TTMA Supplementing and Combo Feeding

[emilie]

Hi all! My DD is 3 weeks old. I was EBF for the first 2 weeks, and then at her 2 week appointment we found that she had not gained weight in over a week and was still a few oz below her birth weight. DD is super super sleepy at the boob. Even when she starts feeds alert she gets sleepy quickly. Ped and LC think she is not feeding efficiently enough even though she has plenty of wet/dirty diapers.

My pediatrician and LC told me to pump after each feed and to supplement her with the expressed BM plus formula to make up the difference if I pump less than 1 oz. After each feeding session I am able to pump 1/2 to 1oz of BM. I have no idea if that is good or not. LC also gave me some herbal supplement to help with milk supply.

I have a few questions for those of you who have been down this road:

- if you supplemented a full time breastfeeding schedule in this way, were you eventually able to go back to EBF? How long did it take?

- if you had a super sleepy newborn at the breast, did they eventually snap out of it? I try everything to wake her up while feeding - wet cloth on the face and neck, skin to skin, tickling her, brushing her hair, breast compressions... sometimes nothing works. Any tips?

- is it worth renting a Medela Symphony? I have a Spectra now and it seems fine but I don't know if a better pump would help my output.

- also, any tips for dealing with the punishing feed-pump schedule? Nursing every 2-3 hours was rough enough, but adding in 15 minutes of pumping plus all the parts cleaning time and stuff every time = I'm barely sleeping. I do not want to throw in the towel on this. But oof. It's rough.

Thanks in advance for any advice!

[lightside]

Hi! I think the regulars here will probably have the best advice but I'll share my experience because I remember the combo feeding struggle so clearly, although it ultimately worked out fine and looking back now it seems like NBD.

We started supplementing with expressed milk at about 6 weeks and then formula at 9 weeks because DS's weight gain plateaued to the point that he fell off the chart. I somehow persevered with feed-pump-supplement routine for a several weeks but was never able to reduce the amount of formula he was having (4-6oz over a 24 hours period) without his weight gain dropping off again. I think I just had a borderline supply. The pumping was making me crazy and I felt like I was neglecting my kid several times a day so I eventually stopped pumping after feeds entirely. At the time I was petrified that it would be a slippery slope to more and more formula but we were able to maintain that routine (usually 3x 1.5oz formula top-ups after feeds per day) until he started solids and eventually refused formula by 8 or 9 months. I did a lot to try to protect our BF relationship, including switch feeding with compressions to make sure he got as much BM as possible, taking a little break before giving him the top-up bottle, always using newborn flow nipples and pace feeding his bottle. We breastfed full-time until he was 14 months old and then gradually tapered off until he weaned at 17 months.

In your case, it does sound like the issue is with her transferring milk if you're sometimes able to pump 1 oz after feeds. Ideally, she would just get that milk directly from you and save you both the hassle. Has she been thoroughly checked for ties?

Another tact for combating sleepiness and getting her to take more milk is switch feeding with compressions. Do compressions until she stops swallowing entirely and then switch to the other side and start over. Keep doing this (switching 3, 4 or more times) until both sides are completely empty. Switching back and forth can also help to stimulate additional letdowns on both sides which will help to keep her awake. 

My only general advice for the feed-pump-supplement dance is to try keep it up if you want to get back to EBF. If you really need to get some sleep and save your sanity, give up one or all of the overnight pumps first. Hopefully within a few weeks, you will have pinpointed the problem or things will just click and she will be getting enough from you alone. But also know that if you don't find a solution and the pumping gets to be too much, combo feeding definitely does not need to be the end of BF for you two. Like I said, others here will have better advice. I lurked here a lot during out hard times. Good luck!

[minae01]

lightside gave some great advice and our situation was similar.

I've had supply issues with each of my 3 kids. 2 were preemies (32 and 36 weeks), so I did a lot of pumping and combo fed all of them. My biggest success came with my 3rd, who was born at 37 weeks on the dot. She had severe jaundice due to my RH neg factor. She had a good latch but was super sleepy at the breast, my milk took its sweet time coming in, and she lost 11% of her birth weight by 3 days old. That's when we started the combo feeding. I would nurse both sides, give an ounce or two of formula or pumped milk, and then pump for 10 min. I did the triple feeding schedule for almost 3 months, getting by with using 2-4oz of formula a day total. At one point, I calculated that my breasts were stimulated from pumping or nursing 14 times a day just to keep up. At almost 3 months, I dropped the extra pumping after each nursing session. I still pumped 2 times a day to try to keep up. After she started sleeping longer stretches, I was able to just nurse in the middle of the night and go right back to bed. That was a huge success to me!

I think we got up to supplementing 6-8 ounces a day of formula (still nursing 6-7 times a day. Once she turned 6 months, hubby went back to work (teacher) and I was a SAHM with 3 kids under 4, it was time to wean. I just couldn't sacrifice the time it took to combo feed her. Anyway, I wish that I could've EBF, but despite my best efforts, it wasn't in the cards for me. I accepted my situation and was happy that I gave her what a could.

One thing that helped with the triple feeding was making my husband help whenever he could. He'd give the bottle while I pumped. In the middle of the night, I would sometimes pump while feeding her a bottle in the boppy next to me. It took some careful coordination and safety measures, but it saved time. I also gave myself goals: make it to 6 weeks and reevaluate, then I went to 8, then made it to 10, etc. It have me a sense of accomplishment. Good luck, momma! You are doing what's best for LO!

[minae01]

I missed some of your specific questions! I want to add that I rented a hospital grade pump for the first 2 months. I then used my PISA and got the same amount of milk.

Also, store pump parts in fridge between sessions. I would toss my parts in the dishwasher with sanitize setting once a day.

She snapped out of the sleepiness as she ate more and gained some weight. It took a few weeks.

I would also suggest making an appointment with an lc for a weighted feed to see how much she is transferring in a feed.

[seamonster]

Did the LC checked for lip and tongue ties? The hospital LC saw nothing on DS, but the midwife at the GP saw it and the private LC I hired had us in ASAP to get his ties revised. So that may be worth a second opinion by a pediatric dentist.

I combo-fed DS until 12 weeks. Until the ties were revised, he had 2-3 ounces 2-4 times a day. After that it was 2-3 ounces at bedtime. My LC had me nurse up from 45 minutes to an hour and if DS was still hungry, offer a bottle of expressed milk or formula. I ate a lot of lactation cookies, drank mother's milk tea, and took fenugreek.

I did a little suck training with DS and bottles actually helped his suck because he couldn't be dependent on my letdown. The LC also recommended trying a SNS, but I didn't end up getting one.

I beat myself up a lot over it, but a lot of that was PPA. I have a friend who is an IBLC who had to supplement with her son the whole time due to low supply, so sometimes even the professionals need help.

[seamonster]

I stuck pump parts in the fridge and only pumped for 10 minutes and not every session because I was exhausted. I used a breast shield on myour opposite side while nursing. Some women do pump one side while nursing the other, but I didn't get that to work for me.

[weeklyplanner]

My son was super sleepy the first 2 weeks. My pedi showed us how to wake him. Not that she was rough at all, but she kind of poked/tickled his armpit. She also said to do it with a cold cloth. She pointed out that new moms are so gentle because they are cuddling and loving on their baby. She was right...my husband was actually way better at poking him/startling him awake. And, I was doing the same thing for my bff when her first was born and she swore she couldn't get her awake. Might be worth a shot?

Oh and I second storing all your pump parts in the fridge and washing them
once a day. Also, maybe buy a second set of parts as back up.

[LadyNymeria]

Jan 9, 2017 1:35:24 GMT -5 emilie said:

- if you had a super sleepy newborn at the breast, did they eventually snap out of it? I try everything to wake her up while feeding - wet cloth on the face and neck, skin to skin, tickling her, brushing her hair, breast compressions... sometimes nothing works. Any tips?

R was very sleepy at the beginning. He would nurse for 5-10 min tops and pass out. I tried all the tricks and typically nothing worked.

It actually took until after his 2 month appointment to stop dropping weight %. Because his diaper count was always ok and he was a happy, healthy baby, we just watched him (instead of supplementing).

By 1 month he started staying awake longer, by 2 months he was nursing longer. So yes, he did eventually snap out of it!

[LadyNymeria]

If you want to catch every bit you can, I'd recommend a Milkies Milk Saver. You put it over your nipple on the side your not nursing on and it collects any leakage. You may not always get much, but eventually it can add up or you can add it to a pumping session.

[babycowbell]

Hi emilie!

This is very close to my scenario. My LO is one month so I barely have any experience and have many of the same questions. At our two week appointment LO had lost weight since the one week appointment so I started pumping after each feeding and usually got around 2 oz which I'd give to her with a syringe at first and now a bottle. Sometimes she doesn't want it and sometimes she wants 3 oz!

I was using a nipple shield which I've been working on weaning her off of thinking maybe she'll get more milk without it. I've also done three weighted feedings with a LC to get an idea of how much she's transferring.

As far as pumping, I started out doing it five times a day to have enough to meet her demand. My first pump of the day is always my largest so I never skip that one since it gives me enough for a couple supplements to nursing. I've since cut back and am trying to only pump twice a day and not worry about building up too much supply for freezing or for just in case scenarios. Since I've cut back it feels much more manageable but I know that's only possible since I always get so much first thing in the morning

She may have a tongue tie too, so our next step is to get a consultation from an ear nose throat doc. It takes me 45 minutes to nurse plus 15-20 to give the bottle plus time for pumping a few times a day, so I'm really tempted to see what an ENT says if we can make nursing more efficient and find a method that's more sustainable long term.

Good luck to you!! I said nothing helpful probably, but know you're not alone in trying to figure this all out!!

[hurricanerek]

You have amazing responses above so I won't add much except one thing: does your LO take both sides every nursing session? You may consider pumping one side while baby nurses off the other. I do this with a single hand pump and produce way more milk than I ever did with a double electric. Babies are always better at stimulating letdown so if you catch the milk on the other side with a pump, you may find yourself with more ounces than you usually get. I wish you all the best! Any breastmilk that your baby gets is so beneficial and it's okay if she isn't ebf.