Not getting enough milk

[Madelyns_mom]

My baby is 6 weeks old, and we have been struggling with breastfeeding since birth. She had problems with her blood sugars when she was born because I had gestational diabetes. Because of this, the hospital said that she could not breastfeed, that she had to have formula because it would stabilize her sugars. She was 6lbs 3oz, and they also said that it would take too many calories from her to feed, so she needed the extra calories from the formula. I told them that I really wanted to breastfeed, but they didnt give me the choice. Every since then, I have been trying to breastfeed. We are still working on her latch, but its not as bad as it used to be. Once she gets latched on, she only stays on the breast for about 5 minutes, and then refuses to latch on again. Because of this, her doctor told me to start giving her bottles of breastmilk after each feeding because she wasnt getting enough milk. After the 5 minute breastfeeding session, she'll drink about 3-4oz out of the bottle. I think that switching to the bottle right after she unlatches, just confuses her even more. I would like to just work on EBF but her doctor says that she will lose too much weight if I dont bottle feed her as well. Any ideas on how to get her to latch on longer so that I can stop bottle feeding her?

[Amy_G_]

I'll probably have to ignore what happened in the hospital, cause her weight was low enough, that breastfeeding should have stabilized her blood sugars and formula was most likely unnecessary, and and and.

let's start over.
what are her weights now.
how's she been doing on gaining weight?
did your milk come in with a good supply, are you doing any pumping?
when the dr said she wasn't getting enough milk, was that because she was losing weight, gaining slowly, or just not gaining as fast as a formula fed baby?

you need a supplemental nursing system, so she can get any supplementation at the breast and not have any bottles.
You need to pump after every feeding and use that milk as supplementation instead of formula, or in addition to the formula.
you could use the help from a lactation consultant to help you get her latch ok, but I really doubt that she has a bad latch. 3-4 ounces of milk in a bottle at 6 weeks is a lot, and the more bottles she gets the more she's learning that fuss at the breast means get some easy flow formula out of a bottle. the bottle requires little work to get milk.
you might want to start by reading up on some things at http://www.kellymom.com/bf/concerns/baby/back-to-breast.html
since you have a baby who is a fussy nurser (but does not completely refuse the breast)

[Amy_G_]

check out the videos here:
http://www.thebirthden.com/Newman.html#Video%20Clips
on latching, supplemental nursing systems and more.

is there a lactation consultant anywhere nearby that you could speak with? or call la leche league?

[samiam]

The best thing I finally did nursing the first time around was to stop trying to figure out if my dd had had enough milk or how many ounces that might have been. All of my kids have been baracuda suckers and after not too many weeks they would eat for about 5-10 minutes total at a feeding unless they were getting tired.

If the weight issues are past you I would follow Amy's advice. I would stop giving the bottles at this point.

[Madelyns_mom]

Any time I need the LC, they charge me $45 for an hour. I dont have the money to keep getting help from them. But, last time I saw her, she told me that the babys latch was good once she actually latched.

She is gaining weight, the doctor just says that its too slow. She was 6lbs 3oz when she was born, and now at 6 weeks she is a little over 7lbs. She wants her to be gaining at least an oz a day.

I do pump for her bottles so shes not getting formula. The LC never mentioned anything called a supplemental nursing system...what is it?

[crissyy]

Any time I need the LC, they charge me $45 for an hour. I dont have the money to keep getting help from them. But, last time I saw her, she told me that the babys latch was good once she actually latched.

She is gaining weight, the doctor just says that its too slow. She was 6lbs 3oz when she was born, and now at 6 weeks she is a little over 7lbs. She wants her to be gaining at least an oz a day.

I do pump for her bottles so shes not getting formula. The LC never mentioned anything called a supplemental nursing system...what is it?

I would recommend you contact your local La Leche League. They are a great resource for one-on-one help and the leaders have to go through training and study to be accredited, so they may be able to help you better in person.

An SNS (supplemental nurser) is feeding system that consists of a bottle that is connected to small tubing. The bottle is filled with breast milk and you run the tubing from the bottle. The tubing then goes in the baby's mouth so they are receiving the breast milk while being latched on to you. Average weight gain for an infant is 6oz per week up to 4 months. http://www.kellymom.com/bf/supply/enoughmilk-older.html My first dd was always underweight. She wasn't even on the growth chart until she was about 3 years old. She is a perfectly healthy, and slender, 5 year old. My ped usually just watched the rate of gain and not the actual pounds/ounces. If my dd was gaining at a steady rate, she wasn't worried, even though she was far below the averages. Is your baby wetting diapers?

[Madelyns_mom]

We have about 7 wet diapers a day and 2 dirty diapers.

[Amy_G_]

did your LC weigh baby before and after a nursing session (no formula or bottle) with same diaper on and everything? the difference between the weights is the amount of milk baby is getting in her 5 minutes or however long she nurses.

Do you have nipple soreness?
there seems nothing wrong with your supply if you are pumping and giving 3-4 ounces of milk in a bottle. So it's either baby is preferring the bottle nipple (cured by getting rid of the bottle nipple) or it's a problem with the latch or a problem with baby's ability to suck--does she have a short frenulum for instance or a funky palate.

[Madelyns_mom]

The LC checked her out and didnt see anything wrong, and I wouldnt really know what to look for. I kind of feel like the LC that I see doesnt really know what shes doing because she did not weigh the baby. No one has weighed the baby besides her doctor, and the last weight check was at 2 weeks old.

[Madelyns_mom]

I'm going to look for one of those supplemental nursing systems and give it a try. I really want the baby to breastfeed, so I'm not giving up without a fight.

[Amy_G_]

Call the pediatrician's office and ask the nurse if you can come in for a weight check and hang out and nurse and then weigh again cause you want to know how much milk she's taking in. Tell em you don't really need to see the doctor and it shouldn't cost you anything. be sure she's weighed on the same scale before a feed and after and don't change clothes, diapers or anything. the difference in ounces is how much milk she takes in at a feeding.

Of course, getting her to "concentrate" and nurse in a doctor's office, even if they give you a room to use, may not work so well. You can rent or buy a good quality baby scale --often they are rented at places that rent breastpumps.

I honestly would see what happens if you don't give her a bottle after she fusses. change her diaper, burp her and then put her on the other side. If she nurses strongly and is satisfied, then fine. If not, then get up and do something else and not offer the bottle. keep a close eye on her for signs of dehydration or reduced number of wet/poopy diapers.

another thing you can do is to try to nurse for longer, or MORE OFTEN. and if you do give her a bottle, put a half or one ounce less in the bottle. but again, watch her output to see what happens.

if she was only weighed at 2 weeks and she's now 6 weeks, how do you know she wasn't gaining weight as fast as the dr wants? I think dr gave you bad advice to give a bottle, because she hadn't gained back her birthweight and then some fast enough, and now you are tuck getting out of this.

check out kellymom for the info on weaning from supplements, it has some ideas.

[Madelyns_mom]

Yea, her last weighing was at 2 weeks, but the doctor said to keep on with the routine until her 2 month visit to see how much weight she had gained by then. I was probably given poor advice because I have to go to a clinic with her, instead of a real doctors office. I thought I could trust them though, because they are part of a hospital.

[Amy_G_]

well I think going from 2 weeks with a baby that isn't "gaining enough" to the next appointment at 2 months before a weight check is poor judgement.

can you get her weighed some place? I think the scales at the post office are pretty accurate. ;) the ones at the grocery store are often not quite good enough. You say she's a little over 7 lbs, how do you know if she hasn't been weighed?

the problem is that you've been supplementing her with the bottle, so you can't just do one weight and say "oh she's gained 3 lbs that's good enough." cause you don't know how much she was getting or would get directly from the breast.

how much weight did she lose right after birth and what was her weight at the 2 week check up?

[Amy_G_]

is there a WIC office in your town that also does breastfeeding help/support for lower income women? have you considered la leche league for free advice from someone in person in your town. they may have a scale and help finding a supplemental nursing system.

[Madelyns_mom]

I've weighed her on my scale at home by weighing myself and then weighing myself holding her. Its not 100% accurate, but it gives me an idea of where she is.

She was 6lbs 3oz at birth
5lbs 13oz when we were discharged
6lbs 4oz at 2 weeks

I called the local WIC office, but I have to come in and fill out all of the applications and such before I can get help. They couldnt get me in until August 27th.

[Amy_G_]

well August 27th seems like a long ways away, but it's not.
She was slow regaining her birth weight,
but who knows where she would be today without the supplementation of your pumped milk by bottle.
weighing her on your scales at home, she probably weighs more than you think. my scales at home are always about 10 lbs off from the ones at the doctor's office. hehe

Also start to encourage her to nurse longer and then give a little bit smaller amount in the bottle. Kelly mom recommends lowering it by 1 ounce a DAY, or every few days. So if it's a fraction of an ounce less in the bottle, she'll still be mostly satisfied but be ready to nurse again in a shorter time. so when she fusses to eat again, put her back on the breast and try to keep her there longer. She may be a bit pissed off about it occassionally though.

I think you'll be fine. It may take a bit of time, but you'll get it. you don't have to fix it all right this minute. she's young and you have time. if she gets stubborn about the bottle, then you get stubborn about the breast.

[Madelyns_mom]

Thanks for all of your ladies help!

[mandeloo]

[QUOTE=Amy_G_;489049]I'll probably have to ignore what happened in the hospital, cause her weight was low enough, that breastfeeding should have stabilized her blood sugars and formula was most likely unnecessary, and and and.
QUOTE]

same thing happened with my son. His blood sugar was unstable and they gave him a bottle or two of formula in the NICU. I wonder why this is the practice?