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Thread: Baby doesn't empty breasts but still hungry

  1. #1

    Question Baby doesn't empty breasts but still hungry

    I'm having trouble with an unsustainable BF plan. I hoped to EBF but my 5 week old daughter was not gaining enough weight through BF alone. By 2 weeks she was still under her birth weight, and didn't reach it until 3.5 weeks. My supply is fine, and we didn't know it at the time, but the issue was that she doesn't empty my breasts, despite being on there for a long time. She does often fall asleep, but she'll also get at least 15-20 min of active sucking time, mostly on my right side, which is my bigger producer, and still doesn't empty it. I do massage and compressions the whole time. I've worked with multiple LCs over the last 5 weeks and they put me on the breast-pump-bottle plan where I nurse, pump what's left (anywhere from 1-2oz) and give her what I pump. I used to only have to supplement 1oz after I nursed but lately it's been about 2-2.5 in order to satisfy her. The good news is that this plan is helping with her weight gain. The bad news is that it's so much work and very exhausting. I only pump for 5-15 min depending on what I'm getting, but the entire process takes at least an hr. However, if I don't have a bottle to give her after nursing her, she gets fussy and continues rooting until she gets more. The LCs have confirmed no tongue or lip tie. My concern is that this plan just isn't sustainable, but I'm not sure how to get her to get what she needs straight from the source instead of stopping but still requiring the rest from a bottle. Has anyone else experienced this? Is there an end in sight that involves her being able to empty my breasts so I don't also need to pump and give her the bottle? Please help!

  2. #2
    Join Date
    Jun 2009
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    Default Re: Baby doesn't empty breasts but still hungry

    Hi Kabunch, I am sorry you are having this concern.

    Of course this plan is not sustainable. It is not supposed to be. In a situation like this where mom apparently makes enough milk but it is suspected baby is unable to transfer milk properly, such a plan is put into place as a temporary measure to get baby gaining normally while the actual breastfeeding problem is addressed.

    And the problem is NOT that your baby cannot "empty" your breasts! If you have enough milk and baby is nursing with a normal frequency and is not able to gain weight, that would indicate baby is having difficultly transferring enough milk per nursing session to gain normally- this is entirely different than saying baby does not "empty" your breasts, as that is common because at this stage most moms make more milk than baby truly needs. Think of it this way. Say a baby needs 2 ounces at a nursing session. One mom has 4 ounces in her breasts at that moment and another mom has 2 ounces in her breasts. Both babies transfer the 2 ounces they need. Both got enough milk, but the mom who had four ounces in her breasts did not get "emptied." This is not really a problem as baby got enough to eat. Make sense?

    When people talk about baby not emptying the breasts, they are usually talking about a mom whose milk production is not adequate. Since "emptying" the breasts increases milk production, doing this (say with a pump if baby cannot) helps milk production. But in the normal course of breastfeeding, many, probably most babies do not actually "empty" the breasts at this age when there is usually quite a bit of milk, more than needed in many cases.

    When a mom who is making enough milk for her baby is told she has to "empty" the breasts every time baby nurses, it sometimes means baby is not nursing often enough. If a baby is not nursing with high frequency, then the milk being "left" in the breasts for longer periods acts to reduce milk production...not nursing often enough is of course also a common reason a baby might not get enough to eat overall and not gain normally. Many newborns need to be encouraged to nurse more often so they get enough milk, even woken to nurse, especially in the first few weeks. But again the problem there is not the baby not "emptying" the breasts but that baby is not nursing often enough. Most newborns need to nurse about 10-15 times in 24 hours to get enough milk.

    So it would help to know how much baby is actually transferring when baby nurses. How many before and after nursing weight checks have you done at the lactation consultations? If you have had multiple lactation consultations, then this (before and after nursing weight checks) could have been done multiple times, which is good because it is best to have several of these to "read" as of course a baby does not transfer the same amount every time they nurse. Generally if it is found that a baby of over two weeks old is capable of transferring 2 ounces or more TOTAL (not per breast) during an average nursing session (both sides, about 20 minutes or so per side) that would indicate baby is able to transfer milk normally.

    If this amount of transfer is not happening when measured with before and after nursing weight checks, the next step is for the LC is to figure out WHY and help you with a plan that corrects the problem. Tongue tie is certainly not the only reason a baby might not be able to transfer effectively. Figuring out why transfer is not normal and helping a mom and baby improve that situation is the specialized job an LC is trained for. The supplementing and pumping regimen is just for the interim while you work on this. Didn't any of the LC's you saw explain this to you? Are these all board certified lactation consultants? (IBCLC's?)

    Also, such regimens can be tweaked to fit what will work for mom. For example, many moms find that supplementing a different way helps. An at the breast supplementer (lactation aid) can be a time saving tool. Supplementing baby before nursing may work better than after. Pumping not exactly at the feeding session but a little later...etc. These things might help with your time management. But again, what you are doing now should be a temporary thing needed just until your baby is shown to be transferring normally.

    However, if I don't have a bottle to give her after nursing her, she gets fussy and continues rooting until she gets more.
    A newborn baby needs to nurse about 10-15 times in 24 hours, and will nurse and nurse long after they are full in order to get comfort. In other words in the first few months of life most babies nurse most of the time. So rooting and wanting to nurse more after appearing "finished" is entirely normal. Since a baby is hard wired to suckle most of the time, of course a baby will "take" a bottle after nursing and drink whatever is in it and then appear to want more even when that is much more than they need. This is one reason bottle feeding at this stage is potentially so problematic and all needed supplementing must be done extremely carefully to avoid over feeding with the bottles.

    The problem with overfeeding with bottles is then baby has less and less need to nurse effectively. Obviously this is a problem when you are attempting to improve baby's effectiveness when nursing! And yes it can be very hard to figure out how much supplement your baby needs to gain normally without it being too much. But this is exactly the kind of puzzle a competent LC helps mom navigate. If you are finding that your baby is taking more and more milk from bottles as time goes on when you make enough milk overall, then this part of your plan is not being done correctly. The opposite should be happening as baby gets better and better at transferring milk. Did your LCs explain how to supplement so this would not happen?

    Here is some more info:

    What to expect at a lactation consult: http://cwgenna.com/lconsult.html

    Lactation aid for time management (also helps prevent over supplementing) : http://cwgenna.com/smartnothard.html

    This article is about weaning a baby to exclusive breastfeeding from formula supplements. It should be much easier and quicker to wean to exclusively nursing at the breast from supplementing with your own milk, but still needs to be done carefully. Hopefully this offers some ideas you can use. This is the direction you want to be going....less and less milk in bottles, not more and more. Once you reduce supplements you can pump less. Once baby is not longer needing supplements at all, you can stop pumping entirely. http://kellymom.com/ages/newborn/nb-...rease-formula/
    Last edited by @llli*maddieb; July 14th, 2017 at 10:24 AM.

  3. #3

    Default Re: Baby doesn't empty breasts but still hungry

    @maddieb, thank you for such a thorough response! It sounds like we've been supplementing with BM too much and even encouraging her to prefer that to the breast, which is definitely not what we intended. Since she was below birthweight until almost 4 weeks I think the LCs were correct in giving us this plan to get her back up to birth weight, but what they failed to do was explain how to wean off this plan once she was caught up. They just kept telling us that she would get stronger as she got bigger and that would help her transfer more milk from the breast, essentially saying the problem would fix itself. That's obviously not what's happening, so now we need to figure out how to wean her from the bottled breastmilk.

    We've done the before and after weight checks at every LC appointment. My right side produces much more than my left, and she typically will transfer about .2 oz from my left side and anywhere from 1.5 to 2oz from my right side. From you it sounds like that means she's transferring enough, but what always happens is that when she's done with the breast she acts very hungry and so we give her more, so she's getting about 4oz total at each feeding (and the supplementing doesn't usually come immediately after, more like 10-20 min after she finishes breastfeeding). Does this mean that, now that she is caught up in weight, we are OVER-feeding her? How do we manage the signs of hunger she shows after BFing - are we misinterpreting them, or do I maybe just need to put her back on the breast, whether it's been 10 minutes or 2 hours?

    My ultimate question is, where do we go from here to transfer from the breast-bottle-pump plan back to just the breast? This is what the LCs said would just happen naturally as she gets bigger, but it seems like that isn't the case since as she gets bigger she just takes more from the bottle. Given that she's caught up in weight, doesn't have tongue or lip tie, and is transferring what you say is enough per nursing session (about 2oz total), I'm not quite understanding where we go from here.

    Thank you for your help!

  4. #4

    Default Re: Baby doesn't empty breasts but still hungry

    @maddieb, thank you for such a thorough response! It sounds like we've been supplementing with BM too much and even encouraging her to prefer that to the breast, which is definitely not what we intended. Since she was below birthweight until almost 4 weeks I think the LCs were correct in giving us this plan to get her back up to birth weight, but what they failed to do was explain how to wean off this plan once she was caught up. They just kept telling us that she would get stronger as she got bigger and that would help her transfer more milk from the breast, essentially saying the problem would fix itself. That's obviously not what's happening, so now we need to figure out how to wean her from the bottled breastmilk.

    We've done the before and after weight checks at every LC appointment. My right side produces much more than my left, and she typically will transfer about .2 oz from my left side and anywhere from 1.5 to 2oz from my right side. From you it sounds like that means she's transferring enough, but what always happens is that when she's done with the breast she acts very hungry and so we give her more, so she's getting about 4oz total at each feeding (and the supplementing doesn't usually come immediately after, more like 10-20 min after she finishes breastfeeding). Does this mean that, now that she is caught up in weight, we are OVER-feeding her? How do we manage the signs of hunger she shows after BFing - are we misinterpreting them, or do I maybe just need to put her back on the breast, whether it's been 10 minutes or 2 hours?

    My ultimate question is, where do we go from here to transfer from the breast-bottle-pump plan back to just the breast? This is what the LCs said would just happen naturally as she gets bigger, but it seems like that isn't the case since as she gets bigger she just takes more from the bottle. Given that she's caught up in weight, doesn't have tongue or lip tie, and is transferring what you say is enough per nursing session (about 2oz total), I'm not quite understanding where we go from here.

    Thank you for your help!

  5. #5

    Default Re: Baby doesn't empty breasts but still hungry

    The kellymom link was very helpful!

  6. #6
    Join Date
    Jun 2009
    Posts
    10,505

    Default Re: Baby doesn't empty breasts but still hungry

    Since she was below birthweight until almost 4 weeks I think the LCs were correct in giving us this plan to get her back up to birth weight, but what they failed to do was explain how to wean off this plan once she was caught up.
    I agree completely. When working on breastfeeding issues, things change very rapidly and what was a good plan on Tuesday may be no longer working by Saturday. This is why follow up appointments are vital but unfortunately are not done much at all.

    I think what would help a lot at this point is to realize that a one month old baby who is nursing normally nurses almost all the time, and then wants to be held the rest of the time. A baby will "act" like they want more when in fact they do not actually need more to eat. Also, many babies actually will get hungry again very quickly. So when baby appears hungry 10 or 20 minutes after nursing and seeming "done," a mom who is only nursing just nurses baby again. She is confident that her body is always making milk and baby will get what baby needs, comfort or more milk or both. The mom who is used to giving baby a bottle assumes baby is hungry and needs lots more to eat, and that the only way baby can get that is with a bottle. Well unless mom is not making enough milk, that is not what is happening. There is more milk and baby can just nursing again. A very good description of what this looks like and why this happens is in the book The Womanly Art of breastfeeding (8th edition) at the beginning of chapter 6. This is an excellent book I strongly recommend.

    Also while one breast usually produces more than the other, it sounds like your breasts may have a very great difference with one side actually being a pretty low producer, at least based on the before and after nursing check numbers. If you think that is continuing to be a problem, I have a couple suggestions for that. One, you could pump on the lower producing side after baby nurses to help that breast make more. 2) you could see if baby will nurse on that side twice each 'session."

    If you think the problem is a funky latch on that side, then you can keep working on latch to help baby transfer better on that side.

    In general the way to proceed is to encourage baby to nurse more and start supplementing less, while also making sure baby is getting enough to gain normally. Some moms get an infant scale so they can weigh baby often, once a day or a few times a week, and that works well for some. Also some moms actually do several before and after nursing weight checks every day to monitor intake. If you feel either of these is necessary to help you feel confident enough to reduce supplementing, you can try that. but I am not a huge fan of that. For one thing, home scales are not always the most accurate, also babies do not gain exactly such and such each day, there will be days of less gain and days of more gain. If your baby is pooping with normal frequency- several times a day- that can be a pretty good indicator baby is getting enough and then maybe you could take baby in to be weighed ever two weeks or so. Some babies start pooping less often after about 6 weeks even when they are getting enough to gain normally so do not panic if that happens. Make sure all weight checks are done on the same digital infant scale, baby in a dry diaper or naked, and that whoever is doing the check is not rushed or distracted.
    Last edited by @llli*maddieb; July 16th, 2017 at 05:15 PM.

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