formilk/hindmilk imbalance or reflux?? Help!!!

[pants]

Hey ladies. Micah is now 6 weeks old and BF is going pretty good. I have a few concerns and just wondering if you ladies have dealt with these and can point me to some advice.

I believe I have and oversupply. I have always thought I did from the beginning. I had this with DS #1 and went to exclusive pumping because he was sooo fussy at the breast. Once we went to exclusive pumping he was a new baby. However it did shorten the duration of my BF him and it was really inconvenient!! I told my DH I wanted to give baby #2 a better shot at BF longer. Now I think i'm having the same issues again. But I also want to rule out if this is reflux or oversupply. Here are some signs and you ladies tell me.


Very strong let down reflex
Usually he'll pull off right after letdown and I spray him and me all over the place.
He's usually fussy during BF sessions. It's kinda wrestling match to finish a session.
He'll burp for every session (sometimes these are watery burps)
He usually hiccups after every session
He isn't taking long naps. Usually 30-45 minutes max
His poo is greenish and seedy. Slightly yellow but more green.
Still has frequent stools..about 6 a day or usually one during every feeding.
He has a ton of gas
He is gaining weight. At 6 weeks he's gained 3 lbs from birthweight.


So I keep going back and forth on what it could be. Any advice would be awesome. I stopped pumping to build an EBM supple when he was 2 weeks old because I was so engorged with every feeding I wanted my milk to level out. It did some..but still thinking I have imbalance. Any help would be great

[Marissamom]

there's definitely signs of overactive letdown and oversupply. I've heard really good things about supplementing with Magnesium for overactive letdown, you can also try block feeding (feeding on one side for a set number of hours before switching to the other side)

[Megan73]

That definitely sounds like over active letdown but I'd be cautious about self-diagnosing oversupply because blockfeeding can really mess with your supply if you don't have it.
I notice that your baby's weight gain is only slightly above the average of 5-7 ounces a week and with oversupply baby's poops are usually frothy, not seedy. From my two nurslings, fussy nursing and gas are pretty normal for newborns.
If you haven't already found it, Kellymom.com has some great info about breastfeeding and newborn stooling. Is there a local La Leche League or IBCLC who could offer you some real-life help?

[PatioGardener]

I agree with Megan - hands on help would be a good idea. Oversupply can actually lead to not so great weight gain in some babies (too much lactose and too little fat, I think) but dropping supply if that is not the issue is not a good idea.

How are you breastfeeding? Do you recline back a little and have baby upright? That often helps them cope with the flow.

I had to clock feed in 10 hour blocks to get my supply under control (plus a whole bunch of other things), so if over supply is an issue there are ways to decrease it.

[gambel]

That sounds like heavy letdown to me, more so than reflux; usually reflux has back arching during or after nursing. If you are hearing wet burps that sound like baby spit up but nothing comes out, that is telltale reflux.

I had a pretty similar situation with my son, but it turned out to be both reflux (from a dairy sensitivity, so I went off dairy) and heavy letdown. 

The heavy letdown can cause a foremilk/hindmilk imbalance (as you know) and that is often associated with green poops, and maybe the seediness, and a looser consistency. It is also consistent with fussiness during nursing and gas. I am not sure if heavy letdown alone would cause reflux; for us, that was a different issue.

I did block nursing for months, which seemed to help with heavy letdown and he gained weight great. I would just nurse on the same side until he had nursed for a total of 30 minutes on that side. It might take 2 or 3 hours for him to nurse for 30 minutes (5 min here, 10 min a while later, 5 minutes after another 40 minute spell, etc.). Then I would switch sides. Sometimes I waited longer (40 minutes on a side) if it took a while. I NEVER nursed on both sides in one sitting until ds was about 11 months old.

It sounds like your supply is fine so you could try the block nursing for a couple of weeks and see how it goes. If you think your supply starts to wane, then pumping for 10 minutes after each feeding will help to bring it back up, but that doesn't seem to be an issue for you.

Another thing is to try different ways of feeding him. For a month or so (until these other things were under control) I nearly always nursed either swinging in our sky chair (one of those hammock chairs) or else while walking around. Inconvenient, I guess, but sometimes I would stick him in a carrier to nurse and go for a walk, and we were both happy. I think that this was better for him because he was always in a more upright position, not laying horizontal across my body (as was suggested above), which helped with reflux. A rocking chair or some other motion might help.

Also, in terms of gas, there are some excercises you can do with baby if you have not already. The book Itsy Bitsy Yoga has them (a book that I love and wish I started using earlier!) as does the Infant massage book:

http://www.amazon.com/Infant-Massage-Revised-Handbook-Loving-Parents/dp/0553380567

The one we did ALL the time was, baby laying on his back, to fold his knees up toward his chest and gently press. It was extremely helpful to ds (and eventually entertaining for us; my husband would demonstrate "farting the baby" for friends with unbelievably reliable results).

I hope that helps. It can be so stressful when nursing is hard! Hang in there and good luck!