This is long- I apologize!
A little backstory first:
Ds was a 33 weeker who never learned to latch and suck at the breast. I EP'd for him til 13 months when he was started on an amino acid formula. He was initially thought to be a lazy preemie, but later it was decided (due to multiple other medical and developmental issues) that he has an unspecified metabolic disorder. he can't tolerate any intact protein, and eventually became intolerant of my milk (even when I was on a 4-food elimination diet). He is now 28 months old and still on medical formula.
Fast forward to dd, 5 weeks. She was a 37 weeker, born precipitously, and ended up with massive facial bruising (the worst the hospital had ever seen) because she flew out so fast and was posterior. She was quite jaundiced (we presume it was from the bruising) and was on a bili blanket for her first 10 days.
We did not supplement with formula during her jaundiced period because my son's medical issues *all* began when I had to start supplementing him with formula (around six months, an ounce or two per day). Dd was extremely sleepy and difficult to nurse for the first week, and especially the firs four days. During that time, she went from a birth weight of 6lb 8oz to 5lb 14oz. I am fairly certain she had pain when she nursed, based on the bruising and swelling.
Since she was nursing poorly, I began triple feeding (nurse, bottle feed ebm, then pump). She started gaining eventually, jaundice cleared, and she is now 7lb 6oz (her length has increased by 2.25 inches since birth).
I have since dropped to 3 pumping sessions per day, which gives me about 12-15 oz total. Since dd has reflux (she is on prevacid), she will gulp down up to 4 oz if I let her, then vomit everything. I try not to top her off after every nursing session, but I limit the bottles to 2 oz when I do.
She still needs a nipple shield when nursing about 90% of the time. She falls asleep at the breast very easily, then wakes up hungry and pissed 20 minutes later. I think she is a bit weak still to fill herself up. I have an infant scale and need to do pre and post-nursing weights, but haven't yet.
She has been evaluated for tt by 2 lc's and our ped, since my son had a serious tongue tie. Her latch has been deemed good. I do find it harder to let down when she's nursing than I do with a pump- that's what EPing for over a year can do, I guess. I do compressions while she nurses, which helps. Her jaw is moving every few sucks, so she seems to be swallowing. If she's sucking weakly I wake her up, relatch, etc.
Anyway, I know I am lucky she is able to nurse at all, but it's getting cumbersome to continue to pump and bottle feed her as well. It's compounded by the fact that my son takes his medical formula from a bottle and only recently became strong enough to hold it himself. He still requires a lot of help, so I often find myself holding 2 kids and 2 bottles.
I selfishly want a trouble-free breastfeeding relationship, I suppose to make up for my EPing time. I would like to figure out how to know when to start phasing out the ebm bottles- I don't want to cause weight loss, so I am wary of doing it when she clearly isn't able to nurse strongly enough to satiate herself at every feed.
Any idea on how old/big she will need to be for that to work?
FTR, she has obvious sensitivities to dairy and, sadly, fenugreek. Fenugreek was my magic bullet last time. I have not tried dom, but she seems so sensitive that I am wary. I keep thinking that I probably have good supply, based on my pumping output. I just don't want this to devolve into an EP situation, as I have a special needs toddler to deal with this time. Formula is not an option, since that was the beginning of her brother's many problems.
Thanks for any insight you can provide!
A little backstory first:
Ds was a 33 weeker who never learned to latch and suck at the breast. I EP'd for him til 13 months when he was started on an amino acid formula. He was initially thought to be a lazy preemie, but later it was decided (due to multiple other medical and developmental issues) that he has an unspecified metabolic disorder. he can't tolerate any intact protein, and eventually became intolerant of my milk (even when I was on a 4-food elimination diet). He is now 28 months old and still on medical formula.
Fast forward to dd, 5 weeks. She was a 37 weeker, born precipitously, and ended up with massive facial bruising (the worst the hospital had ever seen) because she flew out so fast and was posterior. She was quite jaundiced (we presume it was from the bruising) and was on a bili blanket for her first 10 days.
We did not supplement with formula during her jaundiced period because my son's medical issues *all* began when I had to start supplementing him with formula (around six months, an ounce or two per day). Dd was extremely sleepy and difficult to nurse for the first week, and especially the firs four days. During that time, she went from a birth weight of 6lb 8oz to 5lb 14oz. I am fairly certain she had pain when she nursed, based on the bruising and swelling.
Since she was nursing poorly, I began triple feeding (nurse, bottle feed ebm, then pump). She started gaining eventually, jaundice cleared, and she is now 7lb 6oz (her length has increased by 2.25 inches since birth).
I have since dropped to 3 pumping sessions per day, which gives me about 12-15 oz total. Since dd has reflux (she is on prevacid), she will gulp down up to 4 oz if I let her, then vomit everything. I try not to top her off after every nursing session, but I limit the bottles to 2 oz when I do.
She still needs a nipple shield when nursing about 90% of the time. She falls asleep at the breast very easily, then wakes up hungry and pissed 20 minutes later. I think she is a bit weak still to fill herself up. I have an infant scale and need to do pre and post-nursing weights, but haven't yet.
She has been evaluated for tt by 2 lc's and our ped, since my son had a serious tongue tie. Her latch has been deemed good. I do find it harder to let down when she's nursing than I do with a pump- that's what EPing for over a year can do, I guess. I do compressions while she nurses, which helps. Her jaw is moving every few sucks, so she seems to be swallowing. If she's sucking weakly I wake her up, relatch, etc.
Anyway, I know I am lucky she is able to nurse at all, but it's getting cumbersome to continue to pump and bottle feed her as well. It's compounded by the fact that my son takes his medical formula from a bottle and only recently became strong enough to hold it himself. He still requires a lot of help, so I often find myself holding 2 kids and 2 bottles.
I selfishly want a trouble-free breastfeeding relationship, I suppose to make up for my EPing time. I would like to figure out how to know when to start phasing out the ebm bottles- I don't want to cause weight loss, so I am wary of doing it when she clearly isn't able to nurse strongly enough to satiate herself at every feed.
Any idea on how old/big she will need to be for that to work?
FTR, she has obvious sensitivities to dairy and, sadly, fenugreek. Fenugreek was my magic bullet last time. I have not tried dom, but she seems so sensitive that I am wary. I keep thinking that I probably have good supply, based on my pumping output. I just don't want this to devolve into an EP situation, as I have a special needs toddler to deal with this time. Formula is not an option, since that was the beginning of her brother's many problems.
Thanks for any insight you can provide!
