breastfeeding after on bottle first 6.5 weeks

[robbinrl]

We started out in the NICU without being able to bf due to needing a special formula with only predisgested fats (she was born with Chylothorax if anyone is curious - it's rare, only 1/2,000 NICU admissions). She was discharged at 2.5 weeks on the formula and stayed on the formula until June 2nd (6.5 weeks) when we were given the green light to bf as I had been pumping the entire time.

She appears to have a great latch. I thought things were going well, she would go on each breast for 10-15 min each feeding and she would eat every 2-3 hours and more often in the evenings. I was in a lot of pain the first few days, but that pain had started when I was pumping exclusively. I did get a small blister on one of my nipples that has now gone away. She didn't appear hungry in between and her diapers seemed the same. We had her two month visit last Monday she had only gained 4 oz. from her 1 month weight. So I started to supplement (at pedi's request) with a bottle of breast milk after each bf'ing where she was taking between 1 oz and 3 oz.

Last Wednesday I met with an LC, she agreed that her latch was fine, but it looked like she wasn't doing enough of a long sucks that are needed for bf'ing versus the small chewing-like sucks. (She had already gained 4 oz in only 2 days.) At the visit she only ate 1.5 oz total after bf'ing on each side. The LC didn't give that many suggestions besides to bf more often and try to increase my supply. We started bf'ing every two hours at least (except at night, i tried the first couple nights but she just falls asleep immediately if I wake her up) and I started taking fenugreek.

The LC did mention that her tongue looked a little tight. After reading more about tongue tied it does sound like it might be part of the problem. My nipples do come out squashed with a ridge although they no longer hurt. She mostly does seem like she is chewing. But she can stick her tongue out. How do I go about pursuing this more? Should I find a different LC to meet with?

Right now she is pretty consistently taking 2 oz after each feeding. I started back to work today and have pumped 3 times, the first time I pumped almost 3 oz and the second and third time 2, so it seems like my supply is a little low still. I'm planning on pumping every 3 hours at work (more than that would really be a struggle). Should I start pumping after bf'ing too to increase supply? She does suck better when my breast are 'full' but even after feedings where it seemed like she did really well she'll still take 2 oz. Should I start to gradually offer her less from the bottle afterward? Any suggestions would be great.

[~Adorkable~]

congrats of getting my babe home! and welcome to MDC

im not expert on any of this but seeing as i struggle with some of the same things, ill tell you what i think.

i might talk to someone about your nipple coming out squashed, it has been pointed out to me as a sign to be attended to.

my twins did not latch at all till they were about 2 weeks and to be honest we still struggle with various things, but we have good weeks and bad weeks and it is all worth it, all of it.

so hang in there

pumping yourself dry after BF will be a good way to help your supply, in general you always want to pump till your dry.

if you dont think your LC is taking your concerns to heart or not seeing issues through, please get another one, i was totally unimpressed with the one i got to see early on and i think not going to find a different one did harm to my nursing for the long term, i should probably still go see one now, not sure why i haven't. please learn from my regret.

if you learn more about the short chews vs the long sucks ,please let me know, i think it is one of our remanding issues as well, never really thought about it too much but now that you mention it it does seem like a important thing to address

my gut says never pull food away from a young drinking baby, but maybe just nurse more often or nurse twice before offering the bottle. this worked in part for me, i would nurse and then when they acted full (but i knew from experience they would always take a few oz from a bottle) i would wait 15 min and then offer again, often they would nurse "fully" again, sometimes they would show no interest. either way i would finish in the end with a bottle, only dropping the bottle for that feeding if they started to take 1oz or less. 

for instance, they now nurse fully for the feed directly after their 2 long naps, so no bottles after those. i think they are refreshed and nurse more relaxed and fully then for some reason.

our new one that is almost worked out is their feeding just before nighttime bed, if i catch them at the right time, they nurse great and take less than 5 gulps from a bottle, so tonight for only the second time they did not get a bottle at all, i may pay for it with another late night feeding, but each step moves me closer to all boobie all the time.

[homemademom]

I had nipple pain, plus the squashed, ridged nipples and my ds had slow weight gain.  We figured out it was a posterior tongue tie (from these boards, actually) and had it treated by a pediatric dentist when ds was 4 wks old. This link has the names of some specialists and of course, your LC might know someone, too.  It actually took another 6 or 7 weeks to get my ds on the breast because he had a high, arched palate (sometimes called "bubble palate") that can often accompany tongue tie.  But we worked it out, as tough as it was.  Best of luck to you!

[robbinrl]

Thank you both! I am starting to think more and more that it is some form of tongue tie. Luckily I found out our children's hospital nearby (Cincinnati) has a whole breastfeeding department. So we have an appointment for this wednesday with an MD who is also an LC. I am really hoping we can figure this out because I am down to only about 40 oz of frozen breast milk left and I haven't been able to get my supply up by pumping.