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I just went back to work a few weeks ago, and while I'm at work 14-wk old DS takes EBM from a bottle. I pump 3-4 times per day, using an Ameda Purely Yours double pump for about 20 min per session. I only get 2-3 oz or less each session. DS has been taking just 2-3 oz bottles every few hours while I'm at work; When I'm with him I nurse on demand and he nurses pretty frequently - sometimes every 45 min or so the first few hours I'm with him. He seems pretty satisfied during the day, but should I be worried that he's not getting enough to eat? I thought after a little while I would be able to pump more, but it's stayed pretty consistent so far (this is my third week back.)

Also, just the past week or so, we've been having a problem with DS's latch while he nurses. He was badly tongue-tied when he was born, and nursing was terrible until we got his frenulum clipped at 2 months. Suddenly it feels very much as though he's tongue-tied again. My first thought was that scar tissue had built up and caused problems, but he seems to be able to stick his tongue out just fine. So now I'm thinking either he's teething (already??) or it's a sort of nipple confusion. If it's the latter - we're using Playtex Premium Nursers with the slow-flow nipple, which I thought was supposed to good to use while bfing. Any recommendations for a better nipple, something that will make him use his tongue more?
 

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I don't know anything about latch or tongue tie so I hope someone else can help you out.

But 2-3 ounces total per session sounds pretty low. That is from both breasts, so only 1-1 and half ounces each side? Have you tried a bigger horn? Does your nipple rub up on the inside of the horn when you pump? If so, you might need the one with the wider diameter. Also, do you get more than one let-down? With a session that long, you should get two. This mimics a nursing session because you nurse on one side (both sides let-down), then you nurse on the other (both let down again). To get two let-downs, try turning up the speed after the squirting has let up (mimics comfort nursing) for a minute or two and then turn it back down (mimics the longer slower suck). Also try massaging your breasts (helps to have a hands free pump bra). Massaging stimulates ducts that the pump misses. Also fenugreek tea, nice big deep breathes, other relaxation techniques and visualize your baby.

If baby seems okay with the amount your getting, I wouldn't worry too much, they will make up for it at night and when with you if they are not getting quite enough during the day.
 

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I can't suggest a better nipple simply b/c every baby is different and every baby reacts to every nipple differently. My baby wouldn't even do nutritive sucking until we found a really unlikely nipple. We tried every one imaginable (I scoured every store and stole every nipple from friends and LC's, etc) - I must have tried 15 different styles on him.

Many people swear by the Avent nipples as these are 'like' the breast. I think they're stiff and very long. I don't like them. But other mamas do.

My pat answer to anyone with latch problems is to say to take the babe to a speech language pathologist. These highly specialized professionals can evaluate a baby's suck and tell you how to train it to be more effective and less painful. These are gentle therapies that generally work quickly. I would recommend finding one ASAP.

And with respect to your milk supply, are you eating oatmeal, taking fenugreek, blessed thistle, etc? Some women aren't very good at pumping.
I know this is rough on a WOHM, I've been there. It made me cry a lot.
Next time I will probably start on domperidone once I go back to work to keep my supply up. It killed me to supplement with formula.
 

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Hi there-

I'm going to go against the grain and say that 2-3 ounces for both breasts with one session is totally normal. And, 2-3 ounce bottles should be plenty.

Here's info on 'normal' pumping output and ways to increase it:
http://www.kellymom.com/bf/pumping/p..._decrease.html

Here's info on how much ebm baby needs:
http://www.kellymom.com/bf/pumping/milkcalc.html

It is imperative that you understand that pumping output is NEVER EVER an indication of your supply. Your baby will nearly always be more effecient than even the best double electric pump.

Additionally, if baby is having enough wet and poopy diapers and is gaining fine, there's NO way he's not getting enough to eat.

Sorry, no info on the nipple thing. My dd used Avent nipples/bottles and hasn't had any problems. If it's a real problem, you could try alternative feeding methods (dropper, cup, etc.):
http://www.kellymom.com/bf/pumping/a...e-feeding.html

Keep up the good work!
 

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Re Bottles and Nipples: It probably is the bottles causing the nursing problems. But I can't imagine what else you might do about it though if you're working. Some babies seem more prone to nipple confusion than others so even when you introduce bottles later, it might still cause problems. If he's not doing too much damage to your nipples, I'd just try to weather it. Maybe he'll get used to switching from one to the other in time.

I read somewhere that the best nipple to get is the nipple that looks most like your nipples
And that women who have long nipples (like most bottle nipples) have less problems with their babies getting nipple confusion. Makes sense to me. Just make sure any nipple you get has that wide base like the Avent and Playtex Natural Shape do, as that encourages baby to flare their lips rather than pursing them.

Regarding how much milk baby needs, try this website. It's for Breastfeeding After Reduction moms but since they're often supplementing it has lots of useful info for moms who pump and bottlefeed. Note the chart on breastmilk intake guidelines by weight. Weight of the baby is more important than age of baby when determining intake.

http://www.bfar.org/breastmilk.shtml
 

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Make sure your provider isn't just slipping the bottle nipple into the baby's mouth. The baby should still be opening wide to get the bottle just as he/she would for your nipple. The first week I was back at work I was having a hard time latching DD on and realized that our provider was just slipping the nipple into her mouth. Once I showed her how to have Kira open wide things were fine from there on out.

I eat oatmeal once a day to help boost my supply. I have found it helps a lot and doesn't cause the excess gas fenugreek was causing.
 

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Quote:

Originally Posted by wombat
Regarding how much milk baby needs, try this website. It's for Breastfeeding After Reduction moms but since they're often supplementing it has lots of useful info for moms who pump and bottlefeed. Note the chart on breastmilk intake guidelines by weight. Weight of the baby is more important than age of baby when determining intake.

http://www.bfar.org/breastmilk.shtml
Going to respectfully disagree with that info. According to two LC's I've asked (about this thread specifically), the most recent research goes against that information. Specifically, the copyright used at that website is from 1999... in a book those same authors put out last year, they state the weight isn't as determining as age in how much baby should get. Specifically, this new edition says between 1-4 months is the same. However, there is other research that says 1-6 months is correct.

Weight SHOULD be used to determine formula. But, as baby gets older, mom's bm changes and gets more concentrated, so the same amount is still enough. Up to about six months, a bf'd baby requires between 19-30 ounces in 24 hours. If baby eats every three hours, or 8 times, that works out to approximately 3.5 ounces on the high end. Of course every baby is different, and some might need more or less.

Certainly don't want to cause a debate or anything...just putting out some info
 

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theresa_caine : I love all this new research into breastmilk now. Pity it's not more accessible to us. It's probably not a book my local library will have. Can you post the name of the book?

That BFAR site does emphasise those intake charts are just guidelines. Ultimately it depends on the baby. You should email Diana West about any updated info. I'm sure she'd appreciate it.

Sorry, it's a bit OT but I find this milk research fascinating. I've heard milk's composition changes as baby matures (ie protein content I think). I haven't heard it get's more concentrated. By 'concentrated' do they really mean more calories per ounce? It makes me wonder what happens to mom's milk then if she's tandem nursing a newborn and a toddler?

Did I understand you right? Are the authors really saying that, say a 1 mo old baby that weighs, say 7lb should be getting the same amount of breastmilk as a 1 mo old baby that weighs say 11lb? Just thinking of the weight difference between my 1 mo old and some of my friends. When you say the authors said "they state the weight isn't as determining as age in how much baby should get." - do they mean a bit of a weight difference, say a 1lb or so doesn't matter so much, but that say a 4lb difference like in my example, would matter? Am trying to understand what they meant.

If you have the book handy, I'd love more info otherwise guess I'll have to try and get my hands on it somehow.
 
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