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Thread: Looking for pumping and pooping advice

  1. #1
    Join Date
    Jun 2006
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    7

    Default Looking for pumping and pooping advice

    Hey there! I appologize if this becomes long, but I am really at the end of my rope and need some help! My daughter is 8 days old today. She was 7lbs 1 oz at birth and dropped down to 6lbs.7 oz last week. She became very jaundiced--almost requiring a transfusion-and was hospitilized over the weekend. She is my third BF'd baby and my third to have jaundice issues. I did have some latch and supply issues with both of my boys but I managed to nurse both of them for a year.

    There are three main problems I am dealing with. First, is her slow weight gain. She was 6lbs. 9 oz, yesterday at her weight check/bilirubin check. My pedi is very BF supportive and wants me BF but he also wants to her gain weight. The other issue is that at 8 days her poop still hasn't transitioned to BF poops. It is still very black, a little runny with a few seeds in it at times. As a result, her bilirubin levels are not dropping like they should and the pedi has "threatened" to put her back in the hospital. She has been having 8-10 very wet diapers a day so I know she is getting milk--and I really don't think there is a supply issue at this time. He is convinced that I am having supply issues because of the dark poop.

    The pedi and the LC have both said to supplement after BFing-preferably with EBM but to use formula if I have less than an oz. of EBM. So my third issue is that I have always been a "poor" pumper. I have a brand-new PIS and have been pumping for 5 days now. I have tried pumping one side while she nurses, pumping after a feeding and pumping in between feedings. The most I get from a side is 1/4 oz. I just can't seem to get the let-down to "work" with the pump. I have been working with a great LC but she didn't really have any other suggestions. So I am now supplementing with what little EBM I have and formula.

    Does anyone have any experience with the poop issue? Is it really a supply issue? Any tricks for getting more with pumping? You would think that by #3 I would have this all down, but I am really getting frustrated and am about ready to just give in and give her a bottle(we have been using a SNS so far) so she will hopefully gain weight and start pooping.
    TIA, Stacy

  2. #2
    Join Date
    Feb 2006
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    1,168

    Default Re: Looking for pumping and pooping advice

    Hi Stacy -- this sounds stressful; but it sounds to me like you are really on top of the situation and are doing a great job researching your options and working with the pediatrician and the LC to solve this problem.

    The frequent wet diapers are one indication that baby is getting enough milk. The other indications that we look for are: frequency of feeding; frequency and quantity of poops; and weight gain over time.

    How many times has your daughter nursed in the past 24 hours? Since you've successfully nursed two previous children (bravo on that, by the way -- lucky babies!), I'm sure you know what a good feeding looks and feels like -- baby latches in a way that is comfortable for you, goes from short rapid sucks to longer sucks with audible swallows or breaths between; baby comes off the breast on her own satisfied; there may be some sensation as your milk lets down, or your breasts may feel softer. We want to make sure that she is not only nursing often but is also effectively transferring milk when she nurses.

    How frequent are the poopy diapers? You mentioned that they are still very black, but also a little runny and sometimes with seeds in it. It is concerning that at 8 days of age, her poops are still so black. But, the runny texture and occasional seeds are a sign, I think, that things are moving in the right direction. Pure meconium is usually a thick and tarry texture, not runny, and no seedy stuff.

    Would you describe your daughter as being sleepy and hard to wake for feeds? This is something that often goes along with jaundice, and it can become a bit of a vicious cycle, making it harder to get enough food into her to clear out the bilirubin. The goal is to have at least 10-12 good feeds in every 24-hour period -- which means that at least two hours after the start of the last feeding, you need to get her to breast, including through the night for right now.

    As for the pumping -- it is not surprising or unusual that your output is only 1/4 oz. at this point. Pumping is sort of a learned response, and I'm sure you are very tired and stressed also, which may interfere with the letdown required to express milk. It's good that you are using a brand-new PIS, but if it is determined that you do have a real case of low milk supply, you might try renting a hospital pump instead, as they are even more efficient at building supply (I think b/c the motor is more powerful, but I could be wrong about that).

    As for the possibility of another hospitalization (I'm assuming this would happen only if her bilirubin levels stay high or go higher) -- in some places a new techniques for phototherapy are available that can be done at home, either with a portable machine or with a special blanket that can be wrapped around the baby so she can be held and nursed during light treatments. You might ask the LC and your pediatrician if this is an option; I'm sure you'd rather be at home if that is possible.

    Sorry for this very long response; let us know the answers to the questions above, and we'll go from there.

    --Rebecca

  3. #3
    Join Date
    Jun 2006
    Posts
    7

    Default Re: Looking for pumping and pooping advice

    Thanks for the response! In reply to your questons:
    She is nursing at least 10 times a day--more if you count the cluster feedings in the evening(usually wants to be on the breast for 2 hours in the late evening). She is getting at least 4-5 let-downs per side, sometimes though I have to use breast compression to keep the flow going. Most times she falls off the breast looking satisfied, milk visible in her mouth, etc...I have never had true engorgement but my breasts do feel full and uncomfortable before nursing and they are softer after nursing.

    She has not been excesively sleepy with the jaundice. My second son I could barely wake-up but she has been pretty alert through all of this. A little breast compression is usually enough to keep her interested and drinking.

    She has been pooping 1-2 times a day, usually back-to-back in the late afternoon. She did poop overnight and it was very runny with seeds but was still a dark green. It is not the thick, sticky meconium that she had early on but it is dark.

    A part of me wants to take her in for a weight check today but I am afraid that if she isn't gaining it will just be one more reason the pedi will try to push more supplementing. Yesterday she had a total of 3 oz of formula, 2 1/2 oz of EBM in addition to BFing. Each time I tried to supplement it was like I was force feeding her. She really wasn't interested but she did eventually take it.

    Maybe I am just getting upset over nothing, but this pooping issue is really hard to deal with. However, even with the extra formula she isn't pooping anymore than she did on days without it--not sure if it is helping or hurting. It is just frustrating that the pedi and LC both assume it is a supply issue--kind of take that personally, if you know what I mean.
    TIA, Stacy

  4. #4
    Join Date
    Feb 2006
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    1,168

    Default Re: Looking for pumping and pooping advice

    Oh, I totally know what you mean. Like they are so sure of their "diagnosis" that they are overlooking indications to the contrary (the frequent nursing and frequent wet diapers).

    One to two poops per day is on the low side of what we like to see in an 8-day-old newborn. If that has been her pattern all along, that may be the reason that she has been slow to clear the meconium and bilirubin and slow to transition to breastfed poops.

    I've read that infrequent poops may be linked to ineffective nursing -- the sucking and swallowing action tend to trigger the bowels to move, and if the baby isn't nursing well, then as a result she may not be triggering her bowels to move. You're an experienced nursing mother -- does anything about her suck technique or pattern feel "off" to you? She's getting enough milk, it seems, but perhaps that is due to your abundant supply and easy letdown and not due to her ability to milk the breast effectively.

    I'm just guessing here -- we've run smack into the limits of messageboard support. It's impossible for us to evaluate what we can't see. But I will hunt around a little, and if I find any good links that explain this connection, I will share them with you so that you can discuss it with your IBCLC.

    In the meantime, I'd keep up the pumping, and continue supplementing your EBM with formula just for now. Your output at the pump is not at all shabby for 8 days postpartum, and it will increase if you keep at it (which will let you drop the formula and keep your options open if you and your team decide to continue supplementing.) Keep track of her diapers, wet and dirty. It sounds to me, with that dark green runny poop, as if she is finally turning the corner on the jaundice thing, but you'll want to keep any follow-up appointments with your healthcare team to verify that.

    --Rebecca

  5. #5
    Join Date
    Jun 2006
    Posts
    7

    Default Re: Looking for pumping and pooping advice

    Thanks for the reply! Initially she did have a tendency to "slide down" on my nipple, which quickly resulted in sore cracked nipples and I am guessing she did not get as much colostrum as she could have. I chalk that up to my extreme fatigue and the fact that since I was an "experienced" BF'er, the LC didn't stop by to see me until right before I was discharged.

    I have since changed her latch to the "assymetrical" latch taught by Newman. It has made a huge difference in my comfort(and my nipples are finally healing) and she still seems to be getting a lot of milk at each feeding. Her suck-swallow seems to be the same as my other children--probably a little stronger and she has/had a tendency to bite down at times(mainly to stop the flow of milk).

    A couple of things that I am wondering: Could I truely have a foremilk/hindmilk issue? I wonder because I have been losing weight like crazy this past week. I am 10 days PP and I have 1/2 lb until I am at pre-preg weight(18 lbs lost in total). With my others I actually gained weight in the first few weeks of BFing but this time I am just losing. I am eating and I try to make everything as healthy as possible but maybe this is effecting the quality of my milk? I really haven't been able to pump enough to see any separation of the "cream".

    She has been very alert today, two seperate hour long periods where she was quiet and alert after nursing so I think she is getting past any sleepiness that the jaundice may have been causing. She also had one more smaller, runny, slightly lighter green BM this afternoon. We have also been putting her in a sunny window every chance we get(we have had lots of rain this week).

    I really appreciate the replies and support. Who would have thought that something so "natural" could cause so much stress!!
    Stacy

  6. #6
    Join Date
    Apr 2006
    Posts
    4

    Default Re: Looking for pumping and pooping advice

    Stacy, we are experiencing the same thing with our one-week-old son. The seemingly good nursing, jaundice, and strange bm's. Can you rent a Wallaby blanket from a medical supply place? This is helping to reduce our son's jaundice slowly, but surely in the comfort of our own home.

    In researching jaundice I've found that it is moved from the body by urine and by bile. I am beginning to wonder if the strange bm's have anything to do with too much bile in them in order to help move the bilirubin out of his system. I plan on asking the pedi. tomorrow when he calls with the next test result. I've described the bm's to him before, but he's said he isn't concerned yet and wants to see what happens when his levels are more normal.

    I wish you the best with your little one.

    Dawn

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