help me stop supplementing

[nikelodeon79]

I am supplementing formula for my one month old baby because I don't have enough milk. When we first brought him home, he almost had to be admitted back into the hospital because he lost too much weight. That's when we started the formula.

There are several reasons I think my milk hasn't really come in. First, we didn't really get enough opportunity for skin to skin contact and nursing in the hospital. The nurses kept taking him away for long periods of I time. He was circumcised and then wasn't very interested in nursing.

I've also been stressing a lot and dealing with post partum depression issues, as well as feelings of inadequacy because I don't have enough milk for my son.

Noah isn't the best nurser. He tends to nurse lazily and then drift off to sleep. He has no patience and will pull off and scream rather than wait for a let down. He also has gas/tummy troubles.

I am only really able to nurse on one side because the nipple on th left side is slightly damaged. The milk drips out super slowly and there's barely any in there. I have been pumping to increase the supply and only get about an ounce if he hasn't recently eaten and only dribbles if he has recently eaten. I have been drinking a lot of water.

Sometimes Noah falls asleep after nursing for a long period of time. If he doesn't get a supplemental bottle of formula, his diaper will always be dry at the next changing.

With the supplementation, he is at exactly the right point in weight gain, so its hard to change things, but I'd rather get him on all breast milk. The trouble is. I have to go back to work in a month... two months if my boss allows me extra time. There's no way I'll be able to pump enough for the sitter.

I've thought about trying the product Nature's Milk Drops to increase my supply and to aid with Noahs and my digestive issues. Does anyone have any experience with this product? Any other suggestions?

[nikelodeon79]

I should note that I have been to a LC twice and have talked with them a few more times.

[CheriK]

I'm so sorry you're struggling with breastfeeding and PPD issues.  I'm sure this isn't how you imagined motherhood would be.  Are you getting help for the PPD?  Taking care of yourself so you can take care of your baby is so very important, and most women in our society don't get that support.  If you haven't yet explored Kathleen Kendall Tackett's work on treating PPD while breastfeeding, it's well worth reading: http://www.uppitysciencechick.com/index.html.  Also, might want to talk to your doctor about these issues, you may be able to get an extended "disability" medical leave.

Okay, milk supply.  You said you've talked to two LC's.  Are they IBCLCs (international board certified lactation consultants)?  What's their experience in working with milk supply issues?  Not every "LC" has the same training (anyone can take a weekend-long course and call themselves an LC), by working with an IBCLC you have some idea of what education they've received.  You might also want to contact your local La Leche League for support, more information, and resources in your area. 

Good resources for low milk supply are the website and book by Diana West.  Book is "Breastfeeding Mother's Guide to Making More Milk,"  website is lowmilksupply.org.  Lots of ideas about determining causes of low milk supply, targeting galactogogues specifically to your own situation, and reducing/eliminating supplementation.

Your DS is still young, your supply is still being established, so now is the time to put in as much effort as possible.  It's easier to increase supply while your body is physiologically primed to do so, although it's never impossible.  Has Noah's latch been evaluated?  If he's not very effective at the breast, then your body won't establish full lactation.  How much are you pumping?  What type of pump?

Sleepy babies may need to be woken up to nurse.  No fun I know, but not getting enough calories often leads to sleeping longer, which means less calorie intake. . . it can be a vicious cycle.  A newborn should be nursing at least 10 times in 24 hours; if he's often sleeping longer than 2-3 hours, then wake him up!   Formula can also affect sleep cycles; it's harder to digest than breastmilk so keeps his tummy feeling "full" for longer, so he may go longer between nursing sessions.  Keeping supplements small (2 oz or so) and regularly spaced will help with this, pumping whenever he gets formula will help as well.

Have you talked to his doctor about his gassines and tummy issues?  A change of formula type might help.  Getting him off the formula entirely is probably the best help, but that might take some time, so keeping him as comfortable as possible until then is a good idea.

[Megan73]

Hugs, mama. What a tough introduction to motherhood!
I agree with Cheri that you need to take care of yourself first but that at one month you still have an opportunity to increase supply. Have you investigated taking domperidone? It can be very effective in increasing supply and US moms can order it online. Did any of the LCs talk to you about using an at-the-breast supplementer like a Medela SNS or Lact-Aid instead of bottles so your "lazy nurser" doesn't come to prefer bottles? Do you have a double electric pump so you can pump after feeds?

[nikelodeon79]

Thanks for the responses! I will do my best to answer the questions but its hard because Noah is napping on me right now and I'm using my phone. I don't get any computer time because Noah owont sleep unless someone is holding him.

Re: the ppd I did see my doctor and she thinks I'm doing ok. It's complicated by the fact that I have bipolar disorder. I do have an appointment with my regular counselor Monday. I'm just a natural worrier and having this precious boy to worry about complicates things!

The LCs work at the hospital where I gave birth. I am not sure about their certifications. Basically, my appointments with them consisted of them weighing him, watching me feed him, and then weighing him again to see how much he ate. He got about an ounce in 20 min the first appt and a tenth of an ounce the second appt.

There is a LLL in a nearby town but as of yet, I haven't been able to get over my fear of driving alone with Noah so I can't attend the meetings. As it is now, of we have to go somewhere my Hubby drives while I sit in the backseat next to Noah's carseat. Sometimes he screams and is comforted by my presence. I worry about him screaming while I'm driving and unable to comfort him.

I am only pumping a couple times per day because its difficult to find the time and if I pump too close to him needing to nurse, there won't be anything for him to eat. I'm trying to pump more but its hard because he eats very sporadically. He eats every 1.5 to 3 hours. I have a Medela pump.

[nikelodeon79]

I should also mention that the LCs recommended pumping more to increase supply. the only drug recommended was the one that can cause anxiety and my dr didn't think that was a good idea.

Sometimes he refuses the breast and just screams. He did it twice last night. He usually gets two ounces of formula per feeding when he nurses well. I nurse him first and then give formula once he doesn't seem to be getting any more from the breast or refuses to nurse any longer. Sometimes he nurses for an hour and still wants a bottle when he's done.

we have seen his Dr for the tummy troubles and got a clean bill of health.

[nikelodeon79]

I have been watching some videos online and doing some reading and I think our real problem is that Noah is "nibbling" rather than drinking properly. I am going to try breast compressions to see if that helps. Any other suggestions?

[Megan73]

Yes, nibbling is a problem but babies need milk to flow to drink well. I would strongly urge you to use an at-the-breast supplementing system (a Medela SNS or Lact-Aid) instead of bottles. Babies learn to nurse well by nursing and it will keep him happy at the breast.
The drug that your doctor didn't want to prescribe is likely Reglan which can cause depression and anxiety. Domperidone (a prescription drug in Canada and OTC in much of the world) is both more effective and doesn't affect mood. You can order it online. There's lots of info about it on Dr. Jack Newman's BF site.

[CheriK]

Being a new mom is hard enough, without bipolar & milk supply stresses.  Can you get some help to come in during the day so you can focus on breastfeeding for a week or two?  Putting in a major effort now, while your body is still primed to increase supply, is likely to be easier and more effective than making small efforts over a longer time.  Are you being treated for bipolar?  There are treatment options that are compatable w/ breastfeeding.  Remember that a healthy mom is the most important thing, so if you do end up needing some of the meds that are not compatable w/ breastfeeding please don't beat yourself up over it.

Pumping is often recommended to increase supply.  Ideally, you would pump immediately after breastfeeding Noah at as many feedings as possible.  The goal isn't to get a lot of milk (you shouldn't; if you do that is a likely indicator that he's not nursing effectively), the goal is to signal your body to up production by increasing stimulation.  Whenever you can pump after feeding, do so.   No matter when you pump, even if you pump and then Noah needs to nurse, just go ahead and feed him.  Your pump isn't as effective as baby (assuming he's doing a good job of removing milk) and there will still be milk available for him.  You might find that he wants to nurse on each side more than once, or nurse for longer than usual, just follow his lead. 

Breast compression is a great idea.  Jack Newman's videos have some great demonstrations of this, as well as what signs to watch for to tell if he's actively nursing or just hanging out and nibbling.  Also, make sure he's latching really really well with a wide open mouth, a deep latch, and lots of breast tissue, especially his lower jaw.  Some of the "laid-back" breastfeeding positions (google "biological nursing") are helpful for this. 

I would second Megan's comments about looking into domperidone.  But remember that no medication is going to be effective without adequate stimulation.  I really think getting some in-person help with an IBCLC experienced w/ milk supply issues is well worth the effort.  I don't want to upset or offend anyone, but sometimes hospital-based IBCLCs are certified because their job requires it and are only used to working with brand new babies, where the goal is simply to get them latching on.  The plans and recommendations for a mom several weeks postpartum with ongoing bf issues are different.  Many IBCLCs do house calls, and in fact it's likely well worth the cost to have someone come to your home because she can help you with latch and positioning with the chairs and in the environment where you'll be nursing most of the time.  Your insurance may cover this, it may not, but it's much much cheaper than formula and well worth the cost in the long run.  You can go to the ILCA website to search for a local IBCLC, or call your local LLL Leader, who can likely give you names and numbers of local IBCLCs.  The hospital where you gave birth may also have names and numbers for private IBCLCs.

The website I mentioned before, lowmilksupply.org, has tips and ideas about offering supplements in ways that are less likely to impact breastfeeding.  Your LO may be screaming at the breast because he's become used to the fast, effortless milk flow from a bottle.  Eliminating bottles if at all possible, or choosing bottles that are less likely to cause nipple preference, is really a good idea.  A nursing supplementer might help but if he's not latching well and not suckling effectively it is unlikely to "teach" him.  Again, in-person help. . .  It can also help to do some breast compression, nipple massage, or even pumping to get milk flow started before offering to nurse.  Using a medicine dropper or syringe to drip milk or formula onto your nipple as he's latching can help encourage him to latch if he's reluctant. 

1 oz in 20 minutes, depending on his age at the visit, might have been an okay intake (we'd expect about an ounce or two at a week old, 2-3 per feed if he were 2-3 weeks old, but not every feed will be the same amount).  The second test weight is more concerning.  If he's not effectively transferring milk, then you really need to pump frequently to provide your body with adequate stimulation.  At a month old, we'd expect him to need about 25-35 oz of milk a day; it sounds like he's getting the majority of that from formula.  Hanging out at the breast, falling asleep at the breast, and "nibbling" are not adequate to stimulate your body to make milk.  Milk removal is necessary.  If he's really not effective at the breast, then it may be a more productive use of your time to feed him via an alternative method, rent a hospital-grade pump, and really really focus on pumping to increase supply for a few days, then work with someone to help Noah latch well and nurse effectively (which will be easier for him to learn if there is milk there!). 

[nikelodeon79]

I am getting treatment for the bipolar. I just had a counseling appointment on Monday. I am also on medication and was told it is safe for breastfeeding.

I started fenugreek and pumped more and am now able to get 2 oz from the right breast. Still next to nothing from the left. The problem now is that he is having reflux issues and refuses to nurse. He screams and screams. I'm fairly certain its reflux and not frustration. There is a good flow coming from the breast when he let's go... in fact it leaks all over. Just one more frustrating road block. It breaks my heart to see him so upset and th more upset he is, the worse his reflux gets. I'm not sure what to do at this point.

[nikelodeon79]

Just thought I'd update... and it's not a good update. :(

Noah has now been completely on formula for about a week.  I started back to work two days per week (Mondays and Wednesdays).  Last Tuesday (the day after my first day back) he seemed to want to nurse, after about a two week "nursing strike" where he absolutely refused.  We tried it out, and he nursed for a couple of minutes before letting go and screaming. :-(  I tried a couple more times that day with the same results.

I have zero milk left in the left breast and very little in the right.  I'm just not sure what to do at this point.  I will be back to work four days per week starting August 1st.  This does offer me more time to pump, but obviously Noah will have to drink from a bottle anyway, at the babysitter's house.  I am also not sure if I can ever get my supply up.  I am feel like I pretty much have two options at this point.

1) Start domperidone and make sure I pump every 2 hours at work to increase my supply

2) Give up and continue with the formula

I worry that, even if I do end up with a good milk supply, we'll continue with the same issues (latching issues, nipple confusion, too heavy of a let down, etc).  It just breaks my heart when he screams at the breast. :(

I have contacted my local La Leche League and hope to attend their next meeting.