Family Forum / Pregnancy / Breastfeeding / May 2005

First, before going into the details of your post, let me say that
you need to see an IBCLC certified lactation consultant.  Not a
hospital based LC.  BTW, where are your posting from, I assume
somewhere in the US.  There are people here from everywhere.

Did you give birth natural?  Were you induced, and did you have an
epidural.  All these can affect your breastfeeding relationship.

This is not unusual.  Too bad you had not found this newsgroup before
you gave birth.  You could have gotten the information you would need
ahead of time to make it easier for you to succeed.

I don't think the breast shield was a good idea, and I am glad that
you have gotten rid of it.

Regarding the sore nipples, this is pretty common in the first few
weeks.  There are some things you can do for them, such as using
Lansinoh lanolin ointment, and leaving them to air dry uncovered
between nursings.  Somewhere between 4 and 6 weeks it gets much
better, and by 6 weeks most moms find it pretty easy.

How did you determine this?  Newborns want to nurse all the time so
this is pretty normal.  The most well accepted way to tell if a baby
is getting enough milk is to count wet diapers.  At least 6 - 8 cloth
diapers or 5 - 6 disposable diapers a day.  There are also ways to
increase your supply if you think it is not enough.

Againm, what were the signs you were seeing.  What did you pediatrician
say about it?

This is not uncommon, but it is ignorant and ill-founded.  This also
has a drastic negative impact on your body's ability to produce milk.
(I assume you were giving him bottles of formula, and not pumping and
giving him EBM.)  Your body needs the stimulation of nursing to
produce milk.  By substituting formula you are telling your body it
does not need to make as much milk.

We just had a discussion here involving what colic is.  Your baby could
be sensitive to cow's milk protein, one of the most common infant allergies,
and that could be causing his colic.  It takes some dedicated testing
to find out, but this is something you could do.

This is the accumulated result of starting the formula, and of not
doing things to increase your supply.  However, if you are producing
any milk now, you can increase the amount.  It will be a LOT of work
but it can be done.

What are you doing to increase your supply?  Like I said, if you want
to get your baby back to the breast, it will be a LOT of work.  Let's
assume the answer is yes.  In that case we need to understand where you
are in nursing and formula feeding right now, and see what suggestions
we can make.

How many ounces of formula do you feed per day?  How many feedings?
How often per day do you nurse?  For how long each session?
What kind of birth control are your using?  Combination, progesterone
only, IUD, whatever?
Do you pump when you are not nursing?  What kind of pump are you using?
If so, what do you do with the pumped milk?  How much do you get?
How old is your baby now?
Do you work outside the home, or take care of the baby full time?

Please post again with the answers to these questions.  That said,
I'll now talk about thing you can do and you can think about it.

First, aside from the detrimental effects of formula, one of the
big problems is that feeding by bottle causes nipple confusion
leading to bottle preference.  Have you noticed this in your baby?
If so, you will not only need to increase your supply to succeed in
breastfeeding, you will need to retrain your baby to nurse directly
from the breast, and to "unteach" him how to use the bottle.

If he is getting a substantial amount of his milk by bottle, this
will be hard.  The most effective way would be to throw away the
bottle and to start feeding the formula with an SNS (Supplemental
Nursing System) or Lactaid.  Both of these are method of getting
formula or expressed milk into the baby using a method that
mimics breastfeeding, and that at the same time, gives your body
the stimulation you need to produce milk.  You will also need to
get a high grade double exectric pump if your baby is not nursing
regularly and pump approximately every 3 hours 24x7.  You should
feed any pumped milk you get with the SNS.  This whole set-up
will probably cost you between $300 and $400 (US), but it is a lot
less than you would spend on formula!

As your supply starts impoving, you should gradually spend less
time pumping, and more time nursing directly.

More things to boost your supply.

1.  Drink more water. At least a 12 oz glass every 2 hours.
2.  Get more rest.  Nap when the baby does.  Learn to sleep when
   you night nurse.
3.  Nurse more often.  Ths one is a long term project for your.
   Start with pumping and nursing with SNS and graduate to more
   direct nursing.
4.  Use dietary and herbal galactogogues (milk supply increasers)
   Consider using pharmaceuticals.

On the last note:

First, if you are on the combination BC pill, you may have to drop
it to increase your supply, and find a different method.

Oatmeal is a good supply booster for many women.  You should make
this your regular breakfast.

Fenugreek is also a very good supply booster.  3 600 mg capsules
3 x daily.

A commercial product called "Mother's Milk Tea."

If these do not work, you may consider pharmaceuticals.

Domperidome is effective but not available in the US (Canada, yes)
Reglan is also useful, but may have side effects.

Given the way you have been misled, this is a long hard road to
get back on the nursing track.  Best of luck,

Larry

If he still will take the breast, definitely offer it to him for as long
as he wants - some babies will nurse for an hour or longer (I notice in
your other post you say you nurse for about 5 minutes between formula
feeds).  Let him latch on whenever he wants and for how long - that will
help get your supply back up.  As other said, breastfeed him first and
then top him off with a formula feed if he isn't satisfied.  You
mentioned you are home with him -

But either way, congrats on still nursing your baby!  Even if you
combo-feed (formula and breastmilk), keep at it for as long as you can,
he will still benefit from your milk.  Even though you can't pump milk
out, or even squeeze milk out doens't mean he isn't getting anything.

Cara

cara

Since you're still nursing and still have some milk, it's a lot easier
to bring up your supply than if you'd stopped completely.

The most important thing is to nurse first every time he's hungry.
Every time he latches on it tells your body that it needs to make milk.
Even if he just nursed an hour or two ago and you know he'll hardly
get anything, latch him on (even if it's for a short time) before you
give him a bottle.  Your body will start getting the signal to make
more milk again.

Was there ever a concern about dehydration or poor weight gain from the
baby's doctor before you started supplementing?  If there was, then
it's especially important to work with a lactation consultant starting
now.  She can check in with you regularly and follow the baby's weight
to tell you how much you need to supplement or when you can stop.  If
you don't have access to lactation consultants you can probably make a
few appointments with the baby's doctor for weight checks as you
transition back to more breastfeeding or exclusive breastfeeding.  As
long as the baby is gaining enough weight, he's not starving.  You
wouldn't believe some of the fat little butterballs I see in clinic
whose parents or extended families think they aren't getting enough
with "just" breastfeeding.

And last but not least, congratulations for being so dedicated to your
baby!  It's hard for a young mom when the people around you aren't
supportive, but you're doing a great job.  Keep it up!

Kate, ignorant foot soldier of the medical cartel
and the Bug, 2 years!

Amber,

Please see my advice to Marie in NZ on increasing supply.

Larry