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Old 12-14-2011, 06:48 AM
 
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I'm so sorry you're struggling with this. I've been there - twice.
What I did was start taking domperidone - there's a FAQ about it in breastfeeding challenges - pumped after feeds with a rented hospital-grade pump and used a Lact-Aid (www.lact-aid.com) to supplement at the breast. Using the LA is IMO really important - it prevents babies from developing flow preference, which can cause breast refusal, and it was important to me that my babe be 100% fed at the breast, even if he was getting formula. I had both of my sons' tongue mild ties clipped even though the docs and LCs I saw were divided on whether they were severe enough to cause problems.
There's a great book - The Breastfeeding Mother's Guide to Making More Milk - that explores some of the reasons for low supply and strategies to increase it.
Another thing that helped me was renting a baby scale so I could make sure both babes were gaining appropriately - five to seven ounces a week is typical for a breastfed babe.
Hang in there and don't hesitate to come back for help or support. grouphug.gif

Megan, loving her sweet rainbow1284.gif boys, born Aug. 2008 and Feb. 2011, and their sister, born still March 2007 candle.gif
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Old 12-15-2011, 10:00 AM - Thread Starter
 
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His follow-up visit to the ped yesterday was heartening: he put back on 6Oz, his color is better and he's having 6 wet diapers/day so she is content with his progress. He's occasionally waking up and asking to eat, and he's telling me when he is done eating (not just falling asleep on the bottle), and he's being generally more alert which makes ME happy. =) Still no BMs though so we are going to do some rectal stimulation for that (the things they DON'T tell you about parenthood, lol!!)

My supply is still irregular and less than he's eating, but improving. I usually pump about 15mL, but its not uncommon to have an 8mL session, and this morning I paused at 50mL because I had to empty the reservoirs - i'm still pumping! O.o I admit to having real difficulty waking up every 2h at night to pump, and am honestly struggling to meet the 4h mark for those overnight sessions, but i'm trying.

I got a good recommendation for an oral surgeon who is supposed to be the local TT expert, and we have an appt with her on Monday. Looking into the LA system but I think it might have to wait until the next paycheck. In the meantime we're gonna keep doing what we're doing and see what happens! =)

Just a homegrown heretic hopelessly in love with her amazing DH, 2.5 year old Eli, and now expecting a new arrival April 2015.
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Old 12-15-2011, 11:57 AM
 
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Keep up the good work, mama! You could try cup or syringe feeding while you're waiting on the supplemental nursing system.

Megan, loving her sweet rainbow1284.gif boys, born Aug. 2008 and Feb. 2011, and their sister, born still March 2007 candle.gif
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Old 12-15-2011, 06:04 PM
 
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His follow-up visit to the ped yesterday was heartening: he put back on 6Oz, his color is better and he's having 6 wet diapers/day so she is content with his progress. He's occasionally waking up and asking to eat, and he's telling me when he is done eating (not just falling asleep on the bottle), and he's being generally more alert which makes ME happy. =) Still no BMs though so we are going to do some rectal stimulation for that (the things they DON'T tell you about parenthood, lol!!)


Good job!!

 

 

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My supply is still irregular and less than he's eating, but improving. I usually pump about 15mL, but its not uncommon to have an 8mL session, and this morning I paused at 50mL because I had to empty the reservoirs - i'm still pumping!

 

Sounds like your body is learning to respond better to the pump.  You can help it along with

- hot compress or warm shower before pumping

- breast compressions while pumping (and while baby is eating too - very important to maximize milk intake, esp with a less effective drinker)

 

 

Quote:
O.o I admit to having real difficulty waking up every 2h at night to pump, and am honestly struggling to meet the 4h mark for those overnight sessions, but i'm trying.

 

It's horrible isn't it?  Waking up to an alarm to pump is so much worse than waking to feed a hungry baby!  I admit to having turned the alarm off in my sleep multiple times.  But it's super important in the first couple weeks - after that you can slack. :)

 

Are you keeping the pump set up with a cooler for milk and used horns by your bedside?  You don't want to have to get out of bed to pump.  Set a loud alarm so it wakes your hubby too, he can help prevent you from sleeping thru or turning it off.

 

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I got a good recommendation for an oral surgeon who is supposed to be the local TT expert, and we have an appt with her on Monday. Looking into the LA system but I think it might have to wait until the next paycheck. In the meantime we're gonna keep doing what we're doing and see what happens! =)

 

My LC gave me a little syringe-and-tube setup that was kind of like a homemade SNS. You could monkey around with that for cheap before deciding whether to spring for the Lact-Aid.


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Old 12-16-2011, 10:47 AM - Thread Starter
 
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There is just something very sweet about nursing your baby to sleep - and knowing he is satisfied because he refuses expressed milk after nursing. =)

I only have the one set of flanges at the moment, but since I generally have to get out of bed to feed or change the little man, I don't know that it would help overmuch to get any more.

If we nurse, should I still be pumping afterwards? The last LC we saw said not to, as he would provide sufficient stimulation, but I'm wondering if stimulation alone is adequate for production if he is leaving milk behind?

Just a homegrown heretic hopelessly in love with her amazing DH, 2.5 year old Eli, and now expecting a new arrival April 2015.
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Old 12-16-2011, 04:40 PM
 
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Originally Posted by aeterna View Post

There is just something very sweet about nursing your baby to sleep - and knowing he is satisfied because he refuses expressed milk after nursing. =)

 

Yay!!

 

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I only have the one set of flanges at the moment, but since I generally have to get out of bed to feed or change the little man, I don't know that it would help overmuch to get any more.


You can just stick the horns and bottles in the cooler between pumps if you like, instead of washing them every time.  It's kind of chilly on the nips but better than constant washing IMO.

 

Quote:
If we nurse, should I still be pumping afterwards? The last LC we saw said not to, as he would provide sufficient stimulation, but I'm wondering if stimulation alone is adequate for production if he is leaving milk behind?

 

If the baby is removing sufficient milk and your supply is adequate, you don't need to pump after feeds.

Is the baby pooping regularly (at least 3-4 poos per day) yet?  Did you ever do another weigh-feed-weigh (after the one where he only got 0.1 oz) to figure out how much milk he gets out per feeding now?  This would help you determine whether it's important to follow up the tongue-tie concern.

 

On the other hand if the baby is not being efficient or you are concerned about supply, it is helpful to pump after feeds.  The more you can do, the better it is.  I always found it very difficult to pump after feeds because neither of my babies ever wanted to be put down really, I couldn't hold them while pumping, and it wasn't in me to let them scream for 20 min while I pumped.  I did what I could.  Sometimes I could hold the baby in one arm and pump the other side only.


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Old 12-16-2011, 06:37 PM - Thread Starter
 
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Heh, I think a little chill might actually feel nice - my skin is in fine condition but my nipples feel a bit bruised.

No, haven't been back for a feed weigh (although I was actually planning to do that tomorrow). To be honest, last night was really the first time I'd tried to nurse him... Generally I am expressing & then feeding him, because that way at least I know he is getting enough to eat, y'know? I've been pretty skittish about that. Also because, as you said, its difficult to pump after feeding him (he wants to be held), and I'm either dead tired (middle of the night) or just plain cringing at the idea of more stimulation. So was pumping & feeding EBM simultaneously (which also means I can recruit DH's help) rather than nurse, then try to pump.

Don't have that many poos yet, he had his first BM yesterday finally, and it was a big one! Then there were a few diapers which were more like "damp gas" than poos, and nothing so far today. plenty of wet dipes, though.

Will def be checking on weight transfer tomorrow, I know that will make me more comfortable nursing him. He does ok with the nipple shield (we struggle with shallow latch, lips turned under, loss of suction), but seems completely baffled by a bare nipple.

Just a homegrown heretic hopelessly in love with her amazing DH, 2.5 year old Eli, and now expecting a new arrival April 2015.
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Old 12-17-2011, 05:50 PM - Thread Starter
 
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We have weight transfer! joy.gif

Before & after weighing today demonstrated a difference of 1.5Oz - so he IS eating! He also put on another 2Oz since Wednesday (assuming scales are identical), and I've been able to express and/or nurse enough that he hasn't had ANY formula in 2 days now! =)))

...still no poop...this kid's bowels are a mystery. But I'm so comforted to know he is actually getting food when he is nursing... That makes it a lot easier to trust my body to feed him. And he does very much prefer to nurse - he seems to have a distinct preference for the warmth & smell of mama.

His latch is improving every time we try & the new LC showed us a couple new techniques to improve latch as well as make the shield work more effectively. So happy with things right now! Still working on building supply but it seems I might have caught up to his immediate need, at least. =)

Just a homegrown heretic hopelessly in love with her amazing DH, 2.5 year old Eli, and now expecting a new arrival April 2015.
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Old 12-18-2011, 12:44 AM
 
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Glad things are going better for you, mama!  I'm eager to hear how things go with the oral surgeon on Monday.  Something I learned in our tongue-tie struggle was that TT can affect baby's digestion since the tongue action helps to start the digestive process.  With the tongue restricted, the digestive process might not be able to function as it should.  That might explain why your babe isn't pooing as he should... perhaps?  Keep following your instincts!


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Old 12-21-2011, 12:27 PM - Thread Starter
 
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Wanted to update, for myself & others, so here goes:

For anybody keeping track, the last IBCLC we saw (Saturday) was our third. We have a follow-up appointment with her on Friday, and we also have our 2-week ped appointment on Thursday. I am eagerly looking forward to both, as I think we've made some solid progress and I like numbers to prove it. =)

(FYI, for women in Louisville, UofL hospital has a new lactation center that is free to nursing moms in the area.)

Last Monday we went to see an oral surgeon about his tongue tie. I will preface this by saying while I am completely comfortable ignoring three IBCLCs and a pediatrician who have all said "he has a mild tongue tie, but it's not causing a problem" in order to continue pursuing the matter, I HAVE noticed a distinct improvement in his latch, his nursing habits, and his elimination habits, so I'm willing to let it ride if the mild tie will resolve itself (and save my boy the surgery). No surprise, the oral surgeon had the same conclusion as everybody else, but given Eli's marked improvements, I am content that this will not be an issue.

The oral surgeon has an IBCLC on staff for assessments, too, so we saw her while we were there. (this would be our fourth.) Among other things, she recommended I get my thyroid re-tested (I am hypothyroidic) to make sure my levothyroxine was still the correct dosage. I had that blood work done yesterday, and am reading normal on my current dosage with a TSH of 2.3.

I started taking plain fenugreek in addition to the Motherlove More Milk Plus supplement, since I couldn't smell the fenugreek on my skin with the Motherlove dosage recommendations. I am on 1x Motherlove and 1800Mg (3 600-Mg tabs) fenugreek, three times daily. I now smell like an IHOP, and have noticed an increase with that dosage.

The last recommendation was to pump 1 hour after feeding him, but on Monday he started cluster feeding, every hour on the hour all day and then 2-3x/hour for short periods in the evenings. Kinda hard to find time to pee, let alone pump! lol.gif But my breasts feel fuller, I'm noticing an actual letdown, and I'm now to the point where I squirt him in the face when he pops off, so I'm trying to let him nurse as much as he likes to stimulate supply and trust that he's getting what he needs. He does look & act content when he's finished eating, and we're having 5+ wet and 3-5 poopy (finally!! Hooray!!) diapers per day, so I think we're doing pretty well. =)

We're still working on his painful and shallow latch, which has been determined to be caused by him humping his tongue to prevent the nipple from getting very far back in his mouth. The last LC recommended using our pinky fingers for some suck training, and honestly I think things are just getting better as he gets a little bigger. We are off the nipple shield now, that happened kind of spontaneously during a night feeding when I was half awake and didn't want to go track it down, and once realizing he WOULD take a bare nipple, we spent the next day weaning off it.

Oh, and barring one 2-Oz bottle of formula (we were in a rush to get to an appointment when he decided he was hungry, and I didn't have any EBM because I haven't had much opportunity to pump), he hasn't had any formula supplement in four days. GO BOOBIES!! joy.gif

It's still pretty toe-curling at the latch, but me and my ibuprofin will tough it out until he figures it out. I'd much rather suck up the pain than lose this hard-fought supply. We'll get there... thanks to the awesome support. =)

Just a homegrown heretic hopelessly in love with her amazing DH, 2.5 year old Eli, and now expecting a new arrival April 2015.
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Old 12-21-2011, 04:46 PM
 
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joy.gif

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Old 12-22-2011, 10:51 PM
 
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I hadn't caught up with your posts in a while, but was so happy to hear of these improvements!! What a relief!!!!!!!!! Way to go mama, being persistent. You could have easily said forget it, I'm going to formula, but you were determined. Your baby will benefit by that throughout all this life. You should be proud. Nothing better than knowing your baby is growing.

 

One thing that might be good is to just play around in his mouth with your finger throughout the day, get him sensitized to having stuff in there, and he may get a deeper latch. Run your fingers along his gums, under his tongue and let him suck your finger. It might help sooner than later with the latch pain.


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Old 01-13-2012, 11:22 PM
 
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Things still going well?


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