too mellow to transfer a whole meal, any hope?

[patronus]

hi mamas,
my baby is 3 weeks old. here's what's been going on:
normal birth, nothing traumatic. jaundice, needed home phototherapy, resolved by day 10. she was back up to birth weight by day 13 and we've been gaining at a good pace since then.
although she will stay at the breast for ages, elise has never been good at actively sucking/swallowing enough to get an entire meal at the breast. she will poop out and revert to passive sucking and stop transferring milk about half way through.
my supply was low around day 10, so i've been taking reglan for about a week. in the meantime, our lc suggested i pumped 30 minutes after each meal to help get my supply up and supplement (via bottle) to make up the difference in what she wasn't getting at the breast. we're switch nursing to keep her focused. well, my supply has gone up and now elise will sometimes eat an entire meal at the breast (higher flow is easier for her to manage). i've actually stopped pumping in between meals because the fuller my breasts are, the better she eats.
i was at the pediatrician today and his comment was that her personality is so mellow, she just may never manage to eat full meals at the breast and may need to be supplemented always.
my question: could she still continue to get better at transferring milk beyond the age of three weeks and is there anything i can do to help her get better at it?

i really want to get to the point where we're 100% at the breast. i love breastfeeding her and would love for things to be easier at some point. and supplementing is a pain.

[leoheart]

One suggestion would be to wear her as much as possible, skin to skin whenever you can, that way you would be able to respond to her feeding cues more often - more frequent meals would make up for the shorter meals. (This is what my LC routinely recommends for sleepy babies.) I don't think a "mellow" personality at 3 weeks old is really indicative of much - don't get discouraged! Who knows what future days will bring - babies become more alert every day. Yes, pumping and supplementing is a pain, but you're still pretty early in the game. I think if you take it one day at a time, you will soon enough find that you no longer need to supplement her.
Oh, and yes, she will continue to get better at nursing. Her mouth will get larger and her suck will become more efficient. Just keep offering her the breast as much as possible.

[Llyra]

If she's gaining well and thriving, I guess I just don't understand that there's a problem. Is it because she feeds frequently, and stays on the breast a long time? It's normal and natural for a newborn to spend a long time on the breast, and to enjoy lengthy comfort-sucking after the milk has stopped flowing. It's also normal, natural, and biologically appropriate for a baby to prefer smaller, more frequent feeds. If baby is gaining weight at a normal rate, then baby is getting just exactly what baby needs. Yes, she will become more efficient as she grows and becomes more alert. Although some kids (like my DS) will always prefer to nurse more frequently, and many kids will spend plenty of time at the breast NOT actively "eating," because breastfeeding is about so much more than food.

So if I were you, I wouldn't worry about it. If baby is gaining well, there's no reason to supplement, and bottles can undermine your efforts. Sucking from a bottle is a simple matter of suction, and the milk comes easily without too much effort. Suckling at the breast is a complicated action of mouth and tongue. Some babies, although not all, will learn habits at the bottle that will make them nurse less enthusiastically and energetically, so that they're getting less and less at the breast, which leads to premature weaning and compromises your supply.

I think that with a healthy baby who's gaining, all you need to do is follow baby's cues. It can help a lot to learn to nurse with baby in a front carrier or sling, so that you don't feel like you're spending all day sitting around nursing.

[patronus]

she is gaining really well, but that's with supplementation. and i'd be happy to let her nurse for hours if she got filled up, but she doesn't. she'll come off the breast still hungry

my supply seems to be up, but if i pump, my breasts aren't full enough at the next feeding for her to easily transfer and we end up not having a good feeding. if i don't pump, my breasts are full enough for her to eat an entire meal.

once we're doing well, i will need to incorporate pumping, as i'm returning to work after 12 weeks.

[PatioGardener]

Have you seen a good IBCLC? Your ped doesn't sounds so breastfeeding friendly, and I question an LC who recommends bottles before trying to supplement at the breast (maybe you guys tried that already?)

I would not characterize a 3 week old with a mellow personality that will make it impossible to fully breastfeed! I'd be looking into things like tongue-tie, breast compressions for good milk transfer, upping my supply (domperidone, etc.) Dr. Jack Newman has some great videos that may help : www.drjacknewman.com

Hang in there, Mama, there IS hope! Good luck!

[patronus]

i'm not sure if the LC i saw was ibclc. she was one of a few that are on staff at our local hospital. i have another person who is ibclc that i think i may see next.
the ped we saw today is just one of about 5 at our practice. he's not our primary dr. and i won't be seeing him again. not impressed. he basically said he just wants e to gain weight, he doesn't care how we do it.

i don't believe she is tongue tied, a few of the lc's we saw at the hospital looked and she can lift her tongue and stick it out. who would be the best person to assess this?

i am using breast compressions, which really help. i am finishing a course of metrocloprimide and will start fenugreek after i finish. i'm drinking milkmaid tea a few times a day.

we're hanging in there pretty well, things are much better than they were. and things are "working", she is gaining well and we are transferring a decent amount of milk. i'm just hoping we can close the supplementation gap and get things going really well.

thanks for the support and comments, it's nice to know there is hope!

[PatioGardener]

It sounds like you have your bases covered and baby just needs to 'grow' into nursing 100%! I don't know how metrocloprimide works when you finish a prescription (I'm up in Canada so domperidone is the medication of choice here). With domperidone you need to end slowly (taper) so mama's supply doesn't drop.

If you are up for it, supplementing at the breast rather than with a bottle will help baby learn how to breastfeed. You can do it for cheap with a small feeding tube (not idea but good for a short term solution) - usually after baby starts to slow at the breast and you have tried switching sides and baby is slowing again then a mom would add the feeding tube and give the extra milk at the breast.

Keep going, Mama! A good friend of mine finger fed (with the same tube) for 2 full weeks after birth and then transitioned to the breast for at least 2 weeks. Things got 'better' for her around 6 weeks (fully on the breast and good weight gain, and 'easy' by 3 months. It was hard hard work, but she has no regreats. She is incredibly proud that she was able to work through the troubles. She had good support during this time, which I think made all the difference. You may want to look up La Leche League in your area for some 'real life' support too!

Good luck!