Full Draining Block Feeding

[@llli*mbr21052]

Hi All -

My baby is 3 months old tomorrow and we have been having oversupply and forceful letdown issues from the beginning. In the hospital, baby fed one side per feed, and the LC thought that was fine. I have stuck with the one side per feed since then. Aside from the coughing, baby tolerated the forceful letdown until about 6 weeks. Then I pumped for 2-5 minutes before feeding (let down happens at the 3 or 5 minute mark, usually) and then baby tolerated feeds. I faded out the pumping, and baby did great until last week when she got angry at every feed and refused to latch after the 3 minute mark. After going back and forth with the doctor and LC, the only problems here are the oversupply and forceful let down (not reflux,etc.). Baby has gained weight really well - already doubled birth weight+. I went back to the pumping 2-5 oz before the feed and that went well, but we also recently started day care and baby is having trouble going from breast to bottle. Whenever she gets a bottle (and we have restricted to 1 bottle a day up until now), she resorts to getting angry at the letdown with me. Likewise, whenever I exclusively breastfeed with no bottles, she puts up a fight with the bottle. My LC suggested full drainage block feeding and I have been following the protocol as best as I can: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075483/. This is day 2 of 4 hour blocks with a single pump drainage in the morning. However, I still have to pump before each feed because she is not tolerating the let down. Anyone have any experience with this? The article suggests that blocks may have to be increased to 6+ hours. I am afraid to increase blocks beyond 4 as I don't want to risk clogged ducts, etc. At nighttime, baby does sleep between 5 and 8 hours straight. So there is at least 1 if not 2 stretches during the day where the block is longer. Any thoughts? If you have done this method, how many days did it take to regulate? I am keeping baby out of day care until we figure this out...Thanks in advance .

[@llli*esthervegan]

Are your breasts comfortably softer after nursing? Or are they always throbbing with milk? Is the let down so forceful that if you unlatch during a feed your milk hits the nearest wall? Some mothers are pre-selected by Mother nature to be the designated savior of the unfortunate infant who is motherless. A thousand years ago you would have been the person the village turns to to feed the infants/babies. Sometimes we can't out smart evolutionary adaptations.

[@llli*maddieb]

I do not have personal experience with this method, I had OP but managed to get through the worst of it without block nursing. But I am familiar with the idea and think it makes sense. The problem is, if you are regularly pumping a substantial amount before baby nurses, that is working against you- on the one hand you are blocking to reduce production, but on the other you are pumping which increases production. Also, if I recall the article correctly, I think doing the "full drainage" part once a day is not required, and is only to be done if needed?

It sounds like there are two things going on. One is overproduction, which is why a mom might do the block feeding or the FDBF in order to reduce production. The other is fast letdown, which can be handled many ways, but I assume is what you are doing the pumping before nursing.

Yes, fast letdown and OP are often related, and probably are related in your case. But the "cures" for each are not only different, in some ways they are diametrically opposed. Block feeding, as you have found, leads to an even heavier milk flow. (I have been pointing this out for years because block feeding is so often incorrectly suggested when there is no serious OP, only some problematic fast letdown.) But the problem is that the pumping before nursing is acting to increase your milk production further.

Of course, over time, if you can keep with the block nursing long enough, your milk production will reduce and that should also lessen the fast flow. But how long this will take and how long a block you will need to go is very individual. The breasts need to get full to get the message to reduce production. A mother with a very large breast capacity will not get full that fast, and may need to take much longer blocks and it will probably take longer to reduce production than a mom with a smaller breast storage capacity. And storage capacity is NOT the same as breast size.

Also, again, the pumping before baby nurses may make this process take much longer than otherwise, since it is giving your body a different message.

I have a few suggestions. One is, identify what is the most pressing issue. The fast flow, or the OP. For example, if you were experiencing severe engorgement even with baby nursing frequently, that might indicate that OP is the most pressing issue, and reducing production asap is most important. If baby is refusing to nurse due to a fast flow, than forceful letdown is the most pressing issue. If the most pressing issue is identified, then you can work on that one the most, or first.

If both things are pressing, you can try to split the difference. Fast letdown is usually helped most by encouraging baby to nurse very frequently and nursing in a reclined position (Laid back, with baby on top- sidelying also works for some.) Neither nursing position nor frequent nursing will act to increase milk production, so these methods are entirely benign when it comes to milk production. What if you tried those two things, while continuing the 4 hour blocks (or whatever time feels correct to you- and it might be different for each breast.) At the same time, instead of pumping directly before a nursing session, instead, when you start feeling very full on the "blocked" side, try hand expressing just a little bit of milk at that point- not directly before baby nurses but in between sessions? I suggest this because pumping right before baby nurses means that the breast is being more emptied when baby nurses than otherwise. The emptier the breast, the more the body is told to make milk. This is why frequent but "smaller" nursing sessions help. They will relieve pressure, so the letdown at the next session is not so bad, but will not send as strong a message to the body to make more milk as a more empty breast will. This (the "Empty breast = more milk made" part) is also why you might not want to do the "full drainage" part of FDBF every day, unless that is necessary.

What I am not getting at all is what any of this has to do with bottle feedings. Can you explain what the separations are like (Daily, or other, how many hours) and how much milk baby is expected to take during that time in bottles, and in each bottle? Is baby refusing to take anything while at daycare? How are bottles given, Etc. Also, when you say bottles were being restricted to once a day- Do you mean before or after you returned to work?

If you are back at work, maybe you could use that to your advantage if you need to reduce your milk production. That is X number of hours when fast letdown does not really matter, because you are pumping, not nursing. Right? So what if you use at least part of your work day as a time to "block" both breasts? It is the breast getting very full that decreases milk production, the only reason block feeding is done in an alternating fashion is so baby can eat at the same time one breast is being blocked. In other words there is no reason to not "block" both at once. Just be very careful, again, about getting too engorged. This is always a concern when block feeding. This is another time a little hand expression or a little pumping can help relieve pressure and prevent harm while you are still working on lowering your production with "blocking."

[@llli*mbr21052]

Hi! Thanks for your responses - really appreciate the advice/feedback

SO, my breasts don't feel majorly different from the beginning to end of a feed, maybe a little softer. The only time they feel different is when I am engorged and then have baby feed, they get soft. My breasts are never "throbbing" except when they are fully engorged.

I do not have the experience of milk spraying...the only time I have had that experience is when a clogged duct is unclogged. Otherwise, the milk ejection/forceful letdown is not shown externally. When my baby sucks, you hear it going down her throat/into her belly and you see it fill her mouth/splash out. When she detaches, the flow stops and then when she reattaches it returns to its strong state. I am unable to latch her, then take her off when the letdown happens to let it subside as it doesn't subside until she has sucked through it or I pump...does that make sense? It is not a typical letdown/milk ejection I suppose.

So, I did the FDBF again today, and it seems to have helped more. I drained this morning, and for the last 4 feeds I have NOT pumped before feeding and baby has tolerated. At the very moment, baby has been sleeping 9 hours. So, there may be an issue when she wakes with the let down, but I haven't decided if I should pump in advance of her feeding or not for an overnight feed. I just hate to have her get mad after a full night/empty stomach and suffer until the next feed.

Honestly, the overproduction (I am overproducing about 12oz a day - at least that is what I end up freezing) doesn't bother me. I am fine with extra milk. In fact, with my first child I had undersupply. So, I am very grateful for the over supply. My major most important issue is the fast flow as it upsets my baby. Second to that is the bottle feeding. So, what I was doing, was putting expressed milk in a bottle (4oz) and giving it to daycare. I drop baby off at around 9, work out, they feed her the bottle, and then I pick her up after I shower, etc. My preference would be for baby to feed between the hours of wakeup-8:30am-ish, and then after I pick her up from a full day at daycare (once that does happen, haven't done it yet...) at around 2:30-3. Which would mean she would be nursing from about 3:30pm everyday through the morning around 8:30. So, i would only be pumping 2-3 times a day, which could mean that the flow would continue to be a problem (though, if the way today went continues then we probably will be fine).

I definitely think you are right about frequent smaller feedings. I think that is what helped today - blocks with more frequent feedings. I ended up doing 4 hour blocks with feedings every hour-hour and a half. The question is will this continue....

As far as position goes, I have done EVERYthing.....we have done laid back, football, etc. our best position is side lying, which is my default.

Thank you again for your help/advice/feedback...much appreciated!!

[@llli*esthervegan]

Your baby is just 3 months old and she has alot of growing to do...she can learn to use her tongue and palate to adjust your milk flow to her liking. This is a learned skill that all babies (given enough opportunity) acquire. I used to say verbal affirmations to my baby and breasts..like "slow down, relax flow gently..." and I would visualize my baby sucking deep and correctly. As a side note ..a 9 hour stretch of sleep at night for a 3 month old is something I never experienced. My kids were night nursers all way up through toddlerhood.

[@llli*maddieb]

I am glad things went better today.

I agree with estervegan, if the issue is primarily the issue of fast flow, strategies for helping baby be happier at the breast can be most helpful and never cause any harm. Block nursing, on the other hand, will reduce your milk production, and so you have to be careful about that. This article on the dos and don'ts of block feeding may be helpful: http://www.nancymohrbacher.com/blog/...dos-donts.html

If your overproduction is not causing you any discomfort or health issues, I think it makes sense to be grateful for it. Many moms make more than enough the first few weeks or months and see production calm down without taking any steps to reduce it. Over time, milk production tends to adjust to meet baby's needs. If a mom is overproducing, then over time, her body is going to do the job of reducing production as needed, as long as it does not keep getting the message to make more than enough milk due to too much pumping. Pumping during separations is of course needed and appropriate.

Many moms find the return to work a time when they start seeing a reduction in production. Additionally, if a baby is regularly sleeping long stretches, (and mom is not pumping during that time) this will also act to reduce milk production. And in general, many moms notice a dip in production after 3 to 4 months. This is because the body is figuring out how much milk to make for this particular baby.

For bottles, I am not sure how long baby is being left at the caregivers right now. If it is just a few hours, there is no reason baby would take any amount of milk in a bottle. Baby may just not be hungry. Even if baby is used to nursing at that time, does not necessarily mean baby will take a bottle at that time. In any case, 4 ounces is on the large size for a bottle.

For when you are back to work, I suggest talk to the caregiver about bottle feeding the breastfed baby. http://www.llli.org/docs/00000000000...astfedbaby.pdf

[@llli*mbr21052]

MaddieB -

Thanks so much for the info! So, according to that article on nancymorhbacher block feeding can be a problem if the baby is gaining average weight. My baby is steady gaining between 6oz-1lb a week. She is HUGE. This did not happen with my first. My first was VERY tiny. Both started out at 6lbs and my first was only 8.5lbs at 3 months. This one is 13lbs 10oz at 3 months. In the article it says not to do block feeding for more than a week. However, I have been doing block feeding for 3 hour blocks since birth. So, switching to 4 hour block feeds is not that dramatically different and has not affected supply....at least not thus far. I am leaving baby at day care right now for3-4 hour blocks with 1 bottle. She seems to be willing to take the bottle from one of the teachers, but not well with all the others. I think you are definitely right on with that article how to feed a breastfed baby. I think this teacher feeds her like that vs. the others who do not. As far as the block feeding progress, baby has been doing much much better with tolerating flow on the 4 hour blocks. It seems that the only major issues are the first two feeds in the morning after she slept the night through and my breasts are engorged. Otherwise, she seems to tolerate the flow....

Thanks again for your help!!

[@llli*maddieb]

You are welcome. The reason for the block feeding precautions is because block nursing will reduce milk production. That is what it is supposed to do- it is why it is done. There is no other reason to block nurse. This is what is often misunderstood about it, and why some moms do it unnecessarily or for longer or more aggressively than needed.

It is certainly possible that for you, 3 hour blocks were not long enough to reduce production and 4 hours ones are. If a mom has a larger breast storage capacity, she will need to do longer blocks to see production reduce. Or maybe production and consequently fast flow is reducing now because milk production tends to decrease (if it was more than enough to begin with) over time anyway. If you are getting engorged overnight, that is also acting to reduce your milk production. Anytime the breast is allowed to become very full, that tells the body to reduce milk production.

I am not in any way saying do not block nurse, it is a great tool when used appropriately and it sounds like it is helping and that is great! I am just saying (to you and to anyone else reading this) that it is best to be cautious about it. It is easier to reduce milk production than to re-increase it.