How Much Longer Can I????

[EvanNZachsMama]

I am new to the forum/ site, first of all. I don't mean to be rude, but I am going to cut right to the chase. I'm having major issues and I want to cry/ scream/ rant/ give-up.

My Story:
I had my son at 34wks, 4 d after months of bedrest for PTL, including treatment w/ a brethine pump, uterine monitor, 17P injections every 5 days and more. He was delivered after an amnio showed mature lungs, via scheduled c-section because of cervical dystocia and contrax every 2 minutes for months, literally. He spent 4 hrs in the NICU for observation and was returned to me. The LC told me to give him formula to keep him from losing weight, so my routine was nurse him, feed him, pump for 15 minutes every 3 hrs around the clock.
My milk came in great when he was 4 d old! I was pumping 7 oz. every 3 hrs. But I was dumb! Nobody told me to stop the routine I was on in the hospital once my milk came in, so I kept it up. I thought it was a preemie thing and not an until-my-mil-comes-in thing! I was using a new Pump in Style Advanced. But gradually, my supply went down. Then we had some health scares with the baby and they went down even further. Then I went to my postpartum check and was started on a POP, and it went down even further. Then I went back to work sooner than I wanted because of the length of time on bedrest before delivery, and it went down even more.

So...The bottom line is that once I realized my error in continuing to supplement, it was too late and there were other factors. I have tried everything. I started pumping every 2 hrs. No improvement. I thought maybe it was my pump, so I went and bought a Freestyle, thinking it was more expensive than the Pump in Style, so maybe it was better (?). No improvement. I saw a breastfeeding medicine doctor. Started Reglan and Fenugreek. Nothing. I started drinking mother's milk tea while taking the fenugreek, pumping every 3 hours and feeding the baby, stopping the POP, and even eating oatmeal (I HATE oatmeal!). And then I just bit the bullet and BOUGHT my own Medela Symphony instead of renting one, since this is the pump I used in the hospital for the first 3 days when my milk came in so well. (I got the Preemie Plus model because they said it is designed to replace the baby!) I have done "nursing vacations" and more. I've also tried SNS's.

Here is where I am at: The baby nurses every 3 hrs for about 15 min, follows up with 4 oz. of formula. I pump about 4 times a day separate from him nursing and get, at most, 2 oz. and that is with my Symphony. The slightest thing will make it drop. Nothing increases it. Nothing I have done has helped to wean him off of supplements, even the tiniest bit.

I have worked so hard at this. My son is now 3 mos. It isn't fair. I will do anything to make this work and I don't know what to do. I am at my wit's end. My oldest son had horrible formula intolerances and ended up with all sorts of feeding issues, and allergies run horribly in my family, so it is really important to me. I really don't want to give up all together, but there has to be some solution to this if my milk originally came in so well. That tells me I can BF successfully. What is wrong with me?

Thanks,
Andrea

[MominKS]

I'm so sorry you are having a hard time. Are you giving the 4 oz of formula via the SNS or a bottle? If a bottle, I would ditch the bottle and give it via the SNS. Have you considred a lactaid? I use one and love it. Granted I wish I could BF totally without it but I've gone from having to supplement with formula since he was two weeks old to now just giving my son BM with the lactaid and I'm in the process of trying to wean him from it (he's almost 5 months).

[Megan73]

NOTHING is wrong with you, mama. You got bad advice and you're far from the first mama (particularly, from what I've read, a preemie mama) to have that sabotage your breastfeeding relationship. Hang in there.
I totally agree with the PP - eliminate bottles and try a Lact-Aid. This is important on so many levels - stimulating supply, preventing flow preferance (which can creep up on you) and, bottom line, making sure your baby gets all the benefits of being breastfeed even if not everything he eats is breastmilk.
Also, have you tried domperidone instead of reglan? Do you have correctly-fitted flanges?
I would also question whether you're oversupplementing if I'm calculating correctly that you're giving your baby 32 ounces of formula a day on top of nursing and pumping 8 oz a day. What's his weight gain like? Kellymom.com has some great resources on average total intake and weight gain for breastfed babies.
HTH

[aramat]

Hi, mama. I'm so sorry you're having a tough time; I've been through similar over the past 8 months since my 32-weeker was born. Not sure how helpful I can be since you are pumping and I stopped pumping some time ago.

In my case, I'd already exclusively nursed two full-term babies so went into this preemie situation with a bit too much confidence and stubbornness. I stopped pumping for supplements at 5 weeks, and it was all downhill from there! Eight months later, I *think* I *may* know what my issues were, and maybe it is the same for you. 1. Baby's latch -- From what I've read of Dr Jack Newman, it seems he thinks it's All About The Latch. I even read (bad advice) that I could stop pumping if baby had the right latch and was able to nurse super-frequently. 2. Small baby -- maybe preemies just need a few months for their mouths to grow? 3. As a PP mentioned, flow preference! Once my baby reached a certain age, she definitely started to prefer bottles over breast, and it can be VERY challenging to get her to accept the breast to the point of emptying it, because once the flow slows she is ready for her REAL best friend, the bottle. 4. I also had some concerns about a swinging thyroid/hypopituitary issue possibly having affected my milk supply for a little while, as it *may* have been stress/thyroid that caused my baby to be born prematurely.

I have been on a galactogogue that they use here in South America called Sulpiride, and it works pretty well, but now that I am weaning off of it, baby likes nursing more -- I think it made my let-downs too strong. I was taking it 2x's per day but now am down to once every other day; we are down to 3-4 bottles a day now, from 5-7. If Reglan isn't working for you, perhaps you can try Domperidone or a combo of the two? They say Sulpiride and Domperidone can be taken together here, but I never tried it.

For us now, I keep baby next to me at night because she'll nurse more and longer when she's groggy. She does not have the best latch because she treats my nipples like a bottle nipple and doesn't like to open her mouth wide all the time, but I think she's big enough now that it doesn't make as much of a difference.

I keep a spreadsheet open and write down every oz of formula that baby drinks; if we come to a day where baby drinks even just 1/4 oz less than normal, that's a celebration.

You may also be able to utilize milk banks where you are; they have them here, too, but I always thought I'd be able to catch up and go off the formula so never looked into it.

Of course keep yourself hydrated and nourished and thinking "milky" thoughts. The stress doesn't help at ALL. And I've so been there. I really obsessed about this...maybe I still do. BUT: *ANY* amount of breastmilk you can give to your baby is something amazing. You are doing the best you can, and that is all you can do, and that is enough. Your commitment to pumping is certainly to be commended! I wish you the best of luck and hope you find peace and milk.

[EvanNZachsMama]

Thanks, Ladies!

I will try to answer your questions:

I haven't tried a Lact-Aid, but have tried a Medela brand SNS. Is there a preference between the 2?

I have not tried domperidone. I have read into it, though and the process of getting it seems kind of daunting. Because of the side effects of Reglan, they would only let me take it for one month, total, including the tapering the dose up in the beginning and back down at the end of the course. Right before they stopped it, I started to notice a difference and asked them to continue it for 2 more weeks and they wouldn't. Of course this was a BFing med doctor, so I am going to ask my family doc to give me another course of it. I did also start taking Blessed thistle this week after talking to our LLL leader. We also had my thyroid tested to be sure that wasn't the cause, and it was smack-dab in the middle of the range for normal.

As for the supplementing too much--I completely agree! The baby was --get this!-- 7lbs, 4 oz at almost 6 wks early, but he is compact, so his body is small,but he weighs a lot more than he looks. He just recently outgrew his preemie stuff and he weighs almost 12 lbs! So he gains very well, obviously. But the kid's appetite is ravenous. Looking back, in the early stages, I got tricked by the evening fussiness/ wanting to nurse more and thought he needed more supplement. And thus the slippery slope started. The 4 oz. every 3 hrs I originally posted is probably a little over what he is actually taking. He'll nurse for about 15 minutes, then take his bottle. I can give him as little as 2 oz. at a feeding, but only if we do it every 2 hours. If I stretch it to every 3 or 4, he will scream until he gets 3-4 oz. He spits up minimally, and really is a happy baby--hardly ever cries, etc. So I would love to wean him down on the formula, but he won't let me.

Regarding his latch: Sorry if this is TMI, but I am rather well-endowed and have large nipples, combined with his small mouth...Plus he has a mild tongue-tie, but the BF medicine doc didn't think it was the culprit because she said he has an excellent well-coordinated suck. She didn't want to snip it then because it gets thicker toward the back, so she referred us to an ENT only if we wanted to for later speech issues, only if we wanted. The jury's still out on that one. The only nipple soreness I have had is only related to the days I pump like a mad woman all day long, so that makes me think it isn't his latch, but I could be wrong. As far as flanges for my pump go, I ask myself the same question. I think my nipples have gotten smaller. I could pump until I'm not getting a single drop more, and right away hand express up to 0.5 oz. on each side, and not in little drips either--it sprays out. I tried a smaller size tonight and noticed there was much less to hand express afterwards, but there still was some.

So anyway, I think that's all--my long sordid BFing story. Sorry to be so long-winded. I appreciate any and all advice!

Andrea

[aramat]

W/the Sulpiride, it took me about 14 days to notice a difference both times that I started it.

I was doing some reading last night about nipple/flow preference and came across this: http://www.lowmilksupply.org/bottles.shtml Today I am trying some new things bc of what I read here...

[poorlittlefish]

Sorry you are having such a hard time.

I had a breast reduction and had to supplement my first DD. With my second my milk came in but my DD weight gain was only 4.5oz per week. I ordered Shatavari from Swansons herbs and now her weight gain is 7oz per week--it helped a ton.

It is cheap and easy to get. I take 2 pills 2 times per day and it has worked for me. I too, was afraid to try Dom.

Good luck!

[Parker'smommy]

What would happen if you just hunker down for a few days and not supplement at all? Everytime he cries...put him to the breast. He can definitely get your milk supply up better than any pump can. He can also get milk out of your breast better than a pump can. How much you are pumping is not always a clear indication of your real supply. I think he may prefer the bottle and like another poster said, nurses until the flow slows and then wants his milk fast from the bottle. After he pops off, and he cries for more, offer the other breast. I had times where we went back and forth for hours between breasts at that age. It's a great way to get your supply up and stimulated.


Good luck!

[tibeca]

Something you can try is offering to nurse more often. Every 3 hours is actually pretty infrequent for a BF baby. Offer even if your baby doesn't seem hungry. We so frequently wait for babies to cry before offering to breastfeed when they have been showing signs of hunger earlier. Also, have you tried breast compression? Perhaps the issue really is a fast flow that your baby prefers. Providing the extra pressure to the breast can increase flow and help your baby take in more milk.

Here is a link on breast compression
http://www.nbci.ca/index.php?option=...tion&Itemid=17

I also 2nd (or 3rd or 4th) the eliminating bottles and switching to an SNS (any type that works best for you). Nursing at the breast is the best way to increase supply, and the sns will ensure that your LO is getting enough nutrition, and working on your supply.

GOOD LUCK!

[ILoveMyBabyBird]

from my understanding you should slowly reduce the supplement as you increase nursings, so try reducing the formula by 1/2 oz each week and note any difference in weight and diaper output. Also at 3 months i asked my ds's dr. if i could cut out formula all together at night and she said that was perfectly fine since some babies sleep all night, so I just nursed him at night and supplemented in the day, that was much better for me and ds nursed quite a bit at night while i was still sleeping. So maybe try reducing the feeding slowly and start with the night feedings, it is way harder as a new mom breastfeeding, pumping and supplementing in the night, so if you could eliminate the formula and then increase the time nursing that should help your supply, and help you get more rest which probably wouldn't hurt your supply either.

[Megan73]

Originally Posted by EvanNZachsMama

I haven't tried a Lact-Aid, but have tried a Medela brand SNS. Is there a preference between the 2?

If you haven't had problems with the SNS, by all means use it –*and ditch the bottles. But if you struggled with it, the LA is hands down better.