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Thread: Post Frenetomy - Baby not nursing: Do I have to pump now?

  1. #1
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    Default Post Frenetomy - Baby not nursing: Do I have to pump now?

    Baby had laser today - dentist did her tongue and lip tie. She is in so much pain now, crying and unable to feed properly.

    Question for me is should I pump? Since she is hardly feeding (she goes on, sips a little and comes off crying)

    Heart breaks but also need to keep milk supply up. Should I pump?

    Will I get mastistis if I don't - the other thought is, I want a full breast so she can feed easier.

    Thanks

  2. #2
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Hi bunnyears. Yes, if your baby is not able to nurse often enough or effectively enough, you must pump or hand express to make up for that- not too much, but enough to remain comfortable, not getting "full" and to overall protect your milk production.

    I am not surprised that baby is having some issues nursing immediately post procedure, this is fairly common whether laser or scissors or scalpel is used to separated the frenulum. It is generally thought that baby has to "relearn" how to suckle now that they have tongue mobility and this is why some babies find nursing upsetting shortly after procedure. Also of course it is possible baby is upset in general after any procedure, even getting vaccines can interrupt normal nursing patterns significantly. But baby being in pain post procedure is not typical, and if this continues you will need to see whoever did the procedure ASAP to report this issue and to have baby re-examined.

  3. #3
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Quote Originally Posted by @llli*maddieb View Post
    Hi bunnyears. Yes, if your baby is not able to nurse often enough or effectively enough, you must pump or hand express to make up for that- not too much, but enough to remain comfortable, not getting "full" and to overall protect your milk production.

    I am not surprised that baby is having some issues nursing immediately post procedure, this is fairly common whether laser or scissors or scalpel is used to separated the frenulum. It is generally thought that baby has to "relearn" how to suckle now that they have tongue mobility and this is why some babies find nursing upsetting shortly after procedure. Also of course it is possible baby is upset in general after any procedure, even getting vaccines can interrupt normal nursing patterns significantly. But baby being in pain post procedure is not typical, and if this continues you will need to see whoever did the procedure ASAP to report this issue and to have baby re-examined.
    Thanks maddieb!

    In the mornings I now again have very over active let down and baby struggles with this. So I will just pump a little (as I presume this let down "volume" is caused by my prior pumping of 20-30 minutes)

    If I just hand express to get comfortable, this should still be enough for milk supply? I had read from kellymom that I was supposed to pump for 5 minutes after my breast is empty to tell my body to make more. But I am back on the domperidone for now. (high dosage) and this seems to be helping.

    Yes, baby is in pain, but the dentist told us that the baby would be - I asked, "Wll she be in pain and for how long?" and he said "Well if I could ask her, I'd tell you but look this is surgery..."

    (It is laser. He told us to give her Ibuprofen for a few days)

    Thanks again for your reply.

  4. #4
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Pumping v. hand expression- It does not matter how you take the milk out of the breasts...what allows for milk production to be normal is the milk being removed frequently and effectively. Many moms find hand expression works well, others pump, others combine the two. Of course if baby is nursing and getting enough to eat by nursing, then there is usually no reason to do any other milk removal, unless it is to have a stash for a later time or for mom's comfort when needed.

    This specific instruction:
    I had read from kellymom that I was supposed to pump for 5 minutes after my breast is empty to tell my body to make more.
    is for mothers with low or borderline milk production, and pumping is the prime way that they remove milk or they are pumping on top of nursing to increase production. I should add that this is kind of an older recommendation and I have no idea if there is any evidence to back up the idea that pumping after no more milk is coming out is helpful in increasing milk production. Certainly this would not be needed in all cases, because frequency of milk removal also matters. Also of course you could do the same if hand expressing (continue to hand express for a few minutes after the milk is no longer flowing.)

    It sounds like your baby is struggling with fast flow part of the day? Usually fast flow is related to high production. Now fast flow can happen if milk production is not high, usually in that case it would be due to baby not nursing often enough or there being a long stretch of no nursing prior to the session baby struggles at. Additionally, a baby who is having a hard time getting a good latch or organizing their suck/swallow pattern or having difficulty with tongue movement when nursing etc. might struggle with flow due to that, not due to it being particularly fast. But if you think it is related to higher production, remember there is no such thing as part time high production or part time low production. Milk production does ebb and flow a bit over the course of the day, but these are minor fluctuations. Either there is enough milk overall for baby, and baby can get the milk out in appropriate amounts, or not.

    Hope baby feels better soon!

  5. #5
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Quote Originally Posted by @llli*maddieb View Post
    Pumping v. hand expression- It does not matter how you take the milk out of the breasts...what allows for milk production to be normal is the milk being removed frequently and effectively. Many moms find hand expression works well, others pump, others combine the two. Of course if baby is nursing and getting enough to eat by nursing, then there is usually no reason to do any other milk removal, unless it is to have a stash for a later time or for mom's comfort when needed.

    This specific instruction: is for mothers with low or borderline milk production, and pumping is the prime way that they remove milk or they are pumping on top of nursing to increase production. I should add that this is kind of an older recommendation and I have no idea if there is any evidence to back up the idea that pumping after no more milk is coming out is helpful in increasing milk production. Certainly this would not be needed in all cases, because frequency of milk removal also matters. Also of course you could do the same if hand expressing (continue to hand express for a few minutes after the milk is no longer flowing.)

    It sounds like your baby is struggling with fast flow part of the day? Usually fast flow is related to high production. Now fast flow can happen if milk production is not high, usually in that case it would be due to baby not nursing often enough or there being a long stretch of no nursing prior to the session baby struggles at. Additionally, a baby who is having a hard time getting a good latch or organizing their suck/swallow pattern or having difficulty with tongue movement when nursing etc. might struggle with flow due to that, not due to it being particularly fast. But if you think it is related to higher production, remember there is no such thing as part time high production or part time low production. Milk production does ebb and flow a bit over the course of the day, but these are minor fluctuations. Either there is enough milk overall for baby, and baby can get the milk out in appropriate amounts, or not.

    Hope baby feels better soon!
    MaddieB

    Thank you!

    I was just coming back to add some comments and you've already commented on them!

    I was going to tell you that in the afternoon and night, there is no fast flow issue and then I have to check that she is getting enough.

    In the night, she sleeps for 5 hours then 3 hours, so it's more of a build up as you say... ha. And also yes I think she is still sucking the same way (based on last few times).

    I just hope I have enough for her. At the very beginning when she was on the bottle I was pumping but with an older pump that was not effective, nor was I too diligent (I assumed all this stuff would be simpler) so I think I did have lower milk production.

    Thank you again for your comments.

  6. #6
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Quote Originally Posted by @llli*maddieb View Post
    Hi bunnyears. Yes, if your baby is not able to nurse often enough or effectively enough, you must pump or hand express to make up for that- not too much, but enough to remain comfortable, not getting "full" and to overall protect your milk production.

    I am not surprised that baby is having some issues nursing immediately post procedure, this is fairly common whether laser or scissors or scalpel is used to separated the frenulum. It is generally thought that baby has to "relearn" how to suckle now that they have tongue mobility and this is why some babies find nursing upsetting shortly after procedure. Also of course it is possible baby is upset in general after any procedure, even getting vaccines can interrupt normal nursing patterns significantly. But baby being in pain post procedure is not typical, and if this continues you will need to see whoever did the procedure ASAP to report this issue and to have baby re-examined.
    Maddieb

    Do you know if lactation consultants can help with the "relearning" - and if there is a good chance of success? My LO is quite set in her ways and doesn't open her mouth wide and often "settles" at the nipple.


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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Yes, a LC should be able to offer help to baby and mom that would hopefully result in more effective latching in any situation. Specifically for tongue tie I have heard there are post operative exercises that can be done but I do know anything else about that. If you cannot contact your LC right now (or even if you can) you might want to talk to the dentist about what they recommend as far as any aftercare exercises and also about any gentle manipulation to help prevent scar tissue from forming to the extent tightening occurs again. Sometimes this is suggested and sometimes not is what has been reported here over the years.

  8. #8
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Thanks maddieb - I will ask this dentist about it and talk to another LC while the one I am working with is away.

    One additional question - my baby slept 8 hours for once today. I leaked on my bed, but what I am worried (as usual) about is the milk supply again.

    You mentioned that I can pump/express if too full but only until it is less uncomfortable. When I woke up my breasts were full and hard but not uncomfortable.

    However, with this long a stretch (and remembering that the body makes milk when it is necessary and that being full can send a signal for it to stop), do I have to worry?

    eg. should I get up and power pump - I actually pumped one breast after the 8 hour stretch and even though she hardly drank from that breast I only pumped out 30mL (one ounce) - which again leads me to worry (I pray this worry cycle ends soon )

    Questions, more concisely, are:

    1. Will an 8 hour non feeding stretch like this affect my milk supply
    2. What strategies should I be taking to address point 1
    3. IF baby is still not withdrawing effectively, and in general I stop pumping altogether, is expressing until breasts are comfortable sufficient? Or should I be following advice to try to empty breasts completely i.e. pump (I guess I would love to stop pumping if I can - and I am also renting a Symphony, which is expensive and would like to know if it's safe to stop at some point)

    Thank you very much

  9. #9
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    1. Will an 8 hour non feeding stretch like this affect my milk supply
    Milk production is simply not that fragile. We would never have survived as a species nor would any other mammalian species have survived if (biologically) the only way to feed our very young were this fragile. There is no reason to worry about any ongoing hit to milk production due to one long stretch of not nursing. The only immediate concern in such a situation would be you getting a plug or mastitis. Since you leaked, that would act to prevent that from happening to some extent. This is why leaking can be good.
    2. What strategies should I be taking to address point 1
    long sleep stretches here and there are probably nothing to worry about, however, it would be very early for you baby to naturally be sleeping this long frequently or every day. If baby is falling into this pattern, know that you can always wake your baby to nurse as much as you like. It does not hurt your baby to do this, and in fact they may be able to nurse in their sleep if you just make the breast available. Also check that you are not using or overusing sleep lengthening strategies- pacifiers, swaddling, top off bedtime bottles, or baby sleeping in a separate room from you.

    . IF baby is still not withdrawing effectively, and in general I stop pumping altogether, is expressing until breasts are comfortable sufficient? Or should I be following advice to try to empty breasts completely i.e. pump (I guess I would love to stop pumping if I can - and I am also renting a Symphony, which is expensive and would like to know if it's safe to stop at some point)
    It would depend on how ineffectively baby is nursing and how often you pumped, (or hand expressed) it also would depend somewhat on how large a storage capacity you have in your breasts- and this has little to do with visible breast size. A mom with a larger storage capacity can go longer without the milk build up harming production. This is why how the breasts feel is a more accurate measure overall about if milk removal is happening frequently or effectively enough. But most moms stop feeling full at some point anyway, usually between 2-4 months, or rather only feel full when there are any unusually long periods of no milk removal. This is normal and does not mean there is anything wrong with production.

    I am sorry I cannot be more specific but it is really impossible to be specific when every mom is physiologically different and in fact every baby is in need of different amounts of milk to gain normally! Left alone, with baby able to nurse as much as baby pleases, unless there is some pathology going on that is harming milk production, each mom and baby pair (called the nursing dyad) come to a balance where they match each other. Mom makes what baby needs and baby nurses well and often enough to maintain that amount. Simple, really, so simple that you do not have to worry about it.

    Also FYI milk production does not need to increase as baby ages. If a mom is making enough overall daily for baby at two months she never needs to make any more than that. This is mostly because as baby gets bigger, gain rate slows. So caloric intake needs do not change (after about age 5 weeks.)

    I am not convinced there is anything wrong with your milk production. Unless baby is needing supplements of your milk or formula to gain normally, then you make enough milk and baby is getting enough milk when baby nurses. In that case, it is most likely that no pumping is needed to maintain "enough" milk production. None at all. Why you would wean gradually off pumping in that case is simply to play it safe.

  10. #10
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    Default Re: Post Frenetomy - Baby not nursing: Do I have to pump now

    Quote Originally Posted by @llli*maddieb View Post

    I am not convinced there is anything wrong with your milk production. Unless baby is needing supplements of your milk or formula to gain normally, then you make enough milk and baby is getting enough milk when baby nurses. In that case, it is most likely that no pumping is needed to maintain "enough" milk production. None at all. Why you would wean gradually off pumping in that case is simply to play it safe.
    Thank you maddieb! All this information you share is v.helpful and accepted gratefully.

    FYI I am not using any of the sleep lengthening strategies. However, and this is related to my milk concerns (paranoia ), the baby - each night at around 6:30pm or 7pm mostly, will want to nurse. She nurses for 2 hours at this point. I guess this is related to bottle top off (our baby doesn't accept bottles but I presume this is feeding the baby more at night to keep them full)

    At one point, people told me it was a cluster feed but she does this very regularly.

    Tonight, I told my DH that I had no more milk for her, based on my breasts and the time she had been on it. But when I squeezed there would be at least some drops that came to the surface. She stayed on for 2 hours again and then is now in bed.

    Right after, I pumped for 20 minutes and had e 0 drops of milk so this time the baby really did clear it all out. This is rare, i.e. when I pump at night, there is usually milk.

    Ergo, this is also why I suspect my milk production is low (although I fully take on board and trust you, I want to give you this information in case this might change your perception - would it? : [And you are right in that she appears to be still gaining normally - albeit on the lower end but still healthy]) I think I feel like I have low milk supply based on history but also because she stays on so long at night times, and I suspect it's because there's not much so she keeps sucking and sucking?

    maddieb, the baby nurses quite often still, but the night one is really tiring for me - also very often, she seems to just suckle at the breast, or falls asleep. Should I be stopping this behavior somehow? Are these bad habits or is it natural baby behavior? I am looking forward to having more time for myself again too.

    Thank you again, I am very grateful, maddieb.

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