight was the first time in ages that I've hooked myself up to the electric pump.

    At this point I'm wondering if I may not have a supply issue anymore, but who knows. Perhaps he's not latching well because of possibly reattached tongue/lip ties and that's why he can't handle a full breast? Maybe my let down when I'm full is too much for him? Maybe it's not unusual for a baby to have a hard time with engorged breasts? Clearly I'm stumped.

    Help please.

  2. #2
    Join Date
    Jun 2009
    Posts
    10,739

    Default Re: 4m - emptier breasts = better nursing?

    If your breast is very full, the milk may be coming out very fast, and baby may not like this. Breasts get full if it has been a long time since baby nursed (or you pumped) Also if the breast is very full, it may be harder for baby to get a good latch. As far as if you have a supply issue or not, if baby gets enough milk per day from nursing and/or what you pump in a day, then your supply is fine.

    How has weight gain been lately (last month or so?)

    How many times does baby nurse each day?

    How many times do you pump each day and how much milk do you get when you pump?

    How many ounces of your milk and /or formula does baby get each day?

    IS nursing comfortable for you?

    When you say
    I've been paying more attention to hunger cues and he's gone 3-6 hours between feedings
    do you mean that if you offer to nurse more often baby refuses? 3 hours might be fine, but 6 hours is a very long time for a 4 month old to go without eating, unless you are talking once a day and baby has been sleeping during that time.

  3. #3
    Join Date
    May 2006
    Posts
    24,911

    Default Re: 4m - emptier breasts = better nursing?

    with MaddieB.

    I'm wondering if you need to be pumping and supplementing at all at this point? It sounds like you got great help in the beginning, from the LC who got you set up with the pump and helped you with the shield and the tongue tie. But I wonder if maybe she hasn't seen you in a while, and done a basic assessment of breastfeeding? Maybe it's time to just nurse, and not worry so much or go to so much effort.

    Do you happen to have a scale for home use?

  4. #4

    Default Re: 4m - emptier breasts = better nursing?

    Quote Originally Posted by @llli*maddieb View Post
    If your breast is very full, the milk may be coming out very fast, and baby may not like this. Breasts get full if it has been a long time since baby nursed (or you pumped) Also if the breast is very full, it may be harder for baby to get a good latch. As far as if you have a supply issue or not, if baby gets enough milk per day from nursing and/or what you pump in a day, then your supply is fine.

    How has weight gain been lately (last month or so?)

    How many times does baby nurse each day?

    How many times do you pump each day and how much milk do you get when you pump?

    How many ounces of your milk and /or formula does baby get each day?

    IS nursing comfortable for you?

    When you say do you mean that if you offer to nurse more often baby refuses? 3 hours might be fine, but 6 hours is a very long time for a 4 month old to go without eating, unless you are talking once a day and baby has been sleeping during that time.
    Maddieb,
    Thanks for your reply.

    Weight gain over last month has been about 2 pounds, but in last week and a half it's only been 4 oz. He's also been spitting up a ton during that period because of poorly managed reflux so I'm hoping that gain will get back on track. (So many factors going on, it's hard to isolate things).

    Baby typically eats 8-12 times per day but just had shots on Monday so didn't eat much then or Tuesday. I also think he was reducing feedings before that due to lots and lots of spit up. Not all of those feedings are nursings. It depends on what's going on. For example, today he's only nursed for a few minutes.
    He ate 2 oz of formula at 6am because hubby got up to feed him before we had to cut off food for the morning because baby was having a medical test done (he's fine apparently).
    He ate 2 oz of formula again around 7am because we were starving and broke the rules with the test a little bit. I didn't nurse either time so I could get some sleep.
    No feedings the rest of morning because test was at 10:30am.
    Attempted to nurse after but we were at hospital and baby and I can't figure out how to latch without a nursing pillow. So I gave him 1 oz of pumped milk (that's all he would take).
    Another procedure at 11:30 and I attempted to nurse again; had to give him another 1 oz of pumped milk.
    Got home after 12, breasts were too full for baby to latch well so another 2 oz of pumped milk.
    2pm baby was sleeping so I pumped.
    3pm baby woke up, nursed for a few minutes and gave the pumped milk from earlier.
    Now it's 5:45.

    I typically pump 0-2 times a day depending on baby and husband's schedule. Since baby will only nap when being held I almost never get pumping time during day. Got some today because for some reason baby fell asleep in swing.

    Now, 2 weeks ago when I stopped using the shield it was common to go an entire day without supplementing with pumped milk or formula-- unless I had to leave the house or leave baby with sitter. On those days he was nursing every 2 hours.

    I usually get 4-5 oz of milk when I pump (if I'm skipping a feeding).

    Nursing is comfortable.

    Yes, 6 hours is a long time between feedings, but I'm working with a small data set of days since we stopped using the shield and some of those days his feeding was poorly affected by shots and/or excessive spit up. He has been refusing offers to nurse.

  5. #5

    Default Re: 4m - emptier breasts = better nursing?

    Quote Originally Posted by @llli*mommal View Post
    with MaddieB.

    I'm wondering if you need to be pumping and supplementing at all at this point? It sounds like you got great help in the beginning, from the LC who got you set up with the pump and helped you with the shield and the tongue tie. But I wonder if maybe she hasn't seen you in a while, and done a basic assessment of breastfeeding? Maybe it's time to just nurse, and not worry so much or go to so much effort.

    Do you happen to have a scale for home use?

    Mommal,
    Thank you so much for responding. Not sure if I still need to be pumping and supplementing. We had several days of great nursing (10-12 feedings a day, only a few oz of supplement when left with another caregiver), but then he started having excessive spit up and refusing feedings and my breasts got engorged and then he had shots a few days ago. So I think it might still be too early to tell. I'm hoping that now that we have the reflux under control again and he's recovered from his shots we might be able to go back to those days when he was nursing so frequently. I wonder if doing some hand expression, if I can't pump, would help get my breasts soft enough for him to latch well. It does seem to make such a difference.

    LC has seen us recently which is how we got sent back to dentist for re-evaluation of ties to see if they have to be released again. Haven't had that appointment yet. Transfer at LC hasn't been great (1-2 oz) but those have been times when my breasts have been fuller and his latch hasn't been so good.

    I'd like to just nurse and forget all this stuff. Unfortunately I'm not getting baby to spend much time at the breast this last week.

    Getting a scale for home use would be good. There's no place to rent one here so I'd have to purchase one. Might be worth the piece of mind though.

    Thank you,
    If you have further thoughts I'd like to here them.

  6. #6
    Join Date
    Jun 2009
    Posts
    10,739

    Default Re: 4m - emptier breasts = better nursing?

    Weight gain over last month has been about 2 pounds, but in last week and a half it's only been 4 oz.
    Weight gain of 2 pounds in one month is normal, good gain for a baby who is under 3-4 months (gain rate typically slows after that age.) So if baby only gained 4 ounces the last 10 or so days of the month, baby must have gained very fast the first 20 days. So it makes sense gain would slow down a bit. Gain is not typically the same every week, and now that baby is 4 months old, gain will likely be slower than before- that is normal, so be aware of that.


    I usually get 4-5 oz of milk when I pump
    (if I'm skipping a feeding).
    Each time??? That is a lot.

    I am still not sure why baby is being supplemented. Gain sounds normal and it sounds like you make enough milk. Transfer of 1-2 ounces at a before and after nursing weight check may not be great, but it is certainly within normal. The problem with supplementing when it is not needed (or more than is needed) is that the longer baby gets bottles, and the more baby gets in bottles, the more likely that bottles will eventually lead to breast refusal.

    Spit up is also normal most of the time. In part, it is how the baby's body deals with being overfed- getting too much as once. How was reflux diagnosed?

    Reflux typically responds very well to baby being fed breastmilk exclusively (if possible) and frequent, small feedings, and baby being positioned upright (Head above tummy, as baby would be when held snuggled on your chest or snuggled in a carrier, or up on shoulder, etc.) as much as possible especially after nursing. And of course meds seem to help in some cases.

    My oldest also could not figure out how to latch without a pillow. So, I brought the pillow with me wherever I went. I even had a special one I kept in the car.
    But later I realized it was I who was over- relying on the pillow. Have you continued to experiment with various nursing positions to help baby figure out latch without it? As baby gets older, things that did not work well before may start to make sense.
    Last edited by @llli*maddieb; January 21st, 2016 at 08:05 PM.

  7. #7

    Default Re: 4m - emptier breasts = better nursing?

    Thanks MaddieB. The supplementation may be a hold over from early days of being in hospital immediately after delivery and being told by their LCs that he wasn't getting enough and I had to supplement. Working on upright nursing positions to decrease reflux while nursing. Lying flat in a pillow seems to cause most of the feeding to come back up unfortunately (undigested milk quickly returns). I think he does have reflux. I've seen have make awful faces during what appear to be episodes of silent reflux, but the pediatrician made the diagnosis based on our early reports of spit up. He gets held and carried around quite a bit so I think if I can solve the problem of the undigested milk reappearing after 5 minutes of nursing then we might be all set. He stops nursing after spitting that up so I begin to get concerned. I just ordered a scale for home use so I can feel better about backing off while still keeping an eye on his weight to make sure he's not falling behind.

    Any thoughts on the spit up during nursing and then his stopping of the feeding? Good links to upright nursing positions? (I've already checked out kellymom).

    Thank you so much for your help. Both you and mommal.

  8. #8
    Join Date
    Jun 2009
    Posts
    10,739

    Default Re: 4m - emptier breasts = better nursing?

    Again spit up is usually normal. It's just part of being a baby. Some babies spit up more and for longer than others. So
    the problem of the undigested milk reappearing after 5 minutes of nursing
    may not be a problem at all, as that sounds like normal timing for spit up. (Spit up can also happen later or sooner, including while baby nurses.) If baby is full to the point baby is spitting up, why would baby want to nurse more? Maybe baby is done. So I am not sure this is a problem. If weight gain is a concern, it may help to know that slow gain is almost never linked to spit up.... many babies spit up copiously and gain very fast. Another thing that helps with spit up (and painful reflux issues, which is kind of a separate concern) is more frequent nursing, as that leads to smaller meals.

    As far as upright nursing positions, I would suggest take your baby and get comfortable on the couch and experiment for a few hours. Most pictures online will show a baby who is younger than yours, and a mother with a different body type than you. You and your baby will fit together in your own unique ways. My three preferred entirely different positions. I will attach some links for ideas, but I think you will learn more from playing with different ideas with your baby.

    http://www.nancymohrbacher.com/blog?...ding+Positions scroll down, look at the photos and the line drawings further down
    This promo video shows many ideas- you do not need to buy the DVD which is for professionals, just watch the promo http://www.geddesproduction.com/brea...-laid-back.php

    Laid back is often pictured with mom really laid back, and baby laying on mom. Since you are asking for positions where baby would be more upright ( I am not saying this is necessary, I am going by you asking for upright positions) then you can adjust these to have baby more upright by you not leaning back as far. You can be leaning back just a little. Just be sure you are supported so you are comfortable.
    Last edited by @llli*maddieb; January 23rd, 2016 at 11:38 AM.

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •