Unsure what to do... please tell me what you think!

[JonasBG]

Hi. I am breastfeeding my son who is 3 weeks old. We have had a rocky start. My milk did not come in for 5 days and he had lost 13% of his birth weight. After my milk came in, his weight went up some, but he was wanting to nurse for about 50 minutes nearly every hour, or sometimes he would want to nurse for 5 or so minutes every 30 minutes. It was very erratic. I met with a lactation consultant who said he was a 'lazy eater'. Meaning, he was not transferring milk the whole time he was nursing. He'd suck just to kinda take the edge of his hunger then he was just kinda chewing on me, like a pacifier. She had me nurse, pump, and supplement him with formula, and take fenugreek. She said in a couple days I should be able to toss the formula.
Well, 4 days later and he was nearly becoming a formula fed baby. I decided to pump and bottlefeed a couple of days to see what I was making. I am able to pump 18oz a day if I pump 20 minutes every time he eats. He eats about 23oz a day.
Here is what I would like advice about -- I am thinking of stopping the pumping and throwing out the formula and doing nothing but nursing on demand for several days. I will nurse him any time he is hungry for as long as it takes for him to be satisfied. I am hoping this will get him back on the breast, help him learn to suck correctly, and get him off the formula supplements. Will this work? I am terrified he is going to lose weight again. I am so scared of depriving him of what he needs due to me having less milk than he needs and him not transferring it properly. I am also afraid that this will cause my milk supply to decrease (since he isn't emptying the breast).
Please give any advice you can. I have been so close to just putting him on formula. But he's only 3 weeks old. I really don't want to give up!

[KerryS]

Weaning from formula supplementation needs to be done gradually. Certainly it sounds like you will be able to do it, but I wouldn't do it all at once. Here is a link on how to gradually wean from supplementation:

http://www.kellymom.com/bf/supply/decrease-formula.html

When you breastfeed, I HIGHLY recommend you do breast compression which will help "lazy nursers" to get more milk, which will then in turn increase your milk supply and help with baby's weight gain:

http://www.kellymom.com/newman/15breast_compression.html

While you are doing this, I would recommend pumping for 5-10 minutes AFTER feedings to completely drain your breasts and protect your milk supply if he is indeed having problems with milk transfer. A plan of action might look something like this, supposing he gets 4-6 oz. of formula supplement per day:

Breastfeed at least every 2-2.5 hours, using breast compression until the baby is no longer actively nursing (watch for the suck-pause-swallow to indicate that he's drinking the milk)
Give 1/2-1 oz. of supplement after each feeding (preferably through a lactation aid, rather than a bottle)
Pump for 5-10 minutes after giving the supplement (if you're able to get milk when you pump, you can substitute that for the formula supplement)
Keep an eye on wet and poopy diapers to make sure his output is adequate

Every few days, you will want to decrease the amount of supplement he gets per the instructions in the first link, while perhaps bringing him in every week or so for weight checks to make sure he's gaining appropriately.

[madelsmama]

Way to go for sticking with this for so long and welcome!

So, to clarify, what are you doing currently? Exclusive pumping with a little extra formula? Is he at the breast at all?

What strategies did the LC give you for correcting the "laziness"? Is the baby just sleepy?

Have you tried compressions?

You definitely need to ditch the bottles and supplementation in order to get him back to the breast, but there is perhaps a better way to do it than "cold turkey". A few suggestions within this link:
http://www.kellymom.com/bf/supply/decrease-formula.html

If supplementation must be given, hopefully you are giving him your expressed milk (18 ounces is awesome!) and as little formula as possible. If still required, any supplementation can be given via SNS or Lact-Aid, which will allow him to be supplemented at the breast, avoiding bottles.

After he nurses, pump for 10 minutes to provide further stimulation for building supply if you feel you are lacking. However, a pump does not extract milk with 100% efficacy, so likely you're making that additional 5 oz you feel deficient of.

http://www.kellymom.com/bf/concerns/baby/back-to-breast.html

[whitnessforhim]

These ladies have some wonderful advice for you. This is possible!! I agree 18oz is a really great output! You can do this. It won't be an over night thing but very, very doable.

[JonasBG]

KerryS - thanks for the advice. But for the past 4 days, i have been pumping and feeding him with a bottle at all feedings. Any advice on how to go back to the breast from that? Or do i even have to? it was working pretty well for us. He was getting just breastmilk except for one feeding a day, which he got similac. I'm just kind of exhausted mentally and physically with this, I just tried putting him back on the breast this afternoon and he'll nurse about 20 minutes and then he'll just stop. he'll cry at the breast and won't latch on anymore. he doesn't go to sleep and remains fussy and wants to nurse again 30 minutes later. it's like he can't get full. this is the same thing he was doing before i started supplementing and he wasn't gaining weight. I don't want to go back there. I feel like i am at the end of my rope with this. thanks for any advice you can offer

[whitnessforhim]

I exclusively pumped for the first 4mo. of my DD's life. Slowly but surely my milk supply began to dwindle and my body stopped responding to the pump. It took getting DD back to the breast at 4mo. to get my supply back. It is very difficult to maintain a milk supply on pumping alone. Therefore, I personally do not recommend someone EP if at all possible.

The fact that your baby still is willing to nurse says a lot! Personally I would put him to the breast to nurse for every feeding (offering the breast first) and then pump after each feeding. If he is still hungry after you have nursed him I would supplement him with the pumped milk. As your milk supply increases and he familiarizes himself again with nursing I think you'll find that your nursing sessions will start to improve.

Also remember that a lot of babies at this age like to comfort nurse or cluster nurse.

I think you have done a fantastic job eliminating the formula and getting him on BM alone!! However, I would still put the effort into trying to get him back to the breast. Don't stress over it. Offer it to him first and then supplement if needed!

Your doing a great job! Hang in there!

[dodoe80]

I agree with what the others have said. It is still doable, pumping and breast compressions during the feeding should help. If baby refuses to latch on after 20 minutes don't stress over it and give the supplements if he is still hungry.

Don't forget to have lots of skin to skin contact also.

You're doing a great job. Hang in there.

Here is a link on alternative to feeding with a bottle:

http://www.kellymom.com/bf/pumping/alternative-feeding.html

[JonasBG]

Thanks to everyone who responded. I am going to try nursing plus supplementing and pumping again. I'll let you know if it works!

[Nipple_nectar]

I just wanted to tell you to hang in there! Breastmilk digests very quickly and since your baby has a very tiny tummy, it is perfectly natural to want to eat a half hour later. Especially if your baby is experiencing a growth spurt (http://www.kellymom.com/bf/normal/growth-spurt.html). It is also quite common for babies who g from breast to bottles sometimes develop nipple confusion (http://www.breastfeeding.com/all_about/all_about_confusion.html).

This can be daunting to turn around but as long as you are using BFing friendly feeding alternative (http://www.kellymom.com/bf/pumping/alternative-feeding.html) like perhaps a supplemental nursing system (http://www.lact-aid.com), things will improve quickly!



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[trylyn5]

My story is very similar to yours and I would just recommend making sure there is nothing wrong with you as well. That sounds very harsh and I don't mean it that way. I had undiagnosed retained placental fragments for two and a half months and was unable to produce enough milk until then. My symptoms included continued bleeding with times it was very heavy, abdominal cramping (including pressure similar to the time before you need to push during delivery), and low milk supply.