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Thread: Help! Poor supply plus inefficient nurser: mom ready to give up

  1. #1

    Default Help! Poor supply plus inefficient nurser: mom ready to give up

    Hi everyone, I'm hoping to get a little advice, maybe some encouragement, because right now I'm at my wits ends, and am thinking seriously about giving up. I think the only reason I haven't is because I am such a huge advocate of breastfeeding, and the prospect of not being able to breastfeed my son is too depressing to contemplate. Here's my background (and I apologize for the length):

    My son was born at 29 weeks gestation, with IUGR, so he measured at 27 weeks (my placenta stopped working). Aside from a few days on CPAP and a couple of infections he picked up in hospital, he was classified as a feeder-grower.

    I had a difficult c-section (my spinal block didn't take, so they ended up giving me ketamine, which I had an adverse reaction to) so I wasn't able to start pumping until the next day (24 hours after delivery). I pumped religiously throughout my son's stay, every two hours (even overnight) using a hospital grade, double breast pump (Medela Symphony). From day one I was plagued with supply problems.

    It took the better part of 4 days for my milk to come in, and then it took weeks to be able to pump 1-2 ounces. By the time my son was ready to be introduced to the breast (about 34 weeks gestation) I was only pumping 10 ounces a day. Part of this I suspect was a mild case of primary lactation failure (my breasts did not change at all during my pregnancy).

    As my son began nursing, my supply did increase slightly, and for a while I was actually keeping up with his demand (i.e. not having to supplement with formula -- at this time he was still being fed via gavage).

    While in the NICU, we worked with 3 different lactation consultants (who gave sometimes conflicting advice) in an effort to get him nursing. By the time we were ready for discharge, he was nursing well enough to maintain his body weight, but not enough to gain weight. The LCs thought his latch and suck were fine, but that is stamina (i.e. ability to suck for long enough to get enough milk) was poor. It was hoped this would improve in time.

    He was released one week before his due date, and we have now been home 8 weeks. His stamina has not improved and he has again outstripped my supply. Presently, we are doing the following:

    - Feeding on demand (which works out to be 7-10 times a day).
    - Doing pre and post feed weighs (I rented a scale) in order to determine how much he's taken (varies from 1-3 ounces).
    - Topping up via nursing supplement (gavage tube taped to my nipple) with expressed breast milk and/or formula.
    - Pumping until my breasts run dry, plus 2 minutes in an effort to increase supply.
    - Visiting a lactation consultant weekly to double check latch and suck.

    All of this takes upwards of 1.5 hours. It is exhausting (both for me and for him) and I'm pretty sure neither of us can keep it up much longer.

    He is gaining weight, though very slowly (half an ounce a day, if that) and remains in the 3rd percentile of his growth curve (born at 2 pounds 12 ounces, and has just now, at 7 weeks corrected, hit 8 pounds). In all other respects he seems a healthy, happy baby.

    I am taking Domperidone and have tried Fenugreek and Blessed Thistle. I eat a healthy diet (including lots of oatmeal) and drink ample water. I try to nap whenever he is sleeping.

    I really have no idea what else I can do here. His paediatrician wants to see him up the weight gain, and is pressing me to add more formula (my preference would be human milk fortifiers, but I don't make enough milk to mix anything). I can increase the top ups, but what I'd really like to do is improve my supply (is that even possible at this point?, and if so, how?) and his efficiency. Also, I really can't spend a year following this regiment --it will kill me. Advice is most welcome.

    In short, help.
    Last edited by @llli*preemiemom; March 15th, 2009 at 07:23 PM.

  2. #2
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    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    I'm no where near qualified to give advice here. But I did want to offer you my support. You have my full admiration for keeping up the regime that you have. Please know that you've come to the right place for help.
    Mommy to our DD1 early bird (34 weeks, 2 days, 7lbs, 14oz)! Oct. 2nd, 2008 Emergency C-Section, Frank Breech, HEALTHY Girl!
    Weaned @ 17 months
    Our DD2 early bird (37 weeks, 3 days, 7lbs, 12oz) Aug. 10th, 2010 Our Successful VBAC, growing like a bad weed!
    Weaned @ 15 months
    Our DD3 early bird (37 weeks, 3 days, 7lbs, 6oz) Feb. 16th, 2012 Our 2nd VBAC and lightening speedy birth!

    Loving being a Mom of 3, 40 months apart!!
    and

  3. #3
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    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    I'm sorry you're having so much trouble with your supply. It's awesome that you're so dedicated to nursing your son! I wish I had some advice but you're already doing the things I would have mentioned. Hopefully someone else will chime in and offer some helpful tips.

    I understand some of your exhaustion with the whole thing. My son was born at 29 weeks 6 days and is now 8 weeks old/38 weeks gestationally. He was in the NICU for 7 1/2 weeks and came home this past Wednesday. I haven't had any issues with supply, I have the opposite really with way too much milk, so I'll end up donating so it doesn't go to waste. But it does take so much time to go through the whole feeding process. Currently I nurse him, bottle feed with expressed breast milk, and then pump afterwards. This takes at least an hour and I have a 2 year old little girl who wants my attention and needs things done while I'm trying to do this. Then the whole process starts 2 hours later! When I feel like giving up my husband reminds me about the benefits of giving him breast milk, especially for preemies.

    Maybe one thing to consider is if there aren't other ways to increase your supply and he does in fact need to gain weight faster, you could continue to supplement with formula, just increase the amounts, and nurse the rest of the time. Another thing is maybe undress him and nurse him skin to skin as much as possible, squeeze your breasts occassionally when your son stops nursing, or change nursing positions when he gets sleepy. I do these things with my son to encourage him to nurse longer so we can elimate most of the bottles.

    Anyways, I'm sorry you're going through this and I hope someone has some suggestions for you about increasing your supply.
    Mommy to:

    Emmalynn Marie
    Born at 37 weeks on 12/22/06
    5lbs 1oz 19 1/2in

    Owen Charles
    Born at 29 wks 6 days on 01/17/09
    2lbs 14oz 15in
    In NICU for 2 months


  4. #4
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    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    Hi mama.

    Sorry you are having so many issues!

    How long have you been on the Dom? How much are you taking?

    When he is eating with the SNS (your gavage/nipple system), does he drain it? Can you feel a letdown with the SNS? Do you feel a letdown every time?

    You said that he is getting about 1-3oz at his feeds....is it more toward the 3oz than the 1oz?
    I'm Hillary
    Wife to Gualberto
    Mom to Nolan
    Born at 32 weeks-3lbs/10oz
    11-25-2007
    Our precious early angel


    Remember, you are not managing an inconvenience; You are raising a human being ~ Kittie Frantz
    Unthinking respect for authority is the greatest enemy of truth ~ Albert Einstein
    First they ignore you, then they ridicule you, then they fight you, then you win ~ Mahatma Gandhi
    Looking for more information about vaccines?

  5. #5
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    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    What an AMAZING job you are doing!!! Seriously, you are AWESOME for working as hard as you are to give your baby the best.

    I'm also curious if your baby is generally taking closer to 3 oz at the breast than 1. If so, that should be enough to grow on without the need for supplements.

    Are you and the baby's dad large people, small people, or somewhere in the middle? And what were you like as babies- were you big chubby babies, or small slender ones? A lot of infant growth is heredity- and small parents don't generally produce massive babies. If you and your partner are on the small side, .5 oz per day may be normal weight gain for your baby.

    It took the better part of 4 days for my milk to come in, and then it took weeks to be able to pump 1-2 ounces. By the time my son was ready to be introduced to the breast (about 34 weeks gestation) I was only pumping 10 ounces a day. Part of this I suspect was a mild case of primary lactation failure (my breasts did not change at all during my pregnancy).
    This doesn't sound like lactation failure to me- it sounds like lactation success! A lot of c-section moms notice that it takes longer for their milk to come in- 4, 5, 6 days instead of 2 or 3- and considering the wild birth experience you had, 4 days does not sound bad at all. I'm suspicious that the problem may be your pump, or your response to the pump. Pumping does not work for all moms- some can pump lots of milk with ease, others struggle.

    Finally, I just want to reassure you that you will NOT be following your current regimen for a whole year. Your baby is going to get the hang of breastfeeding and he's going to get bigger and stronger and more alert, and breastfeeding is going to get easier. He's only 7 weeks old right now... That's still so young. Nursing didn't get easy for me until my daughter was around 16 weeks old, and we had an easier start that you and your baby have had. I know you are working as hard as it is possible to work, and you must be so exhausted. But hang in there! You and your baby can do it!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6

    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    amysmom, thanks for the support. It's probably worth more than the best of advice.

    jenniebean5, I've heard too much milk can be just as frustrating, but it's awesome that you'll be donating it. I can't even imagine having another kid around, so you have my admiration for that. We're doing lots of skin to skin, and compressions. I haven't done the undressing him thing yet, but it's been winter, and I live in a cold, drafty house. Perhaps with spring around the corner, I'll take the suggestion and run with it. Thanks. And good luck making the transition from bottle to breast!

    nolies.mama, to answer your questions:

    I've been on Dom 6 weeks, at 3 10mg tablets, 3 times a day. I tried increasing, but my side effects get worse (my legs swell and I have dizzy spells) on a higher dose. I'm on the maximum I can handle without completely compromising my health.

    Sadly, I never feel my letdown. I know I have one, because you can see/hear him drinking, and you can see it when I pump, but I'm just one of those women without a tell-tale letdown.

    He does drain the SNS, but it's slow, and that's mostly because I give him both breasts first. In terms of feeds, perhaps it's better to look at the day. Given his weight, he needs about 20 oz, and I make approximately 13.

    mommal, thank you so much for your words of encouragement. They are so appreciated. I answered one of your questions above, but to answer the others:

    No, we are very large people. I'm 5'11" and dad is 6'1", though we are both slender (more athletic than skinny, as we're both avid cyclists and runners). We were both large babies (8p14 and 9p2).

    I'm pretty aware of the limitations of pumping, which is why I try not to be too concerned with those amounts. I worry more about test weights to see how much he is taking from me.

    Finally, I just want to reassure you that you will NOT be following your current regimen for a whole year. Your baby is going to get the hang of breastfeeding and he's going to get bigger and stronger and more alert, and breastfeeding is going to get easier. He's only 7 weeks old right now... That's still so young. Nursing didn't get easy for me until my daughter was around 16 weeks old, and we had an easier start that you and your baby have had
    I also just want to say thank you so much for this advice. I forget that he'll get better with time and that this won't last the whole year. Right now it seems like it'll last forever. I really needed someone to remind me that it wouldn't.

  7. #7
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    Default Re: Help! Poor supply plus inefficient nurser: mom ready to give up

    Quote Originally Posted by @llli*preemiemom View Post
    I really needed someone to remind me that it wouldn't.
    it won't mama.

    I remember in the beginning being so sad and depressed and not knowing where to turn. It was SO MUCH WORK with pumping and feeding and gavage tubes and sleepiness....

    But it DOES get better. And what kept me going was just telling myself "it may suck right now, but soon it won't, and this is the ONLY time I can do this for him."

    And I don't know if I just missed it, but did you say if your weighs were closer to 3oz as opposed to 1?

    When my LO started being able to BF, he was getting about 1.5 to 2oz every feed and my LC was about to throw me a party. And remember that supply is different at different times of day too. So if your LO is getting 3oz a couple times, and then 1oz a couple times, then you're doing ok....you're getting there.
    I'm Hillary
    Wife to Gualberto
    Mom to Nolan
    Born at 32 weeks-3lbs/10oz
    11-25-2007
    Our precious early angel


    Remember, you are not managing an inconvenience; You are raising a human being ~ Kittie Frantz
    Unthinking respect for authority is the greatest enemy of truth ~ Albert Einstein
    First they ignore you, then they ridicule you, then they fight you, then you win ~ Mahatma Gandhi
    Looking for more information about vaccines?

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