I am out of advice for my Sister! Help!

[welsh]

I just got this heartbreaking email from my Sister and I don't know how to best advise her further.
We have tried all the obvious things to increase supply but her DD2 is not satisfied by the breast and has barely gained any weight in 5 wks since birth. Now having 2 x 4oz bottles of formula a day and gained weight for the first time this week.
Her DH works alot but is great when he's home, she has no other family support and a 4 yr old DD to take care of. I am overseas
See her words below and please help....

She basically said, that DD2 @ 5 weeks is so different to DD1 who was a textbook BFeeder, went on for 40 mins and happy and full after it.....but DD2 is on the boob for hours - both sides and is still crying and not at all satisfied.
She fed her yesterday morning from 10am till about 12 - she drained one side, then other for an hour but then was so frustrated!
Acted the same before a bottle was introduced.
There is a huge difference in her after shes had a bottle, she is content and happy!
She simply CANNOT feed her for 2 hours at a time as she has another child and minimal support.
Her latch looks and feels perfect but after an hour she shouldn't be still crying and fussing so much. Afterwards she'll drink 4oz from a bottle like she's starving - and there - happy again!!!
She's feeling so guilty that she cant breastfeed her well, but also guilty that she's still doing it because obviously she is hungry and is better after her bottles!!
She has only gained 3oz in 5 weeks.
It breaks my heart that she thinks I'll judge or be disappointed because I'm so pro-breastfeeding.

[PatioGardener]

Where is she living?

Can she supplement at the breast?
http://www.nbci.ca/index.php?option=...lips&Itemid=13

[feminist~mama]

You said that you've tried "all the obvious things to increase her supply"- but it would be helpful to know what you feel like the obvious things are/what she's tried thus far!

[Friendlee]

I was ebf'ing and my dd didn't gain a single ounce in the first FOUR weeks! But she didn't show any other signs of illness or lack of thriving, so the doctor recommended we not supplement and not bottle feed.

It sure took her a good 7 weeks before she became an efficient nurser. And it really was frustrating. And in that 7 weeks, during times of growth spurts, she was never satisfied. I would feed her and then sometimes top her off with my precious frozen milk I'd stored and she'd have that "milk drunk" effect only after being topped off. She was hungrier than what I was producing...until my breasts were able to catch up. There was always about 3 days before the boobs got the memo. But even in between growth spurts, I dealt with similar behavior.

I didn't know any different. My mom struggled, my sister struggled. I just thought that breastfeeding pretty much sucked and that's how it was. But at 7 weeks, my dd started to learn how to do it better and my breasts REALLY started to produce. It all changed. Now at 6 months, we're cruising along just fine.

I almost gave up. All I can say is that I'm really glad I didn't. When she was 5 weeks, like your sister's dd, I would take her to the lactation office almost daily. We'd weigh her, then nurse, then weigh her again to see how much she was getting and so long as she was getting something and gaining even a small amount of weight, then I was told to keep at it with no bottles.

Is it possible that the bottles are hindering how the baby learns at the breast? You'd think a baby would get it by 5 weeks, but mine sure didn't. Csn she go to a lactation consultant daily to check in? It was free at my hospital so I wonder if there's something like that available to her - it save my breastfeeding relationship with dd!

[CowsRock]

Yes, it would be helpful to know what has already been ruled out. Has she seen a lactation consultant? Often times something very slight can be off with the latch and fixing that can be huge. A tongue tie could cause problems with latch and it might seem like the latch is fine. There are varying degrees of TT. If she doesn't have help, is she sure she is eating enough? I had so many nursing problems in the beginning and my supply was getting pretty bad and my doc thought I was losing weight too fast. I told her I'm eating when I'm hungry and I'm not exercising so don't know what else I can do, kind of feeling like the doc was being silly. Well when I made a point to eat more even though I wasn't hungry, I was suddenly ravenous. I had been so focused on our nursing struggles that I guess I missed my body's cues and my body stopped telling me it was hungry. My supply immediately perked up after that. Hand expressing for a minute before latching can help a babe that feels like they are having to work too hard for the milk.

My son was also one that took a while to really get nursing.

Her pain and frustration is heart breaking for sure. I think you'll get better advice if you can outline what has been tried, who she has seen, etc. How wonderful that you are able to help her.

[MonkeysRUs]

Just going on what you have posted, I would guess that your sister's baby is not transferring milk effectively, and as a result your sister's milk production has dropped. Spending 2 hours at breast and still being hungry afterwards (along with the lack of weight gain) means that her baby isn't transferring any milk. It is possible for a baby to appear to be nursing and have a good latch, and still have something going on inside the mouth that results in baby not getting any milk. The first priority is for your sister to feed her baby. If that means supplementing for a while until she gets her milk production back up, it's certainly not an insurmountable problem. Ideally, your sister needs to be spending as much time as possible skin-to-skin (hard with a four year old I know, so wearing baby STS in a sling around the house might help). She also needs to be pumping 8-10 times a day to try and rebuild her milk production, and may want to talk to her doctor about herbs or medications to increase production. She can either put baby to breast for 15-20 minutes for each feed then pump and supplement, or she can supplement first then put baby to breast for "dessert" and then pump.
These are just suggestions based on what you have told us so far. I strongly recommend that your sister sees a lactation consultant (IBCLC) to try and figure out what is going on.
Best wishes to both of you. It sounds like your sister is trying so hard, and it's so frustrating when things aren't working the way they should be. I also know it's hard to be at a distance when a family member needs help.

[welsh]

A lactation consultant? Ha! It's not a joke at all but the biggest source of frustration....
My Sister lives in a rural area in the UK and there is not one single breastfeeding counsellor in the whole area. There was one but she switched specialities and is now a drugs counsellor! The irony is that my Sisters' midwife commented that my Sister should think about training to become one.

Anyway you wouldn't believe the lack of support and knowledge in the area with regard to bf. Clueless. Doctors, nurses, health visitors alike.
I was with her for 2 wks pp and baby latched on so easily, all looked great. Of course maybe there is a slight issue with tongue tie or latch that I didn't see.

Initially Sis was not eating enough, she knew this.
We talked together about upping her protein, good fats, whole grains etc. Which she has done. Oatmeal.
Also drinking lots of fluids. She's not exercising.
I also asked my Dad to step up and he now cooks her a hearty meal on Sundays and sends leftovers.
I advised her on a sling which she has bought and wearing baby skin-2-skin.
She battled through mastitis and didn't give up.
She is putting baby to breast every 2 hrs at least. Only giving those 2 x bottles of formula after boob.

My Sis is alot more mainstream than me. I'm going to suggest the avenues of herbs, pumping, or an sns but I don't think she'll go *that far*

She stayed in our backwater hometown where very few breastfeed whereas I moved away. She bf her DD1 for 6 months and wanted to go for longer this time. Partly because I nursed my DS1 for 26 months and I'm not a weirdo
I hate that she feels like I'd be disappointed in her.

Thanks all for your advice and support.

[pbjmama]

She could send pictures and get a phone/internet consult. But really, seeing a baby at the breast is so important for problems like these! Have genetic and metabolic problems been ruled out? I'm all about breastfeeding...but even more important is that the baby has to eat. The #1 rule is feed the baby. If that means going to formula, well, let your sister know that you love her and will support whatever she decides - she has to make the best decision for her family.

[mambera]

She might be able to check for tongue tie on her own. There are some web resources available for this.

http://www.kellymom.com/babyconcerns...tonguetie.html

http://www.aap.org/breastfeeding/fil...Newsletter.pdf

[GoBecGo]

Has she had her thyroid checked? I was hypothyroid post-partum, it can be quite common and has a massive impact on supply for some women.

Has she searched for NCT breastfeeding help in her area? I have a friend who is studying with the NCT and she tells me the BFing people will travel sometimes hundreds of miles to help ladies out. Check out their website for more info - they are really knowledgeable and kind ladies.

I definitely know a couple of babes who just didn't "get it" for 6 weeks or so, and did go on to feed well once they learned how. As you know yourself the bigger they get the more skilled they become - often a bigger mouth makes the most difference to a struggling babe and mama.

[welsh]

update..
She has started giving more formula and is now breastfeeding x 3 per day. She isn't engorged at all so clearly wasn't making much milk.
Her DD is like a different baby...so much happier.
Sadly she feels like a failure but didn't have the energy or IRL support to explore other avenues.
We just spoke and she said that she's ashamed to give a bottle in public like she may as well be smoking over the baby or something!!!!!
Thanks all for your replies.

[GoBecGo]

If she still wants to try to recover supply i just found a Medela SNS (with the bottle for formula and the tube to tape to the nipple) on the UK amazon for £21. I'm shocked at how cheap it is, i was a low supply mama last time and i'll definitely be keeping it in mind as a possibility this time around!

I feel terribly for her that she feels formula and smoking into the baby's face is the same - i felt that way too when my milk dried up. It was a very dark and depressing time.

[welsh]

Originally Posted by GoBecGo

If she still wants to try to recover supply i just found a Medela SNS (with the bottle for formula and the tube to tape to the nipple) on the UK amazon for £21. I'm shocked at how cheap it is, i was a low supply mama last time and i'll definitely be keeping it in mind as a possibility this time around!

I feel terribly for her that she feels formula and smoking into the baby's face is the same - i felt that way too when my milk dried up. It was a very dark and depressing time.

That is very cheap!!!

Thanks for your kind words!

[ewe+lamb]

Seeing as your sister is in the UK, she can contact LLLGB - inparticular the central London Group with whom Susan Colson is a LLL Leader - she also runs the www.biologicalnurturing.com website and is an excellent IBCLC - I strongly advise your sister to get in contact with her, she'll be able to give her some help and support - I would tend to agree with the other posters it sounds like tongue tie could be the source of the problem, would she be able to take photos of the baby's palate - and maybe when the baby is crying so that she can see if the tongue is lifting up, it sounds complicated but is entirely possible. I know what you mean about nursing in the uk it's not acceptable to formula feed but the resources which you need to do that are just not there - I really hope that things work out, PM if she needs some more direct help I can phone and see if we can get to the bottom of things.

[dachshund mom]

Will she try domperidone? There's a thread about it on here. I had low supply and was up to supplementing with formula from 3wks-3mos (got up to 10oz/day). I started the dom and got off the formula almost immediately.

People don't like to acknowledge that low supply exists, but it DOES. I had the same problems as your sister. Never engorged or even full. Nursing all the time and had a screaming, rooting baby when I wasn't. Not gaining weight. When we started the supplement it was like night and day, and DD finally started sleeping and stopped crying all the time.

[PatioGardener]

The NCT has a breastfeeding helpline http://www.nct.org.uk/info-centre/ge...help/helplines - not as good as hands on help, but at least a real person to talk to who may be ablet o support and encourage her?