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BF questions from new mom

Posted by on Jan. 27, 2013 at 3:44 AM
  • 10 Replies
Hi. I am bf my two week old but she only latches in for a bit and then detaches. I know she's still hungry. She continues to root. Often falls asleep at the breast. After I feed her she takes about 2 ounces in formula. We started supplementing in the NICU. Any advice?

Also should I feed her on both sides when I nurse?
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by on Jan. 27, 2013 at 3:44 AM
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by on Jan. 27, 2013 at 3:48 AM

maybe shes not latchin fully to get a steady amount?

also my lactation consultant said not to worry about them not eatin much at first since her belly is like marble sized. switchin between breasts might help

by Alicia on Jan. 27, 2013 at 4:33 AM
Has she been checked for tongue tie? Maybe she's having a hard time staying latched because of it. 2ozs is a full feeding, I would cut the formula bottles out completely. Take 1 day and set it 6 diapers. Heavy wets and poops count as 2 diapers. If after 24 hours they are fine then she's getting enough from just you.
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by on Jan. 27, 2013 at 8:22 AM
Shortyali hit it dead on! Follow that advice. Also remember her tummy is tiny so she won't eat much. The 2oz of formula is probably over feeding her AND can cause nipple confusion as well as supply issues.
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by on Jan. 27, 2013 at 9:11 AM
She doesn't need to stay latched at the breast because she knows she'll be getting the much easier bottle and doesn't want to work for her meal.
Stop the bottles and just nurse before she starts refusing to latch completely. She's capable of latching and nursing, so she's not going to allow herself to starve.
If for some reason it becomes obvious supplementing is necessary (lacking 6 diapers in a 24 hour period) get a supplemental nursing system and give the formula at the breast. You also need to be pumping for any formula you give to protect your supply. Every ounce of formula you give is an ounce your body doesn't get told to make, so if you give 2 ounces of formula (which is in itself a full feeding btw) you need to pump 2 ounces.
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by on Jan. 27, 2013 at 9:42 AM

I would switch breasts after about 5/10 minutes or when she starts to fall asleep it might wake her up. But like the others said if she's wetting enough diapers dont worry about it. Plus i did formula supplement my dd for a short time after she was born but I feed her out of a medicine/Foley cup not bottle and VERY small amounts after BFing like 50ml not 2 oz.....that's WAY too much. Good luck I'm sure she will be fine, sometimes doctors are too quick to push formula. 

by Group Admin -Tabitha on Jan. 27, 2013 at 9:42 AM

2oz of formula? thats a full fed...thats the issue.  Baby knows she will get the easier fast bottle if she refuses to nurse any longer...refuse the bottle and keep offering the breast

by on Jan. 27, 2013 at 3:08 PM

The problem is the 2 ounce bottles of formula you are giving. In order to establish a full supply in the "hormonal window" you get in the first 2-3 weeks, you need to work your tail off to get your supply up to meet babys needs in this next week. Make it your number one, and only goal for the week!

I'm angry for you that they did not have you begin pumping to supplement and/or to protect your milk supply. Shame on THEM!

Get in bed with your baby nad nurse, nurse, nurse! When she starts to fall asleep, begin breast compressions (more info below). Instead of givign that bottle, put her BACK onto the breast! Every time she finishes one breast (lets go or falls asleep) put her on the other breast.

More info for you:

Before working to increase milk supply, make sure there is a true supply issue first! Take a look at these articles to first see if you have low milk production:

The golden rule of milk production: The more frequently and completely the breasts are drained, the more milk will be produced: How Mother’s Milk  is Made

Increasing milk production:

  • offer both breasts two times at every feeding
  • use breast compressions
  • nurse frequently (at least 12-14 times in 24 hours)
  • increase skin to skin contact
  • rest, and stay hydrated

What this process looks like:

Offer baby the first breast and allow him to nurse as long as he likes. When he starts to slow down on his sucking/swallowing start doing some breast compressionsWhen you squeeze your breast you should see baby respond with an increased sucking/swallowing. Baby has “finished” the first breast when breast compressions no longer get baby nursing more, baby falls asleep or lets go of the breast. When baby has finished the first breast offer the second breast. Repeat the above steps with breast two, (offer breast, use breast compressions and allow baby to finish the breast) then repeat the whole process again with both breasts. If baby is still hungry after taking both breasts two times, then you can continue the process, nursing on one side and then the other, until he is full and/or falls asleep.

Mom resting with baby after nursing with a starter SNS
When working to increase milk production, increase milk intake, or work to eliminate supplements, spending as much time as possible resting with baby skin-to-skin on your bare chest, encouraging frequent nursing, can make a big difference in a short amount of time. This can also be a chance for mom to rest, with baby napping on her bare chest. It can be a great time to have a movie marathon. If you have older children they can be movies to entertain them while you and baby rest and nurse.

Weaning from supplements:

Consider using an at breast supplementer instead of bottles for the supplemental milk. This will provide extra stimulation to your breasts and prevent a preference for bottles.

Lact-Aid at breast supplementer

If you are using bottles make sure you are giving them in a way that supports breastfeeding and minimizes flow preference. Bottle feeding in a way that supports breastfeeding includes:
  • Using a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
  • Starting by resting the tip of the nipple on the baby's upper lip and allowing him to take it into his mouth himself, as if he were nursing.
  • Keeping the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).
More information on bottle feeding in a way that supports breastfeeding: 

If you are currently supplementing with a bottle at every feeding, baby may expect that the time at the breast is always followed by a bottle. If you are using an at breast supplementer at every feeding, baby may expect the constant flow of milk from the tubing whenever he is at the breast. The first step towards eliminating supplements is to get baby comfortable with nursing without supplements at every feeding. Begin by encouraging comfort nursing between feedings, for at least a few days, before you begin to eliminate supplements. If baby is using a pacifier between feedings begin to replace the pacifier with your breast as much as possible.

Nursing without supplementing

If baby is gaining weight on target and is showing signs of getting enough milk then you can safely begin to wean off of supplemental milk.

One way to do this is to start by eliminating the first supplemental feeding of the day. Follow the steps above to nurse multiple times on each breast and use breast compressions. If baby is still having enough wet diapers (5 per day, plus at least 3 poops if baby is under 4-6 weeks old) then after a few days you can eliminate the next supplement of the day. Eventually you will get to where you are only giving one supplement in the evening and that will be the last one to drop.

Common Questions and Concerns:

I’m afraid to cut back on supplements, I ‘m worried my baby will starve!
Taking away one supplemental feeding will not cause your baby to starve or get dehydrated. You need for baby to be hungry enough to want to nurse more as that will increase your milk production. You can always go back to more supplemental milk if you realize you cut back too much too soon.

I tried eliminating the first time I usually supplement, but baby was screaming and refusing to nurse any more before it was time for the next supplement.
Go ahead and give the next supplement. You can simply delay the time of the first supplement instead of just eliminating it. If you were to delay that first supplement by one hour every day, by 24 days you would no longer be supplementing.

My baby seems hungry 10 minutes after taking both breasts. Does that mean it is time to give a supplement?
No. If baby is hungry again soon after nursing on both sides, offer both sides again. And again. Your breasts are never “empty”. As you continue to nurse, your body continues to produce milk.

How can I nurse so frequently? My breasts don’t have time to “fill up”.
Your breasts are never empty and don’t need time to “ill up”. The emptier the breast is, the faster it tries to refill - similar to an automatic icemaker. Emptier breasts make milk faster than fuller ones (How Mother’s Milk is Made).”

If I eat better and drink more water, will I make more milk?
“Research shows that the mother's diet, her fluid intake, and other factors have little influence on milk production. If the "milk removal" piece of the puzzle is in place, mothers make plenty of good milk regardless of dietary practices. If the "milk removal" part isn't there, nothing else can make up the difference (Smith, 2001).”
The more milk is removed the more milk you will produce. Pumping will remove more milk and help to increase your milk production. However, if you are nursing at least 12-14 times in 24 hours it will be hard to fit in pumping. Some thnigs to ask yourself include: Is it worth the additional stress? Would it be better to spend that time resting with your baby skin-to-skin? If you do pump, you can use it to replace any other milk you have been using to supplement.

Book: The Breastfeeding Mother's Guide to Making More Milk By West and Marasco

Bottles and At Breast Supplementers

by on Jan. 28, 2013 at 9:04 AM
Ok ladies. This morning I nursed her on both sides and then put her down. Since she is used to a follow up bottle I assume she will get fussy again soon. I should then nurse her again correct?

edit: I read through the info. If she still seems hungry I will offer both breasts again. If she becomes too upset I will delay the supplement by an hour. I will also do more skin to skin encourage bf.
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by Gina on Jan. 28, 2013 at 10:54 AM

Quoting AverysMom247:

Ok ladies. This morning I nursed her on both sides and then put her down. Since she is used to a follow up bottle I assume she will get fussy again soon. I should then nurse her again correct?
Yes. expect her to be on the breast most of the time. That's normal at this age. And so is hopping on and off again.

edit: I read through the info. If she still seems hungry I will offer both breasts again. If she becomes too upset I will delay the supplement by an hour. I will also do more skin to skin encourage bf.

by mel on Jan. 28, 2013 at 11:02 AM
Yes just consider the next couple days to be a in bed shirt off couple days.
And be warned the three week growth spurt is expected here shortly. Baby will nurse all the time.
Don't give formula based on fussy factor.
Bf if shes fussy. Go back and forth side to side if you have to. If in 24hrs you've changed 6diapers then baby is getting enough from you.
if you need to supplement, for low diaper count, use a spoon, open cup, syringe, dropper etc. no bottles. And only do .5-1oz
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