Help - Did I ruin our chances at a good supply?

[Ambiebambie1011]

Sorry - it's long - I'm a worried first time mom who really wants to develop a good breastfeeding relationship!

My daughter was born on the 27th of August, weighing 7lbs, 3oz. She lost 3oz before leaving the hospital on the 28th, and by the 31st, she was down to 6lbs, 12 oz. She latched on within 10 minutes of being born, and seemingly was doing well, until it was determined that she's got a small mouth, short tongue and high palate - every time she unlatched, she would leave my nipple looking like a new lipstick tube. She was also jaundiced. We went to the lactation consultant on Monday, got some "help" from a pushy consultant, and were told to come back on Friday. Monday through Wednesday she was doing okay, but never really seemed satisfied. Wednesday afternoon through to Friday, she seemed happy and would unlatch herself from the breast and fall asleep. She was also getting less and less yellow. Her pees and poops picked up quite a bit Thursday and Friday, too.

The problems started on Friday - she was weighed again at our appointment, and was still at 6lbs, 12oz, and the LC decided that we needed to start taking her off the breast after 45 minutes and then supplement with 20-30mls of formula. Since then, it's been a giant downward spiral - we're pace-feeding with a bottle, and dealt with some issues latching on Saturday, but she seems to be fine now. However, after nursing for 45 minutes, she's taking usually 30-50mls of formula.

During nursing, she's fairly sleepy and takes lots of little breaks to nap for a while, then wakes up looking for more. She could go on for hours if I let her. I'm at the end of my rope now, I feel so guilty that I started supplementing in the first place, and I have no idea what to do now. I want to breastfeed, but I want her to grow and be happy, not starving.

We gave her a bottle of expressed BM last night, and I pumped while DH fed her. I managed to pump a full ounce in about 15 minutes. She no longer seems satisfied with just nursing, and it's started to really frustrate me, and I'm upset that my milk isn't enough to fill her up anymore. I'm pumping after each feed for 3 minutes after I notice there isn't much coming out anymore. I usually get about 1/4oz after feeding her for 45 minutes.

I'm starting to take fenugreek and blessed thistle today again, after noticing an improvement last week when I took it. The LC told me to stop taking it on Friday.

I guess it comes down to a few questions and asking for any help I can get!
1 - How do I tell if I have a low supply?
2 - Is her constant wanting to eat normal, or am I just not producing enough for her? After a full nap, she'll nurse every 2-4 hours, depending on how much formula she ended up taking in. At night she goes longer - 5-6 hours.
3 - Should I be taking the fenugreek and BT constantly or do I stop after a few days?
4 - What should my nipple look like once she's unlatched - I'm not getting the lipstick nipple anymore, but instead it's kind of flat and squished on the sides. It doesn't hurt to nurse her, and I can hear her swallowing, plus I know she's getting atleast some of my lower areola in her mouth.
5 - Should I just give up and start pumping and adding the EBM to her formula?

Thank you so much to anyone who actually reads the whole thing...

[starling&diesel]

Go to the Jack Newman website for info on how to tell if you have a low supply. His site is great for all kinds of bf challenges resources.
All I can tell you is to hang in there and consider getting a supplemental nursing system (either a Medela SNS or the Lact-Aid system, which is WAY better and what I use) to use while you boost your supply.
You're in Alberta, right? So domperidone can be prescribed by your midwife or doctor ... that might help too. You can take up to 160mg a day (that's what I'm on).
I also take 3 blessed thistle and 3 fenugreek capsules 3 x a day.
My LC advised pumping for a good twenty minutes after each feeding session, no matter what you produce, you're encouraging your body to make more milk.
It will get easier! I promise!

ETA: My LC advised switch nursing when the babe is acting sleepy at the breast. Nurse one side until she gets sleepy and the switch to the other side and relatch her there.

ETA: You should post this in the breastfeeding challenges section, lots of helpful mamas over there who've struggled with similar challenges.

ETA: Here's a link to a CL posting for a Lact-Aid system in Vancouver. Maybe you could arrange for her to mail it? Good luck!

[Ambiebambie1011]

Thanks - We have our 2 week checkup on Thursday - I'll ask my doctor about domperidone then.

Off to cross-post...Thanks for the suggestion - I didn't even think of BF Challenges.

[kiara7]

First, get rid of that LC. No good LC will tell someone to supplement with a bottle of formula at 1 week old.
Your daughter stopped losing weight- your milk is more than enough. I'm on my phone - sorry for short reply- but drop all bottles and let her nurse as much as she wants. Oh, and find a different LC if you need one.

[kiara7]

And pumping output is not an indicator of supply. Personally, I would just bf, no bottles, no pumping, no supplements. Watch the diaper output and the weight. No reason to take drugs/supplements if there is no need.

[midnightmommy]

I'm not an expert but to me it doesn't seem like you were doing all that bad. her weight might not have gone up, but the lose stopped. My daughter did the same thing to my nipple, but now at three months she doesn't do that anymore. The nurse a little sleep a little cycle also seems normal to me. DD and I camped out in a chair for the first few weeks so we could nurse all the time. Sometimes more than once in an hour. It seems to me that all that constant nursing would really help supply.

I also think that all that nursing helps to keep mama from over doing it after birth.

[Super~Single~Mama]

Since she was at 6lbs 12oz for 2 weigh-ins you don't know if she lost a little more and then started gaining, or just stopped losing. I agree, go back to just nursing. Do it all the time. Get topless and get in bed and nurse all day and all night. You're supply will go up soon.

[Ruthla]

Yes, it's perfectly normal for an almost 2 week old to be constantly nursing. That's how your breasts learn to build up a supply! There's a 10 day growth spurt, then a 2 week growth spurt, and a few more after that but they're a bit more spaced out. If she's nursing every 2-4 hours, then IMO she's not nursing often enough. and getting too filled up on formula to be hungry enough to nurse properly.

I am absolutely appalled that an LC told you to use a bottle! Yes, there are situations in which supplementing with formula is appropriate- but you should NEVER use an artificial nipple before breastfeeding is established. She should have had you feeding the formula via a finger-feeder, spoon, cup, oral syring, or SNS/Lact-Aid (a device that lets you feed the supplement via a small tube at the breast.) And that's only if the formula was truly indicated.

It sounds to me like your baby has gotten a bit lazy, and is starting to prefer the faster flow of the bottle nipple, rather than having to work at the breast. Keep on nursing her and nursing her and nursing her, even if she nurses for 45 minutes every 50 minutes (meaning a 5 minute break between nursing sessions.) I would completely ditch the bottles. If she still needs some formula, I'd purchase an oral syringe (the kind intended for giving liquid medicines) and feed the formula in that.

I know that kellymom.com has information on weaning off formula supplements. If she's only been getting the formula for 2 days, and only getting an ounce or less per feed, then it's probably safe to just stop using it without the gradual weaning process suggested on that website. How much is she getting in a day? I see that it's about an ounce after each feeding, but I'm not sure how many times you're giving the bottle each day.

I would suggest that you simply nurse, nurse, nurse, and completely stop using any formula after nursing. Continue taking any supply-boosting supplements you've been taking. Do all this until her next checkup on Thursday and see how her weight is by then. 2 days should be long enough for your breasts to respond to her increased demands.

[Super~Single~Mama]

I just re-read this, and noticed that you said she nurses every 2-4hours. At that age, I would worried if she wasn't nursing that often! I would just stop using formula, find a new LC, and weigh her every week to make sure she's gaining.

[hotharmony]

1 - How do I tell if I have a low supply?
If your lo is having normal amount (5-6 or more) of dirty diapers and not loosing weight that is a good indication.

2 - Is her constant wanting to eat normal, or am I just not producing enough for her? After a full nap, she'll nurse every 2-4 hours, depending on how much formula she ended up taking in. At night she goes longer - 5-6 hours.
Let's remember that nursing isn't just about food it's for comfort too, a new baby only knows nursing it's their only comfort in this world. At that age my babe was nursing every 45 minutes. I wouldn't let the baby go more than 3 hours max.

3 - Should I be taking the fenugreek and BT constantly or do I stop after a few days?
Take it for at least 3-4 weeks. Remember that nursing is a supply and demand thing the more you nurse the more milk you will have so I would put her to breast at all and any occasion any peep from her and i would go straight to breast.
4 - What should my nipple look like once she's unlatched - I'm not getting the lipstick nipple anymore, but instead it's kind of flat and squished on the sides. It doesn't hurt to nurse her, and I can hear her swallowing, plus I know she's getting atleast some of my lower areola in her mouth.
5 - Should I just give up and start pumping and adding the EBM to her formula?
NO! Don't give up your not off the breastfeeding path there is still a lot to be saved here. Your doing a great job. I would start to wean out the formula and just nurse, nurse, nurse, nurse all day long. If you can find a comfy chair and don't get up just feed your baby. Nurse her anytime you can to help increase your supply.