Is breastfeeding just not possible at this point?

[@llli*mindylane]

Hi. I just had my baby 4 days ago on the 19th. I really wanted to exclusively breastfeed and as a NICU nurse, I felt pretty confident that I'd be able to. However, it has been nothing but frustration.

I thought he started out ok; he'd latch and suck but would get frustrated. I saw lactation at the hospital and she made some suggestions so I thought we'd be good. He ended up losing 8% of his weight by day 2, but they were fine with that. He started getting more and more frustrated with every feed, even though I was feeding him pretty much on demand... usually every 2 hours. We assumed he was cluster feeding.

By the time he saw the pediatrician, he had lost 13% of his weight and it turns out I was just literally starving him. The pediatrician suggested supplementing with formula until my milk came in. I was really against it but also didn't want him to lose more weight. My husband fed him maybe 3 bottles over the course of 24 hours and I started pumping. I first pumped .7mL, then 4, then 12. But he would still take 35-60mL from the formula each time.

I woke up this morning and my breasts are wildly engorged. They are so incredibly painful and I guess that's why he was getting so frustrated. The milk is there but it isn't making its way out. I'm trying hot compresses, massage, pumping every 2 hours... I'm barely getting anything out and they're rock hard and painful.

We saw the pediatrician again this morning. Of course he gained a ton of weight. Thanks to the formula. Now he'll only take a bottle and refused to breastfeed with his last feed. I'm pumping right now and it's no better than the last pump. He's finally sound asleep because only formula will calm him down. I'm pretty convinced that I should just quit trying at the moment. Any suggestions or is it reslly just not going to happen? Thanks.

[@llli*maddieb]

Hi mindylane, I am sorry you have been having a difficult time.

So, of course breastfeeding is still possible! Oh my gosh, baby is only 4 days? Many newborns who do not nurse at this point nurse fine later. Some babies take many weeks before they are able to latch and nurse. However there is no reason to think that will be the case here. I think you are set to get baby nursing just fine in the next few days because baby has shown they can latch and nurse and you are making milk.

First I would suggest see the appropriate professional for the issue you are having. Your baby is refusing to nurse, or for some reason cannot nurse effectively. The professional trained to help in that circumstance is not a doctor but a board certified lactation consultant (IBCLC.) Here is an article about what to expect at an appointment with an IBCLC: http://www.cwgenna.com/lconsult.html

As long as baby is not nursing, it is imperative that you pump at least 8 times in 24 hours. Some moms find hand expression works better, or you can alternate. It does not matter as long as the milk is being removed effectively and frequently somehow. Please, I beg you, try not to worry about how much you get out when you pump. It is never much at this age, it is not supposed to be! Also pumps are not babies, they are a substitute and even the best ones may not do what a baby can. And what a baby takes in a bottle is totally irrelevant.

OK, let's talk about weight gain. Typical weight loss shortly after birth is about 7%-10% of birth weight, although some babies lose more initially and are fine. This percentage assumes weight at birth was accurately measured and weights afterward also accurate in relation to birth weight. If different scales were used, as is common, the checks may not be accurate when compared, also, any little error in calibration or human error can throw weights off as well. It would be interesting to know about baby's output in the first few days (before the formula.) Was baby pooping at all? Your baby nursing lots and not appearing "satisfied" is entirely normal.

13% weight loss in first- what- 3 days? would indicate something was not right, either that baby was not getting enough milk, or the weight checks were off, or a combination. What I do not understand is how one check showed 8% weight loss and the next 13- all in the space of less than 4 days! To me this may indicate scale error. In any case, can we please refrain from using the word starving? You are an experienced nurse and I do not believe for one minute your baby was starving without you realizing it. I think having your baby show this loss and being put on bottles of formula exclusively (rather than as a supplement to nursing) hurt your confidence, and that is going to be the hardest thing to fix. You can start by not thinking that you were starving your baby! You are a good and loving and competent mom and would do anything for your baby. This is all just really new to you and I am sure you are very stressed. It gets better I promise!

Usually by 4 days, a baby has stopped losing weight and has just started to gain. So most babies would still be well below birthweight at this point, what is typically expected is that baby be back to birth weight by day 10-14, obviously it takes a little longer if baby lost a lot initially.

So if your baby has gained a "ton" in a day or so, then he perhaps is being overfed with the formula?

Overfeeding is likely to make a baby disinterested in nursing. At this age it is very difficult to not overfeed with bottles which is why alternatives to bottles may be appropriate. You can also learn paced bottle feeding if you prefer to use bottles.

Babies need to suckle and sp they will tend to drink everything in a bottle whether they need it or not. Formula is not what your baby needed to settle. Formula is not a magic potion that is better than your milk. Newborn babies need to eat at least 10-15 times in 24 hours so they usually are not sleeping long and can be quite fussy for many reasons. That is all normal.

While It is possible baby needed more to eat, that is different than saying baby needed to be switched to formula entirely. Now that your milk is (right on schedule) "coming in" then it is very possible you make enough for baby or will very soon.

I'm pumping right now and it's no better than the last pump

Is this pump a rented "hospital grade"? Also be aware that being engorged is likely to make it harder for the pump to extract milk.- the milk is in there, but the pump cannot get it out! Again I suggest try hand expression, it may well help. Some moms find they can relieve engorgement by getting in the shower and just massaging milk out. Also you need someone who knows what they are doing to watch you pump and make sure the flanges fit you properly.

And keep encouraging baby to nurse! This can be done by simply holding baby skin to skin, snuggled on your chest, and when baby stirs in any way, immediately help baby to the breast. If baby is sleeping a long time, wake baby up and immediately offer the breast. Also, offer the breast while baby sleeps! There is no way a couple days of bottles made your baby no longer want to nurse. Nursing is a biologically enforced compulsion in the newborn. If baby is not nursing now, I think that the possibilities are that baby is being overfed and consequently so full baby is just not interested, or baby is having trouble latching (very common for this to occur when the breast gets very full from all that milk.) This is what an IBCLC can help you with. If you cannot see an IBCLC, are there any volunteer groups around you can call? I am happy to try to help from here, but trust me, I have been there and hands on help is going to get you and baby back on track the fastest.

Here are a couple good articles that may help. latch and positioning: http://feedthebabyllc.com/latch-and-positioning/ and http://www.llli.org/docs/00000000000...astfeeding.pdf
Baby who is refusing to nurse: http://kellymom.com/ages/newborn/nb-...ack-to-breast/
Feeding the non-latching baby http://www.llli.org/docs/00000000000...ching_baby.pdf
and good video on paced bottle feeding. The LC gives a great explanation to have it loud enough to hear...baby in video cries at first but calms down quickly. https://www.youtube.com/watch?v=ykdFuEOIdeE
other alternative feeding methods: https://www.youtube.com/watch?v=vrrrC5NyNnQ
Cup feeding: https://www.youtube.com/watch?v=fCyWvcsdYOE

[@llli*maddieb]

Oh for the severe engorgement you might try cold (or very cool) compresses directly on the breasts, and heat only on your back and shoulders if you are finding heat helpful.

If you had IV fluids that can cause edema and that can make the breasts even harder and more swollen. As I am sure you know edema like this will pass in a few days.

Here is more info on hand expression: http://www.llli.org/docs/00000000000...expression.pdf and video http://med.stanford.edu/newborns/pro...sing-milk.html

Engorgement: http://kellymom.com/bf/concerns/mother/engorgement/

If baby cannot latch well or at all due to the engorgement, a nipple shield may help as a temporary measure. More: http://kellymom.com/ages/newborn/nb-...s/wean-shield/

Also I forgot to mention reverse pressure softening, which is often helpful when trying to get baby latched onto an engorged breast. Here is more info: http://kellymom.com/bf/concerns/moth...oft_cotterman/

[@llli*djs.mom]

4days is really early to give up. It sounds like your milk just came in right now. And they aren't supposed to gauge the weight until you are a lot farther in then 4days. They dont' expect the baby to be back up to birth weight until the week point? Maybe the 2 week point? And a newborn can live just fine on Colostrom alone for days. My milk didn't come in for 5 days. I nursed on demand and he was fine. Although that 1st 5 days he didn't gain anyweight. My nurses werent' alarmed so neither was I. They said as long as he had wet diapers we were fine. He did. I didn't trip. Cluster feeding isn't every 2hours. That's NORMAL day to day breastfeeding. Cluster feeding is the baby wanting to feed non-stop for hours. Like every time you try to take the baby off the breast, the look like this Wide eyes wide mouth. It happens in the very beginning when they are working to get your milk to come in and every time they have a growth spurt and they are working to get your supply to increase due to their growth.
Don't confuse the way formula works for satisfaction on the part of your baby. Formula is not as easily or as completely absorbed as breastmilk. It is harder for babies to digest, it takes longer and creates more waste. So, the baby DOES go longer between feeds but those are the reasons.
Nipple confusion is real. And it sounds like your baby might have it. But at 4 days old you can totally get your baby back on track. Have a nurse in. Stay skin to skin with the baby in bed all day. Have your breasts out so the baby can smell the milk and has access all day long. Let the baby nurse while sleepy or sleeping. Babies are hard wired to nurse. Even a baby that is protesting or striking will usually latch on and suck when they are sleepy or sleeping.
Breastfeeding is natural. That doesn't mean it's easy. It's hard and overwhelming in the beginning for most new mothers. It's time consuming. That is the way nature intends it. The more time the baby spends attached to the mother or on the mother in the 1st weeks the better the baby's chance of survival. It's when you and the baby get to know each other and find your groove. That is how it works. You wake up and get the baby and spend all day feeding the baby. For weeks. That's it. Feed the baby. I think it's important to know that and wrap your mind around THAT as your new normal if you want to make it work. Because new mothers OFTEN fall victim the idea that they aren't making enough milk or that their baby isn't satisfied because of how often newborns want to eat.
Kellymom has good info on weaning off of formula supplements. http://kellymom.com/ages/newborn/nb-...rease-formula/
This is an article of what newborn nursing looks like: http://kellymom.com/hot-topics/newborn-nursing/
Good luck. You CAN do this. But I think it will take a little adjustment on the idea of what is normal now.