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Thread: Very slow weight gain

  1. #1
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    Default Very slow weight gain

    Hi! I really need an opinion on this problem and some advice! Do you think it is possible not to have a sufficient milk supply when the baby is 2 months old already?

    So, my daughter was born on May, 1st (long, difficult delivery and long IV, but otherwise baby was fine). She was 3070 g at birth and 50 cm and 2770 g on day 3 when we were discharged. From then, she started gaining weight, but really slowly. This was a concern so we weighted her frequently. She took a month to go back to her birth weight! We checked the latch with breastfeeding consultant, got all the pieces of advice and follow them (sling carrying, co-sleeping, alternating breasts, fenugreek...) We also saw an osteopath to confirm she had no problems that could prevent her from latching well, and all seem fine.
    She nurses on demand, or rather, I offer the breast even before she fusses too much. It's normally 9-10 times per day, sometimes up to 12 if she's in a sling (I think the breast is tempting). She wets plenty of diapers (even more so after I started fenugreek), I checked by using cloth and she goes at least 10 times a day or more. Her poo looks normal, too, she makes one very full diaper every day, sometimes even two. She is a smiley, happy baby and fusses quite little (But if I don't feed her on time, she'll be very loud and persistent and won't let herself starve, I tried just to check).
    She slept long stretches during the day, sometimes 2-3 hours, but lately she only have one long nap and the rest of the time she catnaps for 30 minutes or so. She cluster feeds in the evening since she was born, then sleeps through the night. Since her weight gain is slow (and my breast is exploding at night), I never let her sleep to see when she will wake up out of hunger, I dreamfeed her at 2 am, 5 am and 7 or 8 am. She seems even more efficient at emptying the breast in her sleep (with full breast it's very visible).
    So, she seems like a dream child, but! Today she's 2 months old and she's only 3470 g. This is only 400 grams - less than 2 lbs! - from her birthweight, in two months! Well, in one month actually, because she took her first month to go back to her birth weight. She did grow in her head circumference and in length, she's somewhat 50% percentile. But her weight curve is so low, doesn't fit any percentile!

    She was checked for all those rare genetic diseases and none found. Her father and I are not bulky, but not skinny either. Her pediatrician told us that she's doing well, we can't really diagnose her with a failure to thrive, but if we're worried he proposes supplementing with formula. In his opinion, my milk is low-fat.
    I found the scholar article which explains that fat content would not matter much for weight gain, only the milk quantity. I keep questioning myself if it is possible that I don't have enough milk? Would she be content and happy while not eating enough? Sometimes she fusses at breast, especially in the evenings (sometimes slow letdown, sometimes she's just tired) , very occasionally I give her 1 or even 2 oz of expressed milk to top her off using SNS.
    If I pump after feedings I don't get lots, maybe 1 oz at the most, from both breasts. If I pump 2 hours after a feed, when she sleeps a long stretch, I can get around 1.5 oz per breast, quite quickly, and then nothing more, no matter how long I pump.I never managed to have a second letdown with the pump. (I give both breasts at each feed as I think my capacity is on the low side).

    So, is it possible to have a low supply that didn't regulate itself with a 2-months-old? Could it be that she is underfed? What do you think I should do? My husband insists that I stop torturing myself with worrying and that we supplement. But so far she is still exclusively breastfed and I really want to avoid formula if I can.
    I was thinking about pumping and feeding her expressed milk in the bottle, but then it's just doing the work for her as she'll probably eat less at the breast? I was also thinking about feeding her just the fat from expressed milk, bit it requires lots of pumping and it's very hard to pump enough and breastfeed (and take care of the baby, rocking, cudfling, changing)!at the same time :-(

    Sorry for such a long post! I really hope to have your opinion guys! Thanks in advance!
    -Worried FTM

  2. #2
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    Default Re: Very slow weight gain

    Ok, I have a few thoughts. First off, I've never heard of 'low fat' breastmilk, so I think your doc may be a bit off base there. My second thought is in regards to the accuracy of baby's birth weight. It's possible that with a lot of IV fluids, her weight may have been a little off. A month is a long time to get back up to birth weight! But then gaining 2 lbs in a month sounds a little more like it. It also sounds like her diaper output is good too, and that she's an overall happy baby otherwise and meeting milestones, right?

    Have you ever done a weighed feed with a lactation consultant? Renting an accurate scale to see how much baby is taking it at feeds might be a good indicator of how much she's getting in a session. It might also give you some peace of mind to weigh baby a couple times a week or something on that scale before you try supplementing. It honestly doesn't sound like her doctor is overly concerned about things at this point. It still might be a good idea to see an International Board Certified Lactation Consultant (IBCLC) for a second opinion, just to make sure there's no issue with milk transfer that may have been missed the first time (like a tongue tie). But again, doing a weighed feed will help you to see how much she's getting. Most babies are actually better at removing milk than a pump, so how much you pump is not necessarily a good indication of how much she's actually getting at the breast.

  3. #3
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    Default Re: Very slow weight gain

    I agree with carm3. Here are some other thoughts:

    This is only 400 grams - less than 2 lbs! - from her birthweight, in two months!
    When I use online converter to convert 400 grams to ounces it is 14 ounces...so less than ONE pound. Am I off somewhere? Sorry if the following is incorrect.

    First I would suggest throw out birth weight. It is irrelevant at this point and was almost certainly inflated. I would suggest instead measure gain from lowest known weight, which I take it was the day 3 weight.

    If lowest known weight was 6 pounds one ounce, and baby now weighs 7 pounds 10 ounces, then total gain since day 3 has been 1 pound 9 ounces, or average gain of 3 ounces a week, maybe a little less. This is half of average gain for this period. So, yes, if these numbers are correct, this is very slow gain.

    If baby gained 14 ounces in the last 4 weeks, that is still only about average 3 ounces a week...so gain rate may have improved but not by much? Again, please confirm my numbers.

    Your baby is nursing 9-10 times a day, sometimes up to 12. Is this because no matter how much you offer, baby will not nurse more often? In the newborn periods average nursing session frequency is 10-12 times in 24 hours, and many babies nurse more often than that especially in the first couple months. Given that no one has found any per session intake problems (?) or other health issues, I think trying to increase how many times in 24 hours baby nurses makes sense.

    If baby will not nurse any more often or it makes no difference, then I think it is time to see the LC again and discuss what options you have. It might involve increasing your milk production and possibly supplementing as needed. It sounds like you are already pumping and using an sns to some degree, so maybe that would need to be increased somewhat.

    The thing is the distance between slow gain and normal gain might not be much, this is why sometimes just a few more nursing sessions per day, or a little more supplementing is all that is needed to get gain on track. I do not think fat skimming is called for, that can be helpful but more usually for very tiny, very weak babies who literally can not take in any more volume so they need more calories in what they can take in. If your baby will take more milk in, then you can just offer your baby all that you pump. (Or, again, see if baby will nurse more often!) All milk has fat in it and will help baby gain.

    Also did LC suggest breast compressions?

    It is reassuring that doctor is not ordering you to supplement with formula...yet. However, I fear that may be coming if gain rate does not pick up substantially.

    The problem is that normally, babies gain slower and slower as they age. The first 2-4 months is normally the fastest gaining time for any human, and then gain rate begins to reduce. So when gain is very slow for that period it is particularly troubling.

  4. #4
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    Default Re: Very slow weight gain

    Quote Originally Posted by @llli*maddieb View Post
    I agree with carm3. Here are some other thoughts:

    When I use online converter to convert 400 grams to ounces it is 14 ounces...so less than ONE pound. Am I off somewhere? Sorry if the following is incorrect.
    First of all, thanks a lot for quick replies, both of you! (carm3, maddieb)
    You are right, my bad, 400 grams is 0.88 pounds. All your numbers are correct, she's gaining roughly half of what she should (but then, she grew more than 2 inches since birth, weird for a starving baby, I think).
    You both are totally on spot with birth weight, I think it was inflated due to IV, too. But then, nothing explains slow weight gain after.

    The consultant I've seen is IBCLC. She didn't specifically check for tongue tie (or at least I didn't notice), but she watched us nursing three times (once in the maternity ward before being discharged and then twice after). Her last advice was that I stop exhausting myself with pumping (I was power pumping during the night then) and that we're fine in terms of nutrition. She referred us to pediatrician to check for other possible health problems - and we found none...

    I'll see her again for weighed feed and possible tongue/lip tie, this is a good idea. I just hope it's that and the problem will be solved...

    I tried feeding more often, but she starts sucking, causes letdown and some 30 seconds later pulls off while the milk is leaking, and starts playing with the breast or smiling at me. Or, she doesn't even seem interested to begin with. Do you think the baby can get used to being undernourished and not be hungry?
    I also feel that she doesn't always finish the second breast. She does sometimes, but generally she loses interest before.

    I'll try supplementing with expressed breast milk while waiting for the appointment with LC. What do you think is best, offering her 1 oz after some feeds or a complete feed of expressed milk before bedtime? I'm just afraid that the more expressed milk she'll take, the less she'll nurse after, and I'm not solving the problem.

  5. #5
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    Default Re: Very slow weight gain

    Well, your baby is certainly not starving. Starving babies are losing weight and dying. This is why I absolutely hate it when people are told they are starving their baby as it is a monstrous thing to say to any parent, on top of the fact it is not true unless baby is actually being neglected or in some other tragic circumstance such as famine.

    A baby who is gaining slowly is not starving. They are actually getting lots to eat. They are getting enough calories to live and to move, and that takes a lot of calories. They are also getting enough to gain, again, that takes a lot more calories. What they may not be getting is quite enough to gain 'normally.' This is why the difference between slow gain and normal gain is usually a pretty small amount of milk.

    Do you think the baby can get used to being undernourished and not be hungry?
    Well, this is an interesting question. In fact this does happen to babies who are getting way too little to eat...as it can happen with people of any age who really are slowly starving. But I am not sure this could be happening with your baby, who is NOT starving. Also, usually what happens for babies in particular in that case is they sleep a lot to conserve energy. Of course all babies sleep a lot, but if they sleep to the point they are not waking enough to nurse 10-12 times or more a day then there may be a problem. This is why those "good" babies who sleep long hours at a time may actually be in trouble.

    I tried feeding more often, but she starts sucking, causes letdown and some 30 seconds later pulls off while the milk is leaking, and starts playing with the breast or smiling at me. Or, she doesn't even seem interested to begin with.
    But, I would also say, so what if baby only sucks a little and gets a little...that is fine, that is still a little more milk into baby, so why not offer even if that is the result? It is normal for babies to have nursing sessions of greatly varying intake, to cluster nurse, to nurse to sleep, to pop on and off, to nurse for half an hour then fall asleep for 10 minutes and then want to nurse again etc.etc, all these crazy patterns that seem odd or even frustrating to adults but actually make complete sense for a baby. Also, again, maybe all baby needs to get that gain up is a little more. So I would still suggest encouraging baby to nurse more often even if sometimes baby nurses only a short time or refuses.

    I also feel that she doesn't always finish the second breast. She does sometimes, but generally she loses interest before.
    Well that is also entirely normal. This is why you would start the next session on the "less nursed from" breast, which ever that is. If you think you need to, you could pump that less nursed from breast at that point, this would be good for milk production. But again, if you can encourage baby to nurse more often overall, you might be able to avoid or at least lessen to some extent pumping or supplementing.

    I'll try supplementing with expressed breast milk while waiting for the appointment with LC. What do you think is best, offering her 1 oz after some feeds or a complete feed of expressed milk before bedtime? I'm just afraid that the more expressed milk she'll take, the less she'll nurse after, and I'm not solving the problem.
    Ok so here are my thoughts on this, but of course I cannot tell you how much baby needs in supplements or indeed if baby needs them at all.

    When supplementing, I think small amounts of supplements at a time make the most sense and here is why. A "complete" feed before bedtime would be similar to a "top off bottle" and we know those tend to interfere with normal overnight nursing frequency. As far as how much each time that is up to you...I think it is a good idea to not supplement every time baby nurses so that at least some sessions can be "normal" and leisurely so baby can suckle and relax and fall asleep etc at the breast without you having to jump up to pump or make baby take a supplement...so maybe pick a number of ounces you want baby to have daily and give that in small increments of up to an ounce or a little more at a time at certain nursing sessions? Supplements can be given either before, during or after baby nurses, there are benefits and drawbacks to each method, so maybe experiment and see which works better for you, or just keep mixing it up.

    I'm just afraid that the more expressed milk she'll take, the less she'll nurse after, and I'm not solving the problem.
    You are right, it is important that supplementing be done so that any interference with normal nursing frequency, normal clustering patterns, and length of sessions is kept to a minimum. It is not an easy task and what is going to work best in each case will vary so much, there is no way to give a one size fits all answer to how to supplement. You may also find that things differ day to day in how you find it best to approach supplementing. That is fine.
    Last edited by @llli*maddieb; July 2nd, 2017 at 11:40 AM.

  6. #6
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    Default Re: Very slow weight gain

    Sorry, these last days were very busy, as I tried putting to practice all tips and bits of advice.
    Here I am with the update. (I hope maybe some time later some mothers with a similar problem might see the thread and find it helpful)

    To begin with, I rented a hospital-grade pump (instead of my electrical single-breast pump) and I started with three days of "nursing vacation", spending the day in bed, skin-to-skin, nursing as often as every 30 minutes and pumping if she wouldn't take the breast. It was very tiring, especially because my little one at that moment (from weeks 6 till 9) wouldn't nap unless walked and rocked. At the same time she wasn't taking long naps since week 6, and between nursing, pumping and rocking her to catnap there was literally not a spare minute. Which is fine, I told myself, if I eat microwaved food, set the pile of clean diapers on the bed table and if I don't set any other objectives for the day :-) But even then, these three days were difficult, especially mentally, because frequent feeding means the feeling of empty breast, difficult sucking for the baby, fussy baby, and wondering if I have enough milk. Luckily, it lasted only 3 days.
    At this point we had an opportunity at my midwife's to weigh the baby and she gained 5,3 ounces in 9 days; that's about 4 ounces per week, better than what she did before.
    We are on vacation since, coming back in a week's time. I'm pumping about 3.5-4 oz a day to supplement. I could probably pump more, but then it's taking away the relaxed time with the baby. I don't want to pump myself accidentally into oversupply either.

    I'm supplementing by 0.5-1 oz at the beginning of few feeds using SNS. I'd say she's less interested in long feeds when I do that, so I'm really not sure she's eating more than before. Adding SNS at the end of the feed is complicated, as I don't know at which point she'll lose the interest in the feed and stop.
    We tried supplementing a little by bottle, too, in the evenings. This is when she cluster feeds, so I was hoping to make her more patient for the slow letdown. Sometimes she'll take the bottle, and sometimes she'll fuss but she won't. That made me feel that her evening fussiness is more 'I'm tired' than 'I'm hungry', and her cluster feeding has more to do with comfort than with meals.
    All in all, with all this supplementing we now know one thing, the baby isn't hungry. Whether her daily milk intake is correct or not, I still don't know (we'll do weighed feeding once we're back home in a week), but she eats as much as she wants, and she doesn't seem to want more. That's already a good thing, because if her pediatrician insists that we give her formula, I can always say "Yes but we tried and she won't take it". How's it going to be better than EBM? The milk I pump after feedings is all "cream".
    Coincidentally, after she hit 9 weeks she started napping long stretches again. Not sure if it was a long sleep regression or something to do with feedings. It is now challenging for me to feed her as often as I'd like. If I wake her up from her nap instead of waiting for her to wake up, she's grouchy and she doesn't want to nurse, so we're at 9 feeds a day at the moment. Today she went to bed at 6:30 p.m. and skipped her cluster feeding. I dreamfed her at 9 p.m. and she keeps sleeping. It's 10:30 and my breasts feel rock heavy again, this is crazy, I'm going to dreamfeed again... And I was worried that I didn't have enough milk in the evenings with all her usual fussiness!
    I'm curious to see what her total weight gain will be for this month.

    P.S. Not sure if it's relevant, but I also started babywearing her all day long, even for most of her naps. I heard that this helps babies to thrive.
    Last edited by @llli*dettcat; July 11th, 2017 at 02:40 PM.

  7. #7
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    Default Re: Very slow weight gain

    So, here's my news: I am really desperate.
    We did a weight check, and in a month she gained in total 300-350 grams, that's 10-12 oz, depending on the scale and the time of the day! :-( Apart from that, she grew well, she's following 50-percentile as she always did. Her pediatrician said she develops well and looks well, apart from the fact that she's really skinny. So we went to do all the bloodwork, to test for renal impairment, genetic diseases, etc. I was crazily worried and so disappointed that a month of extremely hard work yielded nothing at all. Constant babywearing, encouraging to feed, pumping (good luck with that with feeding one hour apart and when the baby is sleeping on you!), nothing helped.
    I power pumped that night after putting her to bed (Tuesday) and noticed that the output dropped to less that 1 oz (normally 2 oz). I could see the pump any more, or change from my pajamas, all I wanted to do is to cuddle with my LO and cry in bed all day.
    Wednesday we managed to get an urgent appointment with endocrinologist, that's where they did all the bloodwork. So many tubes of blood for such a tiny baby, and she was crying so hard, I was crying with her. This is when I noticed that she's not happy with the breast, she'll be frustrated that there's no letdown after only 3 seconds sucking, and she'll want to change breasts after only a minute or two. I started thinking that I already saw similar behavior few days earlier, but thought she was just tired and fussy. Only this time it was worse.
    It continued this way all afternoon, and she wouldn't nurse well unless asleep or with white noise, but even then she'll demand changing breasts very often, and she wasn't swallowing often.
    Thursday this continued, I was nursing her while she's asleep or in her naps. She wouldn't demand, and I was offering very often, but she'd only spend very little time at the breast each time. I googled and figured she probably had bad appetite after her vaccinations on Tuesday. I also felt that the breast don't feel full during the day, but it was hard to figure when she was constantly on and off the breast. She still gave a good diaper output, so even though I was worried, I was waiting what's going to happen on Friday, when I had an appointment with lactation consultant. Also, I was still sad beyond belief, imagining all horrible things like infant diabetes and faulty kidneys.
    Friday we went to see an LC, and she nursed very little, 3-5 sucks before swallow, demanding a switch after a minute, than again, and then arching her back and sucking on her fingers instead. Anyhow, my supply dropped DRAMATICALLY. At the same time, I got a call that they found nothing, her bloodwork is perfectly normal. So the only possibility is low food intake. But we couldn't even verify it any more, there was no point to do a weighted feeding at this point, with my supply so low.

    So I got a prescription for domperidone, bought fenugreek, homeopathy, and all sort of supplements, and I'm going back to see an LC in one week. Meanwhile I had to start giving her formula :-( A thing that I resisted for 3 months - well, now it's done. I have no other choice, since I have very slow flow, she's still on nursing strike unless nursing with SNS, and she's not a chubby baby that could go on little food even for 2 days. And my freezer supplies were all gone, supplementing her this month (there wasn't much anyway).
    So, with some formula I though I'd have some time off to relax and pump and build my supply, but no! She won't take the formula from a slow nipple bottle (she'd take my milk though). The only way she's ok with it is if I mix it at least at 50/50 with breast milk and feed her with SNS. But even then she makes a funny grimace and pops on and off. If I put breast milk in SNS, she'll be gulping like crazy, but she'll never ask for food really.
    All this is horrible: a skinny breastfed baby that won't take formula or an empty breast. It's shattering my heart.
    I don't know what to do, I still manage to pump only about a half of what she's meant to eat - and this assuming that she takes a little bit of milk directly from the breast while on SNS. The worst part, I dreamfed her at night (I still seem to have heavy breast an night time, after 5 hours sleeping), and then I pumped 2 oz, and then I couldn't fall asleep for hours and hours till morning, wondering why would my supply drop so badly... I know there's a hormonal drop at 12 weeks, but THIS WAY???

  8. #8
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    Default Re: Very slow weight gain

    Hi dettcat. I have read you whole post and I am so very sorry that you are having this stress. It sounds like your LC and you have a plan, the domperidone... and you are supplemenmting baby now. This sounds like a reasonable plan.

    At 3 months of so many moms stop feeling full between nursing sessions. In fact many describe it as feeling "empty." Flow and letdown 'speed' slows too. All of this is usually normal. Nursing behavior often changes at this point as well, in different ways.

    Pump output is not a great way to measure production. I am not sure why before and after nursing weight checks were not done...have they ever been done? But if you are seeing a reduced pump output I suggest be sure to troubleshoot your pump.

    When you say that with power pumping your output dropped from 2 to 1 ounce, do you mean per session? Because that would be expected- that individual session output reduces when you are pumping more frequently.

    What causes milk production to drop is ongoing suboptimal milk removal- meaning, not frequent enough or not effective enough milk removal over time. It usually is not a dramatic drop but gradual. A day or two of non-optimal milk removal is not going to have any permanent impact normally.
    Some herbs or medications will cause more dramatic milk production drops- but I assume you would be avoiding anything like that? Also some moms report lower production right around their period or ovulation, again this is temporary.

    If your baby will not take the formula I am not sure what you can do aside try changing the formula.

    What strikes me is you mention baby not having an appetite. One thing that causes poor appetite is low iron. Because the cord is typically cut quickly, a baby born via cesarean is more likely to be low in iron although this does not typically appear until after 6 months. Also I think low B-12 (as you might see in breasted babies of vegan moms or a mom who is on some other type of exceedingly restrictive diet) ) also causes poor appetite.

    Of course formula is fortified with iron and I assume B-12 as well- basically formula needs all vitamins added to it. So if that is part of the problem then formula might correct it...but direct feeding of an iron supplement would as well.

    An excellent book that discusses slow gain from a breastfeeding perspective is My Child Won't Eat. It is not just for babies, but it includes babies this young in it's focus.

    Kellymom's low milk production article explains why many moms think there is low production when in fact that is not the case.

  9. #9
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    Default Re: Very slow weight gain

    I just wanted to add that as worrying as slow gain is, what the tests showed is a healthy baby- correct? When a baby gains slowly, the testing is done to rule out the possibility of some serious, underlying illness, not to prove that there is not enough intake, as it does no such thing. Her other growth parameters are normal and also show a healthy baby and the pediatrician says baby looks well and is developing normally. Also if I am understanding correctly, your baby has overall not indicated she wants more than she has been getting and in fact is even now - when you believe your production is low- refusing supplements to some degree! If, now that baby is getting supplemented, her gain rate goes up, that would probably be reassuring to everyone but again, it would not prove the issue was low intake before.

  10. #10
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    Default Re: Very slow weight gain

    Dear maddieb,

    Thanks so much for being so kind and supportive. I need to say, to get back some trust in my breasfeeding capacities it matters more to hear some words of support than to get some words of advice.
    I don't think it's something wrong with the pump, as I see the same thing in her nursing behavior (I got her to take the breast twice fir short periods yesterday, but other than that, she's still on nursing strike).
    The reason we didn't weigh a feeding with LC was because the baby refused to nurse for more than 2 minutes, so she never made a proper feed. Also, it was interesting to know how she was feeding BEFORE this supply issue hit me.
    Also, I'm using Medela Symphony, but I own an electrical one-side pump, and I'm pretty sure that if I get back to it, tge output will be the same.

    What bothers me really, and I wonder if it can be some disorder is that I seem to pump whatever's the breast storage capacity with the first letdown, and then when /if I have a second letdown I pump drops, literally, maybe 1/4 oz or something, and it only lasts a minute, even less, and then it stops.

    I even keep wondering if it was always this way and I was managing to do 3 months of breastfeeding just on frequent feedings with whatever's in the breast at this moment, but I keep telling myself that this is absurd, or else I would have never made it through any of the growth spurts, where the baby nurses every 30 minutes on the empty breast, and it still lets down.

    In any case, this is what seems to be happening now: I can hardly produce "on the tap", and during the day my breasts feel empty, so not much is coming out. The baby's frustrated and won't take breast for nore than 2-3 sucks (I wonder why, because normally takes her more than that to provoke a letdown). So she'll only take breast with SNS, and even then, sometimes she doesn't have enough patience to wait till the milk comes all the way through the tube.
    Still no luck with formula in the bottle.
    Now when I recall the last days before the nursing strike, this is what was happening while nursing: she'd start, but woukd have to do many sucks before swallow, and very soon the flow will stop, do she'll claim a different side, do the same there, I'd switch her bacj ir she'd lose interest.

    Another thing is that I don't feel this usual tingling sensation of breast filling up an hour or so after feed any more. Even when the baby cries, I don't get this sensation of "milk coming". So frustrating to not understand what is happening and why.

    I so wish that things go back to where they were before! Not for the health benefits of breastmilk and not because she diesn't like formula (pretty sure I could find the one she likes eventually), but because I miss those momants with her, and miss being able to produce milk. It also feels so weird not to be able to take her to breast when she's upset! (Sitting here in the middle of the night with a breast pump, crying right now). Or not being able to nurse her to sleep! I feel like mom deprived of my mom powers, basically I feel less like a mom :-(

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