I can't seem to save breastfeeding after her NICU experience. I need help.

[CrazyCatLady]

This is my fourth child, and third time breastfeeding.  My baby is now 11 days old and I am not making anywhere near enough milk for her.  She was in and out (mostly in) the NICU for the first week of her life.  She is also a sleepy baby and is hard to wake for feedings.  Her latch is not great, but she doesn't respond much better with a nipple shield.  I pumped at home and did everything I could to maintain a supply once I was released from the hospital, but I never felt my milk come in and my supply is pitiful.  I partially blame the hospital for keeping me there for three days and not making a pump available to me then.  I feel like I lost my chance then to fix things and it may be irreversible now. :(

I have no money what so ever for supplements, teas, etc.  I have a good pump.  I also have an SNS, but she likes that about as much as she likes the nipple shield.  I could be using all of this stuff wrong for all I know.  My dp is away right now, so baby and I are trying the staying in bed, skin to skin thing.  But she still doesn't wake much to eat.  And when she is awake she is starving and screaming for food.  At this point she is getting 2-4 two ounce bottles of formula a day...and it seems to only be getting worse as the days go on.

I really don't know what else to do.  Our nursing relationship is slipping away and I really want to save it, but I'm out of ideas at this point. :(

Edited by CrazyCatLady - 8/24/11 at 10:52am

[CrazyCatLady]

I've also pretty much stopped pumping.  Seems like every time I pump, she wakes up hungry as soon as I'm done and then I resort to giving her a bottle.  I am trying to just do breastfeeding only, especially since I barely get an ounce out of both breasts when I do pump.  But maybe I'm just screwing things up more this way?

[greenmulberry]

I am so sorry! I have not been in your shoes before, can you go to the NICU babies forum and see if those mother's have any words of wisdom?

Can you tickle her cheek to get her to wake more while she is nursing?

My baby had a less than adequate latch at first but it improved as she grew stronger.

[CrazyCatLady]

I have tried everything.  Nothing wakes her and even if I do manage to wake her...she will fall back asleep the second that the nipple is in her mouth. :-/

[poorlittlefish]

Oh wow, so sorry.  I guess what I would tell you to do is commit to 2 weeks of pumping after every feeding.  I had a breast reduction and had a pitiful supply initially with DD 1.  I would feed her, pump for 2 mins on each side after EVERY feeding.  Then next time I fed her I would feed at the breast and then supplement with whatever I pumped at my last session.  After a while, my supply built and she stopped taking the bottles. 

Now, I did supplement with formula a bit in there too due to weight loss and you might need to do that at first--feed her at the breast the the formula supplement but after a while your supply should react.

She was also sleepy, I fed her naked and applied a cool washcloth to her feet to keep her awake.  This is a hard row to how, maybe just try to commit to doing this for a week, then 2 if you can. 

Good luck to you.

[gemasita]

I was going to say the same thing as poorlittlefish - if you can just keep pumping and try to build your supply, then you can keep working on the breastfeeding over time.  If you don't continue to pump when she doesn't eat, your supply might not be there once she gets the hang of it.

[desertrose]

I'm so sorry you're going through this.  I so know what that's like although I didn't have a baby in NICU.  My first was a forced induction and he was weak and sleepy and my supply was erratic, at first too much and then nothing at all. I don't know if there's anything I can say to help, but I will try.

For your supply, besides sleeping and not stressing :

Make sure your iron stores are up. Are you taking your prenatals still?  I'd recommend yellow dock syrup or an iron-herbal supplement, but you can't afford supplements, so...

Eat lots of calories. carbs, fats, proteins, everything. water.

For me, oatmeal helped to produce more milk. Also, you can try barley water (cook barley, drink the water).

For my baby, he became too weak to breastfeed but as soon as I started pumping and putting it in bottles, he ate like a champ and recovered. After the first month I was able to get him to breastfeed sometimes, along with bottles, but then my milk suddenly dried up by the 3rd month.  But I was NOT sleeping well, was stressed to the extremes, and I had not been eating adequately, nor taking any vitamins.

Beyond this, get a blood test to see if your thyroid might be out of whack, that can mess up milk supply too.

Gosh, what else can I say.  I'm so sorry she's not eating.  Keep trying!   Maybe stick her in the sunlight to eat, try anything to keep the little sweetheart awake!   You can only do what you can. Just make sure she's eating, whether it's formula or your milk. Get her strong. It's so stressful, I know.

I will pray for you and your darling!

[mambera]

Sorry you're going through this - but at 11 days you *totally* still have time to turn it around.

I would concentrate on trying to make the SNS work actually.  (I hear the Lact-Aid is better/easier but I know you said you don't have money for more gadgets.)  Especially since you aren't getting much from the pump and it sounds like baby is easily frustrated.  If you can get the SNS going successfully you can ditch the pumping and the bottles, saving you a lot of pain and avoiding the nipple preference issue.

Can you try wearing the SNS every time you nurse so that she gets more used to it?  If she knows the tube is only there sometimes she may be less tolerant of it than if it's just the norm.

Are you waking her frequently to eat so that she isn't starving and frustrated when she does wake?  I was told at least every three hours at night and every two during the day for my sleepy nb (sadly I wasn't as on top of it as I should have been and ended up with a permanent supply issue).  The cold washcloth on the feet mentioned above is a good tip if you haven't tried it already.

Definitely visit the NICU forum if you haven't already.  GL!!

[homemademom]

I'm so sorry, mama. I had low supply with my 5th baby after nursing the other four, so it was very disappointing. We did turn it around, though (after lots of pumping), and at 6 mths old, he is ebf.

2 4 oz bottles isn't very much milk per day, especially if you're producing so little.  It could be that your baby is actually hungry and that's why she's so sleepy.  When does she have another weight check?  At this point, I would focus on getting calories into her, whether bm or formula. Also, at 11 days, I think 4 oz is too much at a feeding (generally). You might try giving half that, but more frequently.  And then, as the others have said, just commit to pumping every two hours. In our case, I would latch my baby once a day at least so he wouldn't forget how, but the rest of the time, I gave him bottles of ebm and formula.  I feel for you. When will your dp be back?  11 days pp with no one to help has to be so difficult.  (((hugs)))

[CrazyCatLady]

There is so much good and helpful advice in this thread.  I've learned a lot and I feel so much better already.  I will respond to everything eventually, but I wanted to respond to this first real quick.  What I meant is that she gets 2-4 two ounce bottles of formula a day.  That's on top of what I pump and/or give her from the breast.  She definitely doesn't eat enough...but she does eat way more than 8 ounces a day total!  And 2 ounces is her max per feeding, if she eats that much at all.  Didn't want people here thinking that I'm starving the poor girl or stuffing too much into her per feeding.
 

Originally Posted by homemademom 

I'm so sorry, mama. I had low supply with my 5th baby after nursing the other four, so it was very disappointing. We did turn it around, though (after lots of pumping), and at 6 mths old, he is ebf.

2 4 oz bottles isn't very much milk per day, especially if you're producing so little.  It could be that your baby is actually hungry and that's why she's so sleepy.  When does she have another weight check?  At this point, I would focus on getting calories into her, whether bm or formula. Also, at 11 days, I think 4 oz is too much at a feeding (generally). You might try giving half that, but more frequently.  And then, as the others have said, just commit to pumping every two hours. In our case, I would latch my baby once a day at least so he wouldn't forget how, but the rest of the time, I gave him bottles of ebm and formula.  I feel for you. When will your dp be back?  11 days pp with no one to help has to be so difficult.  (((hugs)))

[APToddlerMama]

Haven't read the replies, but wanted to respond quick before I need to go help DS. 

Anyhow, I had a NICU baby too, who was preterm.  I worked with three LCs and this is what I came away with that worked (might work for you *if* your baby's issues are similar).... I would nurse DS about every 2-3 hours (depending on his signals).  He'd nurse for around 10 minutes on each side and then I'd pull him off (SLP told me beyond this he was getting too tired and not transferring due to his prematurity).  Right after that, I would give him a bottle of milk that I had pumped earlier in the day so that he would be full.  Then I would wait about an hour from when I had nursed him, and pump on each side for about 10 minutes/side.  I'd save that milk for right after the next time he nursed.  It took about a month for me to get my supply up and for him to get the whole suck, swallow, breathe thing down enough to not need me to pump, but we got there.  I'm sure you know that nursing and how much you produce is mostly about supply and demand.  Your baby might be like my DS (guessing probably if she's had a NICU stay) in that they don't have the energy or coordination to do a good job nursing and get all their nutrients that way.  So, your supply doesn't increase unless you pump because baby isn't doing an adequate job of nursing well enough to increase your supply.  The pump will help you increase your supply until your DD is able to breastfeed well enough to remain well fed.  good luck.   

[CrazyCatLady]

Well after a couple of feedings my baby spit up today.  And there was way more breastmilk coming out of her than I would have guessed.  More than I get with the pump anyways.  I wonder how hungry she is and if I'm reading her cues wrong sometimes?  My other babies were so mellow, that if they ever complained I knew it was either a diaper or food.  So I am wondering if sometimes I freak and feed her formula when she doesn't really need it.  Maybe sometimes she is just being a baby and fussy?  This is so stressful.  Thank you all so much for the help and advice.  I don't really have the money or resources to reach out for help anywhere else right now.  Your taking the time to reply to my thread really means a lot to me.

Quote:

Originally Posted by poorlittlefish 

Oh wow, so sorry.  I guess what I would tell you to do is commit to 2 weeks of pumping after every feeding.  I had a breast reduction and had a pitiful supply initially with DD 1.  I would feed her, pump for 2 mins on each side after EVERY feeding.  Then next time I fed her I would feed at the breast and then supplement with whatever I pumped at my last session.  After a while, my supply built and she stopped taking the bottles. 

Thank you for the advice.  A few minutes on each side after feedings sounds a lot more achievable than trying to do 15-30 minute sessions.  Especially since their isn't much in there right now anyways.  I already started pumping again today thanks to this post.  I hope it works!

Originally Posted by gemasita 

I was going to say the same thing as poorlittlefish - if you can just keep pumping and try to build your supply, then you can keep working on the breastfeeding over time.  If you don't continue to pump when she doesn't eat, your supply might not be there once she gets the hang of it.

Very good point.  I am definitely getting back into pumping.  It just feels kind of pointless sometimes when I am barely getting an ounce from both breasts (and usually I'm getting even less than that).  Hopefully my supply will come back soon. 
 

Originally Posted by desertrose 

I'm so sorry you're going through this.  I so know what that's like although I didn't have a baby in NICU.  My first was a forced induction and he was weak and sleepy and my supply was erratic, at first too much and then nothing at all. I don't know if there's anything I can say to help, but I will try.

For your supply, besides sleeping and not stressing :

Make sure your iron stores are up. Are you taking your prenatals still?  I'd recommend yellow dock syrup or an iron-herbal supplement, but you can't afford supplements, so...

Eat lots of calories. carbs, fats, proteins, everything. water.

For me, oatmeal helped to produce more milk. Also, you can try barley water (cook barley, drink the water).

For my baby, he became too weak to breastfeed but as soon as I started pumping and putting it in bottles, he ate like a champ and recovered. After the first month I was able to get him to breastfeed sometimes, along with bottles, but then my milk suddenly dried up by the 3rd month.  But I was NOT sleeping well, was stressed to the extremes, and I had not been eating adequately, nor taking any vitamins.

Beyond this, get a blood test to see if your thyroid might be out of whack, that can mess up milk supply too.

Gosh, what else can I say.  I'm so sorry she's not eating.  Keep trying!   Maybe stick her in the sunlight to eat, try anything to keep the little sweetheart awake!   You can only do what you can. Just make sure she's eating, whether it's formula or your milk. Get her strong. It's so stressful, I know.

I will pray for you and your darling!

This all makes so much sense.  I really can't afford groceries right now and I am very stressed.  Of course my supply is low when I think about it.  I am also severly anemic, that's what caused them to induce me and why she is somewhat premature acting.  I had no idea that could also affect my milk supply.  I went grocery shopping this afternoon and loaded up on a few things for me, especially water.
 

Originally Posted by mambera 

Sorry you're going through this - but at 11 days you *totally* still have time to turn it around.

I would concentrate on trying to make the SNS work actually.  (I hear the Lact-Aid is better/easier but I know you said you don't have money for more gadgets.)  Especially since you aren't getting much from the pump and it sounds like baby is easily frustrated.  If you can get the SNS going successfully you can ditch the pumping and the bottles, saving you a lot of pain and avoiding the nipple preference issue.

Can you try wearing the SNS every time you nurse so that she gets more used to it?  If she knows the tube is only there sometimes she may be less tolerant of it than if it's just the norm.

Are you waking her frequently to eat so that she isn't starving and frustrated when she does wake?  I was told at least every three hours at night and every two during the day for my sleepy nb (sadly I wasn't as on top of it as I should have been and ended up with a permanent supply issue).  The cold washcloth on the feet mentioned above is a good tip if you haven't tried it already.

Definitely visit the NICU forum if you haven't already.  GL!!

I will definitely start working on the SNS more.  I would love to be able to ditch the pump!  I was told to wake her every four hours, and honestly I'm lucky if I can do that.  I will start waking her much more than I have been though...or I will try anyways.  I like the washcloth idea.  Diaper changes and sponge baths have not been working at all, so any tips are helpful right now.  I know she needs to eat more than she does.  I visited the NICU forum but it is pretty dead there.  Plus my baby wasn't technically a preemie, so I don't really fit in very well there.

Originally Posted by APToddlerMama 

Haven't read the replies, but wanted to respond quick before I need to go help DS. 

Anyhow, I had a NICU baby too, who was preterm.  I worked with three LCs and this is what I came away with that worked (might work for you *if* your baby's issues are similar).... I would nurse DS about every 2-3 hours (depending on his signals).  He'd nurse for around 10 minutes on each side and then I'd pull him off (SLP told me beyond this he was getting too tired and not transferring due to his prematurity).  Right after that, I would give him a bottle of milk that I had pumped earlier in the day so that he would be full.  Then I would wait about an hour from when I had nursed him, and pump on each side for about 10 minutes/side.  I'd save that milk for right after the next time he nursed.  It took about a month for me to get my supply up and for him to get the whole suck, swallow, breathe thing down enough to not need me to pump, but we got there.  I'm sure you know that nursing and how much you produce is mostly about supply and demand.  Your baby might be like my DS (guessing probably if she's had a NICU stay) in that they don't have the energy or coordination to do a good job nursing and get all their nutrients that way.  So, your supply doesn't increase unless you pump because baby isn't doing an adequate job of nursing well enough to increase your supply.  The pump will help you increase your supply until your DD is able to breastfeed well enough to remain well fed.  good luck.   

I will try this too.  Especially now that she can latch it seems more possible.  My baby wasn't preterm, just acts like she was and has some random medical issues.  And it's true, she just isn't coordinated enough to nurse very well right now.  Which is so different for me.  My other kids took right to the breast.  So by the fourth child I figured this would be so much easier than it's been.
 

[homemademom]

Originally Posted by CrazyCatLady 

There is so much good and helpful advice in this thread.  I've learned a lot and I feel so much better already.  I will respond to everything eventually, but I wanted to respond to this first real quick.  What I meant is that she gets 2-4 two ounce bottles of formula a day.  That's on top of what I pump and/or give her from the breast.  She definitely doesn't eat enough...but she does eat way more than 8 ounces a day total!  And 2 ounces is her max per feeding, if she eats that much at all.  Didn't want people here thinking that I'm starving the poor girl or stuffing too much into her per feeding.
 

Oh no, I didn't mean you were only giving her 8 oz total. Sorry for the miscommunication! I just meant that if she's taking 8 in formula and your supply is very low AND she's not waking, chances are she's not getting the 20 or so that she needs at her age.

Counting diapers should give you a better idea of what's actually getting in there, along with weight checks. This link gives you the guidelines on wet and poopy diapers. I thought my ds was getting enough in the beginning because I changed his wet dipes, but when we realized he wasn't (no poops and weight drop) and started supplementing, I realized that my idea of "wet" before wasn't any where near what it should have been. "Sopping wet" is definitely important. And he is my 5th baby!  

Good luck!  

Edited by homemademom - 8/26/11 at 10:48am

[greenmulberry]

I think this could be the case. My DD was fussy and I always thought she was hungry, and in fact the nurses told me she was fussy because she was hungry and to offer her formula after feeding, but I realized that was a bad plan and stuck to just breast and it all worked out well. She is just an opinionated baby.

I think, that laying off the formula and keep offering the breast is the way to go. If she keeps suckling when she is hungry, even if your supply is low it will catch up.
 

Originally Posted by CrazyCatLady 
 

Well after a couple of feedings my baby spit up today.  And there was way more breastmilk coming out of her than I would have guessed.  More than I get with the pump anyways.  I wonder how hungry she is and if I'm reading her cues wrong sometimes?  My other babies were so mellow, that if they ever complained I knew it was either a diaper or food.  So I am wondering if sometimes I freak and feed her formula when she doesn't really need it.  Maybe sometimes she is just being a baby and fussy?  This is so stressful.  Thank you all so much for the help and advice.

[craft_media_hero]

You might consider offering a half oz less of formula after breastfeeding and nursing more frequently. Every two hours sounds good, I would not wait four hours, for sure. Then after maybe 4-5 days, reduce the formula another half oz and continue to nurse more frequently while pumping after feedings. Hopefully you will be able to replace the formula in the with expressed breastmilk, too, whether that is through the sns or a bottle. Any time she is awake, offer the breast for "practice" nursing, even if she just fed. She may comfort nurse which will help stimulate your supply, too.

Also, I wanted to say that an oz from each breast is great! At 11 days pp, getting 2 oz at a pumping session is really good, considering that your baby's tummy is the size of a ping pong ball and that you are pumping after already nursing. Keep it up! You're doing great!

Another good tip is to try to fit in a power pumping session if you can. Say you bf baby then offer the supplement and she goes down to sleep, you know she'll sleep for a few hours, turn on a movie and spend 15 minutes on with your pump, 15 minutes off, on, off, on, off, etc. through most of the movie. This will stimulate your supply the same way that cluster feeding does--since your baby is sleeping through the regular cluster feeding times (usually in the evening), recreating this with your pump could really make a difference.

Keeping baby skin to skin as you have been, in bed, is great. Even if she's sleeping, you can wrap her up skin to skin if you have a Moby or similar, even keeping her in your lap while pumping is good--just having her close and smelling her baby smell will help stimulate the happy nursing hormones :)

Remember, our bodies make milk almost constantly, so even if you just fed or just pumped, even 15-20 minutes later, your breasts are already producing more milk. They are never really completely empty, and the more often they are drained, the more your body knows to produce more milk.

You said that you are broke for groceries/supplements--maybe you could qualify for temporary food stamps? At my local natural grocery, whole herbs qualify as a food stamp purchase, and I buy whole fenugreek, fennel, red raspberry leaf, etc. and brew it in tea when I need a supply boost. Same with the barley water and oats. ETA I just remembered that you mentioned anemia--if you could get temporary food stamps, then you could rock the high-iron foods, too, like green leafies (esp in smoothies), raisins, beans, red meat, etc. And drink, drink, drink, have a big water bottle and pound that stuff whenever nursing or pumping (and in between, too ;)

[poorlittlefish]

You probably figured this out already but I jsut realized I told you to pump for 2 mins after feeding....I meant 20.  Hope today is a better day.

[craft_media_hero]

Originally Posted by poorlittlefish 

You probably figured this out already but I jsut realized I told you to pump for 2 mins after feeding....I meant 20.  Hope today is a better day.

Or 2-5 minutes after you see the last drop of milk. If you do this after every feeding, I believe you will notice a definite increase in supply after a few days. I would give it at least a few weeks!

[CrazyCatLady]

I realized last night how dry many of her diapers have been.  So getting more food down her has become a huge priority. 

I have been using the SNS for almost every feeding since last evening.  Getting her to latch on it is tricky, but the feedings otherwise go pretty good.  She does tend to fall asleep with it though and then I can't wake her again.  It's much easier to force a bottle nipple down her than my nipple, SNS or not.  So I need to figure that out.  I also don't get how the SNS will build a supply when it's giving her so much formula per feeding?  But I'm sticking with it since people swear by it.

The only bottles I use are the ones that mimic the breast.  She struggles with those just as much as she does the breast, so I think they work well.  They also seems to have helped her latch get stronger.  But boy does she hate those bottles.  She really liked the ones from the NICU much better.

I still get nothing per pumping session.  With my other babies I could easily pump out 3-6 ounces per pump session.  So it's sad to not even be able to pump enough to cover the bottom of a bottle. :( Plus every time I start to pump...she wakes up screaming for some reason.  So that's frustrating.  But with pumping, the SNS, and letting her comfort nurse a lot...hopefully I will get some milk someday...

[APToddlerMama]

Originally Posted by CrazyCatLady 

I also don't get how the SNS will build a supply when it's giving her so much formula per feeding?  But I'm sticking with it since people swear by it.

The only bottles I use are the ones that mimic the breast.  She struggles with those just as much as she does the breast, so I think they work well.  They also seems to have helped her latch get stronger.  But boy does she hate those bottles.  She really liked the ones from the NICU much better.

I still get nothing per pumping session.  With my other babies I could easily pump out 3-6 ounces per pump session.  So it's sad to not even be able to pump enough to cover the bottom of a bottle. :( Plus every time I start to pump...she wakes up screaming for some reason.  So that's frustrating.  But with pumping, the SNS, and letting her comfort nurse a lot...hopefully I will get some milk someday...

I am no expert in any way on breastfeeding, but I just wanted to share my experience with you on the whole SNS/bottle thing.  I started with the SNS too but ended up tossing it.  It was a pain and I was already getting plenty of nipple stimulation from pumping and nursing.

What bottles are you using?  A Haberman that makes the flow incredibly slow?  If it is, that is what we were using too as the LC at the hospital had suggested it.  However, after seeing 3 LCs and not making any progress, I saw a speech therapist (at a Children's Hospital and one who specifically works with feeding issues) with DS at 3 weeks old, and she told me to quit using the Haberman and to use a regular bottle nipple with a regular slow flow like a typical newborn would have.  I hesitated to use it, because the LCs were always saying things like "its not a nipple preference.  Its a flow preference."  Regardless, I was at a loss for what to do and the LCs weren't helping me that much, so I took her advice.  Within about a week of that, everything just suddenly clicked for DS.  I am not sure if all of it was a coincidence, but getting rid of the Haberman and SNS did not hinder us at all.

As far as pumping, I wouldn't expect to be getting 3-6 ounces yet, especially spending 3 days in the hospital without a pump and not having that much nipple stimulation.  I am guessing your supply issue is coming from the fact that you just need either more pumping (and time) or a baby who does an adequate job of sucking/swallowing/breathing who can increase your supply.  Pumping will probably have to do the majority of the work right now.  With babies who are still getting the whole coordination thing down, leaving them to suck endlessly tends not to increase your supply like it might in a typical situation, and baby also tends to tire out so much that it ends up being counterproductive. 

Also, your hospital might have scales that they loan that measure to the gram.  We used one of these and it was fantastic.  I realized that DS was getting an incredible amount of milk in the mornings after I had gotten a little sleep (like up to 6 ounces) but by the ended up the day, I was sometimes producing 1/6th of an ounce... Weighing him before and after feeding him helped me know how much to supplement so I didn't end up wasting breastmilk and also didn't sabatoge myself and tank my own supply by adding more formula that I absolutely had to.  I am sure you know, but the more formula we have to use, the less our bodies keep up with what baby needs making it that much harder to get the supply up.

Anyhow, I hope some of that helps.  Like I said, I'm no expert but that was our experience and everything did work out in the end.  Good luck.  Hang in there! 
 

[craft_media_hero]

I just wrote this long post and then it disappeared

I am going to bed now but will come back to this thread and see how you are doing.

*hug*