bad start to breastfeeding? sup/pump/nursing survival tips needed

[GoodUserNamesTaken]

Hi,

My babies are about to wake up, so I have to make this quick, but I could really use some success stories and survival tips from those who had a bad start to breastfeeding, but still got it to work in the end.

If you are on the APmultiples list, then you've seen my story already... but the short version is that I didn't get to nurse my babies at all the first day, the second day I nursed here and there, and pumped once, the third day I pumped here and there and nursed them, but very little... That's the simple version of the story! They were born at 36 wks and 6 days, and they are three weeks old now.

When we got home, I was nursing them and then giving them formula. I contacted a lactation consultant last week to help me get them to full breastfeeding, and now, I nurse them, supplement, AND pump. I try to pump at least 4 times a day, if not 5, and that is in addition to nursing them at almost every feeding, too. At night, I don't pump as I can't take the stress, but I do nurse them...though I worry this isn't good and I should force myself to pump at night, too. I'm taking fenugreek and drinking fennel tea, too.

I don't know.

I find it all very overwhelming, I feel like the entire day is spent nursing, supplementing, or pumping. I don't mind nursing, but I HATE pumping, and I hate when I have to give them formula. I'm able to give them breastmilk for about half the day, but I run out at night and have to sup with formula. (If I pumped at night, I'd probably have enough for the nighttime...)

Right now, I just want to know it's possible to get to exclusive breastfeeding from where I am, and survive the time until it comes... Some days, I feel confident, and other days, I worry it'll never happen or that I'm going to lose my milk or that I am losing my milk. My bigger twin has gotten much better at nursing, and I can hear him getting lots of milk when he nurses, but he still wants/needs the bottle afterwords often. My littler twin, my girl, isn't a great nurser, but I have high hopes of her getting better once we reach my due date (which was Feb 11th... they were born at 36 wks and 6 days).

ANY advice, or stories of encouragement, or survival tips, would be greatly appreciated. I want this so much. I loved nursing my older boys, and it breaks my heart every time I worry that my twins might not get to nurse as they did.

[DeerMother]

Yes, the pumping/nursing is non stop for at least the first month. With premies, maybe longer. It is exhausting!
Why are you supplementing? Could you drop the formula and nurse more often?

[GoodUserNamesTaken]

We supplementing b/c my milk supply isn't where it should be, b/c of the poor start (hospital experience was a NIGHTMARE ) and b/c both babies were poor breastfeeders. The good news is that my son in the past few days has started nursing better! So I've been nursing him and not supplementing for a couple feeds a day, and then, when he wakes up, giving him the supplement then. But I can see he's getting better and better at this.

My daughter, however, is still not great at breastfeeding. She falls asleep too fast, and doesn't have a good suck-swallow going. So she can't get enough on her own. But I'm hoping with time, maybe even just another week ?? she will get better. I let them nurse for every feeding, about, so they are getting tons of practice.

In the meantime, I'm nursing then for about 30 - 45 minutes, followed by bottles, followed by pumping to increase my supply... it's so exhausting. I know twins are hard, but I feel like I have triplets, if you could the pump as one of my babies to feed!

I can't wait until I have them both nursing only... The lactation consultant said we will get there, but right now, it feels like it's years away.

[attached2mason]

Not much time to post, but just a couple ideas to discuss with your LC and/or LLL leader.

1. Have you considered a supplimental nursing system? That way all stimulation is at the breast, all the time. Might mean you could cut out the pumping and nurse more and the formula in the SNS would suppliment your supply

2. New theories on supplimentation suggest that another way to approach it might be to use formula/expressed bm FIRST (seems crazy I know) just to take the edge off of hunger a wee bit and then have them finish the majority of the feeding at the breast. Recent research has shown that babies fed in this way are more likely to nurse effectively cuz they aren't just waiting for the bottle at the end. It is still a new theory, but I do have some info on it that was sent to me by my LLL higher-ups that I could email you if you like. I can't vouch for this method as I have not worked with any moms using it, but I thought I'd share the info so you could discuss it with your LC.

3. Have you considered prescription medication (i.e. dom peridone)?

4. Have you considered a 48 hour nurse in - where you camp out in bed and nurse nurse nurse, nothing else but eating, and other basic necessities? Cut out the formula entirely and spend all your time nursing . . .supply often responds well toward the end of the second day. This isn't for everyone, but many moms find it very effective since continuing supplimentation over time can seriously dampen the establishing of a good milk supply.

Just a few ideas to consider. Best of luck, mama

[GoodUserNamesTaken]

Thank you, Amy.

I'm concerned that if I gave the bottle first for my girl, she won't wake up the nurse after. My ds might go for that... Though today, I nursed him, then gave him a bottle a bit later, and when he rooted for more, I nursed him again. That worked well.

The LC mentioned a SNS system but ruled it out for some reason, but she did it more to herself in her head (ie, she was kind of talking to herself.) I might mention this to her next time, especially for my ds, since he is nursing well.

Yes, I'd LOVE to do the nurse-in! DS is ready for that I think, even if my DD is not yet ready. I was waiting for the "go ahead", but wasn't clear when that would come. I don't know if I need to pump-pump for awhile first, or what...

[GoodUserNamesTaken]

Amy,

PS, yes, please do email it to me. Sending you a PM with my email.

[jeliphish]

Where are you located? Maybe a MDC mom is near you and can come over to help you some. I know you are tired and overwhelmed....I cannot imagine having my first nursing experience be with twins. You are going wonderfully so far mama!

[Novella]

Not blasting attached2mason, because it's always good to share new ideas. Not completely blasting the new theory because I'm wasn't involved with the study and am not a scientist.

However. . . for real?! Basically this is saying that a hungry newborn offered a breast will purposely delay or nurse ineffectively, because he/she "is just waiting for the bottle at the end". Waiting?! Hungry?! Doesn't appear to be the sort of instinctive behavior that would perpetuate a species.

Originally Posted by attached2mason

2. New theories on supplimentation suggest that another way to approach it might be to use formula/expressed bm FIRST (seems crazy I know) just to take the edge off of hunger a wee bit and then have them finish the majority of the feeding at the breast. Recent research has shown that babies fed in this way are more likely to nurse effectively cuz they aren't just waiting for the bottle at the end.

I think the suggestions for the nurse-in and the supplemental nursing system were good ones. The continued formula supplementing at night is a chicken-and-egg thing, isn't it. Sorry to hear you've had such a frustrating start.

[GoodUserNamesTaken]

Originally Posted by jeliphish

Where are you located? Maybe a MDC mom is near you and can come over to help you some. I know you are tired and overwhelmed....I cannot imagine having my first nursing experience be with twins. You are going wonderfully so far mama!

I actually have lots of LLL friends who are helping, though none have personal twin experience. I really want to hear from those who have BTDT, yknow?

Also, this isn't my first nursing experience, but it is the first time I've ever had a problem. I nursed my two older boys for 2+ yrs, loved it, and never even owned a bottle. I was so upset when the hospital required the babies to take bottles (forcing them at times to eat even when asleep!!!), and limited my nursing time and contact w/ the babies. It was seriously traumatizing.

PS. I'm in Israel.

[DeerMother]

GoodUserNamesTaken,
fwiw, I didn't get off to a great start w/ ds either. He was in NICu while dd was not. I was torn between the two (on different floors) and didn't nurse him until his 2nd or 3rd day of life. Having a successful nursing relationship really required a lot of patience and persistence. Even when we had thrush and he refused the breast, opting for ebm, I still continued to offer and eventually he took to it.

Please ask anyone and everyone you know for help w/ meals, laundry, chores etc. so that you may focus on feeding your dc. Hang in there.

My hospital experience was lousy also, sending you healing thoughts.

Originally Posted by Novella

However. . . for real?! Basically this is saying that a hungry newborn offered a breast will purposely delay or nurse ineffectively, because he/she "is just waiting for the bottle at the end". Waiting?! Hungry?! Doesn't appear to be the sort of instinctive behavior that would perpetuate a species.

I don't know. . . makes sense to me. IME, when a nb is hungry, they are HUNGRY! If they aren't getting what they need at the breast as quickly as they want it they grow frustrated. I can see how taking the edge off w/ a small amount of a bottle may encourage them to nurse.

[attached2mason]

Novella, I can appreciate your skepticism and have taken no offence, no worries . I can't say I'm entirely convinced either and think it would only be useful in certain situations. I know it was met with a great deal of debate at the conference it was recently presented at. Goodusernamestaken - I will email you when I get home from work tonight as the info is on my home computer. Oh, and to be clear . . .when I say enough to take the edge off I'm not talking 3 oz . . . I'm talking quite small amounts, varying of course by the age/weight of the baby.

When working with moms as a LLL leader my first choice would always be to cut out suppliments completely as soon as possible. They tend to really mess things up and make things worse over time. Often they are not even necessary and are only necessary because you are giving them - chicken and the egg indeed. Supply only builds when it is given the chance to build.

Hopefully the nurse in works well for you!! I've seen it work many times. 48 hours is a short period of time and even if there isn't quite enough at first usually it will catch up quite quickly. As long as babe continues to have decent output the suppliments are not necessary during that 48 hours. Working with one baby at a time on it sounds like a good idea - and perhaps less overwhelming .

I offer all of this, of course, just as ideas to weigh based on your situation. Without working closely with a nursing pair/trio it is tough to know which path makes most sense. In any event, focus on adequate output (pee/poop) and not oz taken or even weight gain - but as an experienced mama you already know that .


You can do this, mama. Really you can. It will take work and determination, for sure, but your dedication is obvious and that will carry you far. In order to make this work you need confidence, support, and good information - if you have enough of all three I just know you'll be exclusively nursing those babies in no time!

[GoodUserNamesTaken]

Originally Posted by esaesa

GoodUserNamesTaken,
fwiw, I didn't get off to a great start w/ ds either. He was in NICu while dd was not. I was torn between the two (on different floors) and didn't nurse him until his 2nd or 3rd day of life. Having a successful nursing relationship really required a lot of patience and persistence. Even when we had thrush and he refused the breast, opting for ebm, I still continued to offer and eventually he took to it.

Yes, this is what happened to me, too. My ds was in one nursery, on a monitor, and my dd was in a special nursery, not quite NICU, but considered to be in between the two. And I had to constantly choose who I would go see. It was easier to see my ds b/c the visitation times were less restricted. But I would cry at night from guilt in the hospital that I didn't see my dd as much as my ds. My husband and I felt when we left the hospital that only then, we were getting our daughter... it felt like they took her from us, and then gave her "back" five days later. It was so hard.

[~bookcase~]

My twins were next to each other but I still faced the problem that ds was sooner into an open crib where I could pick him up w/out permission, but dd was in an incubator for almost the entire 4 weeks and I held her much less and for shorter times.

Ds went demand fed at 36 weeks and dd took like 5 weeks longer to get to that place, so don't fret. I know each day I was so stressed and wasn't sure it would ever happen - even when it was finally happening I felt like we might have problems at any minute (and we have had slow weight gain forever with her )

Get skin to skin when you can as it's so healing and hormonally helpful.
Chat to them about the experience of SCBU (for you and for them).
Check dd doesn't have tongue tie.
Take domperidone if you can get it/ herbal galactagogues if it's not.
Pump as much as you can for a few days, even if it's only here and there 10 mins, on top of your current expressing.
I'd try supplementer too.
Tandem when you can to let your dd benefit from stronger ds's let down initiation.

IT'S POSSIBLE!

[Spring Lily]

I haven't read all the posts yet, but it is ABSOLUTELY POSSIBLE to have a bad a start like this and still be able to exclusively nurse. My start was even worse--babies in the NICU for 3 weeks, couldn't nurse at all for meals until 7 weeks of age. They were on bottles full time for almost two months, most of it formula.

We just worked at it, the same way you are. The worst time was the crossover between nursing and pumping. The best thing I did was take a couple of days where I pretty much stayed in bed with them all day and we napped and nursed. That is all we did. Our start was so bad it took a month to get off of the bottles, but we did it and they haven't had a bottle since they were 3 months old. I won't lie, it was the hardest thing I've ever done, but it has been totally worth every second of pain and frustration and all those tears I shed (constantly). Keep working on it, they might have to hit their due date or even a little past it to really get good at nursing. It really varies, some do great when they're early and some are full term and still need a couple of weeks. There *will* be a turning point soon, if you can hold out a little longer.

[twinmama2010]

I am with you!

I wish I could tell you a story from the other side- but I'm in the same boat. 2 pre-term babies (38 weeks) having difficulties with BF- and we are on a similar plan to you. We are breastfeeding 8-10 times per day, pumping 7 times per day, and supplementing with formula after each feeding (as per a lactation consultant). I keep wondering if we will get off this horrid schedule and just be able to nurse at the breast on demand...so I'll keep looking at this thread for hope.

Hang in there! I've wanted to give up numerous times...I am SO sore. But- we can do it! Just know there is another soul out there trucking right along with you. Best wishes!

[CalaRei]

You are telling my story.

My babes were "term" at 37 weeks, but the smaller one was struggling a little with breathing, so off to the NICU he went. My larger one stayed with me and nursed nursed nursed, but things went downhill quickly. He lost 10% of his body weight. I started pumping, the nurses started supplementing. Not sure if it was because I had retained placenta (which wasn't discovered until 10 weeks) but it took a long time for my milk to come in. The littler one would latch, but weakly and not really suck. The LC in the hospital even needed to dribble just a little formula down my nipple to entice him on.

So we came home doing the nurse-supplement-pump rigamarole, and it was hell. The babies were so sleepy that even the supplementing was slow. We had to set alarms to wake them... then do the whole routine. The little one would routinely take 40 minutes to eat 2 oz of supplementation. With feedings every two hours, I don't think we slept at all. Early weight gain didn't go so well, so we even were on a high calorie formula

Eventually, I to started to get the feeling that someone noted above: Nursing isn't getting me food fast enough, I'll just wait for that bottle after. So I instead started replacing feeding sessions with bottles. At the very least, it saved my sanity, and was totally a turning point for me. I could bottle feed and then pump. I was so worried, though, that that nipple preference would set in. My larger twin would suck down 4 ounces in 10 minutes!!

As I started to see my pumping output increase, I slowly began putting back nursing sessions in. We got down to every third. Went to nursing all night long - MUCH easier than fussing with bottles at night, plus better milk supply maintenance. It got to the point where they only got 2 or 3 bottles a day. I was careful during this transition to watch hunger cues and offer half an ounce supplements after if I felt the need.

The key for me was NOT TO TAKE IT PERSONALLY. My LC put it best - we are so lucky to have a substitute when we need it to help us along. This was just how we made it through, and I was so happy to give them what I could.

But then something happened. We offered the larger baby more than 4 ounces, and he didn't want it. Then... around 8 weeks, he started gumming the bottles instead guzzling it. Silly boy was starting a nipple preference in the opposite direction! He outright refuses bottles now unless he's half asleep or pretty darn hungry.
(I took an evening to go scrapbooking last week and got a text from my hubby: Tycho kindly requests the presence of your breasts.)

The littler one has been near exclusively nursed for the past month, and gaining excellent weight. Even the LC's pediatrician thinks it's totally appropriate for him to drop supplements now! And this on top of his reflux, I'm incredibly pleased, and so so grateful that I didn't give up back in the haze of nurse-sup-pump-repeat like I'd cried about.

If you need more support, please PM me - I know you can do this!!

[cdahlgrd]

My twins were born at 38 weeks. It took us 2 months before they breastfed.

My supply was slow to come in and they NEEDED suppliments. We used bottles. I tried to use the sns. I couldn't use it by myself and then, the boys would REFUSE to nurse if they didn't feel the tube. . sigh. That was after only 2 days using it. (And I firmly believe that about babies waiting for the bottle!! They are WAY smarter than we give them credit for!!)

They also had latch problems: small mouths vs. huge nipples. It took time for them to grow big enough to latch effectively.

I tried to pump, nurse, pump, bottle, pump, nurse, etc. but my help went home and I coudn't do it all by myself. So I stopped nursing and just pumped and bottlefed.

After 2 weeks of no nursing at all(and much less stress around feedings), my dh suggested I try again and see if they would latch. . . .and they did!! They were 8 weeks old and FINALLY nursing like they had been nursing from birth. 1 twin needed a few more days of bottles on occasion because he would get tired and not empty his breast. But that was just a few days.

We nursed for 3 years.

What I learned: The most important thing was that they got some breastmilk and I got some rest too. After that I had to accept that I was not the only person making choices in this triad. . . .I may not get to breastfeed them. But I could pump and give them breastmilk.

Set a time limit: I was going to pump for 6 months and re-evaluate. That was the only way I could get through the pumping. Perhaps for you it will be, "Continue pumping and sns feeds for 2 more weeks and then re-evaluate." It helps to think about a limited amount of time to the tortu. . . ummm pumping.

Swings (or bouncy seats) are necessary for pumping.

Pump 1x in the night while you get your milk up. Don't clean the pump or refridgerate your milk until morning, it will wait just fine.

You can only do what you can do. Your babies will love you even though you aren't perfect!

[attached2mason]

I just dug up the email I got from a LLL Canada forum for leaders and discovered that the article I read is all posted on a website so I'll post the link here:

http://www.lowmilksupply.org/finishatthebreast.shtml


Please don't take this as my endorsement of the new method and certainly make sure to discuss it with your LC first. Every situation is different and has so many nuances, yk? I thought I'd throw the info out there, though, in case it is helpful. Some of the responses from fellow LLL leaders have been that they have been using it with the moms they work with and have found it to be a good alternative to SNS. The article doesn't mention cup, syringe or spoon feeding but I wonder if those alternative methods instead of the 'pre-breast bottle' might reduce nipple confusion possibilities and increase need to suck while at the breast.

There are many situations where supplimentation is not necessary at all while there are others where it is truly necessary - unfortunately the cases where it is necessary are often linked to poor hospital policy and/or birth management , not because the mama in question has done anything wrong. Frustrating!

[lexbeach]

Congrats on the arrival of your twins, and I'm sorry that the breastfeeding part is not going as smoothly as possible.

How many ounces of formula are you supplementing with in a 24-hour period? What is your babies' weight gain like?

I do think the nurse-in is probably the easiest and quickest way to get to the point of exclusively breastfeeding, but I'm hesitant to recommend it wholeheartedly without knowing how many ounces of formula your babies are currently getting.

Right now your supply is still in constant flux. This is the time to try to get off the formula supplements. After 6 weeks, it gets much harder (though not impossible by any means).

Do you have access to a baby scale? Could you rent one for a couple of weeks? Perhaps if you could weigh your babies every couple of days, you would feel more confident in eliminating a certain # of ounces of formula per day.

HTH!

Lex

[kalynnsmom]

I don't have any advice to offer, but did want to say that it is possible to nurse exclusively after having struggles. My boys were born at 34 weeks. Gave bottles and one of them refused to nurse at all. So, I had to pump for the first few weeks. It was pump, nurse, pump, nurse.. It was really frustrating and I never thought I'd be able to nurse them. About 6 or 7 weeks, he finally latched and got both of them nursing. They are three and still nursing (but on their way to weaning)