Questions about satisfaction, diapers, and weaning from a formula supplement

[lisamarie1081]

Quickly, here's my situation:

I had DS 2.5 weeks ago by c-section after 12 hrs of cervidil induction, 24 hours of pitocin, and 12 hours of epidural.  I barely got to see him after he was born, let alone get any skin-to-skin action.   I'm quite sure he wasn't getting anything from me for the first week of his life as evidenced by his nearly 1 lb weight loss by discharge and subsequent 5 oz loss the day after our arrival home.  The ped recommended temporary supplementation with formula since the kiddo was obviously starving.  We gave him 1 oz after each feeding and he gained something like 7 oz back overnight.  We continued with this since I could hand express any milk and the pump (the Medela pump in style advanced) gave me only 1/2 oz total from both breasts.  DS learned what it was like to have a full belly and probably really liked it!  We've been through a growth spurt or two since then where he DEMANDED to eat 2 oz of the formula after nursing for nearly 45 minutes, so I reluctantly let him.  (Btw, I'm a first time mom -- his "demands" may be misinterpreted, since I"ll admit that I don't really know what I'm doing!)

At our 2 week check, DS had gained back his birth weight + 5 oz.  The ped clearly wanted us to scale back on the food -- especially since I had been feeling like he was still hungry after nursing and that I may not have enough milk for him still.  He provided some breastfeeding/bonding advice that I've followed -- like ditch the pump (I had been pumping to know how much BM he got, giving DS that bottle and then giving him the formula as needed), increase skin-to-skin and start to wean from the formula.  That last recommendation didn't come with very clear instructions.

So, with a situation that wasn't all that "quick", here are my questions that I'd love to hear your feedback to if you have similar experiences:

1)  How do you tell when baby is satisfied?  I need to know the difference between plain old fussing and hunger-fussing.  I know about the tell-tale signs like sucking hands, rooting, moving his mouth and tongue, etc.  But, I feel like DS reaches for his hands out of frustration over anything!  I have read where they drift off to semi-sleep or go limp in their bodies when they are done.  THe limpness is usually what I look for.  If he is starting out the nursing session with tense clenched arms and fists and finishes loose and limp, has he likely had enough?  It seems like he isn't fussing so much after a feeding since I've started the side-lying position with him  -- since starting that (or maybe its coincidence), it seems like he's becoming satisfied from all nursing positions and I only gave him 6 oz of supplement today. 

2)  When I give DS as much supplement as he wants (which would be about 50% of his daily intake), he poops in nearly every diaper.  As I diminish his supplement, he poops go with it.  Today, with only 6 oz of formula, he's had 1 huge poopy diaper.  They are nearly all yellow and seedy ... just wondering if soiled diapers will temporarily drop off as I wean him from formula supplement?  I would suspect so as his body adjusts to 100% breastmilk, but just wondering what your thoughts are.

3)  I am reading ALOT (and the ped agrees) that says pumps aren't as efficient as the baby at removing milk from the breast.  I can pump only 10-15 minutes before I'm dry ... does that mean that the baby is done in that time or shorter?  He typically nurses for a total of 40-50 minutes ... is alot of that time probably just sucking or can he trigger several letdowns and, if so, how does that happen?

4) Baby is sounding a little congested/mucousy in the last day or so and his one eye is having alot of gunk oozing from it -- could this be a reaction to something I'm eating?  It's not in his nose and he can breathe clearly, so I can't suck it out ... not sure what's going on there or if it is breastfeeding-related.

5)  At night, DS will sleep anywhere from 3-5 hours at a time before waking and asking to feed.  Sometimes in the late evening, I need to wake him to nurse.  Putting him back down after each feeding is virtually effortless.  But, during the day, it seems like he wants to eat CONSTANTLY ... barely 1.5 hrs between each feeding and 45 min each session.  It's usually first thing in the morning and throughout the day that he wants the formula supplement -- I think of it as if he's hibernating for winter ... but I'm not even sure babies can do that?  Aren't their stomachs only so big?  I'm not really worried about his sleeping times -- in fact, with the exception of the fact that he doesn't like to nap during the day, I'm happy that he sleeps so well at night.  :)  Just wanted to see what you all thought.

So - - thereyou go.  I know those are alot of questions, but they are just all the things on my mind.  Answer what you want/can.  I'd appreciate any feedback you can provide!  :)

[MichelleZB]

Hi Lisamarie--

Okay, I'm going to suggest a radical change in your thinking. Here's breastfeeding: the easy way.

I have no idea if my baby has a specific hunger kind of fussing. People ask if he has a "hunger cry". I don't know. I guess? Sort of? Here's how I tell if he's hungry: I try him on my boob. If he eats, he was hungry.

Don't worry about whether your baby is getting "enough" at each feeding. You tell he's done when he stops eating by either coming off or going to sleep. If he wasn't full, he can just eat again later when he wants.

No need to supplement. If he's still hungry after eating at both breasts, just put him back on the first one. You don't ever have no milk. There's always something in there. Having him nurse frequently is the way your boobs will know to make more milk for next time.

I can see you made this post about two weeks ago. If your son is about a month old now, he's easily still at that stage where you kind of have to pour yourself a tea, put on a movie, and nurse for hours. It gets better and your baby will get easier to figure out! Hang in there and nurse, nurse, nurse!

[jeninejessica]

Originally Posted by lisamarie1081 

2)  When I give DS as much supplement as he wants (which would be about 50% of his daily intake), he poops in nearly every diaper.  As I diminish his supplement, he poops go with it.  Today, with only 6 oz of formula, he's had 1 huge poopy diaper.  They are nearly all yellow and seedy ... just wondering if soiled diapers will temporarily drop off as I wean him from formula supplement?  I would suspect so as his body adjusts to 100% breastmilk, but just wondering what your thoughts are.

Yes. And they may not pick back up again. DD only has generally one soiled diaper a day. Just pay attention to make sure he's still getting lots of wet diapers and that's the important indicator. Because their bodies are better able to use what's in the breastmilk, there won't be as much 'extra' to output. 

3)  I am reading ALOT (and the ped agrees) that says pumps aren't as efficient as the baby at removing milk from the breast.  I can pump only 10-15 minutes before I'm dry ... does that mean that the baby is done in that time or shorter?  He typically nurses for a total of 40-50 minutes ... is alot of that time probably just sucking or can he trigger several letdowns and, if so, how does that happen?

Absolutely, the pump is not a reliable indicator of what the baby -could- be getting. ie if you're pumping 3 oz in 15 minutes, then you could expect that the baby will be able to get -at least- 3oz in 15 minutes. However-- that's also assuming that that he's actively feeding for the whole time- which they don't often do. If you listen and watch careful you can probably see that sometimes he's swallowing, but sometimes he'll just suck and not actually be intaking milk, just being there for comfort, or giving his body a second to catch up with the milk. 

So while you may run out of milk -for the pump- in 15 minutes, this unfortunately doesn't tell you much about what is available for your son, or how long it should take him to finish eating. All you can reasonably say is that he is able to get -at least- as much milk as you get with the pump, but most likely it's quite a bit more. Does that make sense?

4) Baby is sounding a little congested/mucousy in the last day or so and his one eye is having alot of gunk oozing from it -- could this be a reaction to something I'm eating?  It's not in his nose and he can breathe clearly, so I can't suck it out ... not sure what's going on there or if it is breastfeeding-related.

Probably not realted to the nursing. However the nursing might help. Sounds like some sort of infection or cold. Squirt some breastmilk in his eye. It'll likely clear up. I've found if it's some sort of allergy, it's more likely to present as tummy and output related (ie his poops will get funny colored or really mucousy, he'll have lots of gas, or visible troubles pooping, etc)

5)  At night, DS will sleep anywhere from 3-5 hours at a time before waking and asking to feed.  Sometimes in the late evening, I need to wake him to nurse.  Putting him back down after each feeding is virtually effortless.  But, during the day, it seems like he wants to eat CONSTANTLY ... barely 1.5 hrs between each feeding and 45 min each session.  It's usually first thing in the morning and throughout the day that he wants the formula supplement -- I think of it as if he's hibernating for winter ... but I'm not even sure babies can do that?  Aren't their stomachs only so big?  I'm not really worried about his sleeping times -- in fact, with the exception of the fact that he doesn't like to nap during the day, I'm happy that he sleeps so well at night.  :)  Just wanted to see what you all thought.

So - - thereyou go.  I know those are alot of questions, but they are just all the things on my mind.  Answer what you want/can.  I'd appreciate any feedback you can provide!  :)

DD is like this too. During the day, she's a nightmare to put to sleep. But between midnight and 8am the next morning, I can nurse her, pop her off and she'll fall asleep right away usually, no problems. It's a good thing, it means their bodies have adjusted that it's nighttime and no playing and awake activity is needed. During the day, DD (and she's 3 months now) does want to eat every 2 hours at least. I don't fully understand it, but yes, a lot of books and articles talk about how they nurse so much during the day so they don't have to as much at night. Some babies will cluster feed right before bedtime too. All normal. :)

Other than that, just what the PP said, nurse nurse nurse and trust your body. I don't know how much you're supplementing right now, but if you can, I would recommend stopping it altogether, and for a little while just letting him nurse all the freaking time. The more he nurses, it will signal to your body to keep producing more milk :)

[lisamarie1081]

Thanks for all the GREAT feedback!  I wish I had seent his post earlier.  I haven't checked back in a while.  When I wrote this (and about 10 other posts), my whole life seemed to be consumed with breastfeeding and how I could increase my supply.  I am now much more chill about "having to" give my son formula supplement, so I laid off the constant research.  I have, however, continued to read on the topic and visit other forums.

This being my first son, I had/have a lot to learn.  (Isn't that the understatement of the century?!)  He's a few days shy of 7 weeks old and I'm trying hard to get the nap thing to happen because I go back to work in 2 weeks.  I don't have to physically "go" to work ... I work at home as a cyber school teacher and will need to be teaching live for anywhere between 1 and 3 hrs a day -- the remainder of my workday is flexible, but I need to be near the computer to respond to colleagues and/or students and families if necessary.  So, I need my son to not be crazy cranky because he refuses to sleep. 

This child's will is amazing.  Over the weekend, i read an email from BabyCenter which listed some baby schedules from parents of babies at different ages, whether they were breastfeeding or formula feeding and whether or not there were siblings -- so, a variety of circumstances.  It FLOORED me to realize taht some people have babies who coo themselves to sleep and do the same when they wake up.  Mine will NOT be put down in his crib awake without a ferocious fight and he will NOT tolerate laying in his crib awake more than 5 mintues before he's fed.   I think I created this monster -- being a first time mom, I didn't realize that milk could be soooooooo delayed by a traumatic birth experience.  I did know that supplementing with formula was a no-no, but when the kid loses 1.5 lbs in the first few days, I got nervous and accepted what the docs (and lactation consultant at the docs office) suggested.  We supplemented before he was a week old -- even though my milk started coming in a day or two after we started supplementing.  He never cried before he had formula -- then, I would give him 1 oz at the end of each feeding and when he fussed or cried, I gave him more.  As the vicious cycle goes, I gave him more as I felt he needed it and he became a "content" baby when he was rested, full, and clean.  I probably created this fighting spirit.  I'm not at all a fan of the "cry it out" methods -- but he does alot of that because he wants things so instantaneously.  It's only after 6 weeks of research, trying every food and herb out there to increase my supply, and pumping like crazy do I realize that I really need that little guy to do the work he should've done those first 2-3 weeks after he was born.  I have a terribly soft heart for his cries, as I'm sure many moms do -- so I don't really trust my own will when it comes to cutting him off of formula altogether.  I know he will freak out at the constant hungry feeling he'll have and the lack of instant gratification he's sure to encounter ... even though i know it is good for us all in the long run.  Oddly enough, my husband usually works a lot of evenings and hasn't lately and won't be for a while.  he endured the days when I tried to get DS exclusively breastfed and he knows what a challenge it is with this kid's cries.  I'm a little afraid of doing that again ... not only to have the baby endure it -- but to have my DH watch it all over again.  I feel like I need to move into a hotelo for a few days to accomplish this.  Anyway -- I have to start working again in 2 weeks, so I feel like this is my last shot at getting supply high enough to exclusively breastfeed.  Do you think it's possible to increase my supply with constant nursing, then be able to pump more at each session?  While I work at home most of the time, my first week back will require me to leave the house to proctor our state's standardized exams -- one whole week away 8am-4pm.  If I work at establishing supply over the next two weeks, I'd hate to have to give him formula again because I can't pump enough.  Any ideas?

[jeninejessica]

I'm typing quickly in between freak out times of our own here, but here goes--

I totally understand, and it is so hard to let them cry. I'm not saying you need to let him cry because he's hungry, but I definitely recommend a "nurse in". Arrange for help- whether it's your DH, a friend or family member, or a postpartum doula you have to pay. And then find the comfiest place in your house- your couch or bed. And don't move for a few days other than to get up to go to the bathroom and shower if you must. Bring books, a laptop, an ipod, knitting, anything you can to keep yourself busy. Strip your top off, and strip baby down... and just give him full and complete access to the breast for two or three days straight. Encourage him to eat every hour when you're awake, and probably every 2-3 when he's sleeping (you can pick him up gently and place the nipple near his nose and he'll likely latch on and nurse in his sleep). At first, he will empty the breast quite easily, but every time he nurses, it signals to your body to make more, so you will probably notice that towards the end of the nurse-in, you're getting fuller faster. If he's getting a bit fussy after nursing still try calming him other ways first, but if he's still acting very hungry, then give him a little bit of formula, and keep decreasing the amount that you give him after each feeding. But always always always offer the breast first, and keep offering until he pushes it away. 

I think it is definitely possible to increase your supply with the constant nursing. As for the pumping while you're gone-- two things. First off-- if you have to give him some formula during this time, then that's not the end of the world. Every bit of breastmilk he gets instead of formula is a wonderful thing you're doing for him. This doesn't mean you're a bad mom for having to supplement. Secondly-- yes, in geenral, increasing your supply will increase what you can get from the pump. Start now, and every two hours if he's not nursing, then pump. even if it's just half an ounce, it should help your body get used to letting down for the pump better. Watch cutesy baby things while pumping. It sounds like a trick, but I swear it works. If you really need to get more, I've found that pumping while DD is nursing on the other side almost doubles my output. I let down really poorly for the pump, so it helps to have her stimulating the letdown. It's hard, but worth it if you need the pumped milk. 

Is it possible for whoever is watching him to bring him to your a few times during the day for an at the breast nursing? This would be the best way to ensure your supply doesn't dip again after that week. Youll also have ot make sure you're pumping during the day while you're away. 

Gotta go, but will be back later with more thoughts!

[Quinalla]

First, you didn't "create a monster" at all, don't blame yourself, some kids just are more stubborn/willful or whatever personality word you want to use and some kids hate napping or sleeping in general. My kid was both of these things, she didn't start liking sleep until ~13 months old or so, hopefully yours will learn to like them sooner, and she was and still is so, so stubborn. Sounds like he is not sleeping too badly at night, so that's something! And yeah, I was soooo jealous of moms with easy sleeping babies, mine started to like sleeping a bit better like I said ~13 months, that was when she consistently was only waking once a night and was better about taking a nap longer than 20 minutes. There is a reason I decided I wanted my first to be 3 at least by the time I have my second just in case the second is a sleep fighter too.

Also, I supplemented with formula at the beginning too and weaned her off in a couple weeks. In hindsight, I may not have needed to supplement, but I don't regret it as I made the best decision I could at the time and we went on to have an 18 month BFing relationship that I brought to a gentle end on my own terms. So you can do it! As for weaning off formula supplementation, I just reduced the amount I was giving a little bit at a time (maybe drop .5oz every 2-3 days, wish I could be more specific, but I honestly don't remember well). I would definitely have a nurse in, just take as much time as you can and just try to encourage nursing during all awake time you can and if there is a long sleep stretch, then I would try to pump during that stretch too to trigger demand. You don't have to go crazy with the pump, but especially if you start getting full/engorged, I would try and pump a bit to send a demand signaI. I know switching breasts back and forth at the same feeding helped my daughter too. She seemed to be able to get multiple let-downs easier that way. You can get your supply up in a that time period (providing there aren't unusual issues of course), your supply will respond pretty quickly. I also had one breast that produced more and was easier for her to latch to, so switching breasts at the same feeding worked well as she would often get frustrated on the slacker breast

But yeah, get as much BFing in as you can with pumping if needed for some more stimulation during long naps and so on and be as rested and well fed as you can (I know how hard it is, make sure to ask for help as often as possible, that was surprisingly hard for me to do, so you have my permission if that helps if it is hard for you too). It's ok if your baby wants to nurse a lot and for a long time, so don't worry about nursing too much. But again, yeah, if he's crying for more, put him back to the breast at least once before going to formula, and try to just give him enough to get him relaxed a bit and then put him back to the breast. And don't worry about it too much either, you'll get there!

[jeninejessica]

ok, so yes with the agreement that you did not create a monster. Some babies are just born like this. I'm told that high needs babies tend to give back more once they're older. I can't wait. I'm n for some super loving :)

I kind of got distracted with my nurse in suggestions-- but the helper should be bringing you anything you need-- they should be able to prepare and bring meals, changes for the baby, anything that would require you getting out of bed. Your only job for those days should be resting and nursing. 

Also I totally get the disbelief about moms who put their babies down happy, then fall asleep, and then wake up happy. Urban myth I say ;)  No really though, it is in no way the norm, but Tenley will occassionally now fall asleep if I nurse her and then lay down beside her. It gets easier as they are more able to control their own bodies and be interested in the things around them. 

I highly suggest reading Sears- Keys to calming the fussy baby http://www.amazon.com/Keys-Calming-Fussy-Barrons-Parenting/dp/0764191365/ref=sr_1_fkmr2_3?ie=UTF8&qid=1331348503&sr=8-3-fkmr2 . I can't say I found any real new tips to help us... but I did end up reading the entirety of the first few chapters to my husband, just out of sheer "hun!! Smeone knows what we're going through!" You may find new tips, but mostly, it just felt like such a breath of fresh air to hear someone else describing what we were going through. It does go into the background of a lot of baby behaviors too, which helped with the patience. 

Anyways, I feel like I'm rambling, so I should probably get back to my own fussy baby. If you hae more questions, please, ask them! Someone here will be able to help!

[lisamarie1081]

Thank soooo much for the feedback and ideas!  I really do appreciate them ... and the prompt replies.

I'm sold on the idea of the nursing vacation, as I think it may be only last real shot at increasing my supply in order to occasionally pump so that I can leave the house to go places, do things, and even so that I can work with a routine in two weeks.  I'm not a person who does that well, though -- sit around and have others wait on me, that is.  I had a csection and I didn't spend any time being waited on once I got home.  I prepared meals, I did laundry, I was the primary caretaker for the baby even though my husband was home with me for a week.  I have a really hard time with sitting still like that for so long.  BUT -- if it is necessary .... I will try my best.  I plan to start this Thursday or Friday coming up.  My husband will be around all weekend long to help and postponing it will give me the time to clean my house and finish the laundry so that my mind is also not distracted during this rest period.

In the meanwhile, I plan to keep closer track of how much formula the baby is eating and get prepared to start weaning slowly after the vacation (just in case I don't end up full to the brim after three days in bed with DS!). 

Here are a few questions I have:

-- I got my period today, about 7 weeks ppd.  Is that going to affect the likelihood of my success with the nursing vacation?  I know that breastfeeding is supposed to affect the menstrual cycle, but does the cycle affect breastfeeding?

-- If I was religiously pumping every 2 hrs since he was born (or whatever it took), would I have gotten my period so soon?  Or, does your body only signal to go back to "normal" when the baby is not at the breast?

-- During this nursing vacation, should I supplement at all?  Would it be really bad to give him formula if he's screaming and crying out of hunger?  We are nearing the end of his 6 weeks and in the last two days, I've noticed that he's sleeping a GREAT deal more and occassionally requiring much more food during his awake hours.  If he's int he middle of a growth spurt and I try to do this vacation without supplementing, is that okay?  (probably sounds like a dumb quedstion ... it's not like he's going to die, I know that ... but it seems cruel and unusual to withhold food.  :/  )

I think that's it for now.  Thanks again for all the help!

[jeninejessica]

That makes sense about waiting til the weekend when you know you'll be less stressed. I'll be thinking of you! It's difficult-- funny, because you wouldn't think sitting around doing nothing is difficult, but it is. 

I don't believe getting your period should effect milk supply at all. It's the decrease in hormones that triggers your cycles to return, but once they've returned I don't think it affects your supply. 

I -think- I've read that the baby being at the breast will keep cycles away longer than pumping. I'm not really sure why, or what the science behind it is. It could be related to how much you're able to get with the pump, as opposed to how much the baby removes-- so your body believed earlier that the baby was gaining nutrition from elsewhere. 

As for supplementing during the nurse-in... I say let your baby and your instincts be the guide. Ideally you will give him as little formula during that time as you can. Remember that every time he has formula, he will have less desire to nurse, which will defeat the purpose. That said-- of course you do not want him to be starving, not the goal here at all. So take cues from him, supplement when you need it, but as a last option. Offer the breast first, always. If he's still fussy, give him maybe half an ounce of formula, then try the breast again, rinse and repeat. Basically, give him the formula to take the edge off, but keep offering the breast every time, and in between. If you stop to burp him, offer the breast before putting him back on the bottle. He probably will be a bit more fussy, but in the end, he will signal to your body to produce more, and towards the end of the weekend, you'll probably find that you're feeling more full.