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Thread: everything going wrong..desparate for help!!

  1. #1
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    Default everything going wrong..desparate for help!!

    I don't even know if I can be helped at this point or how much more I can take. I am a first time mom with a 9 week old baby. He was induced 2 weeks early after learning he was IUGR at week 36. They think it was a problem with the placenta and cord and he was measuring a few weeks behind. When he was born his blood sugar was 11 and he was taken to NICU after we did some breastfeeding. Nobody really helped me and I was trying based on videos and articles I read, and the breastfeeding class I took. I ended up camped out in the NICU breastfeedkng every 3 houra for th first week od his life. They had me pumping and supplementing to get his sugars up so he could be disxharged. I met with 2 LCs there becauae I was in excruciating pain. Baby had a shallow latch that we could not improve and I was told it woild get better as he grew. I had to use a nipppe shield which saved me from having to quit.

    I knew we needed to wean from the shield but whenever I tried I just couldn't get him to open his mouth wide enough. One issue is I have enormous breasts that are making me so angry everyday because I feel I can't really control them well eough due to the shape and having low nipples. Another issue is baby has a small lower jaw. He was checked for ties and does not have any. I have tried all different positions and just canot get a deep latch. Nipple sandwich doesn't work for us. I do everything I see and read about and we can't get it together.

    At 6 weeks things got pretty bad and baby was nuraing nonstop which I thought was just a growth spurt. It never ended though and I started to notice he was actively suckin less, and comfort aucking more. He had been having 8 wet diapers and 5 poop diapers but around this time the wets were not as soaked as they had been. A trip to the ped revealed his weight ain had slowed. He had only gained 4oz in a 2 week period and I was told to see a LC and supplement after every feeding. Breastfeeding ia so important to me and I was so upset that I needed to supplement. I srarted oumping but could not keep up with him. Also, baby refuses to take a bottle. I then sae an LC and a different ped. They said that baby's small size means he is too weak to nurse effectively and will not do so unless he gains more. I was told that I need to up his weight before any real progress would be made and that feeding him was most important. They told me about laid back nursing which went well in the office. Still, my nipples come out crimped evrytime and no matter what the latch is too shallow. I am in pain and my nipples come out white. My isse now is that my aupply lowered from his inabilotyto effetively nurse and I can't pump enough so I started some formula which I hate. I am crying everyday. We are using SNS since he won't take ghe bottle but now I don't think he gets ANY milk from me at all. I almost never see swallowing since we started aupplementing. I don't know ehat to do anymore. He just goes to sleep on my breast even though I do everything to try to keep him alert including skin to skin. I feel lioe breastfeeding is over for us and that devastates me to no end. I have another LC appt this week but I am so lost.

    Forgot to say that baby hates the nipple shield now and refuses it. If he does accept it he just comfort nurses.

    Baby was born at 5 lbs 1oz
    left hospital at day 7 at 4lbs 9oz
    last weight at almost 9 weeks was 7lbs 2 oz after beginning the suplementing. One week prior he was 6lbs 7 oz

    I guess I just need support at this time. Thanks for reading this insanely long post

  2. #2
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    Default Re: everything going wrong..desparate for help!!

    Sorry for all the typos I am on my phone.

    I need to add that even with all the supplementing baby still never really seems satisfied. It makes no sense!

  3. #3
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    Default Re: everything going wrong..desparate for help!!

    Hi and welcome!

    When a mom feels like her plan is not working, usually the plan can be tweaked. There are a few rules that must be followed, so that milk production is protected, mostly. But within those rules, there is lots of wiggle room and doing some wiggling might make life more manageable.

    One thing I think it is important be clarified right now is if baby is really not getting enough to eat, or is gaining poorly for some other reason. If I understand correctly, baby was growing slowly enough in utero that a very serious intervention was done- inducing birth pre-term. That is a big deal. Now, baby is pooping an amount that would suggest normal intake, and yet is gaining slowly. This is why I wonder if the slow gain is really because baby is not getting enough to eat, or if there is something else going on. Just because baby is gaining very fast now when supplemented does not eliminate the possibility there is an underlying health issue.

    Also, think about what is normal and how far off "normal" baby really is. Obviously, baby was small to begin with and then lost several ounces after birth. But then what happened? Average gain after baby starts gaining weight is about 6-8 ounces per week. I do not see your baby far off that, but it is a little unclear the way you have given the history. Here is what I see- At the end of first week of life, baby was 4 lbs 9 ounces. At about 7 weeks (about 6 weeks after that one week check) he weighed 6 lbs 7oz, so had gained a total of 30 ounces, or an average of 5 ounces a week. (Or if this was this over 7 weeks, the average would be 4.25 oz per week.) Is my math or timing off? Please check. If my math and timing are correct, I would not call this terrible gain. It’s on the low side, of course, but some sources would say this (4-5 ounces per week) is in fact within normal gain rate or very close. I think what makes it appear to be so little is that baby was so little to begin with and then lost weight that first week.

    Then, if I understand correctly, you started supplementing, and baby gained 11 ounces in a week. Correct? This is way above average gain.

    It is important to remember what it means when a baby “needs” supplements. This does NOT mean baby does not get any milk from mom or that breastfeeding will never happen. It also does not mean that baby will never exclusively nurse, but it MAY mean that. Some babies will always need some amount of supplement, but can still nurse as well.

    A baby uses most of the calories he takes in to stay alive and to move. (Squirm etc.) So when a baby is not gaining all that well, but IS gaining, this does not mean that baby is starving or anything like it- it just means, baby is getting ALMOST enough milk, enough to live, enough to move, enough to gain- but not quite enough to gain normally. The difference between slow gain and normal gain may be just a few ounces a day.

    Also, When baby is over-supplemented, it causes baby to gain very fast, and it is possibly detrimental to breastfeeding.

    When nursing hurts, this indicates a problem with latch. Such a problem can also lead to baby not being able to transfer milk efficiently. So solving the one issue is likely to help the other. Time may help, but it does sound like nursing laid back helped as well. So that may be something that can be built on.

    You do not say how much baby is being supplemented each day, or how, or how often baby nurses. And what do you mean when you say you cannot “keep up?” I mean, I know this means you are pumping less than baby is being supplemented, but how much less? How much do you pump, how often, etc. Also, I am also not sure how you are differentiating between comfort nursing and some other kind of nursing. All nursing is comforting and milk transfer is usually happening even if baby is "comfort nursing" (But more slowly.) So it is a little hard to figure out what is going on there….is baby perhaps being oversupplemented, how is you milk production, etc.

    But here is how I see the situation based on what you have written. I list these with a P for pro and a C for con. I am laying it out like this in an attempt to help you take stock of where you are. You are understandably very upset, exhausted, and emotional. When we are very emotional we make emotional decisions. Your emotions about this situation are normal and will help guide you, but you also want to look at things with some logic as well.

    1) You make milk. (P) Maybe not enough for baby to gain normally, (C) but pretty darn close. (P) Also, Milk production usually can be increased (P)
    2) Baby can and will nurse, (P) but it hurts. (C) Nipple pain is the most common and most fixable nursing issue there is (P) but it is also probably the most difficult for a mom to live through. (C)
    3) You are trying an alternative to bottles for supplementing- a lactation aid (P) but if baby is not able to latch normally, and nursing is painful to you, this may not be the best tool at this time for you and baby (C)
    4) Baby is latching without the shield (P) but not comfortably or effectively (you think) (C)
    5) Prior to supplements, baby was gaining between 4 and 5 ounces per week on average. (P) This is somewhat slow gain, but it is still gain. After supplements were begun, baby more than doubled gain to 11 ounces in the last week- much more than average gain Maybe (P) ? But could also be (C) because it may mean baby is being over-supplemented.

    As far as baby never seeming satisfied, can you explain what you mean?

  4. #4
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    Default Re: everything going wrong..desparate for help!!

    Sorry my post was unclear in some ways; I feel very disorganized at the moment!

    Ok so let me tell you more about the weights. At 10 days old he was 4lbs 10oz. Two weeks later was 5 lbs 9 oz. 16 days after that he was 6 lbs 3 oz. Then another 2 weeks later was only 6 lbs 7 oz and that is when dr became concerned. Our lactation appt was 4 days after that weigh in and he was 6 lbs 9oz. At that point he had very little suplement as he refused the bottle and it was difficult to use a spoon and dropper with him. We started the SNS and it was in those next 3 days that he gained 8 oz and his next weight was 7lbs 2 oz.

    I was given a goal plan of 18oz a day of supplement to see what his gain would be like. We could never reach that goal. He has had between 13 and 17 oz.a day and that is at the breast with the SNS. It was presented to me that this would be temporary and I was instructed to pump 6-8 times a day to build supply. I could only pump 4-6 times a day since feedings take a long time (up to an hour) and he doesnt do well when put down. I have tried to pump while I nurse but find it difficult to manage with large breasts. I pump anywhere from .5-2oz total but usually it is about an oz. The 2oz is rare. So not enough to just supplement with breast milk. He gets whatever I pump and at other times gets formula. I started out giving him an oz through the feeding tube but he would still be hungry so usually he gets around 2 oz. One time he took 3. He nurses usually atound 9-11 times a day now. before this supplementing It had been getting to the point where I didn't know where one feed ended and the next began. He was constantly giving hunger cues and when he was awake was never content. So i nursed constantly. Now, he has been sleeping better but still when he is awake is almost never content. He is either nursing or looking to nurse. This has been how it is since we took him home and I honestly can't believe I made it all this time.
    As far as comfort nursing, he used to do a lot of active sucking where I would see him swallow, and then there were times when he was just lightly fluttering his tongue and it was more like a pacifier. I always allowed him on the breast as long as he wanted either way. Starting at 6 weeks I noticed he was doing way more of the fluttering and very little swallowing and active sucking with pauses in his chin. He wasn't getting as much to eat which was apparent in his diapers becoming less wet, and more than ever he seemed to be constantly hungry and never satisfied. Since we have been working on his latch, he has some time on the breast without the tube, and he pretty much will asleep right away or will just do the light fluttery sucking. There have been a few times where it seems like he is improving the latch but then the next time he will keep his mouth and jaw tight again. After writing my post there were a few times throughout the night that I knew he was getting milk from me without the tube, so that was a relief, as I was starting to feel that this would never happen again. I could see and hear him swallowing and see pauses in his chin. I just don't want to lose the breastfeeding relationship and I am feeling very anxious about it.

    I was told at the lactation appt that because of his poor latch and poor sucking, it caused me to have a lower supply which in turn made it difficult for him to nurse and created a cycle. The dr squeezed my breast and determined not enough was coming out.

    When we went back to the ped to review progress she was so happy about him gaining weight as fast as he did. I asked her about coming off of supplementing at some point and she said I probably have to do this forever. It is so draining to constantly make bottles, wash bottles, wash the tube, pump, wash the pump parts. My husband helps but still it is a lot and he isn't home during the day.

    I hope this was helpful. If nothig else it helps me to write it all out.
    Thanks for reading

  5. #5
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    Default Re: everything going wrong..desparate for help!!

    Ok you are right, I am confused. 18 ounces of supplement per day is a tremendous amount of supplement, as normal total intake per day is 25-35 ounces. So if baby was gaining without any supplement, I am not sure why so much supplement was ordered.

    (FYI, by supplement, I mean anything baby gets that is not coming directly from your breasts into baby- In other words, your pumped milk is also a supplemental feeding, as is formula. Knowing how much you can pump each 24 hour day to give baby, as opposed to how much formula baby gets, is helpful to know as well.)

    But perhaps I am not at all understanding when supplements were started and how much baby is actually taking in supplements each day, or how exactly the supplements changed gain. I am really sorry, I only have a limited amount of time to post and my brain is just not able to make sense of it without seeing it written out in a linear weight check history with dates, that indicates when baby got supplements and when baby did not, how much, and also indicates any time a different scale was used. I am NOT going to ask you to do that as you are overwhelmed and I am not sure how much it would help me here online, although someone else might ask you to do that and you can if you like. But I would suggest that you might try to do that before seeing the LC, after asking her IF it is info she can use.

    You are seeing an LC again this week. Correct? Is this someone you have seen before? Will this be a complete private consult? Is this an IBCLC?

    Here is what I suggest.
    Ask if she thinks a before and after nursing weight check would be helpful. These can help show what baby is capable of transferring when nursing. If it is 2 ounces or more, that is considered pretty good, usually. The problem is that since babies do not take in the same every time, and smaller feedings are also normal, baby not transferring that much is not conclusive. Also if baby took 2 ounces, but it took an hour, that might indicate an issue. In other words, the scale alone is not the whole story. But this can help both you and the LC have more info to work with.

    Discuss the amount of supplement you have been told to give, and how it is being given. Tell her you are getting exhausted with all the work and need some tweaks to your plan, but, assuming you are still wanting to keep trying, make sure she knows that you are. An IBCLC has been trained to handle these sensitive issues with compassion. She would not shame you for wanting to stop, nor tell you it is useless to continue. If you are getting a negative message like that, then there may be a communication problem or this might not be the LC for you. So try to be as clear about your needs and concerns as you can, and expect compassionate and clear communication from your IBCLC.

    I am not sure who squeezed your breast and used that as a test for milk production, as you talk about LC and then Dr. in that same sentence. But while this is something an LC might do (after asking permission) because it may give her some information that she would then add to everything else she can see and discover during a consult, it is in no way a conclusive way to measure milk production! I would also find it odd that someone decided you would "always" need to supplement. Unless they have a crystal ball, I am not sure how that is so certain. Yes, baby nursing poorly may have hurt your milk production. But there are ways to increase milk production.

    As far as satisfaction- It is normal for babies to want to nurse most of the time and want to be held the rest of the time, and some babies are more needy in this area than others. So a baby not appearing "satisfied" is a pretty unreliable way to measure if baby is getting enough. More reliable ways are 1) Accurately measured weight gain, and 2) Poop output (but infrequent poops at this age may not indicate a problem.)

    What a baby can transfer when nursing is another reasonably good indicator of ability to transfer milk, but several weighted feeds would give you more info than just one.

    How much a mom can pump is not typically a very good indicator of milk production, unless mom is and has been exclusively (only) pumping for a time with no nursing. Pumping an ounce on average when baby is also nursing with normal frequency is normal. Here is more info on this: http://kellymom.com/hot-topics/pumping_decrease/

    Here is a good article about what to expect at a lactation consultation: http://cwgenna.com/lconsult.html

    I assume you have tried breast compressions? http://www.breastfeedinginc.ca/conte...agename=doc-BC

    Are you taking or have you considered galactagogues?

    This is an excellent book on milk production issues written for mothers. Making More Milk

    Also pump type, quality, fit and condition matter.
    Last edited by @llli*maddieb; January 25th, 2016 at 12:14 PM.

  6. #6
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    Default Re: everything going wrong..desparate for help!!

    Thank you so much for taking time to reply. It is difficult to explain the whole situation in writing.

    We did a weighted feed and he had only transferred 1.25 oz and it was maybe 40 minutes.

    I am going to a IBCLC wednesdayfor a private session. I know her as a midwife but this will be first time seeing her for help with breastfeeding.

    At the lactation appt we had, they had me meet with the LC and a pediatician at the same time. It was the ped who squeezed and said not much was coming out. They are in an office affiliated with my son's pediatrician and share his medical records. The LC I am going to this week is in a completely different office.

    I am having a hard time trusting that my son's ped is giving us the best recomendations. I understand he needs togrow, but I feel she wants him to continue to grow at this unnatural rate. I already switched peds once before because the original dr he was seeing kept telling me to use formula to make him sleep long periods at night (among other reasons.) I have read a lot of forums of moms with IUGR babies and feeding/gaining issues seem to be common among them. However when I brought this up, his ped said no it has nothing to do with the IUGR.

    With him being satisfied, shouldn't there be at least a small amount of time when the baby comes off the breast and is content and awake? While being held? He seems frantic at times, rooting and bobbing his head up and down when he is off my breast. The only time he pops off on his own is to go to sleep. Is this normal?

    I don't have much support as most people I know don't know anything about breastfeeding. My friend told me I should just give up and do what is healthy for my son and give him formula. Regardless, he won't even take a bottle so if I decided that is what I want he wouldn't even take it. I have to go back to work in a couple of weeks and at this point he isn't going to eat while I am gone.

    I want to be able to pump more but I barely have time with how much/how long he eats. Each time at the breast is like an hour long. I end up pumping and then feeding him soon after because he doesn't take much of a break between feedings. I have a new medela in style advanced double electric. The last 4 times I pumped I got .8oz, .4oz, 1.1oz, and 1.4oz.

    I have been tracking exactly how many oz of supplement he takes each day fpr the last week but last night got lazy and missed wrting down a few. First day he took 13.4oz total, then 13.9 oz next day, 12.8oz, 17oz, 16.2oz, 15.2oz. I go based on his cues each feeding. He never wanted as much as 18oz. This past 24 hrs he got less because I was trying to have him nurse some without it but I don't have the exct amount.

  7. #7
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    Default Re: everything going wrong..desparate for help!!

    Anybody else that can provide any insight? The more I think about it the more I am sorry I started supplementing that much. I never wanted to do that.

    I wanted to rewrite his weight history:

    Birth 11/20: 5lbs1oz
    Dishcarge 11/27: 4 lbs 9oz
    1st ped appt: 11/30 4lbs 10oz, clean diaper
    2nd ped appt: 12/14 5lbs 9 oz, different scale, clean diaper
    3rd ped appt: 12/30 6lbs 3oz, different scale, naked
    4th ped appt: 1/14 6lbs 7oz, different scale, naked
    Lactation appt: 1/18 6lbs 9oz, different scale-digital, naked**supplements began after appt
    5th ped appt: 1/21 7lbs 2oz, same scale as last ped appt, naked

    The scales at the ped office are not digital.

    Am I right to want to decrease supplementing since gaining that much in a short time is too much? I feel he was being overfed but the ped thought it was "beautiful" gain

  8. #8
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    Default Re: everything going wrong..desparate for help!!

    With low birthweight babies, pediatricians often like seeing gain which exceeds normal- it gives them an intuitive sense of security, even if they might look askance at such rapid gain if you were staring with a larger baby.

    Going forward, here's what I would do (forgive me if you're already doing some of it- I haven't read this thread as carefully as should have):
    - Look into getting a scale for home use. You're looking for a digital baby scale which reads to the 1/10 of an oz. With this scale, you can do your own weighed feeds, and determine exactly what your baby gets from you when nursing. If it's around 2 oz, you probably don't need to supplement- just put him back to the breast the moment he wants it. If it's less than 2, a supplement of 1-2 oz might be required, the amount depending on his intake at the breast. If it's more than 2, definitely no need for a supplement.
    - Look into renting a hospital grade pump. The Medela PIS is a good pump, but you'd probably get more milk with less effort from a hospital-grade pump.
    - Make sure you discuss the fit of your pump shields with the LC. Better fit = improved output and comfort.
    - Nurse the baby as much as possible. Don't worry too much if he is acting hungry after he comes off the breast- either give him a small supplement or put him back on the breast, or give him a small supplement and then put him back on the breast so that he associates being at the breast with the feeling of being fed and comfortable. It's quite normal for young babies to act fussy pretty much all of the time that they are not sleeping or eating- your baby's post-feeding fussiness may just be a fact of life, considering how young he is.
    - Be pushy at the doctor's office. Ask for the same scale each time, and write down the baby's weight yourself, so that the pediatrician doesn't have the only data, and you can catch any errors in data entry.
    - Forgive your breasts for the way they are shaped. Believe me, I know that is hard to do! We live in a culture that has completely unrealistic standards about breast shape- the only "good" breasts are both large AND perky, with nipples that stand out when your bra is off but are somehow never visible through your shirt unless you're in a wet t-shirt contest, and they somehow manage to fit into the baby's mouth like a hand into a gloveerfect. Speaking as a mom with larger, softer, floppier breasts myself, it's a lifelong struggle to accept the way you are shaped and love your body for what it is. If loving. Your breasts is a step to far, just try to accept them, and remember that even moms with "perfect" breasts struggle to nurse their babies because nursing a baby can be a real challenge, no matter how you're shaped. There's a great website called Shape of a Mother- I think it might be shapeofamother.com?- that shows how variable real women are. It's really empowering!

  9. #9
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    Default Re: everything going wrong..desparate for help!!

    I agree with mommals excellent suggestions. Also,
    The scales at the ped office are not digital.
    Does anyone else find that odd for weighting infants? Am I being a scale snob?

  10. #10

    Default Re: everything going wrong..desparate for help!!

    Quote Originally Posted by @llli*maddieb View Post
    Also, Does anyone else find that odd for weighting infants? Am I being a scale snob?
    My midwife's clinic doesn't use a digital scale for their weigh ins. They *have* digital scales and will bring it with them if they come to your house, but they don't use them at the clinic. I thought it was so weird.

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