*update* Is DD gaining enough? Ped. says no. What can I do?

[TXmom2]

First, sorry this is so long!!!

I'm so confused. Breastfeeding has been such a struggle. Isn't it supposed to be "natural"? Every time I start to relaxx and enjoy it, there is another setback.

Short story: I have had low supply and difficulty with letdown since 5 wks PP. DD has been on the slow path of weight gain. Other than her weight, she is doing wonderful.

Long story: DD was born on July 7th weighing 7lbs8oz. and nearly 19in. long. Discharge weight = 6lb14oz.
7-14-09 (1wk) = 7lb.4oz., 20.8 in.
7-21-09 (2wks)= 7lb.15oz.
8-10-09 (5wks) = 9lb.3oz., 22.5in.
*noticed drop in pumping output & fussiness after feedings..DD not satisfied. started Fenugreek. supplementing @8oz breastmilk &/or formula daily
8-27-09 (7wks) = 9lb.13oz.- feeding eval, transfered 44gm
*worked on latch correction and added lactation tonic
9-9-09 (9wks) = 9lb.15oz., 23in
*started Dom. (along with lactation tonic) and started to reduce supplemental feedings
9-15-09 (10wks) = 10lb14oz
*cut out supplemental feedings. went back to work and pumping output continued to drop...thought DD was just taking more
9-24-09 (11wks) = 10lb4oz
*went back to supplemental feedings, @ 8 oz daily
9-29-09 (12wks) = 11lb3oz (with onesie) feeding eval.= transfered .5oz
10-2-09 (12.3wks) = 11lb2oz
10-26-09 (16wks) = 12lb9oz - feeding eval. = transfer 1.5oz.
*Staying home with DD now, started cutting out supplemental feedings again...down to @6oz./day
11-11-09 (18wks) =12lb5oz, 24.8in
12-3-09 (21wks) =12lb7oz
12-18-09 (23wks) =13lb6oz, 26.4in

I ran out of the Dom. and am waiting on my order now. I did see an improvement while on the Dom. DD was happier and went longer between feedings.
I am taking More Milk Plus and Goat's Rue (since 11-11), eating Oatmeal at least 2x/day, drinking lots of water. DD nurses on demand, all day. (I'm not working now and am at home with her) She literally only goes 10 minutes(usually)-2hours (at most) between eating and she nurses for about 20 minutes per side. I don't get much time to pump (to increase supply) but do in the morning (@7:30am) and at night after she goes to bed (@3am) she usually sleeps from 2:30am-9 or 10am. I can't pump during the day because she is nursing all day. The biggest thing I've noticed is that I only notice letdown a few times a day (the tingling and her gulping) Does this mean I'm not letting down all the other times she's nursing? She does get very frustrated at the breast at times....maybe because she's not getting anything????

When she takes a bottle (EBM), she will drink 3-4oz and scream when its empty. (I know she shouldn't need more but she sure acts like it) I offer the breast after she drinks the bottle and she'll nurse for another half hour-hour.

Her diaper output varies, but averages just barely 5-6 wet diapers per 24 hrs. Only 1-2 of those is very wet and she often wakes up dry

Other than me feeling like she's just not getting enough to eat, and fighting the breast (pulling, pushing, twisting, popping on & off, etc)...she's doing wonderfully as far as milestones...Been rolling from tummy to back since 7wks. Rolling from back to tummy now. Holds head well, focuses on objects from across the room, pushes up while on tummy, reaches for toys & brings them to her mouth, stands on steady legs when you hold her up....on & on..

WWYD? Would you be worried?
Should I keep up some supplements until I notice enough changes in her feeding/diapers? grrr...... I just don't know what to do and I'm so discouraged with it all

[PatioGardener]

Did you use the same scale for all the weights? It would worry me that she lost 4 oz from 16 to 18 weeks. I would have expected a baby to gain 8 oz during that time. The only 2 heay wet diaps would concern me too.

When a Mama stops domperidone suddenly her milk supply often plummets because the domperidone had 'taken over' for the natural way that prolactin is produced in the body. That is why Mamas are encouraged to wean slowly from domperidone when they stop taking it. Perhaps your milk supply took a dive when you ran out of dom?

Have you looked into donor milk to get you through this rough patch? I would supplement in your situation. I feel the low diaper output and no weight gain mean that more milk is needed.

Hang in there, Mama. You are working so hard for your baby!

[Megan73]

I'm sorry you're struggling with this, mama. You're doing a great job!
I agree with everything Patio said.
It's so great that you're pumping at 3 a.m. when your prolactin is highest. It's great you're getting more dom, too.
I'd add that it would be helpful to eliminate bottles and use an at-the-breast supplementer instead, such as a Medela SNS or, better yet, a Lact-Aid. That way your little one won't be frustrated at the breast and will stay there long enough to get all the breast milk available. It will also prevent her from coming to prefer bottles, which can happen.

[Bokonon]

Some of what you are describing is actually very normal - the frequent feedings, shortened sessions, and generally fussiness at the breast at 4 months. My DD is 6.5mo. I have an abundant supply, and she still nurses 15-20 times a day, for 5-10 minutes per session. At 4 months, it was almost impossible to nurse her unless she was sleepy - she did the fighting, crying, etc. This is very common in 4 month olds.

Also, if the weights were not taken on the same scale, they shouldn't be compared, as different scales can differ by up to a pound. Additionally, I wouldn't put too much stock in the evaluation feedings, because baby might have been distracted and not take as much as normal - and babies' intake varies all day long, just as adults' does. I would recommend renting a Medela BabyWeigh scale and doing test weights before and after EVERY feed in 24 hours to get a real picture of how much baby is taking in.

I would also recommend posting your concerns on KellyMom, where the board experts and IBCLC can look over the situation and ask some questions to better help you.

You're doing a great job for your baby - hang in there!

[lilysmama1124]

I second using the sns and doing before and after weights for 24 hours. You are doing awesome so try to stay positive. BTW you may not always feel a letdown when it happens. Also what kind of pump are tou using? A hospital grade rental will be the most efficient and effective at simulating supply

[Kiara.I]

I don't know how much domperidone you were taking, but on this page:
http://www.nbci.ca/index.php?option=...tion&Itemid=17
you see Dr. Newman's recommended dosages. Maybe once you get restocked you can try a higher dosage, if you weren't at his maximum, and just stay on it longer term.

He also has an article on stopping Domperidone, for the future.

[TXmom2]

Originally Posted by PatioGardener

Did you use the same scale for all the weights? It would worry me that she lost 4 oz from 16 to 18 weeks. I would have expected a baby to gain 8 oz during that time. The only 2 heay wet diaps would concern me too.

When a Mama stops domperidone suddenly her milk supply often plummets because the domperidone had 'taken over' for the natural way that prolactin is produced in the body. That is why Mamas are encouraged to wean slowly from domperidone when they stop taking it. Perhaps your milk supply took a dive when you ran out of dom?

Have you looked into donor milk to get you through this rough patch? I would supplement in your situation. I feel the low diaper output and no weight gain mean that more milk is needed.

Hang in there, Mama. You are working so hard for your baby!

thanks. All the weights are on the same scale except for the feeding eval's...maybe that is a little better? Also, I'm sure running out of Dom is when the problems got worse. How do you go about the donor milk? What are the risks to using it?

Originally Posted by Megan73

I'm sorry you're struggling with this, mama. You're doing a great job!
I agree with everything Patio said.
It's so great that you're pumping at 3 a.m. when your prolactin is highest. It's great you're getting more dom, too.
I'd add that it would be helpful to eliminate bottles and use an at-the-breast supplementer instead, such as a Medela SNS or, better yet, a Lact-Aid. That way your little one won't be frustrated at the breast and will stay there long enough to get all the breast milk available. It will also prevent her from coming to prefer bottles, which can happen.

Thanks for all the support I don't know if I really want to spend all the money on the at-the -breast supplementer. Especially since I only supplement once or twice a day...and only when my supply drops.

Originally Posted by Bokonon

Some of what you are describing is actually very normal - the frequent feedings, shortened sessions, and generally fussiness at the breast at 4 months. My DD is 6.5mo. I have an abundant supply, and she still nurses 15-20 times a day, for 5-10 minutes per session. At 4 months, it was almost impossible to nurse her unless she was sleepy - she did the fighting, crying, etc. This is very common in 4 month olds.

Also, if the weights were not taken on the same scale, they shouldn't be compared, as different scales can differ by up to a pound. Additionally, I wouldn't put too much stock in the evaluation feedings, because baby might have been distracted and not take as much as normal - and babies' intake varies all day long, just as adults' does. I would recommend renting a Medela BabyWeigh scale and doing test weights before and after EVERY feed in 24 hours to get a real picture of how much baby is taking in.

I would also recommend posting your concerns on KellyMom, where the board experts and IBCLC can look over the situation and ask some questions to better help you.

You're doing a great job for your baby - hang in there!

I posted on KellyMom, thanks. Also, I am looking for a baby scale...that might reassure me alot

Originally Posted by lilysmama1124

I second using the sns and doing before and after weights for 24 hours. You are doing awesome so try to stay positive. BTW you may not always feel a letdown when it happens. Also what kind of pump are tou using? A hospital grade rental will be the most efficient and effective at simulating supply

I have the Medela PIS and am currently renting a hospital pump (Symphony) not having much luck woth either one. I was getting 3-5oz before and am now getting a few ml

Originally Posted by Kiara.I

I don't know how much domperidone you were taking, but on this page:
http://www.nbci.ca/index.php?option=...tion&Itemid=17
you see Dr. Newman's recommended dosages. Maybe once you get restocked you can try a higher dosage, if you weren't at his maximum, and just stay on it longer term.

He also has an article on stopping Domperidone, for the future.

yeah, I was taking 90g/day. Didn't plan on stopping suddenly...I thought I had another box left but I didn't


Overall I just feel like my supply has tanked (I know no Dom has probably caused it) but I'm trying all the other options to increase it while waiting for more Dom. I'm taking both Goat's Rue and More MIlk Plus, eating all the Oatmeal and extra calories, trying to drink more water....what else can I do? I can't pump after nursing because DD IS nursing ALL day long! It's so frustrating and sad I just feel like I'm letting her down.
It will still be at least a week or so before the Dom arrives
We are leaving for a 5 day trip tomorrow and I only have about 14 oz of EBM left. So far, I've been unable to pump any more so if I don't get my supply back up I'll have to resort to formula....I don't know what else to do

[TXmom2]

Just wanted to update for all those who helped

DD is doing well now. I am back on the Domperidone (80mg/day) and after finally finding a IBCLC who recognized the tongue tie, going to the ENT and getting the tongue tie released DD is nursing well and only takes about 20 minutes total for feedings.
I'm noticing more output (diapers), happier baby after feedings, and more milk production
She has gained more now and is 13lbs,6oz, 26.4in long.

Thanks to all those who encouraged me

[Camile Rynd]

Thank You!!

I just read this whole thread and I wanted to take the time to thank you for your diligence and can do attitude! You are truly heroic and I'm so glad to hear that you and your little one will have a future of breastfeeding and bonding together! Congrats and job well done!!!

[Megan73]

Awesome! You rock, mama.

[PatioGardener]

Super news!!! We need more nurses/doctors/LCs who are skilled in diagnosing and treating tongue-ties! Great to hear that you are doing well!

[xelakann]

yay!