Milk not flowing, Short letdown?

[@llli*iris92]

Hello, new here.
My 4 wk old is not gaining weight, so the pediatrician is having me supplement by pumping after every time he nurses, and then giving him a bottle. LO nurses every 3 hours or less. He falls asleep a lot when he nurses, and I'm working on keeping him awake to get the milk he needs. We also had his tongue tie corrected, doesn't hurt when he nurses just a tiny bit of pain when he latches which I hear is normal. I really don't think hes getting enough while nursing, he nurses for 30 mins to an hour on and off sometimes and is so fussy afterwards. (Not every time[/U] but often enough where its becoming a problem)

I've noticed when I pump, my milk only comes out for about 30 seconds or less during the "let down" and then stops completely for about 5 or 10 minutes. Then another let down for 30 seconds and nothing again. I'm not sure if this is the norm for some? But it seems really inefficient.

Things I've tried:
Hot compress before, massaging during, looking at pictures of baby, adjusting the dial on the pump.

I'm only pumping about 1.5 oz combined from 4 or 5 pumping sessions during the day. I haven't been able to pump after every feed, its been a challenge to get any sleep and pumping in the middle of the night would really mean no sleep. I am getting so worried about getting him enough, and I'm really confused how to balance breastfeeding and pumping.

If he isn't nursing efficiently, is he losing/burning more energy then he's getting?
Is only getting 1.5 oz extra a day really going to help him significantly gain weight?

We've set a goal for him to gain close to 10 ounces in two weeks, to see if the pumping supplementation works. Please any advice on pumping will be greatly appreciated.

[@llli*maddieb]

Hi and welcome! Sorry you are having this concern!

When a baby is not gaining normally when breastfed, then that indicates there is some breastfeeding issue. Pumping and supplementing may help baby gain better, but it may not be solving the breastfeeding issue.

The professional to see for breastfeeding issues is a IBCLC, or board certified lactation consultant. Some very good LCs are not board certified, but in all cases you want to see someone with real experience and lots of training and follow-up is often critical.

Here is more on that: http://www.cwgenna.com/lconsult.html

so the pediatrician is having me supplement by pumping after every time he nurses, and then giving him a bottle.

So, just to be clear, pediatrician wanted you to only give baby the milk you could express in a day, without giving you a number of how many ounces he/she wanted baby to be supplemented with?

Is only getting 1.5 oz extra a day really going to help him significantly gain weight?

It depends on what you mean by significant. But 1.5 ounces is approximately the amount of one not so large feeding.

But, pumping is helpful for another reason, and that is that extra milk removal is helpful if mom has low milk production.

What exactly is the issue here, with the gain? Can you provide a weight check list with day of life of each check? Please note when a different scale was used and if any scale other than a digital infant scale was used, or unit conversions done or for any other reason you think the gain was possibly not measured or recorded properly. Please also note when tongue tie was corrected. Also, what has Baby's daily poop pattern been like and what have the poops looked like, and can you approximate volume?

Now, I will address the pump output issue.
Some moms just do not get much milk out when they pump. It happens. Also of course there may be a milk production issue. However, very often when pumping is not effective the problem is with the pump. With what you are describing that sounds very possibly like a pump issue to me. So it is important to troubleshoot your pump.
First, is it the right pump for the job? For your situation the pump everyone agrees is usually the best is a rented "hospital grade" or multi-user pump. Some moms do better with lower quality pumps, but that is unusual.
Flange fit is vital for proper pump performance. Your pump manufacturer or whoever rented your pump to you should have guidelines on this. If you need more info, let me know.
Otherwise troubleshooting involves checking over the pump carefully, making sure tubing has no holes or poor connections, change membranes. If that yields no results, you may need to try a different pump or try to get this pump suction tested, as the issue could be a motor malfunction. If this is a used or older pump that is more likely, however, it can and does sometimes happen with new pumps too.

Aside pump troubleshoot, have you tried hand expressing instead of pumping? Or before or after pumping, or when milk stops flowing, etc?

Now, time management:
Of course it is very hard to both pump, bottle feed, and nurse a baby. It is double or triple the work of the already daunting task of caring for a newborn, if not more due to washup etc. So you need HELP. What kind and how much depends on what your other responsibilities are, but this is the time to ask directly for help from everyone and anyone who can give it.

Many moms in this situation think they have to nurse, supplement, then pump, or some other precise arrangement every time. this is not necessary. For example, no need to always pump after a nursing session? You can, but you could also pump in between. For obvious reasons you may not want to pump right before you plan to nurse baby, however, if you just pumped or are pumping and baby starts to cue, it is perfectly fine to nurse at that point. It is not going to hurt anything if that happens. So if pumping right after nursing is not working or is not happening for any reason, you can pump a different time.

Baby does not need to be supplemented always after baby nurses. Some babies do very well getting a small amount of supplement before they nurse. It wakes them up and gives them energy to nurse better when they nurse.
Also, using a lactation aid (an at the breast supplementer) you can supplement baby WHILE baby nurses. These can be fiddly to use and there is a learning curve but they can be very effective in helping the overtaxed mom with time management, plus, they are very effective in preventing bottle preference from developing, a serious issue when a baby (especially one this young) requires supplements. More: http://www.cwgenna.com/smartnothard.html

In other words, you can mix it up. Babies do not nurse on a schedule, and so there is no reason for them to be supplemented on a schedule or for mom to pump on a schedule. If a schedule is working for you, fine. But often moms find that setting goals (I will pump X times today, I will offer to nurse baby X amount today even if it means waking baby, Baby will be supplemented X amount today) works better then an "every nursing session" or "every such and such hour" type schedule.

Sleep: Can you put together a 4-5 hour sleep stretch once at night, and catnap during the day? This is a typical sleep pattern for moms of newborns. Yes, they are tired but functioning. Of course it is hard to pump overnight, but effective overnight milk removal has to happen one way or another.

If he isn't nursing efficiently, is he losing/burning more energy then he's getting?

No, at least not in the sense that nursing is something that is taking more energy than eating some other way. If a baby is nursing and not getting enough to eat, that of course is a problem, but the same would be true if baby were sucking on an empty bottle. In fact sucking on the empty bottle is much worse, because when baby suckles at moms breast, it helps mom make more milk. In other words, if a baby is not gaining and consequently needs supplements, baby can still nurse like a normal baby and also receive supplements. A normal newborn often takes 30-60 minutes to nurse at least some of the time, and needs to nurse 10-15 times in 24 hours, and is often fussy after nursing. All of that is normal, which is why the most accurate way to tell baby is getting enough is by properly measured weight gain and not baby's behavior.

Babies do not gain well if (rarely) they have something wrong with them, and (more commonly) they do not get enough overall to eat. Period. Eating the normal way (nursing) does not take more calories than eating any other way. It takes energy to be alive. It takes energy to move, and it takes energy to gain weight. So, the body first makes sure that energy (from calories) is used to keep baby alive. Then it lets baby move, and if baby is getting enough beyond that, baby will gain. So slow gain is an early warning sign that something may be wrong.