Feeling confused... am I supplementing without a need?

[sattygirl99]

I started supp'ing for a true need... Day 5, no poop, only damp diapers stained with red/orange uric acid crystrals and no weight gain (he stopped losing but wasn't gaining)... Now I'm wondering if I'm continuing to supp because of fear moreso than need.

My supply has come up dramatically in a week.... Last Thursday when I started supp'ing, I was getting barely enough to cover the bottom of the bottle between feeds... Even in the morning. I started domperidone on Friday I think it was and leaked twice after that (2 and 3 days later) which I hadn't done at all! This morning I nursed without supp and when I pumped 1.5 hours later, got 3/4 oz! He's sucking (though still a bit lazy, he's a little sleepy yet) and swallowing, popping off with milk dribbling out his mouth (without the lact-aid)... but then we get to after 1pm where I feel like I have nothing and he's nursing a TON... So I supplement him and he takes about an oz and them promptly spits up.

How do I know it's OK to back off the supps? I've already backed off ALOT... He was taking 1-1.5 oz per feed and now he's taking maybe 6ish oz a day (I'm only supp'ing when I feel like he's unsatisfied and I'm stopping the flow when he falls asleep).

I had supply issues with DD.... I can't help but have the fear. She was borderline FTT due to her transfer issues (I had good supply, she just didn't transfer well due to TT) and then a whole downhill slide and my supply dropped. This time, it's been true supply issues where it's low but I seem to have more milk now. I'm not quite a week into the domperidone (and only taking 90mg so I could go up if needed) and not even 24 hours into the MMP (which I'm taking 3, 3 times a day)... I'm on the quest for shativari too because I've heard such wonderful things about it.

My LC isn't the best of help... She's very quick to say 'feed the baby first'... Well, I am... But how do I know that he really needs ALL of this supplementing? Maybe he really only needs a few oz a day and we can slowly wean from that over the coming weeks. Supping 6 ish oz a day and he's still peeing and pooping nearly every diaper (the size of a quarter or larger).

(btw - we're supping with donor breastmilk so no formula to slow down his bowels and/or digestion)

Thoughts and advice please... this situation is so much different than DD's and I'm just baffled and wondering how much my fear is playing into it all.

[katelove]

I think I would be inclined to start decreasing the supplements (either volume or frequency) and see what his urine output did. If it was still adequate (I'd expect it to drop a bit) then I would keep reducing the supplements.

His urine is going to give you a good idea of how things are going in not-quite-real-time so you can easily increase the supplement again if it drops off and I wouldn't think it would have any significant impact on his weight gain if he is generally well.

As much as is practical for you I would let him BF for as long as he wants too. He may be still working on his efficiency and the stimulation is only going to help your supply. Especially if you feel like it drops off in the afternoons. As long as you've got the time and as long as he's not getting frustrated cos he's hungry and not getting full then I would feed.

All the best
Kate

[emilysmama]

When I was weaning off the SNS, I felt confident because I watched the diapers and recorded them in a log.

After every nursing session, I changed the diaper. (At that time, each side took 45 minutes because it was an unusually slow baby. So maybe you want to just check the diaper 30 minutes after finishing feeding for a normal baby like yours.) By the time the feeding was done, the diaper was already wet. I used cloth diapers, so it was easy to tell that the diapers were really wet and not just a little bit damp. It can be really hard to tell with disposable diapers whether the diaper is getting wet. So if you don't use cloth diapers, maybe you want to resort to the nurse's trick of putting a piece of tissue in the diaper to see if the tissue gets wet.

I kept a log of feeding times and wet diaper changes. I counted wet diapers, and I also recorded how wet the diapers were. I found that I had 12 very wet diapers in 24 hours, and that made me feel better.

I felt confident when I got a wet, not just a slightly damp, cloth diaper after each feeding. To me, it seemed to correlate that stuff was going in, because soon after that, lots of stuff was coming out. I also felt more confident because the sucks became steady, although still weak, but more definite.

That's when I stopped the SNS, and when everything still continued as described as above, I felt confident that everything was fine. (Plus, daily weight checks at the pediatrician office was free and didn't require appointment.)

[ILoveMyBabyBird]

is it possible that your milk didn't come until after day 5? I know, the lc at the hospital i delivered ds at said her daughters milk didn't come in until day 10. Sometimes things like that happen. I would definitely begin decreasing the supplement slowly and record diaper outputs. IF your can't tell if a sposie is wet you are suppose to take a clean one and wet it with 2 tablespoons of water and have it as a reference.

[sattygirl99]

Well, we did a test feed today and it seems as though the issue is that he's not transfering very well. He's a 'lazy nurser' and just doesn't seem to suckle very much effectively. My LC seems to think that if I get my supply up (which his inefficent suckling and transfer is most likely why my supply is low) and he gets bigger and stronger, it will fall into a normal pattern.

My milk came in like 48 hours after birth... It was expressable and actually my first 'real' letdown he choked on.

He's gained back to his birth weight and a bit above (born at 8lbs 1oz, currently 8lbs 4oz) with the supplementing and his gain is 'normal' so I don't think he's being overfed. She wants me to continue to supplement at the breast, 1 to 1.5 oz a feed (which is about what he was taking anyway) until we know he can transfer better and my supply is up. I've got a hospital grade lactina pump compared to my PISA (which I hated btw) and I'm just going to have to pump every 2 hours at least and/or 30-1 hr after a feeding. I'm a little fearful that his suck won't ever get better and that it'll be a battle forever but people get through this with preemies, surely I can do this too? Sad, term babies aren't supposed to have weak suck!

His diapers aren't wet if I don't supplement... They're only damp, unless I let him go a long time. It's clear he's not getting much.

I'm having someone come this weekend to encapsulate my placenta and she seemed to feel really confident it would help with my milk supply in a big way. I hope she's right! I was planning to consume it via smoothie but haven't been able to get past the taste.

[poorlittlefish]

Side note---I use Shatavari (2 capsules, 2 times per day) and it has bumped me to a full supply after a breast reduction. I get it online at Swansons and it is cheap--$7 or so for a month supply.

[AislinCarys]

Ok, a transfer issue was what we had, DD just didn't feed very effectively, and my supply dwindled.

You may have to work very hard to keep your supply up, and to get it back up - it does not happen by itself! You need to keep baby feeding effectively, too, that will make you make more milk.

http://www.drjacknewman.com/

This site has a lot about milk transfer, active (effective) feeding, how to manage milk intake, making sure baby is getting enough milk etc. And there are videos, showing how to know baby is feeding effectively. Switch-nursing and watching out for swallowing were really the most important things we learnt. And to use an SNS or a lact-aid.

Fenugreek is also really helpful with supply.

And try to fix it now, the longer you go with it, the more your supply dwindles, and the harder it is to sort it out (and takes much longer).

We got there. It took a long time, but DD is still breastfeeding, a lot, now, at 2 1/2!

Please feel free to PM me if you want to ask anything!

[emilysmama]

When my dd was a baby, we had to teach her how to suck. She was sleepy. She wasn't just a lazy nurser. She didn't know how to suck at all. In fact, she didn't know that she was supposed to open her mouth.

Here are two things that we did that helped her develop strong suck.

1. Clean adult pinky finger in her mouth, over but not touching her tongue, closer to the roof of her mouth than to the tongue. Pad side facing up (nail side facing down). She automatically started sucking, and it got stronger. We did this for months, not because it took her that long to develop sucking skills, but because that's what we used instead of a pacifier to avoid nipple confusion.

2. We used a Haberman feeder made by Medela. The hospital had them, or you can buy them directly from Medela, or you might possibly be able to buy it from a medical supply store that sells Medela breastpumps. It's a bottle to feed expressed breastmilk or formula. When the baby uses this type of bottle, the baby won't develop nipple confusion. Also, this type of bottle requires the baby to suck more like breastfeeding, instead of like using a regular baby bottle.

These two things strengthened my dd's sucking skills so that she was eventually able to become a strong nurser, without ever developing nipple confusion.

[evabea]

my dd also lost too much weight the first week and we supplemented with formula for 2 days, when she showed good weight gain and great pees and poops. That first week she was a terribly sleepy nurser, we constantly had to wake her. The LC was also a cranio-sacral practitioner and offered her 2 little sessions-- after the second session her sleepy nursing stopped for good. Could have been a coincidence, but it was striking.

[sattygirl99]

Thanks everyone!

I met with another LC (well, she's a friend of mine) yesterday and she evaluated his latch and said it looks good... Over the last week, my supply has come up... ALOT. I went from 1/4 oz combined to pumping 1 to 1.5 oz a session. We stopped supplements yesterday now that he's not so sleepy (he's nursing ALOT better now and not falling asleep until he's done). He's nursing a lot still, every 1-1.5 hours but he's draining both breasts at a feed (as in, I pump after and get nearly nothing). He's sucking and swallowing for a longer period of time and yesterday he had 11 wets and 5 or 6 poops.

Oh and his weight gain has been fast with being supplemented... He was born at 8lbs 1 oz, down to 7lbs 10oz at 48 hours and the same at 4 days old and was 8lbs 4oz last Wednesday, 8lbs 6oz last Friday (2 oz in 2 days) and 8lbs 10oz on Monday (over 1 oz per day). I will probably get a weight on him tomorrow and as long as he's gained at least an oz from his Monday weight (.5oz per day), things are good... I'm trying to trust and know that I can always add a supp or 2 back in (which I will do at the end of our 24 hour mark if the diaper output isn't good enough). It's hard but even if I go tomorrow and he's lost a little bit, I can always add some back. I can't imagine though, if he's transfering (and he's transfering ALOT more now, I can tell just by the suck swallow pattern, plus I'm doing a ton of compressions to help) what I'm pumping and nursing every 1-1.5 hours, then he's doing OK. He may not be a quick gainer but as long as he maintains .5 oz per day and enough pee's/poops, we're good.

My pedi was very supportive of us doing this too... I haven't pumped since yesterday morning. I think the pump damaged my nipples because it's too strong.. I'll have to go back to using my PISA instead. But I haven't had much time to pump since he's nursing pretty consistently every 1-1.5 hours, except at night where he's been going 3 hours instead of 5 plus. I feel full at that 3 hour mark though and even leaked this AM so I feel confident my body has gotten the memo now!

Will update as we go along!

[sattygirl99]

Emilysmama - thanks for your advice... It's not that he has a weak suck in general... It was only at the breast, which in turn is likely due to him being so severely tongue tied to start. My LC friend said it was partially because he was used to pursing his lips to get milk out and since I'm correcting his lips and ensuring they flange and cup the breast, his suck is getting better. I also have an overactive letdown and so he doesn't HAVE to work that hard... I've started nursing on a recline so my letdown isn't so strong, making him work for it more. It's gotten loads better since the 2nd tongue clip. He would suck on a finger or paci with gusto, just not the breast.. Now he has a strong suck at the breast and yowzers it hurts! He's also a quick nurser too, I've learned and it has nothing to do with my supply... he can drain the lact-aid in 5 min... He only nurses and actively gets milk for 5-10 min and not because I don't have milk... But because it all comes out in my strong letdown. Same goes for pumping... I can pump for 30 min and only get that one strong letdown but get 1-2 oz of milk combined.

[emilysmama]

I'm glad that you are solving your problem.

[Lisa1970]

I think you should just drop the suppliments. A baby rarely actually needs suppliments, but misinformed doctors might tell a mother to do it. Some people do need it and their milk does not come in. But in your case, only 5 days post birth and you were already supplimenting, that is of concern. Babies always lose weight in the first few days and then gain it back. If you suppliment, your milk might not come in fullly. I did suppliment this last time because I had health problems myself. But at 3 weeks, I had to give up the supplimenting because my milk was not fully coming in. Now he is 13 months and breast milk seems to be plentiful.

Good luck and I hope I have helped!

[sattygirl99]

It wasn't the weight that was the issue... He was getting enough milk to stop losing weight, and he didn't even lose 10%... It was that he was barely wetting... not pooping... still passing uric acid crystals (red/orange in the diaper). The uric acid if a sign of dehydration... It's normal in the early days before milk comes in but my milk came in on day 2 (I know, it drowned him the first time he got a milk let down) so it wasn't considered 'normal'.

We are weaning from the supplements. I tried just dropping it and he started passing uric acid again so my LC suggested I slowly wean off them instead.

Just to clarify.... No one told me to supplement. I did becuase I knew that him not peeing and pooping on day 5 was not normal. We didn't start supplementing DD until she was 4 weeks old... She was nearly FTT because we waited so long. Very lethargic, lost a lot of weight... It took a long time before she would even nurse effectively because she was weak and she weaned early and I think it's because nrusing was such a fight with her. My LC and Pedi are actually incredibly supportive of what I'm doing now... Counting diapers and only supplementing in the evening... We went from an oz every feeding to supplementing only 3-4 oz a day. I'll slowly wean down from that amount too.

[emilysmama]

Originally Posted by sattygirl99

It wasn't the weight that was the issue... He was getting enough milk to stop losing weight, and he didn't even lose 10%... It was that he was barely wetting... not pooping... still passing uric acid crystals (red/orange in the diaper). The uric acid if a sign of dehydration... It's normal in the early days before milk comes in but my milk came in on day 2 (I know, it drowned him the first time he got a milk let down) so it wasn't considered 'normal'.

We are weaning from the supplements. I tried just dropping it and he started passing uric acid again so my LC suggested I slowly wean off them instead.

Just to clarify.... No one told me to supplement. I did becuase I knew that him not peeing and pooping on day 5 was not normal.
...

My LC and Pedi are actually incredibly supportive of what I'm doing now... Counting diapers and only supplementing in the evening... We went from an oz every feeding to supplementing only 3-4 oz a day. I'll slowly wean down from that amount too.

I think you are doing exactly what you need to be doing. You are eventually going to be just fine.