Expectations with triple feeding

[filips]

Hi everyone! I’m kind of desperate and having a hard time getting a hold of the lactation consultant I saw on Tuesday, so I figured I’d try here while I wait for their return call.

Some background:

I am 19 days PP from a c section (after 30 hours of labor) and my supply is still very low. I was EBF for the first few days in hospital and my baby lost 9.2% of his weight. We started supplementing with formula and he was able to go home 3 days pp.

The hospital lactation consultants told me that I shouldn’t introduce a pump if I could avoid it for the first two weeks. So we were BF and supplementing 1-1.5 Oz of formula through day 14.

I finally got an appointment with another LC and she did a weighted feed. He got 12ml from my right (slacker) and 20ml from my left. He also has a ‘weak suck’ and shallow latch and cannot stay awake for feeds no matter how naked or cold he is. It’s so hard.

So this LC recommended I pump after each feed for at least 15 min while my husband gives him 1.5 of formula — and the feeds I should not allow him more than 15 min on each breast with a focus on deepening his latch and keeping him alert, which has not really been all that successful, especially on my slacker with the shorter nipple. I have been doing for the last three days, but my volume seems to have decreased.

I measured everything I pumped for 24 hrs (8 pumping sessions) and only got 5 Oz total. Some sessions I barely got a quarter of an ounce out of my slacker breast. My hope would be to bank enough milk for use to supplement the next day instead of formula, but. 5 Oz would only cover three feeds.

I’m supposed to do this for two weeks before I go back for another weighted feed but it’s so exhausting and my husband goes back to work Monday, so I don’t know how I’m going to do triple feedings during the day alone.

I also got refit for 20mm flanges and have been using them but it hasn’t changed anything.

I’m using a spectra S1 pump and noticed that the minute I see a letdown and switch to expression mode, the milk becomes drips than nothing within 30 seconds. I don’t know what I’m doing wrong. I’ve tried so many combos of cycle and suction and they all have not made any improvements. I’ve even stayed on massage mode through the letdown and it only got me a couple more mls.

Can anyone tell me if a) this volume is low or normal? And b) if there are ANY tips you have to improve my pump usage? I feel like I’m strapped to this or the baby 24/7 and I can’t figure out how to get better at this! It all feels so fruitless.

Thanks in advance!

 

[billfojesus]

@filips I’m so sorry you are in this position. I had some similar things happen with my first. My OB told me to start pumping and the nurse refused to help me set up the pump and told me I shouldn’t be pumping that early. If your supply is normal then yes many people say not to pump the first 6 weeks so you don’t create an over supply, but if your supply is low and your baby is having trouble then yes you should pump especially if supplementing.

Triple feeding sucks. There’s not really anyway around that. It’s exhausting and time consuming but it’s not meant to be forever - only until you can get your supply to meet what your baby needs to eat. I would put my baby laying on my lap and pat his butt or use a bouncer when I had to pump after. Some people can pump and feed their baby the supplemented formula or breast milk at the same time but I wasn’t ever able to do that.

I did eventually make enough, and now with my second kid breastfeeding was soooo much easier. Make sure you are drinking and eating enough. When your husband is home try a power pumping session each day. I wasn’t able to give up the middle of the night pumps with my first, even when he started sleeping through the night - when I tried my supply dropped. Some foods are galactagogues and can help your supply like oatmeal. Coconut water usually helps me too.

Last but not least, your sanity is extremely important both for you and your baby. You can always combo feed or switch to formula entirely if you notice this taking too heavy a toll on you.

 

[usexpat97]

@filips I am sorry you are struggling. I just wanted to drop in and say i had to top up with formula for my 1st. I was on domperidone and still produced little milk. My son was similar in that nothing kept him awake and i had to use a nipple shield on my one nipple (slightly inverted).
Around 8 weeks i was able to stop topping up and i stopped pumping by about 12 weeks. i did have to work hard initially to build my supply but we did figure it out eventually...he is 2 and would probably still nurse if i hadn't of been ready to quit haha.

 

[cubeless]

@filips Triple feeding is unrealistic and leaves you no time to sleep or eat. Do the best you can, top off baby with formula, and try not to stress about your supply. The first few weeks are hard enough without this pressure.

 

[lordybee]

@filips Hang in there, mama! You’re doing great! It’s exhausting, but you are fierce and you will get through it.

My little one had a tongue tie and a weak suck even after the tie was released, and my milk was quite late to come in. She dropped to below the first percentile and we had to supplement for a while, both with expressed milk and with formula. I was heartbroken and felt like such a failure. I feel for you. But, we did eventually figure it out to exclusively breastfeed! Our IBCLC made all the difference for us.

My recommendations:
- Pump 8 to 12 times per day for 15 min per session, including several night sessions.
- Try power pumping. I did it once per day for a week and it improved my supply greatly.
- Confirm with your LC that you have the correct flange size and pump settings. Breastfeeding and pumping sometimes changes the size of things, so re-evaluating might be helpful. I stay on the massage mode for 2 min regardless of when the letdown comes. For massage mode I used 73 cpm and level 3. For pumping I used 54 cpm and level 7. Your manual will help to figure out the cpm for your pump.
- Use a breast massager while you pump. I like my LaVie vibrating massager.
- Pump while you are warm and relaxed. I found I got more when I pumped right after a hot shower.
- I used a single hand pump (Medela Harmony) when my husband went back to work. It took longer, but it made me cord-free and silent, which was very helpful. They are inexpensive. You might give it a try and see if it makes pumping with a baby more manageable.
- Eat enough, drink enough, and try to get some rest.

I only had to use formula for about 10 days, and then I was able to keep up with her. Things started to really improve for us when my baby was about 2 months old. And she was feeding 100% at the breast by 4 months old. It’s gets easier and less scary, I promise. Sending you and your little one love.

 

[filips]

@lordybee I got a hand pump after seeing many people talk about how it was more helpful, it comes tomorrow

 

[lordybee]

@filips How is it going with the hand pump? I hope well. Thinking of you.

 

[filips]

@lordybee I like having it! I’m not pulling anything spectacular from it on its own, but it’s good for sort of getting my nipples started and then I switch to the manual. I’ve been able to get an additional half ounce out of each breast pretty consistently since yesterday

 

[lordybee]

@filips And once is big improvement! I’m glad things are improving. Way to go!

 

[lordybee]

@filips I should also add that tons of skin to skin encourages successful nursing, both for the baby and for the mama. It took for days of constant contact for her to embrace breastfeeding after the grew accustomed to the ease of the bottle, but she eventually came to prefer the breast. And breastfeeding is so much easier without constantly pumping!

 

[ldingle]

@filips I’m sorry to say your first LC really screwed you. If you are supplementing you need to pump for 15 min every time you supplement to send your body the signal to make up that milk. Not doing this for two weeks would have really impacted your supply, so now you are in the position of having to get it up. I had to do this too, after it turned out my baby was basically not pulling anything and my supply dropped. It’s hard but not impossible.

Right sized flange is good, S1 pump is good. If expression mode is not working well for you it’s okay to stay on bacon mode (letdown mode, but the button looks like bacon ) the entire time. Be sure to massage during pumping. I would be aiming to pump 8-9x a day.

Given the uphill battle you are waging I would add power pumping (google it) and supplements. My pediatrician recommended fenugreek and this has had a very strong positive impact for me. I understand some women find the opposite, so keep an eye on it. You should see the uptick in about 3 days. I later added blessed thistle and goat’s rue and both of those also had good impact.

If you can get your pumping output to equal the baby’s intake then you have the supply side handled and can just work on your baby’s nursing. Time makes a big difference as they get bigger and stronger, around 8-10 weeks is when many see a big improvement. I would also have baby evaluated by a pediatric dentist and potentially an OT feeding specialist.

 

[arunnihar]

@filips You’ve gotten some great advice about increasing supply, and it’s certainly doable with great effort (I gradually went from producing 10ml per pump to now 3-4 oz, also had a babe with tongue tie and latch issues that didn’t get better until about 3 months). But I want to be super honest and tell you that triple feeding was INCREDIBLY hard, and there is no way I would have been able to do it on my own. My husband was also on 3 months leave and took care of feeding formula, holding the baby while I pumped, as well as washing pump parts.

Are you able to get a support person like a family member to come stay with you when your husband goes back to work?

Otherwise, on days when I truly went crazy from triple feeding, I would take breaks from nursing and exclusively pump the whole day. It still sucked but seemed a little more manageable than triple feeding. Baby’s suck skills won’t suffer from nursing breaks. In fact, some moms EP for the first few months and are able to successfully latch again once their babies have grown a bit bigger and stronger.

I’m not at all discouraging you from pursuing nursing/TFing, but it’s super hard, and staying open to other options may keep you sane.

 

[imsavedbyjesus]

@arunnihar I agree and would just add a success story to help with OP’s spirits. We triple-fed for 3 weeks and were able to get off of it! Now that was triple feeding without formula (just nursing, pumping, and giving BM and repeating). I do know formula really hurts the development of mom’s supply in the early weeks.

 

[sypnyc90]

@imsavedbyjesus Adding another success story to show OP the light at the end of the tunnel - our little one has a tongue tie and lip tie and wasn't able to latch well from the start. That combined with a fractured collarbone from labor made breastfeeding very difficult; poor guy would scream in pain. So I exclusively pumped instead, and occasionally would try nursing to see how it would go. It took forever for my supply to catch up and it was extremely emotional and difficult. I second the recommendation for a support person during the day, it's so so hard

He just turned 3 months, and now I'm pumping 25-28 oz a day, and we just started replacing one pumping session a day with breastfeeding and he's doing great! It took a lot of power pumping, support from an IBLC and my husband, and lots and lots of tears to get to this point but it is reachable!

Tips that helped me was to pump no more than every three hours; pumping every two hours is so difficult and unsustainable. My schedule was to pump for 20-30 min a session at 3am, 6, 9, 12, 3, 6, 9pm then sleep from like 10pm -3am while hubby was on duty with the baby. I would leave massage mode on for 2 min, then switch to expression for the rest of the time. Then I was on duty from 3am to 8ish. Allowed us both to get some sleep and felt like a more manageable pumping schedule. Now I'm pumping every 4 hrs and sleeping through the night! Make sure you are eating and drinking enough, too! I aimed for drinking 2-3 of those 32oz water bottles the hospital gave us. I found eating baked goods helped increase my supply; I especially enjoyed Kodiak cake's chocolate muffins!

 

[imsavedbyjesus]

@sypnyc90 That’s an amazing story! Congratulations to you and baby!

 

[crafty]

@filips I had similar issues with my baby- bad latch and weak suck.

Get evaluated for a tongue and lip tie - the moment we got hers removed her latch was immediately improved. Wasn’t perfect but she could open her mouth wide enough to get more than just my nipple.

For the weak suck you could also see an OT to help. The one we worked with taught us suck exercises, cheek support while feeding (I think the position was called inverted side lying), as well as a very slow flow nipple and specialized nipple shape (made for preemies) on evenflo bottles. I highly suggest these bottles. Everything else in my opinion is utter trash if you’re working on suction and latch issues. I tried a dozen different bottles before my OT mentioned them.

After about a week on those bottles and doing the exercises her suction was 10 times better. She still has stamina issues but we’ll get there.

As for your supply, I totally get it. How many times per day are you pumping? Are you getting enough calories? Hydrated? Stressed?

The first few weeks I pumped it was the most stressful time for me. I was constantly worried about supply and watched every drop come out like a hawk. I was also pumping 12-14 times a day to try to increase supply.

Eventually I got burned out and reduced the number of pumps to 8. I also started watching videos on my phone to distract myself from watching the pump. Things are starting to tick up. This morning I pumped 4oz in one sitting- that’s not common for me.

Also be sure that you’re wearing loose fitted clothing and a bra that fits your new boobs- that also affected my supply.

I would also buy the nipple measurement tool from legendairy and make sure your flange size is right. I was fitted for one that was too small and caused blisters on my boobs.

Your supply is still getting established- there are a ton of things to consider and try before something clicks. You’ll need support to make it happen, but you can do it.

Look for another IBCLC. Not all are created equally. Better yet look for an OT who is ALSO an IBCLC. It changed everything for us.

 

[filips]

@crafty Thank you for all this! What is an OT? I really do think I need to see someone other than the hospital provided outpatient support

 

[crafty]

@filips An OT is an occupational therapist- you’ll need a pediatric OT for your case. In my experience the in-hospital IBCLCs aren’t as helpful as outside that setting. The one that saw me told me my daughter’s latch was PERFECT when it was giving me bruises and cracks.

 

[kipdave]

@crafty Would you please share the exact details on the nipples and bottles that you have had success with? Thank you!

 

[crafty]

@kipdave Sure! We use the 4oz bottles with the standard slow flow nipple

https://a.co/d/262q2fR