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Thread: falling behind due to supplementing

  1. #1
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    Default falling behind due to supplementing

    Hi, baby was born 6 weeks early and went to NICU. They gave her bottles of my pumped milk there. Now she is 5.5 weeks and her original due date is today (2-17). The issue is that she's been on the breast for the last 3.5 weeks but I've still had to give supplemental bottles bc my milk supply is not sufficient. I've tried pumping after feeding but this has become too difficult to continue. She currentlys needs between 2-6 oz/day in supplement so I'm close to fulfilling her need but still not there and I feel like I'll never catch up. I need advice please! I'm taking 3 fenugreek 3xday. Baby eats every 2-3 hours although today for some reason she slept 4hrs twice (I slept through it with her not expecting her to do this). I give her the supplement when I suspect she is still hunrgry and has eaten less than 1.5 oz (I have a scale right now and I weigh before and after feedings). How can I catch up quickly?
    Last edited by 1stimer; February 16th, 2006 at 08:27 PM.

  2. #2
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    Default Re: falling behind due to supplementing

    To catch up quickly, don't supplement. Can you stay in bed with her one day this weekend and have dh bring you food and lots and lots of water in bed so that you only have to get up to go to the bathroom? Then just stay in bed and do nothing but nurse and gaze at your beautiful baby all day and all night. It will do wonders for your supply. Your babe will not starve without those last 2-6 oz for the day or so it will take your supply to catch up.

  3. #3
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    Default Re: falling behind due to supplementing

    But won't the baby be frustrated she's not getting enough to eat? She won't go to sleep without a full belly so will this wear her out? Today I tried to avoid giving a supplement during one of the feedings so I fed her on and off for 2 hours but at the end of it she was still hungry and hadn't slept yet (after she'd eat a little I put her in her rocker chair and waited for her to show signs of hunger again which always took about 10 min). Thanks for your help.

  4. #4
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    Default Re: falling behind due to supplementing

    Wow, it sounds to me like you and your daughter have come a long way and are having much success already, after a very challenging and scary beginning. Pat yourself on the back and take heart! If you have come this far together, you can surely go the last few steps and get your supply up to match her demand. I believe in you!

    Mamallama is describing a "nurse-in" -- and I recommend this also. A big key is having lots of skin-to-skin contact while you rest together and nurse.

    Your breasts make milk even as the baby is nursing, so being mostly naked together and nursing whenever baby shows any interest will get extra milk into her and also stimulate your production.

    Her prematurity has been an extra challenge, as she has probably had a harder time doing the "work" at your breast that stimulates your supply. I don't know a lot about overcoming the challenges of prematurity, but a nurse-in should help regardless.

    After the nurse-in, you can also kangaroo-care her, keeping her close to your body with lots of skin-to-skin contact and easy frequent access to the breast. Even if she just ate a few minutes previously, put her to breast every time she shows hunger cues. The breast is never completely empty; there will always be at least some drops of milk there for her.

    I hope that moms with experience nursing premies through this stage will chime in with advice and encouragement.

    --Rebecca

  5. #5
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    Default Re: falling behind due to supplementing

    Thank you for the encouragement. Everyday feels like a struggle. Each time I think I'm getting closer it seems slip farther away. Especially with the growth spurts (I believe she's entering one now). Sometimes after she's eaten I have time recognizing whether she's still hungry, upset with reflux or just wants something to 'chew' on. I guess each time she puts her hands to her mouth I'll try whip out the breast for her and see if she takes it.

    I did try a marathon session yesterday where I let her eat her usualy 15m per side. Then I put her down and 10m later she appeared hunger (I don't think she was full from the feeding session). So I put her to breast, she ate a little, then stopped nursing. I put her down again and sure enough 10 m later she wanted more. This went on for about 1 hr before I gave in and gave her the bottle. Would she have ever been satiated? Sometimes she pretty good at the breast, and sometimes she nods off and all my prodding won't start her again. But I guess if I put her down that helps to wake her back up.

    With this nurse-in, when do we sleep? Should I sleep with her in the bed? I know many people do this but I've also heard it's dangerous because I could smother baby - I don't think I would but it's possible.

  6. #6
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    Default Re: falling behind due to supplementing

    Those marathon nursing sessions, where bare minutes pass before baby is again cuing hunger, are absolutely typical of growth spurts. Again, I don't know a lot about premie-specific behaviors, but I would imagine that a healthy premie has big-time growth spurts, to catch up on the growth she would have been doing more easily in the womb (does that make sense? I really hope former premie moms will jump in here to correct me if I'm wrong.)

    With the nurse-in, you absolutely should sleep in the bed -- both of you, whenever you're not nursing. After 6 weeks of pumping and nursing around the clock, plus the NICU stay, you must be exhausted! More rest will do a world of good for your milk production.

    The baby can sleep safely in your bed, even while you sleep. There are certain precautions you should take to make your bed a safer sleeping environment -- avoid heavy comforters, minimize pillows and keep them where they won't fall over the baby's face. A baby should never be in bed alone with an older child, or with an adult who is altered by alcohol, drugs, anything that might make the adult difficult to rouse.

    For the nurse-in, you need a helper -- your husband, perhaps? -- to bring you food and drink and change diapers and basically tend to your every need for 24 hours. If you are anxious about napping with your baby in bed, ask your helper to hang out in the bedroom to keep an eye on both of you while you are sleeping.

    If you feel this exceeds your comfort zone (and it is a personal choice, of course), then try lots of kangaroo care for a few days first. Can you wear the baby skin-to-skin with a baby bjorn or a pouch? Literally get her nestled right up against your bare chest and keep her there. Nurse as frequently as possible. Avoid giving bottles as long as she seems willing to nurse for even a minute or two every few minutes.

    Good luck and let us know how you're doing.

    --Rebecca

  7. #7
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    Default Re: falling behind due to supplementing

    Sometimes the baby gets frantic and starts crying, screaming, kicking at the breast if the milk isn't coming fast enough. How can we get past this for the nurse-in session? Should I make sure she's very full ahead of time or just follow our usual feeding schedule and at the last 'regular' feeding put her in bed with me and start the nurse-in?

    Thanks,

    C

  8. #8
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    Default Re: falling behind due to supplementing

    Quote Originally Posted by 1stimer
    Sometimes the baby gets frantic and starts crying, screaming, kicking at the breast if the milk isn't coming fast enough. How can we get past this for the nurse-in session? Should I make sure she's very full ahead of time or just follow our usual feeding schedule and at the last 'regular' feeding put her in bed with me and start the nurse-in?

    Thanks,

    C
    That isn't hunger, that's nipple confusion. She got used to the bottle giving instant gratification. Your baby honestly doesn't sound to me like you don't have enough milk. It sound more to me like someone told you the baby should nurse every x hours and if she wants to nurse more/longer than this x amount of time, you dont have enough milk. That's not true. Babies nurse for comfort, to fulfill their need to suck, to feel you close to them (newborns want/need to be held 24/7, ime), and hunger is only one of many reasons to nurse (that's why most breastfeeding mom stop saying breastfeed and start saying nurse. it's so much more than feeding!) My first baby nursed for 40 minutes at a time every hour for the first few weeks. So I only had 20 minutes of not nursing every hour and I had to squeeze in my bathroom breaks, grabbing something to eat, shower, etc into that time. That was still on the normal range. My 2nd baby nursed for 10 min every 2-3 hours from birth on. Every baby is different and has different sucking needs. I struggled with OVERSUPPLY with my first son, had no supply problems w/ my 2nd (after the first 3 months or so where I did have oversupply---but not as bad as it had been w/ my first.)

    Quit weighing her, quit supplementing, and nurse more often! Don't look at the clock. Some babies nurse every hour, some every 3, some every half hour (this is what my 3rd did. Every half hour for about 10 min. for the first few weeks. He's 5 mos now and still nurses every 2 hours or so, sometimes every hour.) Your supply will catch up very quickly. Your breasts are never empty, if the baby still seems hungry, give her the other side again. Switching sides a lot during a nursing session encourages more milk to be made. This is why moms with over supply are told to nurse on one side only. So moms w/ low supply should switch every 5-10 min.

    Don't doubt yourself. Your body provides for your baby. You just need the confidence to let it do it's job w/out second guessing.

  9. #9
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    Feb 2006
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    Default Re: falling behind due to supplementing

    I would suggest the nurse-in, I wish I did.
    My son is 18 weeks old today and was born 3 weeks early. We had one issue in the beginning which is what I consider the defining point for our situation. On his 5th day of life, we noticed no peeing and pooping so we were frantic and the hospital nursery from where he just came said that we shoud supplement with formula until we see diaper output. So, that's how this "supplementing game" started. I rented a pump to establish my supply a bit better and then purchased a Medela PIS.

    Now, I am almost an exclusive pumper and can get him to nurse for short periods of time in the middle of the night, in the morning and in the evening. He seems to never get enough milk from the nursing sessions and is hungry soon after. He now KNOWS that he will always get a bottle because that's what we started way back when.

    I wish we did some things like a nurse-in to get the situation switched back. We even saw a lactation consultant who didn't really help much at all.

    Now that I am back at work, there's no use changing the situation. I pump 5 to 7 times a day and he gets the breast milk in a bottle. It's a bit inconvenient for me but since it's the best thing for him, that wins hands down. I plan to pump at least 6 months.

    So, take it from someone who has been there and done that, take everyone's advice and try to rectify the situation by getting your baby back to the breast. I wish I did.

    Good Luck.

    Karen

  10. #10
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    Default Re: falling behind due to supplementing

    There's nothing more upsetting than a frantic and screaming baby, is there? Of course I can understand how it then seems so necessary to offer the bottle.

    The way I read your post, though, here is the key phrase: "if the milk isn't coming fast enough." Your daughter has gotten used to the faster, easier milk flow from a bottle.

    This may sound incredibly cruel, but if she is kicking and screaming ... she ain't starving. Malnourished babies are dehydrated, sleepy, and weak. It is WONDERFUL that your little 34-weeker is healthy and strong enough to kick and scream. Try to think of it as music to your ears, in that sense. Then be the loving momma who knows best, and insist for a little while that she do the work to get her milk at your breast.

    During your nurse-in, if she gets too frustrated and upset to nurse, have your helper open his shirt and carry her skin-to-skin for a while while he walks around soothing her. She can suck on his pinkie finger. She should eventually settle and be willing to try again to nurse.

    I agree with mamallama that you probably don't have a supply problem, you have a nipple preference problem. But if you continue to give supplements, even EBM supplements, without then pumping to replace every ounce of supplement she has drunk ... you very soon WILL have a supply problem. So now is definitely the time to fix this problem and get her onto the breast full-time.

    Cut out the supplements. If and only if you start to see signs of dehydration, then supplementing may be necessary -- but I would advise using a supplemental nursing system so that she is still doing all her sucking at the breast.

    --Rebecca

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