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Thread: Pumping/night feedings and increasing supply

  1. #1
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    Jun 2006
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    Default Pumping/night feedings and increasing supply

    SORRY THIS IS SO LONG!

    Hi, we are in trouble as my 6 week old son has put on only 5 oz in 2.5 weeks (he’s now 8 lb 8 oz) and my pediatrician has diagnosed me with low milk supply. My poor son has to suck so often before he swallows, he either gets very frustrated or he falls asleep and feedings go on forever – or until I stop them. If I double pump an hour after feeding him I get only 1 to 1.5 ounces. I have been taking Mothers Milk Plus for 3 days but it doesn't seem to have had much impact. I just began to supplement him with formula because the poor child is clearly distressed, but I want to get my milk back up and phase out the supplements, so I would appreciate any advice on these two issues:

    First, how should I fit in the pumping? I always thought I should pump after a feeding, but I have just been advised to do it before, because the baby is more effective than the pump. True, I’m sure, but I’m terrified of frustrating him further and making him reject the breast. I can pump one breast while feeding him on the other, but one breast doesn’t give him very much. Also, how often should I pump?

    Also, I’m concerned that (although I basically feed him around the clock for most of the afternoon and evening) the fact the baby is sleeping for 5-6 hours at night is having an impact. He does that because we give him 2-3 oz of expressed milk in a bottle beforehand. Of course we love the fact that we can get some good rest, and the pediatrician says that I need rest to have a decent supply, but I’m still concerned. Should I be waking him up or pumping during the night? (Pumping would be easier because the way feedings are now, they go on until I stop them as baby keeps waiting for more).

    I would so appreciate your advice!

    dri

  2. #2
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    Default Re: Pumping/night feedings and increasing supply

    Hi DRI,
    I can tell that you are very concerned about your ds. I hope I can give you the information and support needed to get you over this rough patch.

    Could you please tell me ds's weights? (birth, lowest, any other weight checks to present).

    What type of pump are you using? New or used?

    What are your goals at this point with nursing? (Exclusive for 6 months, at least a year, etc)

    How do you know when ds needs to eat? What are the feeding cues he shows?

    How do you know when he is finished? When to take him off?

    Without the answers to these questions, I would still suggest pumping after every feeding and giving the pumped milk via whatever means you wish (bottle, cup, dropper). Waking him to nurse during the night might help (depending on how often he is nursing otherwise). Only you can gauge whether or not you are up for this. Some moms in your situation find they need a few hours away from the nurse/pump/feed routine which can become tiring. It is hard for me to know what to suggest until I hear how often you are nursing/pumping right now.

    Are you in touch with a local LLLL or lactation consultant? If you need helping finding someone just let me know.

    I will wait for your responses.

    Take care,

  3. #3
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    Jan 2006
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    Default Re: Pumping/night feedings and increasing supply

    I was too quick to click "post". I also wanted to suggest breast compressions at every feeding. These can be very effective. Here is a link:


    http://www.kellymom.com/newman/15bre...mpression.html

    (not LLL source)

  4. #4
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    Jun 2006
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    Default Re: Pumping/night feedings and increasing supply

    Hi, Kate, thanks so much for your quick response!

    His weights were as follows:

    Birth - 7lb 4oz
    4d - 6 15
    14d - 7 13
    21d - 8 3
    31d - 8 5
    39d - 8 7

    In the couple of days after he was born he lost more than 10% of his birth weight and so the hospital recommended that we supplement him. We supplemented him until around the 14th day, and in the first week after we switched to exclusive breastfeeding he had good weight gain, but then it fell sharply. (In case it’s relevant, I should point out that I am 5`4” and my husband only 5’3”. My mom also says that I had very slow weight gain as a baby.)

    I am using a Lactina Select, used. I was renting one but then bought a used one. The one I bought is faster than the rental one, which must have been defective, although the suction was still fine.

    My goal would be exclusive breastfeeding for at least 6 months, but returning to work will represent a major challenge after that.

    Cue for feeding is normally when he cries, and also when he sometimes sucks his fists or roots. I know you’re not supposed to wait until he cries, but more often than not he begins crying the second he wakes up – there are not many warning signs to look for! Feeding is normally the first thing I try when he is unhappy, and he always accepts the breast. I used to wonder if I was just a human pacifier, but given his low weight gain hunger seems the more likely reason.

    I never really know that he’s finished because he almost never drops the nipple. During the night and morning, I end the feeding (after doing my best with breast compression, which works a bit but only for a limited amount of time) when he has fallen asleep and either lets me break the latch or doesn’t fight too hard! Often also when he is having to suck too many times before a swallow (up to 9/1) and I have a supplement ready for him. In the afternoon and evening, for the last two weeks or so I have basically camped out on the sofa with him and just let him feed and sleep on my breast – from about 2pm to 12pm. Under those circumstances it’s hard to say how often I’m feeding him! Yesterday, though, when we began to supplement and I didn’t camp out, we fed him about every 2-3 hours.

    I was pumping about 4-5 times a day, but once I started camping out on the sofa that fell to 2, max. 3 times. I thought that having him on the breast for so long was guaranteed to keep the supply up, even though he sleeps for a lot of it (he manages to feed while he’s asleep as well). Seems I was wrong. Until a few days ago, I was getting up to 2.5-3.5 oz in the morning from the breast he didn’t feed on (they were full and the first was always enough – I would get half that over the rest of the day), but now I’m getting 1-1.5 max, and even less over the rest of the day (I suspect he’s going through a growth spurt, though).

    I have been in touch with an LLL leader and she was extremely friendly and helpful. She told me to told me to pump very frequently, maintain good nutrition (this is a challenge as my baby will not let me put him down for a second, but I don’t think I have been doing too badly) and take a nursing holiday. But she also told me to pump before feeding the baby, and I was very confused by that – hence this post. We didn’t talk about night feedings.

    Thanks so much, and I’m sorry to make these messages so long!

    dri

  5. #5
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    Default Re: Pumping/night feedings and increasing supply

    Hi,
    It is really not problem that your messages are so long! It helps me get a better picture of what is going on.

    Just to clarify, you said he lost more than 10% of birthweight, but by my calculations, that would have been down to 6-9 and you said he went down to 6-15. I calculated that he lost 5 oz after birth, and that would only be 4% of his birthweight. Is that right, or did I miss something?

    The reason I wanted to clear that up is this: even though it is done and there is no changing it, I would want you to know that there MAY not have been a reason to supplement him after that weight loss. I fear that maybe that initial supplement gave him food that he didn't take from you and affected your supply. I would hate to see that happen to you again someday. Now, maybe I am wrong, and I am certainly not a physician, I am just reading info from my BAB (LLL Breastfeeding Answer Book) and relaying it to you!

    Anyway, I did some math and I show from lowest weight of 6-15 to last check at 8-8 (5 weeks) your ds has gained an average of 5 oz. per week. LLL suggests that average weight gain at this age be about 5-6 oz. per week, but some babies can do fine with 4 oz. per week and some gain more. That is just an average. Now, I understand you are concerned about the last 2 weeks, as he has not gained as much lately, but I just wanted to show you that he is well within the range of normal for average weekly gains (realizing of course that he has been lower than this the past 2 weeks).

    The average amount moms are able to pump at this time is about 2 oz. So, you are again within the range of normal getting 1-2 oz.

    I asked about cues for feeding because some moms with slow-gaining babies have been known to miss cues. Not that they aren't trying, but sometimes it happens. It doesn't sound like this is the case with you, because ds sounds like he is nursing lots, but I just wanted to be sure. Basically, anytime he stirs, whether awake or asleep, nurse him! If he is sleeping and moves his head around, nurse. If he wakes up, nurse him. If he is happy, nurse him. (You get the picture!) We try to remind moms not to watch the clock. This constant feeding should really help stimulate your supply. You mentioned holding him a lot. This is great! Way to go! Lots of skin-to-skin time is great, as is co-sleeping and bathing together. Some moms in your situation find a sling to be extremely helpful. It allows you to be close to the baby and still be hands-free! You can also nurse while he is in the sling.

    You mentioned that he nurses while asleep. This is great! Does he seem to nurse more then? He can nurse whenever works for him, so sleeping while nursing is certainly ok! I hear your concern about his long stretch at night. Have you considered co-sleeping? This would allow you to get some rest while still giving him access to the breast. You may be able to cut down that last supplement because he will nurse more at night, thereby stimulating your breasts. And, you don't have to get up and pump then, because he is doing it.

    Do you supplement after every feeding (when you are pumping) or do you wait and give him the milk at the end of the day. Is the supplement EBM or some formula? I would suggest that if you pump after he nurses that you feed him that milk after that feeding, instead of waiting and giving him lots at the end of the day. If he truly is NOT getting enough, this will make him happier and give him more energy to do the job he has to do-nurse!

    I am not sure why the LLL you spoke with suggested pumping before a feeding. The only reason I could think of would be that she thought maybe you could encourage your let-down that way. Maybe she was suggesting just pump til the milk lets down and then put ds to breast-so he doesn't have to work as hard??? I am just guessing. But my information would say to pump after each feeding.

    A few more questions:
    Has ds always been weighed on the same scale? There can be significant differences between scales.

    I am assuming by the sound of things he is not sucking on a pacifier?

    Has he had a suck evaluation by an IBCLC?

    Are you taking any medications? Do you have any major illnesses? Has someone told you that your breasts LOOK normal?

    Sorry for more questions...just trying to help you see the bigger picture!

    Take care

  6. #6
    Join Date
    Jun 2006
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    Default Re: Pumping/night feedings and increasing supply

    Hi there, Kate, thanks so much again for your reply! The pumping after feeding advice is a weight off my mind as I felt awful giving him a mostly empty breast.

    On his initial weight loss, it was in the first 2 days that he lost more than 10% of birthweight, and once we started supplementing him he bounced right back, leading to the 6 15 weight on the 4th day.

    What you say about his average weight gain is really interesting! Do you measure from lowest weight (in which case the average would be even higher than you calculate), or from birth weight? I suppose somebody has to be in the lower percentiles! But our pediatrician does seem to be a little worried about him, and I suppose the issue is that he started out in a considerably higher percentile and is slipping down to the bottom. Do you still think that we are getting worried too early after the experience of the last two weeks?

    I'm really surprised (and reassured!) that most moms only pump 1-2 oz at this stage. I was worried because I read that babies take in 3-5 oz at each feeding at about 6 wks of age, so my output seemed desperately inadequate. But is it that the pump is much less effective than the baby in getting the milk out, then?

    On him nursing while asleep, I would say that he's not as effective as when he's awake. But he's more effective than when he's asleep and not on the breast! I suppose a concern would be that it's an easy alternative for me to him being frustrated at the breast or trying to wake him up all the time, though we still do have official feeds when he wakes up. When asleep, he nibbles away and when the let-down comes he gulps away. Unfortunately, my let-downs are infrequent and don't seem to last very long...

    I wish I could nurse while lying down! But I have big floppy breasts and have to keep a couple of fingers on the areola so that he can breathe. It ends up being less relaxing than sitting down!

    On the nursing at night, of course I'd still like to sleep for 5-6 hours if I can, without it affecting my milk supply. But what do you think is the longest I can go without that happening? In the meantime, we are waking up roughly every 3 hours - because he's going through a growth spurt, I think. What do you think if I pumped once during the night and gave him the expressed milk, instead of feeding him? We were there for 75 minutes in the early hours of this morning, and pumping is sometimes more straightforward (but only as a nighttime option given the other benefits of bfding)!

    We are supplementing basically whenever we feel he is still hungry, day or night - either breast milk if we have enough, or formula as a fall back.

    on your other questions:

    Same scale always, yes.

    He only likes his mother's breast as a pacifier!

    No official suck evaluation, but two lactation consultants told me early on that his latch was good, and he practically takes your finger off if you use it to pacify him!

    No medications or anything like that. My breasts are quite "special", I would say - 40D before pregnancy, very large areola, and flat nipples. The latter were commented on at the hospital as a possible issue, but baby seems to have coped very well with them.

    Thanks again Kate, and I would really appreciate your opinion on these latest questions.

    dri

  7. #7
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    Jun 2006
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    Default Re: Pumping/night feedings and increasing supply

    Kate, just to add that I got up at 3 am to pump, 3 hours after the last feeding, and I got 3.5 oz. How does that sound, bearing in mind I suppose that's when you should get most? (and it wasn't enough for baby, who wanted 4.5 oz!)

    I was also wondering if my baby is going through a growth spurt, then can the formula supplementation be compatible with my production keeping up with him, even if it's not very much (yesterday it totalled just under 3 oz)?

    Thanks again!

  8. #8
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    Default Re: Pumping/night feedings and increasing supply

    Well, I can't really tell you what to do here. One of LLL's mantra's is "You are the mom and you have to do what you think is best." I can give you info and suggestions.

    I would highly suggest you have that baby nursing and on your breast as much as possible. I know you are dying for some sleep and I can understand that. If you feel that skipping that middle-of-the-night feeding is helpful to your sanity, then you have to do it. And by all means, pump then also. Sounds like you got a fair amount last night.

    If he is having a growth spurt and you are supplementing part of that with formula then it could undermine your goal of increasing supply. But that is such a tricky one. We usually tell moms that their supplies will increase with increased feedings. But if you feel that is just not happening and have to give some formula, then you may have to do that.

    That is why I asked what your BF goals were. Some moms are adament from the start "no formula". Some moms get to the point where they are happy to continue nursing even if it means using a little formula. I don't think you are necessarily at the point of having to do that yet, but maybe that would just be something that would help you overall.

    About the weight loss, yes growth is measured from the lowest weight. So if he was actually lower than 6 lbs. 15 oz. then his growth average would be even higher.

    Is he having weekly weight checks at this point? You will have a better picture with the next check up.

    Here is an article written for Leaders who are helping large-breasted mothers. You may wish to check it out.
    http://www.lalecheleague.org/llleade...yJun89p35.html

    Oh, and keep in mind that the average I mentioned for moms to pump is of course not moms who are pumping exclusively. They would get much more milk.

    Hang in there!

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