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Thread: Pulling off and screaming -- at my wit's end!

  1. #1

    Default Pulling off and screaming -- at my wit's end!

    Hi All,
    My daughter is 7 weeks old today. She latched on like a champ and breastfeeding was a snap for the first few weeks. Then she started pulling off and screaming. Her poops stopped being yellow with white fat flecks and started just being yellow and voluminous and runny...and frequent! She would poop a lot every time she fed and she also spits up a lot.

    I went to see a lactation consultant when this first started and was diagnosed with fast let down and over-supply. They said she was eating a lot and latched properly and gave me some strategies to manage the fast let down.

    I've used the strategies to manage the fast let down, and I've also cut all dairy from my diet. It seemed to help at first, but the pulling off and screaming continues. So then I thought maybe she was only getting fore milk, so I went to feeding on breast at a time and not switching until it was empty. Seemed to help at first, but problem continues. Meanwhile my oversupply has gotten out of control. So I tried block feeding -- same breast twice in a row. This seemed to help a lot. From last night until halfway through today she cluster fed and did not scream. But her poops were suddenly bright green (weird). Then she slept for two hours, my breasts re-filled, and even though I pumped off the foremilk she is screaming again.

    The screaming seems to correlate to some extent with pooping but she also usually poops right after she starts feeding on a full breast, which is also when she starts screaming.

    Her weight gain is in the low normal range -- she was 6lbs 3 oz at birth, gained her weight back within the allotted time, and was 7lbs 2oz at her one month. Based on our home scale, she gained 10oz over the last 12 days.

    Any advice?? I'm on the verge of giving up and trying formula!

  2. #2
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    Default Re: Pulling off and screaming -- at my wit's end!

    Hi and welcome. Sorry this is a bit of a mystery, as some things are not adding up. So I am going to just try to get some clarity...Sorry if this is a little rambling.

    No possibility of a latch issue according to your LC? Did you have any before and after nursing weight checks at this appointment and what did baby transfer? Did she examine baby's mouth at all? Also, is nursing comfortable for you?

    It does sound a lot like fast letdown...so I assume the LC suggested nursing frequently, and laid back position for nursing? Also, taking baby off when the flow starts, letting the milk go into a cloth, then putting baby back on? When you are doing laid back breastfeeding (you reclined and baby on top) to help baby handle the fast flow, does that help at all? How many times in 24 hours does baby nurse? Are there any longer periods where baby does not nurse? Is baby typically wanting to nurse one side at a time, or two?

    So when you say your OP is getting out of control, do you mean you are getting super full between nursing sessions? engorged? Plugs? Mastitis? Have you been pumping or hand expressing when you experience fullness (or any other time?) If so, how much about (how often and how much are you expressing in a day (if you know.)

    Also, fast letdown and too much foremilk... pretty much the same thing, but can cause two different issues. For many babies, neither is any problem, for some one is, for others, both are.

    So the potential problems are 1) the milk comes too fast for baby's liking, causing baby to pull off and protest, and in the worst cases, refuse to nurse.

    2) This one is harder to explain. When the milk comes fast like that, it means baby gets lots of "foremilk" (The less fatty milk that comes at the start of a nursing session) all at once. Now foremilk is wonderful stuff. It has everything a baby needs to gain well, be well hydrated, and have the tons of energy that a baby needs to do the incredible amount of eating and growing a newborn needs to do. But that energy comes from lactose (milk sugar) and SOME babies seem to have some difficulty with digestion when they get too much all at once. The discomfort is usually minor, but more unpleasant for others. What it is not is a medical problem. Breastmilk in that case is still very much the most healthy food for baby. (Same with if baby is allergic to something mom eats.)

    What poops look like matters not, it is the discomfort that is a problem (for SOME babies.)This is not the same thing as lactose intolerance. A baby needs lots of lactose to live.

    Weight gain sounds average... so that is not in character for OP. Typically with overproduction, gain is well above average. In any case, with average gain I would strongly suggest be wary of block nursing to reduce production. But fast letdown can occur without op. Here is more about block nursing: http://www.nancymohrbacher.com/artic...=Block+Feeding

  3. #3

    Default Re: Pulling off and screaming -- at my wit's end!

    Thanks for the reply! Here are some clarifications...
    Everyone has said the latch is wonderful...the doctor in the hospital, the hospital LC, the LC I saw. Breastfeeding is very comfortable for me.
    The LC weighed her before and after and said she took in 3 oz total. I feel like she spits up a ton, but the LC didn't seem to thiink it was excessive.
    Yes, the LC said lie on my side so the extra could drip out or on my back. Both of those definitely seem to help -- they stop the choking and coughing and sputtering -- but she will still scream sometimes, even when I do that.

    I don't think she mentioned more frequent feedings? I feed every 2-3 hours but the past few days she was pulling off after only a few minutes (and screaming) and then wanting to eat again shortly.

    The milk seems out of control to me because when I'm nursing on one side it will literally spray out of the other and because she never gets to the hind milk -- I can pump like 4 ounces and still have a ton left.

    I usually only pump at most once or twice a week: if I have somewhere to go. Recently I started trying to pump off the foremilk because eating that seems to coincide with screaming and because pumping it off does seem to take care of the issue -- she eats longer and without screaming, but that just seems to ramp up milk production even more.

    So maybe it is #2? Is there any fix for that?

    Thanks for your help!

    oh, a couple more things: I used to feed both sides. Now she seems to want only one. I feed, burp, offer other side. If she doesn't want the other side, I change her, then offer again. The screaming usually occurs in close proximity to a high volume, very liquid poop. Just now she ate on one side for 20 minutes, I changed (etc), she took other side and then immediately started screaming. That's pretty typical.
    Last edited by @llli*confusednewmom; June 8th, 2017 at 06:10 PM.

  4. #4
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    Default Re: Pulling off and screaming -- at my wit's end!

    Ok great, this is making more sense. Also I think there may be a couple easy to adapt practices that will help (along with time.) Still not sure about that gain though, it does not fit really. But let's leave that for now as baby is gaining OK and that is the important thing.

    So maybe it is #2? Is there any fix for that?
    yes, and it is the same fix as for number 1, as this is just another set of symptoms for the same phenomenon- fast letdown. Sorry I was probably confusing you with my numbers.

    I don't think she mentioned more frequent feedings? I feed every 2-3 hours but the past few days she was pulling off after only a few minutes (and screaming) and then wanting to eat again shortly.
    So, the longer a breast "goes" without milk being extracted, the more milk builds up in the breast and the faster the letdown. So encouraging baby to nurse very frequently can help a lot. I had OP with all three of my children and without a doubt I found that nursing very frequently plus nursing laid back or sidelying was the key to helping both baby and me be much more comfortable.

    So my first suggestion is to definitely allow and even encourage baby to nurse very often. As often as baby likes, and then you offer more often as well. Several times an hour for parts of the day if you and baby like. There is no such thing as nursing too often. You can keep baby snuggled against you most of the time, with easy access, and that will usually encourage lots of nursing. I also found that when production was at its peak I even had to set my alarm when I slept to make sure baby and I continued to nurse at least every 2 hours until my milk production calmed down. But I was getting terribly engorged so I needed this.

    What is great about nursing really often is it helps the flow be less and the breasts feel less full without resorting to pumping. Pumping is "extra" milk removal and yes, does tend to increase milk production beyond normal if mom already has normal or high production. Nursing frequently encourages NORMAL milk production. It sends the right message to the body- please, make enough- not too much and not too little. Because baby will still take in roughly the same amount total each day, just with smaller meals. This also may help with excessive spit up, but spit up is usually entirely normal and nothing to worry about.

    The milk seems out of control to me because when I'm nursing on one side it will literally spray out of the other and because she never gets to the hind milk --
    So, do not worry that she never gets to the hindmilk. This is not a problem.
    I can pump like 4 ounces and still have a ton left.
    So this sounds like you may have a large storage capacity in your breasts, and probably, a little OP. Basically this means you were made to feed every baby in the village if that were ever needed.

    This might explain why block nursing may not have helped. If you have a large storage capacity, then it might take a very long block to start to feel full and to tell the breast to slow down production. Meanwhile, all that milk was building up in the breast, causing the fast letdown. In any case, block nursing is not indicated as your OP problem is manageable without it, (spraying is just an inconvenience, while painful engorgement and mastitis is a health issue) and baby's gain is not high enough to really consider it safe to reduce production dramatically, which is what block nursing does.

    The hardest thing with OP and FFLD is trusting that time and nature will fix it. And they will. So do what you can to help in the immediate (nurse frequently, with helpful positioning) but otherwise, be patient. What will almost always fix any OP issue is time. 6 weeks is the typical "peak" of production. If a mom makes too much at that point, then the body will begin to ramp production down after that. (This does not mean milk production cannot be increased beyond that point- if needed, it can.) So if you do nothing, you will most likely see your milk production gradually reduce over the next few weeks. By around 3-4 months, production might feel so different (no more feeling full, no more spraying or leaking, etc.) you might think something is wrong and now you do not make enough milk! Don't worry, these are almost always normal changes.

    I used to feed both sides. Now she seems to want only one.
    Good, just let her nurse one side at a time if that is what she prefers. Since you will be upping the frequency baby nurses, those two things (frequent but one side at a time) will work well together to cut back on the "too much foremilk all at once" problem. Of course if baby wants both sides here and there, that is fine too. Also if baby nursed, conked out, and wants to nurse a little more in a very short period, you can just offer the same side again so baby can sleepily comfort nurse without too much milk flow. "When to switch" is something you and baby will just develop a feel for.

    I feed, burp, offer other side. If she doesn't want the other side, I change her, then offer again.
    Does baby tend to not nurse to sleep? I wonder if all this activity (burping, changing, offering other side) is stopping her from doing so. One thing I figured out with my oldest is that if he looked like he was nursing to sleep, to let him. Not burp him, and not change him (even if he pooped) and just let him sleep. Sleep stretch was usually very short, but that is normal. If a baby needs help to burp, they will usually let you know, and it may be some time after they ate rather than right after. If the poops and pees are contained, you can leave them be for a while, most of the time. If baby is irritated by a rash from all this pooping, I can offer suggestions there as well.
    The screaming usually occurs in close proximity to a high volume, very liquid poop.
    So that sounds like a fast let down poop. They can also be quite explosive, and maybe that is what is bothering baby(?) Or maybe just the gas that is going along with the poop which is what makes them explosive. This is an example of the gastrointestinal discomfort fast letdown can cause. So hopefully that will begin to correct soon.

  5. #5

    Default Re: Pulling off and screaming -- at my wit's end!

    Thank you!
    What you say about feeding more often makes a lot of sense. The past few days she has independently begun cluster feeding (growth spurt?) and you are right, the times she's had screaming fits have been after her few long sleeps when the breasts had had time to refill. So I will work on feeding more frequently.

    Nursing to sleep: So I'm the kind of person who reads way too many books, and all the books said that you should not nurse to sleep because it encourages the baby to need to nurse in order to sleep which will cause sleep problems later on? So I've consistently not nursed her to sleep.

    Diaper rash: no, she's good there. I've been pretty pro-active about prevention so that hasn't been a problem yet.

    Thanks again for all the advice! I really appreciate it.

    One last question: When you say feed more often, what about when she's asleep? Should I wake her to feed her during the day, or just let her sleep?
    Last edited by @llli*confusednewmom; June 9th, 2017 at 07:06 AM.

  6. #6
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    Default Re: Pulling off and screaming -- at my wit's end!

    and all the books said that you should not nurse to sleep because it encourages the baby to need to nurse in order to sleep which will cause sleep problems later on? So I've consistently not nursed her to sleep.
    Yeah, babies are hard-wired to nurse to sleep, so as far as mother nature or whatever creator you believe in is concerned, babies are meant to be nursed to sleep, it is in their nature. Why it became a thing to claim this totally normal behavior somehow causes problems is beyond me. It just seems counterproductive to not nurse a child to sleep when it is usually by far the easiest way to get a baby to sleep. I do not know what specific problems you have been warned about, but I assume it has something to do with a child who is nursed to sleep as a baby consequently "always" needing to nurse to sleep. Well my children all nursed to sleep as babies and toddlers and they all began to get to sleep (and stay asleep) fine on their own without nursing- or any other comfort measures- when they were developmentally mature enough to sleep like a big kid rather than like a baby or young toddler. So, no problems.

    Diaper rash: no, she's good there. I've been pretty pro-active about prevention so that hasn't been a problem yet
    Great!

    One last question: When you say feed more often, what about when she's asleep? Should I wake her to feed her during the day, or just let her sleep?
    I think you can take this on an as needed basis. There is no HARM in waking a baby once they are asleep in order to nurse. None at all. But if you are comfortable (not too full) and baby is not getting upset about the flow after a longer sleep, (and of course if baby is nursing enough overall to gain well) then no need to wake baby if you prefer not to.

    Since you like to read, here are the only parenting books I suggest. I have read a bazillion it seems and after three kids, oldest about to turn 14, I find these are the only ones that were actually consistently relevant to my experience as a parent that are also based very firmly on scientific evidence about health, wellness, and child development: The Womanly Art of Breastfeeding (8th edition) and Sweet Sleep (both from LLL) and Kiss Me! by pediatrician Carlos Gonzalez.
    Last edited by @llli*maddieb; June 9th, 2017 at 09:51 PM.

  7. #7
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    Default Re: Pulling off and screaming -- at my wit's end!

    I definitely second the idea of laid back nursing to help with things. This is a good video that helps to show some different ways to position yourself with baby https://www.youtube.com/watch?v=DiT6wPC6iIc . With my second, I had such bad leaking/spraying that I'd have to have a burp cloth over my other breast when I was nursing in order to contain all the milk. It was super annoying, lol...but it definitely got better over time. And the laid back nursing helped with baby popping on and off because of a fast flow. Gravity is your friend in that instance!

    With regards to the nursing to sleep thing...I'm of two minds when it comes to nursing an older baby to sleep. With my oldest, I nursed her to sleep most of the time until she was a year (though she would fall asleep in the car and occasionally walking with her head on her dad's shoulder when she was small enough), and then after that point she could fall asleep no problem without nursing, as long as it wasn't me putting her to sleep. I stopped nursing her to sleep at night just after she was 2, and that wasn't really a big deal if I remember correctly. With my second, I've noticed that she does tend to sleep longer stretches if I put her to sleep without nursing, but to be honest it's much harder and takes longer. So I don't always do it. But as a very young baby? Heck yeah, I nursed to sleep. Like the PP said, babies are just hard wired to nurse to sleep. I wonder if part of the reason people think you shouldn't get them into that 'habit' is because so often moms have to go back to work and people think it'll make it harder for other people to put baby to sleep? IDK. But those first few months with a new baby are so hard to begin with, I think it makes sense to go ahead and do whatever feels natural and is easiest for both mom and baby. Babies are ever changing and surprising - you might put all this effort into 'not nursing to sleep so you don't form bad habits' just to find that whatever you do to put her to sleep doesn't work down the road! Babies are funny that way

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