A whole bunch of questions

I'll try to answer what I can but there are others here who know more than I do so hopefully they will post too. (I had a similar experience as you - dd was delivered at 34 weeks, 10 day nicu stay, ng tube and bottles at first, got her totally to the breast at 3 weeks, battled thrush and low-supply. She's now almost 18 months and still nursing.)

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Well, babies generally get more out of bm which typically means their bowel movement frequency goes down. My dd eventually went every few days - a huge, whopper, blowout mess. I would say there's nothing really unusual about your son's pattern given that he's had both bm and abm.

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if he's getting formula in the bottle, it takes longer to digest which might be making him sleep longer. Or it could just be the time of day that he's getting bottles. I didn't really notice a difference with my dd and she never really ever slept that long - maybe 4 hours at a stretch max.

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Very typical. Most women experience a greater supply in the mornings and the lowest in the afternoons. When I was working through low supply (due to an ill-advised depo-provera shot), my dd would nurse just fine until about 3 in the afternoon and then she just couldn't get enough out and I would have to give her a bottle. Then we could resume nursing later in the evening. Eventually this stopped - I was making more milk and we could nurse anytime. Your son might also be going through a growth spurt which could contribute to the nursing marathons. This is ok - he's trying to build your supply. Also, it's pretty normal for babies to spend 45 minutes per feeding in the first few months.

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well, since I've experienced thrush, I'm always quick to think of this even though you don't see white. Thrush can be present without whiteness. Were either of you given antibiotics during delivery? Both my dd and I were and this set up the yeast imbalance for us. You could try bathing your nipples in a vinegar and water solution and taking some probiotics. Or it could just be that your son isn't latching as well on that side. My dd gave me the lipstick look too until she got big enough to really open her mouth wide. I just kept encouraging her to open her mouth wide and then I would slam my nipple in there. Try stroking your son's cheek to encourage him to open wide. You could also try a different hold to see if that makes a difference. I suggest checking out Kellymom's thrush resources just to be sure you don't have thrush (http://www.kellymom.com/bf/concerns/index.html)

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might be a combination of both but I don't think it's abnormal. Could be a growth spurt.

I don't know anything about heat/dehydration/nursing frequency.

Keep up the good work! Luckily for me my dd never got nipple confused (she would always take the breast when offered but it took a while for her to get strong enough to get a full meal out). I have a cousin who's got a nipple confused 4-week old. Can you send some advice my way for getting her back to the breast? How did you manage that?

~Hope

You have a lot going on. I'm really impressed with your desire to make nursing work for you and your child.

Are you getting help from anyone in your area? La Leche? Lactation Consultant?

It is not uncommon for breastfed babies to go longer between poops. Momma milk is easier to digest. I wonder how many wet dipes he's having?

"--After his bottle, he sleeps A LOT--like, 6 hours a stretch. "

Some babies do like to sleep but sleeping this long while you are trying to increase your milk supply is counter productive. I know you I know you may have heard never to wake a sleepy baby-but that doesn't hold true in your situation.

"--In the morning, I have adequate milk and he feeds and is happy...after lunch, though, things deteriote into a 10 hour nearly non-stop feedathon."

Most women experience a drop of milk supply as the day goes on. Many babies experience periods of fussiness in the afyernoon evening hours.

--one of my nipples is itchy, always erect, and the "bumpy" tip is enlarged and swollen so that the bumps (are these ducts?) are very visible and look like tiny grapes. Also, very painful when he first latches on, and he always "lipsticks" this side, even though it's easier to grasp than the other side, which is normal. I don't think it's thrush--no whiteness on either of us. When he comes off it's often blanched, I think because it's so much bigger than the other side that he holds it tighter.

Not sure about this. Sometimes thrush is asymptomactic. I would show this to a LL Leader or LC or another experienced nursing momma. Sounds like you might need help with latch on that side.

--When will the feedings space out a bit? Is this normal for a 6-week old, or is it low supply?

Nursing does space out but for right now the focus should be building up that supply.

Have you tried getting into bed with your babe, plenty of skin to skin contact. Nursing on demand. Have you gone to a LL meeting?

I too was told to supplement my first son. I didn't realize I was undermining my own sucess until later on.. Eventually with help we were exclusively bfing.
Good luck on your journey.

--On mostly formula, he had mustard yellow and seedy poops. On mostly BM, he has pumpkin orange poops, and far fewre (maybe 2 a day)

he is more effecient at digesting breastmilk, so he needs to poop less on BM than FF. The colors are also normal.

--After his bottle, he sleeps A LOT--like, 6 hours a stretch.

Try feeding him less in the bottle. He needs to be sleeping less at a stretch so he can latch on to you and help increase your supply. As long as he is having 5-8 wet diapers a day, he is getting enough.

--In the morning, I have adequate milk and he feeds and is happy...after lunch, though, things deteriote into a 10 hour nearly non-stop feedathon.

very typical pattern! Let him nurse as much as possible to increase your supply.

--one of my nipples is itchy, always erect, and the "bumpy" tip is enlarged and swollen so that the bumps (are these ducts?) are very visible and look like tiny grapes. Also, very painful when he first latches on, and he always "lipsticks" this side, even though it's easier to grasp than the other side, which is normal. I don't think it's thrush--no whiteness on either of us. When he comes off it's often blanched, I think because it's so much bigger than the other side that he holds it tighter.

I am not sure about this. I would recommend contacting an Internationally Board Certified Lactation Consultant though. Call your hospital or Le Leche League.

--When will the feedings space out a bit? Is this normal for a 6-week old, or is it low supply?

Every baby is different when they space out their feedings. The best thing to do is start reducing the supplimenting and increasing the time at the breast along with the other things you are doing to increase supply. 6 weeks is not a typical growth spurt, but it may be in your baby's case.

--Summer is coming--will the heat cause him to nurse more, for replenishmnet of fluids lost to sweating? We don't have AC.

I had my baby in March in Phoenix AZ! He did seem to nurse more during the summer. Just watch for that 5-8 wets a day to make sure he is hydrated.

Good luck!!!

Thanks for the great responses, you guys. I am a little heartened to see that so many of my worries seem to be "normal" to you.

I've been feeling so discouraged today...on day 4, we see no improvement with the Reglan...in fact, I seem to have even less milk, if that's possible. I don't know if Dom would work better for me...I feel like it's unlikely. Supply is my biggest problem...the (possible) thrush pain I can handle, the inability to accomplish anything else but nurse I can do for a few more weeks, but it breaks my heart to see him working so hard for so little milk. I am flirting with the idea of quitting, after all we've been through, because I feel like we are not making any progress, and he's always, always hungry.

As for beating the nipple confusion, Schatz, we did it by banning the bottle outright for a couple days...it actually took us two tries, once at 3 weeks, again at five weeks of age. I just set up a station and sat down with him and nursed him all day and night, whenever he was hungry (which is always). At first he screamed and screamed for the bottle, but actually, that phase just lasted a few (heartwrenching) hours and then he accepted that the thing was gone, and he had just the one option, and he slowly figured it out. His latch has gone from terrible to better. Oh, and we also used the nipple shield for about two weeks, which at first he didn't like, then he did like. I liked to see the evidence of milk being transferred (it pooled in the tip of the shield, or didn't, when mmy supply was out), and I started beginning a feeding on the shield, then taking it off and letting him go bare once he was enthusiastic about that feeding. A lot of people hate the shield, but it was a good, temporary tool that helped him make the transition from bottle to breast. He still loves the bottle, and we had to reintroduce it because I just didn't have enough milk by the end of the day, and we both need to sleep. Of course, now he sleeps too much, but that's my next challenge! He's impossible to wake when he's in the formula coma.

I am really, really trying my best here, and so is he, so I hope we can keep spirits up, but boy, is it a sad thing to not have enough milk for your baby.

Yamjam,

I had almost an identical troubled start as you. My dd is 6.5 weeks and still does nothing but nurse. I'm wondering if your supply is truly low or if you have a piggy baby like mine

Is ds fussy after or during nursing? If not then he is probably getting enough and just doesn't want to leave the breast. Its a wonderful place to be!

When I was getting my baby back to the breast and practically relactating (my milk was nearly gone) I would just give dd 1/2 to one oz. in a bottle so that she would be satisfied but ready to nurse again very soon. You might try that rather than giving him a whole bottle.

For the blanching. You could have Reynauds syndrome. You can check kellymom for symptoms. It causes blanching and is nearly always cured with 100 to 200mg of vit. B6 for 4 days, followed by 25-50mg per day thereafter. You can stop the B6 when symptoms diminish. If they return, jump back on the maintenance dose and up it as needed.

I have Reynauds and she used to always blanch them in the lipstick way as well. Both are now getting better and will hopefully fully resolve soon.

I hope I didn't repeat to much of what the other posters said. I didn't have time to read them all but wanted to offer my experience and support.

Another thing about blanching. It can cut off milk flow. When mine were blanching bad I would have to unlatch dd and use a blow dryer to return blood flow and then the milk could flow again as well. If you notice that your nipple has a white line across it and is pointed or "lipsticked" try squeezong milk out. If none comes or it comes real slow that could be why your ds isn't getting enough milk. Try the blow dryer. You will see your nipples turn pink! Try sqezzing milk out again and I bet it comes right out! I had to do this for about a week while the B6 was working and her latch was improving.

I hope things get better for you both! Congratulations on hanging in there. It is SO worth it.

Cheers,