Scared to make the jump from pump and bottle to EBF

[mousebandit]

Warning:  I am totally sleep-deprived, so this may be rambling and not make much sense!  Please bear with me!

My new LO is 6 weeks now, and we're still doing the pump and bottle.  I want to make the jump back to EBF, but I'm still pretty nervous about it. 

The background:  born at 37w5d with vasa previa and IUGR (didn't figure out why) at 4 pounds 14 ounces.  She had pretty decent latch and suck in the hospital, with LC nurses pretty much doing all the work for me at every nursing, LOL!  Started pumping in the hospital though because of a low blood sugar reading and we supplemented with formula for about a week until my milk was really in good. 

Have been pumping and bottle feeding breastmilk since then, with some attempts at nursing again.  We use scales here at home, and she only gets about 20 mL per nursing, and that take her like 10 minutes of pretty hard effort, and then she's totally asleep.  For comparison, 30 mL is about 1 ounce, so she's getting less than 1 ounce in 10 minutes of effort.  I also have a very hard time telling if she's really doing the suck, swallow thing.  It's definitely not vigorous nursing, that's for sure.

With the bottle she takes about 80-100 mL per feeding, so there is a huge gap there to make up for.  For the last 2 weeks I have pretty much just done the bottle and pump.  And my pumpings are not nearly as frequent as they should be, so I am worried about supply issues, too.  With the new baby, and a 1-yr-old and a 3-yr-old, I am really feeling the fatigue and stress, and more often then not, it's either pump while baby screams, or delay the pumping (which then usually doesn't happen until next feeding, if then).  And at night, I have not been pumping, so that is really not good either.

I really want to just get us on track, but her latch is so shallow and she's getting so little for so much effort.  She has finally hit 6 pounds, and seems to be gaining slowly but steadily.

I'm debating just jumping to nursing only during the day, and hoping that she gets the picture and really starts to nurse good.  I guess this would assume that she's just been lazy so far, which may or may not be the case.  I did have an LC come out to the house and she says that LO definitely can take a deeper latch, that she just isn't, but there's no physical problem, just little and sleepy, etc.  We tried a nipple shield, and LO got 40 mL at that feeding, but it took a lot of work, and I haven't been able to really make much happen with it since then (nor have I tried much, to be honest). 

Will she be able to go from less than an ounce per nursing session to over 3 ounces quickly enough to not lose weight?  Will I be nursing all day long (not a good plan with the toddlers and no one to help me).  Have I already totally screwed my long-term milk supply? 

My other little girl was a preemie and had nursing issues but were MUCH, MUCH further along in the process by 6 weeks - totally back on breast I think.  My 1-yr-old little boy ended up being a bottle baby, which was beyond horrible, and I have massive guilt over it.  I just can't allow that to happen again, but I don't seem to be able to force myself to make the nursing, bottle-feed, and pump happen at every feeding.  It's been a huge struggle just to get her to gain 1 pound over the last 6 weeks!  The lack of sleep is slaying me, and I feel bad when I don't drag out of bed to pump at night, knowing it's hurting my supply, but my flesh is weak! 

So, as rambling as this post probably is, I think I got a few questions put in here.  Basically, can I and should I dump the bottle during the day?  I know if I do I should still do a clean-up pumping after each feeding right?  How do you get all this done with other toddlers around?  How do you get the pumping done if baby is fussy after feedings?  I have apparently trained my new LO to expect to be held or snuggled while she sleeps now, so that is not helping, LOL!  How soon can I lose the pump?  It feels like I need it and hate it at the same time.  I'm terrified of losing my supply in another month or two - that's what happened with ds.  No amount of fenugreek or pumping at that point would bring it back.  How do I make sure I'm not headed for that again?  Hubby is working 12-hour days, 6 days a week, and we just moved to a new town, so I am pretty much on my own for all of this.  

Thank you so much in advance for any help, advice, kick-in-the-rear, anything!!  I'm not really very coherent lately and I don't want to screw things up, and I really want to get on to a normal breastfeeding life!!  

Mouse Bandit

[Megan73]

I'm so sorry you're struggling with this, mama. Hugs.
My concern from your post is that your LO isn't yet gaining well so I'd hesitate to shake up your feeding routine. A newborn should be gaining five to seven ounces a week. You can check out the resources on infant growth at Kellymom.com.
I'd keep pumping, supplementing and putting her to the breast and as she gets bigger she may well get better at transferring milk. Has she been checked for a tongue tie? Normally I'd suggest supplementing at the breast with a Lact-Aid but that may not help with a babe who's struggling to transfer milk. Did the LC suggest this?
I know it sucks but I'd pump, pump, pump whenever you get the chance - especially at night when you have more milk. It's really the only way to keep your supply up while your LO figures out how to empty your breasts on her own. Can you "power pump" when your toddler is in bed and DH is home? A hands-free pumping bra might be a good investment.
Hang in there!

[foreverinbluejeans]

I agree that as difficult as it is pumping is going to be needed for awhile longer. I think you are focusing too much on weighing and measuring. Weighing before and after feeding may not be an accurate measure of how much milk the baby gets. It seems like it should be but some experts don't think so. Since your baby is a more normal size now unless you have been told you must measure feedings it may help to just do baby weight checks every other day. You can move away from the medical model and gain confidence.

You could try pumping one breast while nursing with the other. That would save time and may increase the amount you can pump. Try kangaroo care when not pumping and wear your baby next to your skin in a carrier that is right for the baby's neck development. That will allow you to do things with the other children.

The World Health Org recommends at least 2.5 years before trying to conceive if the pregnancies were normal, longer if there were problems. I know the doctors don't tell women in the US. You have had 3 babies so close together and it could have contributed to the problems with this baby. Your stores may be depleted. If you can hire help with the house, don't feel guilty. Pre-teen neighbors can be very helpful and cheap.  It may be a long time before you start to feel normal again. 

[KateDavies45]

I don't know if this helps but it worked for us...DD was born 35w and some days (long story) and spent 4wks in the NICU several days for breathing problems and the rest for not being able to figure out how to eat by mouth....at about seven weeks she was still slow to gain weight and I was having problems with over supply and but was still really paranoid about not pumping enough (all the hospital LC's warmed me it would be harder to keep up the pumping at home so I was pretty militant about it even though I was getting ridiculously engorged all the time)

So I decided to try not pumping and only BFing her at night that way if she fell asleep after only a few minutes it was no big deal and I could make up the difference during the day with bottle feeding AND I wouldn't need to pump at night. We were cosleeping at the time so it was easy enough to offer her a boob every time she woke up. (which was alot) It took about two weeks of that before she really got the idea and got her latch right and then we started BFing more during the day and slowly giving fewer bottles. DD is about to be 7mo next week and is still EBF (though in the past week or so we've tried a few solids for fun). I don't know how many full bottle feedings you're doing at night but even if you only skip one or two to BF that's a start. I do agree with PP that since your LO has had weight gain issues that I would take it slow. Maybe offer a boob first when she's hungry, but don't let her fall asleep, and keep at it for a few more minutes? also I found doing that breast massage thing the hospital some times teaches you to do before pumping can also help bring your milk down for baby just do it right before you nurse her.

Also  if you're still having latch probleIms I'd say it's worth it if you can to go see an experianced LC or even just a WIC peer councilor to help you get that part down! Keep trying mama! 

[tincia]

What I was told to do with my middle babe was to feed her an ounce to take the edge off her hunger, then breastfeed as best we could, then offer the socond ounce of the bottle, but really watch for cues as to wether the second half of the bottle is needed (however in your case with slow weight gain, i would think if she'll take it then great). This way if u don't get a chance to pump, at least you've done something to help maintain your supply, although ideally if u can pump afterward, that would best to ensure your breasts are emptied since it doesn't sound like the babe is able to yet.
If u can, maybe try to see your lc again or a new one if u weren't impressed with the first one. Does your community offer any free services where a public health nurse will come help u get the baby feeding then occupy the toddlers while y continue, and then even watch all three while u have a quick nap? I live in Ontario and while I have never taken advantage of it, i've heard its amazing! The idea of hiring a local teenager/tween is a great idea even if it is just to entertain the toddlers while u work at really latching well, or even to hold the fussy baby while u pump. If u live somewhere that high school students are required to complete volunteer hours, u could even get the help free!

[etsdtm99]

i didn't have time to read the other replies - but if pumping every feeding is not working for you, you can try power pumping - or leaving the pump out for 4-6 hour blocks and pump every time you walk by up to every 45-60 mins for 5-10 mins (or until it gets annoying) - after 4-6 hours, wash everything, refrigerate the milk,a nd start again .. this is an alternative to pumping during or after feedings..  also, you could do the same thing with the baby if you think she could handle it  - have you heard of biological nurturing/laid back braestfeeding? (google it if not, videos should show up in the search)   its hard with 2 other kids, i know, but a week or two of letting things go and just holding the baby on your bare chest for most of the day could get her breastfeeding and wouldn't that be worth it?   if you are producing enough milk to pump everything she needs, then she should be able to adjust (now since it is past her due date) to nursing on demand.. - i would also say that weighing once a day or every other day would be plenty during this 'try nursing out' time ..  if you weigh before/after every nursing you will go insane 'she only got X" will happen a lot more than "wow she took 2 oz!"  she doesn't need to take in a  full bottle feeding at the breast!  the hardest part of this transition is going to be going from the bottle feeding/nicu/ measuring mentality to the nursing and just trusting it mentality .. it won't happen right away, and of course you need to be sure she is doing ok.. and as long as she is having enough wet/dirty diapers, give the weight checks a few days to a week to show gain (i would be nervous about a 'significant' loss because she is so small, but i would be ok with good diaper output and maintaining weight give/take a couple ounces)

[mousebandit]

Thank you ladies for the replies!  I hadn't heard of either power pumping or laid-back nursing, but I think we're going to try both.  I stopped weighing her so much, but I do think that she has started to gain more normally.  She went up 8 ounces in one week then 7 ounces the next, so that's more like normal, right?  I got on Kelly mom and went through everything again and found some stuff I hadn't read before.  Found the page that shows how to make your own hands-free pumping bra from a regular nursing bra.  Doing it right now and it's working!  That will help tremendously, at least with the mental part of having to pump so much.  At least I can do something at the computer or *something* at the same time.  I do have an LC, and I like her - she seems awesome and was recommended by a midwife I know and trust.  I will be seeing her again, but probably not until my husband's work slows down.  I can't really afford another home visit, but if we go to the hospital where she works it's free.  I just don't want to take all 3 kids, and hubby is working 7 days a week, 12 hours a day for a few more weeks. 

I do have another question - if WIC will loan me a hospital grade pump, would that be worth it?  The pump I have is a Medela, double pump, I don't know the model or name but I'm guessing it's at least 9 years old, maybe older.  It has a nylon blue case all around it, and is something you would take to work without being able to tell it's a pump.  THere's an insulated side compartment, I guess to store milk, and a place to store the power cord and another spot I'm guessing for bottles/flanges.  The LC seemed to think it was sufficient, but I've been reading a lot where the commercial grade was really that much better.  We'll hopefully be on WIC for at least a few more weeks, so I'm thinking about driving down there tomorrow to see if they loan out pumps.  THe wic office in my old county did. 

I love the idea of power pumping, but if I go X number of hours without nursing or pumping, will I find or might I find that at 2-3 months my supply won't increase sufficiently to keep up with baby's demand?  THat is what happened with last baby, and I have to attribute it to insufficient pumping sessions.  We had way more than he needed up until about 3 months, then his demand kept going up and my supply went nowhere, even with massive tinctures and herbs.  I am currently pumping about 10 oz. more per day than she is drinking, but I don't want to screw this up and not be able to fix it later.  I would be thrilled if I could power pump during mornings and evenings and then not pump at night, but everything says to not go more than 5 hours without pumping.  I also like the idea of substituting BF only for a couple of feeds, but my LC warned me against not pumping after BF feeds because if the breast is not emptied, it will signal to make less milk and supply will decline.  Can't risk that.  Thoughts on this??

I do agree that the babies were too close together, mostly the last 2.  THey were only 16 months apart and that is way close.  I don't doubt that it contributed to things.  Is what it is now, though. 

Thank you again for all the hugs and help!  It really makes a difference.  And, she's up to 6 pounds 6 ounces at last weighing, so I feel like there is hope that she will do better at latching on as she gets bigger and gets more fat on her cheeks too!  :-)

Mouse Bandit