Does my baby really need formula?!

[amazonMama]

Hello! I'm Jenny, mom to my sweet little 11wk old boy.
We just came home from our 3rd meeting with the LC and I'm super discouraged!
Our nursing relationship started out pretty good despite the jaundice and bili blanket and my milk waiting til day 5 to come in. I thought I had a good supply and he a good latch. Then when ds was about 1 mo the nipple pain was bad, I was treated for yeast (and ds too), but pain came back so LC at my OB's office sent me to the LC at the hospital.

When I went to see her about the nipple pain, she wanted to focus on ds's weight and weight gain (ok she did offer some latch tips to improve ds's latch and offered to look out for yeast). But she wanted me to weigh him regularly, pump after every feeding, nurse frequently, start fenugreek...

Admittedly the pediatrician almost got on me about ds's weight gain just the week prior at his 2 mo check. He had only gained 1lb above his birth weight by 2 mo. But I pointed out that my dh is tall and very thin and ds gained over 3 inches since birth and seems to take after dh. So the ped let it rest but did point out that he wasn't staying on the growth curve.

So, I left the first LC visit armed with a pump and started all the things she said. It was discouraging and stressful. After the second visit I went home with a scale. Now I could see how little he was eating--less than an ounce per feeding. But some feedings at night were over 3 oz! But in the end after today's visit (10 days after starting all this intervention) she says even though I've increased my supply a bit and he's gaining weight a little faster than before, it's not the 21oz per day that he needs and he's not gaining up to the right amount per day...so he needs formula to make up for it.

I am so torn up about this! I don't want to supplement with formula. But I don't want my baby to go hungry!!! I'm nursing and pumping and giving him every drop that I pump after he's done. I've added blessed thistle to the fenugreek I take starting today.
But until my milk supply gets up to what everyone says he needs, will he be ok?!
I thought LCs were supposed to be so supportive of bfing?!
Is he going to be ok?
Will a few ounces of supplemental formula after he's finished nursing sabotage any milk supply increase efforts?
If he starts formula will I ever be able to wean him off it?


I'm a wreak tonight! Just great for milk production I know!

[mizdavie]

I know how hard this is! I went through a similar situation. My advice? Relax and trust your body. Is your LO gaining and having adequate wet diapers? If so, all is good. Supplementing simply lessened my supply and made my LO refluxy, fussy and gave her diaper rash. Now I feed on demand, pump during nap times and she's growing like a weed! Listen to your heart! YOU know what's best for your baby!!

[rtjunker]

How often is LO feeding? Frequency can often make up for quantity, so if LO is only consuming 1 ounce at a time, I'd try to feed every hour if 21 ounces a day is the goal. The bonus is that this will help with any supply issues, as the supply is directly linked to demand.
Also, while formula may not be ideal, it can provide adequate nutrition for an infant, and supplementing may be necessary depending on your unique circumstances.

[jgallagher66]

I think you should find some additional support. Did she suggest a supplemental nursing sytem? If you just supplement with a bottle after every feeding, you're not going to produce more milk. Most likely you will produce less. It sounds like she has suggested a few things to increase supply but there are more options.

I agree with Mizdavie that all of this anxiety and worry is not helping your supply and that breastfeeding works best under more relaxed conditions. I'm not sure that's going to happen though unless you get better support. Have you contacted La Leche League. If you could connect with some other more experienced nursing mothers and hang out at a La Leche meeting, you might get more relaxed and lots more ideas for increasing your supply. Here are a few of my suggestions but real life support is the best if at all possible. Can you find another lactation consultant? Personally, I love kellymom for online breastfeeding information. Here is a link to that site's links to finding breastfeeding support:

Kellymom.com/bf/concerns/bfhelp-find/

There is lots of info. there on increasing supply as well including when and how to supplement and how to wean from supplements.

If you have to supplement temporarily until you get better support, don't give up! You can increase your supply and go on to have a wonderful nursing relationship. My 4 th child was in the NICU because she was premature and had latching issues. She ended up getting formula supplements and developed nipple confusion. I kept pumping and fed her my milk in a bottle but I was determined to get her off of the bottle. We workedfor 3 months. I put her to the breast first for every feed. She just didn't seem to get it. We kept trying and one day she latched like a pro and went on to nurse for over 2 years. Getting the right help is so important.

A couple of things that I really think help with supply in addition to what you are doing is to hang out in bed with your baby for as long as you can. Get tons of rest. Have someone bring you good, nutritious food and lots of water and nurse as often as you can, sleeping and resting in between with your baby. Also lots of oatmeal in addition to the fenugeek can help.

Search the Mothering archives as well. There is a ton of information on things to try.

Good luck. You're doing good mama.

[amazonMama]

You all are so encouraging! Yes, LO is having the recommended number of wet and dirty diapers daily.. On the low end of recommended some days. But I think he's doing we'll in that regard.

He nurses every 1-3 hours during the day and we get a little longer stretch at night. The times when he nurses more frequently---closer feedings, he gets less than an ounce. And when he goes longer between, he gets more than an ounce--up to 3.5 ozs. So the frequency does help, in the long term but not in the short term.

I did find a LLL group and hope to call tomorrow. They meet once per month and the closest group to me is 1.5hrs away (same town as my LC). I think the phone support may be encouraging plus some meetings!! Dh and my mom are huge supporters, especially dh! He maybe almost as committed to this bfing success as I am. He's stocked the house with every superfood, waits on me hand and foot, gets all our other kids out the door to school in the morning singlehandedly, searches for and orders every galactagogue...he's great! I want to try shatavari and he wants me to try it, but I'm nervous since it has phytoestrogens. He's ordered the DPD. The LC didn't recommend either one: she'd never heard of the shatavari, and she wasn't allowed to recommend the domperdone, but she seemed happy for us to try the DPD once we brought it up. She didn't suggest the SNS, but I asked her for one and got a starter one. I told dh if we did the formula I'd only want to give it with the SNS. Would that cause the formula to have less of an impact on my supply? He takes the bottle fine and never refuses the breast still latching good, but I just thought if the formula wasn't an "easy" option (because the bottle would be easier given all this nipple pain) maybe I'd work even harder to wean him off it, plus the stimulation is more than an added bonus if he takes the formula with the SNS.

More rest, less worry, more frequency are all great suggestions! Thank you! I'm very encouraged by hearing your stories too! I can do this! Even if ds needs formula, I can do this! We can continue to nurse! That's what I hear you saying.

[womenswisdom]

Painful latch and inability to remove milk efficiently are huge red flags for tongue and/or lip tip. Many, many LCs are not properly trained on how to identify these, especially the hard-to-miss posterior tongue tie. Check this video (http://www.youtube.com/watch?v=5opSbXvL7yQ) and also join Tongue Tie Babies Support group on facebook to get more information about tongue and lip ties. They are pretty easily fixed if that is what is going on, but make sure you see someone who really knows what they are doing and can revise enough to be complete.

[amazonMama]

Originally Posted by jgallagher66 

If you have to supplement temporarily until you get better support, don't give up! You can increase your supply and go on to have a wonderful nursing relationship.

do you really think I could do this? Oh, I so wish I could increase my supply while supplementing! I feel like supplementing is a death sentence to increasing my supply! Maybe there still is hope! I keep on crying tonight!

[phathui5]

If you're already pumping and supplementing him with breastmilk, I don't know why you would need to add formula to the equation.

A couple of questions:

What was his birth weight? His weight at two weeks? His weight now?

When he nurses, are you hearing swallowing? 

Is his drinking like this:

http://www.nbci.ca/index.php?option=com_content&view=article&id=123:really-good-drinking&catid=6:video-clips&Itemid=13

Or more like this:

http://www.nbci.ca/index.php?option=com_content&view=article&id=125:nibbling&catid=6:video-clips&Itemid=13

[amazonMama]

I couldn't watch the videos due to my connection speed, but I know what you're talking about. I read the descriptions on the videos. Ds drinks like the first one for the first few minutes of nursing, when I can here him swallow. Then he switches to the second type of sucking after that. If I leave him t that breat long enough, he might start sucking like the first again...a second let down I think.

He weighed 6 14 at birth. Dropped almost to 6 lbs in the first week and ped threatened formula then, but my milk hadn't even come in by that weigh in!! Can't remember the exact weight. Then at 2mo he weighed 7lb 15. Now at 12 wks he weighs 8lbs 8.6oz.

[ESR2]

I'm no expert, but it doesn't sound to me like he's having any problems gaining weight. He's not huge, but I think 8 lbs. 8.6 ozs. at 12 weeks when he started out at not quite 7 is respectable. My daughter, who is almost seven, was 7 lbs. 3 oz. and 21 inches long when she was born, dropped down to 6/14 in the hospital, then started her own very slow, steady pattern  of weight gain. She's always been 80-90% for height, but it's only been within the last six months or so that she's cracked the 50th percentile for weight; she eats like a champion, and always has, but she was a long, skinny baby who has grown into a tall, skinny, very active kid, and her pediatrician has always told me that she's perfectly fine hanging out on the lower end of the scale. Her 4 1/2 year-old brother, who was born almost two pounds heavier and an inch shorter, has followed the same slow and steady pattern, and he's just as healthy and happy as she is. I think that as moms, we are conditioned to think that if our babies aren't chubby, then they aren't healthy, and that's not always the case.

[phathui5]

It looks like he's only 26oz above his birth weight now, which is a gain of 2ish oz a week.

Unless you do what the kellymom site suggests and: Always figure weight gain from the lowest point rather than from baby’s birth weight

In that case, he has gained 40ish oz, which is 3.3oz/week, not great, but not as bad.

This is an infant weight gain calculator (I did the previous calculation myself):

http://kellymom.com/health/growth/weight-gain-calculator/

This might be helpful; a breastfeeding log:

http://kellymom.com/ages/newborn/bf-basics/bf-logs/

[CookAMH]

I agree that weight gain isn't TOO bad, but it is under the low end of what kellymom recommends. My DD only gained about 8oz in a month from month 1 to 2, and we had nursing and supply issues. She nursed only 3-4 min on one side only, and after some research, I was led to suspect tongue tie. Some babies with TT will nurse a LONG time trying to get enough milk bc they can't latch well...some babies will tire out (like my DD) and quit. My DD also got very agitated and upset and we had a period of refusal to nurse. I didn't supplement because what I could pump, she'd take and sometimes not even take. She still needed more intake though. She's still small at 22 mo (about 24 lbs) but she has grown since then, regularly, though she never caught up.  Two day after her clipping, she nursed and fell asleep suckling at the breast for the first time EVER. I rejoiced.

All that to say, I think 1) the guidelines for a newborn/young infants growth while nursing are reliable and at THAT AGE, family history doesn't really play in. A little baby needs to grow. Chubby is healthy, though not required, but slim, slow growth is a sign of something that could be going on, and 2) don't rule out TT which has become increasingly common. I had found an LC who knew what to look for, and was able to get it clipped. She actually needed to have her lip clipped too. Things improved after that.

I could also just *tell* when my DD was growing from week to week. I just knew from picking her up all day every day. I knew she wasn't growing enough, and I had to find answers. It was very hard work, but I had support. I'm so glad you have support - it can make all the difference in the world.

So, pumping - can you pump enough extra to feed her? Perhaps go for nursing every 2 hours and if there's a longer time at night, pump then and feed the next day. I really worried about giving the bottle and having her prefer that, but in the end, I don't think that was much of an issue.   To help giver her more, I picked her up at 11p each night and nursed while she slept, and for weeks, I set my alarm for 5a and got up and fed her then. She slept well at night and I was uncomfortable skipping those feeding.

This was the best information I found online on tongue tie back when I was madly researching it.http://www.kiddsteeth.com/articles/breastfeedingdrkotlowtx.pdf