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Thread: Paranoid about weak suction?

  1. #1

    Default Paranoid about weak suction?

    My baby was born on the 23rd of February, four and a half weeks ago, at 36 weeks of gestational age, so he reached his full term age during last week. He was 2.5 kg at birth, and about 3.3 kg now. 

    He spent two days in NICU and five total days at the hospital. During this time the nurses gave hime formula and later my milk from the bottles, when it came.

    I got some counselling with breastfeeding at the hospital, after he left the NICU. They basically told me that his mouth was too small and my nipple a bit flat, so I started using Medela nipple shields. By weighing him before and after the nursing, we saw that he was not taking in enough milk, so I had to keep pumping and giving him the bottle afterwards. I had enough milk to feed him by then, about 500 gr a day at least.

    Once we came home, I rented a pump and a scale and continued the same routine of nursing, double-weighing, supplementing my own milk with a bottle and pumping. About a week and a half after the birth, the midwife came for the routine check-up and, since he had gained weight, she suggested to stop the stressful routine and exclusively breastfeeding for four days, then she would come to weigh him again. After these four days, he had gained 180 gr., so I continued for three more days, after which the midwife weighed him again. It was shocking to find that he had lost 50 grams during this time! The midwife thought that he was understimulating me because of the nipple shields. So I started the old routine again, but this time it was even more stressful because my milk had decreased quite a bit, and I had to use up my freezer stock. It took about five days of nursing (still with the shields) and power pumping to get my supply back.
    At this point, he was a little older than 3 weeks. One day, about five days ago, he finally started consistently latching without the shields and I noticed (by double-weighing him at every feed) that he was taking a lot more, and faster, than before with the shields.
    So, the last five days I have been nursing him exclusively and checking how much he drinks at every feed, and I have been amazed how much difference there is with when we were using the shields. He is also gaining weight every day, so far. Every feeding still takes about one hour and a half, however, even though the actual drinking takes about half an hour at most. He either gets fussy or falls asleep most of the time.

    The problem is that I am so paranoid that my milk supply will decrease again by exclusively breastfeeding him, perhaps he has a weak suction, so I have been pumping every time for 10-15 minutes after each feed to keep my supply up. This is of course not ideal. First of all, it is stressful time consuming and is making it harder for me to sleep. Second, I see that he shows some symptoms of oversupply, being gassy and fussy and with often greenish stools. Third, sometimes he gets hungry again right after I am done pumping and gets frustrated for not finding much milk. Also, the crazy pumping from those few days in which my supply was low has given me sore nipples that feel sometimes uncomfortable when he latches, but I hopefully fixed this by buying different size shields.
    My questions are these: in your opinion, is it safe to stop pumping after every feed, or maybe decrease it to one or two sessions per day? Or should I wait for a couple more weeks to do that? If I do, what is a safe way to check that everything is going well, and fix it in time? Is it possible that I have an oversupply, even though I only pump about extra 100 ml of milk per day?

  2. #2
    Join Date
    Jun 2009
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    10,754

    Default Re: Paranoid about weak suction?

    Hi, it sounds like you have had a rough time but are now seeing light at the end of the tunnel. Your concerns that baby is not stimulating your milk production are normal after an experience like yours, but it is also a concern many moms share, even when they have had no problems. So it might help to talk about milk production and what helps it and what hurts it.

    The problem is that I am so paranoid that my milk supply will decrease again by exclusively breastfeeding him, perhaps he has a weak suction, so I have been pumping every time for 10-15 minutes after each feed to keep my supply up.
    Of course exclusive breastfeeding (no pumping needed) is the norm. Assuming your baby is getting enough milk to gain normally, you can usually assume that your milk production is being stimulated appropriately, because it is not "stimulation" that makes milk production normal, but milk removal.

    There are two important components to milk production being normal. One is, effectiveness of milk removal. The other is, frequency of milk removal. Assuming a baby is nursing effectively enough and frequently enough to gain normally, usually you can assume that milk removal effectiveness and frequency are where they need to be for milk production to be normal. On the other hand if baby is NOT gaining normally, you can assume that there is a problem with milk removal effectiveness and/or frequency.

    What is normal nursing frequency? Most sources say 8-12 times a day. But I think 8 is very low. If there is a newborn who is nursing less than 10 times in 24 hours I have not met them. Some sources say 10-15 times a day and this is the one I think is much more realistic. So the question is, how often is your baby nursing? How many times in 24 hours?

    What is normal for effectiveness? This actually varies a great deal. In the early newborn period, a normal nursing session might range from 1/2 ounce to 3 ounces. So it is a big range! What is important is that baby is nursing often enough to get enough milk overall, even though milk removal varies so much session to session. It is possible that your baby taking so long to nurse is a sign that milk transfer effectiveness is not where it needs to be. On the other hand, some newborns jut like to hang out and nurse a long time. So long sessions are not always a sign something it wrong.

    Given your experience so far with all the issues, and given that your baby is taking a long time to nurse right now, I would make two suggestions. (This assume baby is now nursing at least 10 times in 24 hours and gaining normally without supplements, even without supplements of your expressed milk.)

    1) Just for now, pump, but not after every nursing session. Choose a number of pumping sessions per day that seems doable to you, and pump that often. 2 might be ok, but it might be low, at least until you see a lactation consultant and can be sure all is ok. So maybe 4? It is really hard to say exactly, this is why you need to see someone. Keep in mind that if baby were not nursing at all, you would be told by most LCs to pump 8 times a day. Since your baby is no longer nursing with a shield, and assuming baby is needing no supplements, you can probably pump much less often than that.

    2) See a board certified lactation consultant (IBCLC) to get help specifically with latch and milk removal concerns. An IBCLC is trained to recognize nursing issues and address the specific issues they see. A midwife may or may not have such training.

    Second, I see that he shows some symptoms of oversupply, being gassy and fussy and with often greenish stools.
    The #1 sign of oversupply is very rapid weight gain. If rapid gain (more than 8 ounces a week) is not happening, then you probably do not have overproduction. Gas, fussiness and green poops are all normal newborn experiences.

    Third, sometimes he gets hungry again right after I am done pumping and gets frustrated for not finding much milk.
    I get what you are saying, but this is not a serious issue assuming baby is gaining normally. Try not to overthink things. Your body is always making milk and babies fuss for many reasons.
    Also, the crazy pumping from those few days in which my supply was low has given me sore nipples that feel sometimes uncomfortable when he latches, but I hopefully fixed this by buying different size shields.
    Ill fitting flanges and other pump issues definitely might cause nipple injury/pain. But so might a poor latch. Again I suggest see an IBCLC for nursing pain or nipple injury.
    Last edited by @llli*maddieb; March 26th, 2017 at 09:10 PM.

  3. #3

    Default Re: Paranoid about weak suction?

    HI Maddie, thanks for replying. Sorry, I know my message was a bit confused, and so am I.

    I actually met wit a lactation consultant twice since the birth. These were covered by the public insurance. The next meetings are going to cost quite a lot, and I cannot afford many, so I am trying to use them wisely. Of course I know that it would be the right thing to do.

    The consultant suggested in the first week that I weigh the baby before and after each feeding to know how much he takes. I am still doing it, so I know pretty well that my baby is drinking plenty of milk. What I am afraid of is that he is drinking so much because I have extra milk, and if I stopped pumping, he would not be able to get as much as he needs. I have no idea wether this makes sense or is just paranoia.

    But I kind of suspect that this was what happened in the second week when I first experimented with exclusive breastfeeding (but I had the shiekd back then). He gained a lot during the first four days and then lost a bit in the last three, damaging also my milk supply. Of course now he's much stronger, and we don't use the shields anymore, so it could be a very different situation.

    Does this make any sense?

  4. #4
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    May 2006
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    Default Re: Paranoid about weak suction?

    That makes perfect sense! When a mom-baby pair has a rough start, it can be very scary to back off on pumping and supplementing and weighing, etc.

    I think MaddieB gave excellent advice- in your shoes, I would back off on the pumping but still retain a few sessions per day. Continue to weigh the baby, keeping a careful tally of his intake. If you get through a week with no appreciable decline in his intake, drop another session and continue to weigh him frequently. Continue the process until you have dropped all the pump sessions.

    I know a lot of moms who have been caught in the consuming cycle of weighing, pumping, and worrying. But there is a light at the end of the tunnel! it gets better, I promise!

  5. #5
    Join Date
    Jun 2009
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    Default Re: Paranoid about weak suction?

    Yes I agree with mommal. Here is what I wrote earlier but did not post as I was called away from computer:

    What I am afraid of is that he is drinking so much because I have extra milk, and if I stopped pumping, he would not be able to get as much as he needs. I have no idea wether this makes sense or is just paranoia.
    It makes sense. This actually can possibly happen- a baby might have nursing issues that would cause poor milk transfer that are hidden because mom makes so much milk baby does not have to be nursing effectively to get enough. When her milk production reduces to normal, the problem with baby's ability to transfer milk is revealed.

    Of course now he's much stronger, and we don't use the shields anymore, so it could be a very different situation.
    I would think yes, most likely this is a very different situation now. But I am afraid it is impossible to know for sure without more time going by or a trained person watching a nursing session and concluding that there is no problem with transfer. This is why I suggested seeing an IBCLC, but it is possible they would not be 100% sure either.

    If you would like to see an LC again, maybe there are low cost clinics or some other way you can see your LC again or a different one. Often there are more resources available than you might have heard of. It never hurts to ask. To find out what may be available, you can call your LCs, ask any local LLL or other breastfeeding support group, breastfeeding coalitions, etc. Also your LC may be able to talk to you on the phone for a follow up.

    If that is not possible, I guess you can just reduce how often you pump gradually and see how things go.

  6. #6

    Default Re: Paranoid about weak suction?

    Thank you both.
    I called my lactation consultant today, she suggested to pump a couple of times a day and see if the milk intake drops too much in the next week, then maybe go to once a day. She also says that his latch is ok, and not to worry too much.

  7. #7
    Join Date
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    Default Re: Paranoid about weak suction?

    Ok sounds good. Please keep us updated if you like.

  8. #8

    Default Re: Paranoid about weak suction?

    Now I have pumped twice a day for a week and then switched to one 20-minutes session, with a 10-minutes break in the middle, for about five days.
    He has been growing a lot (about 1.4-1.7 ounces a day).

    I think I should try and stop pumping altogether, but I am afraid to take the leap. Also, pumping every night for 20 minutes is a pretty sustainable routine, and I am slowly building a freezer stash for when I will be back at work.
    On the other hand, it would be nice to sleep a bit longer, and to feel that I don't depend on the pump. Also, I think my baby is suffering from my oversupply a bit, he is always crying, often gulping and coughing, especially in the middle of the night.

  9. #9
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    Default Re: Paranoid about weak suction?

    Baby is gaining great, so it does seem like you can take away the pumping entirely and be fine. I think you could probably just stop pumping with no further thought. However if that makes you nervous, then you can instead try pumping for half the time, or pumping every other day, or both, and take it down from there. If you want to talk about making a stash, we can talk about that. Many moms find they waaay overestimate how much of a stash they need and so overestimate how early/often they need to pump to build a good stash.

    As far as baby having an issue with your op, that is possible. Is baby acting this way when nursing or other times as well? Often the simplest way to help baby be more comfortable in such situations is to encourage baby to nurse frequently but on one side per session if that is what they prefer.

  10. #10

    Default Re: Paranoid about weak suction?

    Hi Maddie, thanks again for taking the time to answer me.

    So far, it's going well. I have pumed every other day for a week an then stopped completely five days ago, while keeping track of weight an milk intake.
    He has been growing well in the meantime, about 10 ounces a week, although his weight fluctuates from day to day, sometimes going sllightly down, which is a little bit scary. He always recovered so far, though.

    Also, I have been quite engorged all day yesterday, I hope my supply is not starting to go down too much.

    Might this be the time to offer him a bottle occasionally, to get him used to it, so that he does not refuse it later? He has not seen a bottle for a month exactly.

    How about a pacifier? He started being quite cranky in the evening, refusing the breast and not sleeping for two hours or so, and it would perhaps help.

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