Anna hasn't gained any weight since she was 11 days old. She's now 24 days old. She also hasn't pooped in 4 days and has a bilirubin count of 17.

SOOOO, today the Dr. sent me home with a double Medela electric breast pump and two cans of Nutrimigen formula.

He told me I need to give her two ounces of formula at each feeding before I even TRY to breastfeed her. I attempted that and she didn't even finish the full two ounces of formula, so she didn't breastfeed after the supplement.

So, since she didn't nurse, I pumped and only managed to get 1 ounce total out of both boobs. Is this normal? Is there a way to increase how much comes out when I pump?

How often should I pump? I may end up exclusively pumping for her due to her latch and incredibly lazy suck issues, so I'd like to get my volume up as much as possible to get her off the wickedly expensive formula as quickly as possible.

We go in tomorrow for another bili test, and then back Monday for a weight check and exam. If she isn't gaining some weight by then and having bowel movements, and if her bili is still high, they're going to pressure me to admit her for IV nutrition and the full-wrap bili lights.

I need all the help I can get!!

~Leigh

Well, I'm not a LC and don't know about latch issues but it seems to me that you should NURSE first, pump second. Baby sucking is a better pump than the electric.

Are you having letdown & the only problem is her latch? Or is it a supply issue?

Also, be really really really hydrated. Drink water while pumping. Massage your breast while pumping. Have her nurse one side while you're pumping the other.

i have always heard nursing first as well HUGS to you both ~ she's a beauty :heart:

I have always heard to nurse first as well. BUT, her doctor specifically told me to give her formula FIRST before I put her to the breast.

I guess he doesn't trust her to eat enough if we nurse first.

I feel like I have an adequate supply. The doctor's phrase when he addressed the issue was "it's not inadequate supply, it's inadequate nutrition". I have no idea what he was trying to tell me. It was not her usual ped, since we were asked to bring her in after hours on Friday.


I'm off to nurse her again and then pump some more.

How LONG should a pump session be, anyway?

~L

I pump until no more comes out. Usually 15 minutes or so. But I'm a good pumper.

absolutely Nurse her first, then offer her formula. Babies will stop eating when they are full. If you feed her the formula first it will affect your supply and can also cause nipple confusion. I think you should feed her until she falls off or either shows signs that she is still hungry and there isn't anything left and then give her the bottle. You might want to pump a little bit before she nurses so that she can get the hindmilk quicker incase she is getting full before she gets it.

A pumping session shouldn't nessecarily last a certain ammount of time but I always aimed for 15 minutes.

I hope that everything is going smoothly soon :) Good luck and if you still aren't sure call a LC, they know alot more than the dr. re. this stuff IMHO

I'd be looking for an LC and an SNS

when my oldest was born I exclusively pumped for the first six weeks. The little bugga just wouldn't latch. I did try almost every feeding to get him on there. Your body will produce on demand. If you pump in between each feeding time you should be able to pump enough for a bottle and still produce at feeding time. Try to be relaxed while you pump. I was pumping 40+ ounces a day in my prime. But at six weeks, like magic, he latched and we went on to successfully nurse for 21 months and even tandem for the last 4 months. Good Luck.

ditto the LC

Thanks so much for the encouragement.

I have (and will again) seen a LC at the hospital. She's very nice and encouraging, and says that I'm doing the best I can with the child I've got.

I think, for the moment, I'm going to disregard the doctor's "order" to give formula first and nurse first, then suppliment, then pump after each feeding. If we go back on Monday and she's made no progress, I'll give second consideration to his suggestion.

Can somebody tell me about "letdown"? I feel like an idiot because, even after nursing two other children fairly successfully, I have no idea what letdown is, how to accomplish it (especially with a pump), and why I have never felt one.


~L

I'm sure someone can describe a letdown better than me, but it's when the milk starts flying out. For me, it's a few min. into the session. When you are pumping you get quite a few "squirters" and there's quite a bit of force.

Good Luck!

I would suggest an SNS supplemental Nursing System, or a Lactaid. It is athin tube that attaches to a bottle and can be taped to your breast. That way Anna gets your milk plus supplemental milk, but you get all the stimulation.

Don't panic about not getting much yet - because you probably had mag/sulfate - that stuff can delay/reduce milk coming in for the first couple of weeks. That could also explain lack of weight gain from just nursing. There was another mom in the NICU same time as me that had been on the mag sulfate and had this problem only no one told her about that - so she just gave up trying to pump or nurse her twins and took them home on formula. I read in "The breastfeeding answer book" about that the day after she went home.:(

Just keep pumping and your milk supply should come up. When I was pumping for the girls - I pumped for about 15 min every 3 hours during the day and went one longer period at night of about 5 hours. I do understand your being told to bottle first - we were told that with Maribeth also - she came home VERY jaundiced and was too sleepy to nurse. If I tried to nurse her - I would wear her out too much to bottle feed - so she was dropping weight the first bit home. Which was really scary as she came home at 4 lbs even.

So I'm going to tell you what worked for us. If Maribeth was awake and alert - eyes open and looking around - I would try and breastfeed her first. If she latched and seemed to swallow - I would skip trying to bottle feed. If she didn't really latch or I didn't hear swallowing - then we would go ahead and top her up with a bottle.

If I was having to wake her up to feed her (which you have to do with really jaundiced babies as they do NOT wake up when it's time to eat so demand feeding doesn't work until they aren't so jaundiced - they also WILL fall asleep before they are "done" because of the jaundice) - then I wouldn't even try bf-ing her. I would just bottle feed her and pump.

I was lucky not to have to use formula because I had the time they were in the NICU (6 weeks) to build up my supply and freezer stash - so I could bottlefeed EBM. But if you can keep up with the pumping - I'm pretty sure your supply should pick up to the point where when you have to bottle feed - you can do it with breastmilk.

Don't stress about putting her to breast at every feeding. In fact - Maribeth didn't turn the corner on even trying to latch until I gave up trying for a few days (because I was watching her cues of being alert/awake/routing). With her being preemie and jaundiced - my trying all the time to bf her was wearing her out. So I had to really back off nursing her, pick up on the pumping and wait until she was awake enough to really try to nurse.

Once the jaundiced cleared up and she got past her due date - she picked up nursing no problem and ended up being my baby that then refused bottles (Megan would and still does suck on ANYTHING). btw - my girls are almost 8 months now and still both bf-ing.

wanting to add also here that getting her exposed to sun as much as you can - outside or through a window - will help with the jaundice

I would say nurse first or at least pumped milk. If you're worried about her not getting enough, it seems like maybe she isn't taking much formula either?

If she was drinking a lot from the bottle but not long at the breast... that would make sense, but it doesn't sound like she's
taking much from the bottle?

Maybe try feeding her more often? Nurse first, if she seems fussy after nursing then worry about your supply, but if she just doesn't want to eat much, I'd guess it was something else, although I'm not sure what I'd guess?

A baby should be more efficient than the pump, so don't freak about only getting an ounce. It may just be "pump anxiety".

Drink lots of water, get rest, and eat oatmeal... make a batch of oatmeal cookies if you're not into the morning kind....

Originally posted by quidnunc
I'd be looking for an LC and an SNS

ITA! :ditto:
I am not a big fan of hospital LC.. I would pay out of pocket- it's worth it when you consider the price of formula yk?
I also agree with the SNS. My fear with having her on the bottle (esp BEFORE YOU nurse- should be after) is that she will reject your nipple. At least with the SNS you get some stimulation at the same time.
My DS was in a similar boat as your little one and it took a full month (lost 1.5 pounds) of torture to get him to the point where it went down and he didn't gain until he was over a month old..
I also wanted add that when I pumped I got no more than an ouce for both breasts no matter how long or hard I tried. I worked with a hospital grade pump and an LC but never did get hardly any. I worried but after the month of jaundice DS gained a lot of weight (no formula at all) to the point of being 30 pounds at only one year old (he ate very little solids until 2.5yo so it was all BM). It is so true that the baby is the best pump and just because you can't seem to get much out of a pumping means little when it comes to your supply :)

Good luck mama!!

leigh ~ i never felt my milk "let down" until my 3rd child. nursed ds # 1 until 18m, dd is still nursing & ofcourse Teague is too.

don't strerss about not " feeling it"

goodluck:)

Wow- this sounds almost exactly like what we went through with our little Lea. Course there was a little more involved since she also had underlying genetic problems- but she too wasn't gaining weight, had a very weak suck, and I needed to supplement and pump to get my supply up. Only difference is that Lea was a bit older when we finally started supplmenting- she was 3mos old.

What we did:

After nursing for approximately 30minutes (switching between both breasts)- I would use the SNS to give her an additional couple ounces (again switching between breasts). At first I supplemented with formula, until I was able to get donated EBM from a friend. (trouble with supplementing even an ounce of formula is that it DOES fill them up more, so at the next feed she wouldn't be as hungry, so wouldn't stimulate my supply as well). After using the SNS I would (double) pump for an additional 15minutes. At first what I pumped wasn't much, but it added up and gradually I was able to completely give only MY milk in the SNS.

If you add that up you will see that it took me approximately 1 hour for each feeding. It was alot of work, but completely worth it.

Then I would add 1.5hours to where I left off and start all over again. I did this around the clock at first- setting my alarm and doing it at night too.

Lea started recieiving occupational therapy about a month later, and I learned some techniques to increase her oral strength- and it helped GREATLY to improve her suck.

What you do is start out by massaging her cheeks- pulling inward towards her lips. Then you massage the upper part under her nose, and the lower part on her chin- also massaging towards her lips. Kinda like making a pucker. Then you firmly massage around and around on her lips. Then you go inside the mouth and massage the gums- all this time using firm pressure. Then you massage the tongue- pulling down and out. Then you massage the roof of the mouth.

After this you start by using the pad of your finger - touching (and using firm pressure) the tip of her tongue- then turn your finger around and touch the cooresponding place on the roof of her mouth. Then turn your finger around again and touch her tongue a little further back - then touch the roof of her mouth again, once again a little further back. YOu do this a few times (while moving back in the mouth) and usually you can really feel the baby want to start sucking on your finger.

This really helped Lea strengthen her suck- and I would recommend at least giving it a try a few times before nursing. I wish I would have known about it sooner- it made a **huge** difference. If you have any questions please don't hesitate to ask- I know how hard it is- that place where you are at with needing to supplement and pump.

I was able to stick with it- and we are still nursing now at 20months. It was hard, but so so worth it.

Nurse first pump 2nd OR Pump while nursing.

Also, I'd call a La Leche League leader or an LC and have her come to your house and help you with the latch. If it's latch issues, that should be resolveable with help.

I am sorry you are having problems, but feeding your baby formula before she nurses won't teach her how to nurse from you and it won't help your supply at all and it might actually damage it.

a Breastpump is not like a baby, it cannot get milk out of you the way a baby can. Try latching baby on and pumping off the other side. When you let down, the pump will be more efficient too. Don't panic! Stress and frustration and worry can all cause your supply to dwindle. Relax while pumping and visualize your breasts releasing milk.

Have you read any BFing books that can help you with latch while you look for an LC or LLL leader? The Womanly Art of Breastfeeding has help for latching on baby as do many of the other books out there.

I seriously think you need to find professional breastfeeding help. A Pediatrician is there for the well-being of thebaby NOT for breastfeeding support or education. A LC or LLL leader can come to your house and help you.

Best of luck!

one other thing I was thinking was that if you can't get a SNS, and you must supplement- I would consider using a dropper or syringe for the supplements instead of the bottle. Using a bottle is not going to help a baby who has a lazy suck bf. It will only make things more difficult.

I used a syringe to feed Lea for awhile too, after a couple months of using the SNS she still needed to supplement and I was bone tired of using the SNS- so we switched to syringe feeding. We got really good at getting an ounce down pretty quickly.

Just because she has a lazy suck doesn't mean you won't be able to nurse her! It just is going to take a little more work to get past that. :)

Good luck mama.

Oh how could I have forgotten to mention the S&S she was my breast friend when I was nursing my boys ;) And I also never felt a let down, well once I did but it was only once. It felt tingly and itchy and that's all I remember since it was once. Not everyone does feel let down so don't worry too much about it.