Expert: Sally Wendkos Olds - 9/14/2008

Question
I have a 6 week old son, who is wonderful. I love being a mom, but the feeding has since the beginning been very difficult, and today ended in tears. J (our son) had a rough start with his tongue needing clipped, and my milk not coming in, leading to excessive weight loss (14%) and us having to start bottles and use a pump. Add into that my husband having two emergency trips in the first 3 weeks, taking him away from us for 4.5 total days (and I didn't know anyone to help where we lived), and a move to another state at week 4, along with my husband starting a new job on Monday of this week. . . sigh*. I am exhausted just relaying it all. I've been to lactation consultants, called La Leche, and this is what I've been rec'd/told. I have nipple vasospasm (am taking supplements which helps drastically), and that J is a gourmet eater, loving to take breaks in between his courses, and especially when he is breastfed. I was rec'd to feed him from the breast until he has a hard time sucking and gets frustrated (which now that doesn't happen as often, but still happens like every other feed) and to feed every 3,4th feeding, or as much as I could handle. When we went to the lactation place after an hour of active breastfeeding - he was still only consuming 1.5oz's, and so we had to still give him a bottle. This still must be the case, because he will still need some bottle after I feed him from the breast.

I feed 1-3 times in the daytime and give him pumped milk all the other times. He has not had formula since the first week of his life.

My question is this: Is there anything I can do about getting him to eat from the breast only? I am exhausted. And J has started having major gas problems that even mylecone doesn't seem to help. He screams/cries in pain for about 4 hours a day the last 5 days. I've started to really cut out things from my diet to see if that is a part of the culprit. But especially when he is in pain, breastfeeding is not so easy. He pulls and tears at my breast, and even with the bottle is miserable trying to drink even though he is so hungry. I end up crying with him at times.

Will I have to pump, and feed him, till he's ready for solids ? Or till I give up? Does anyone else go through this? I feel like I am the only one out there that is doing both of these things...

Thanks for your help,
Krista

Answer
Dear Crista,

First, congratulations for offering your son the best start in life by breastfeeding him! I'm so sorry to hear about the rough times  you and he have been having over the past six weeks. First, be assured that other moms also have big problems and can often overcome them to have a gratifying breastfeeding experience. Also, other moms pump and nurse. You'll get information about just pumping if you look up "Exclusive Pumping" or "EPing" on the Internet. You'll see that there are many moms who feed their babies breast milk solely by pumping.

It has to be so hard for you to be under this kind of stress from so many life factors at once. You've had a lot thrown at you lately. I have a few thoughts, and I hope one or more of them will help.

Have you taken your baby to the pediatrician? His gassiness may indicate that he has GERD (gastroesophageal reflux disorder), which the doctor can treat with medicine. You might also ask the doctor about the supplements you're taking.

You say you have called La Leche League -- it might be a good idea to ask to meet with your local leader or someone else in the local chapter. And also to attend some meetings. It would be so helpful for you to have a good, strong support network to help you through these rough spots, especially since you're in a new city, away from the people who might have been there for you before.

With all your stress, you may be having problems with your milk supply. I'm attaching a section from my book (see below), with suggestions for building it.

I hope you find some help soon.

Good luck,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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Ways to Build Up Your Milk Production
New mothers sometimes fear that they won’t have enough milk to feed their babies. They hear stories about other women who “didn’t have enough milk,” and they worry that they might be in this category. But when you look closely at the situations of these other women, the problem can almost always be ascribed to lack of information, lack of encouragement, or faulty nursing technique by either mother or baby. You need to tell yourself that millions of other women nurse their babies, and you can, too. Following one or more of the suggestions below should increase your milk supply within a few days.
• Nurse your baby more frequently for several days, using both breasts at each feeding. This is the single best way to enhance your flow of milk.
• Wake your baby, if necessary, to feed him more often.
* Pump or express milk between feedings. But don’t get discouraged if your pumping yields as little as half an ounce of breast milk. Your baby is almost certainly getting more than this. Even the best pump is less effective than a vigorously nursing baby. (More about pumping in Chapters 16 and 17.)
• See a lactation specialist if your baby is not suckling well or nurses only a few minutes at a time.
• Cut back on your schedule. Do less. Rest more. Nap at least once a day, more often if you can manage it. Ask someone else to help with marketing, cooking simple meals (or getting take-out food), and doing basic laundry. Most people like to help a new mother, so take advantage of this willingness now. You can always reciprocate later on.
• If you can, take an occasional day or two off from work or from other obligations (by, for example, having someone come in to care for your other children) so that you can focus only on nursing your baby.
• Check your diet. Are you eating enough? Are you eating the right foods? Are you drinking enough fluids? Some women find that eating or drinking more seems to produce more milk. Keeping a glass of water or juice near the spot where you nurse is a good idea. You don’t need to drink any more than you need to meet your thirst, but some nursing moms find that they are thirstier than usual.
• Make a special effort to relax, as suggested in the box on page tk. Of course, this is hard when you’re concerned that your baby isn’t getting enough milk—but the more you can relax, the more milk your baby is likely to receive.
• Develop a few affirmations that you can repeat to yourself, such as: “I am a bounteous supplier of milk for my baby”; “I am doing the best thing I can as a mother”; “My baby is growing fit and healthy from my milk”; “My milk is my baby’s perfect food.”
* Visualize your baby at a little older age, looking well fed and  happy.
* Galactogogues: Virtually every culture in the world has recommended certain foods or substances to nursing mothers, in the belief that they help to make milk. In China, nursing mothers have been urged to eat “a mixture of pork fat and red gram (a type of bean), cuttlefish soup, shrimps’ heads in wine, and a special sweet wine made from glutinous rice, given together with the larvae of the blow-fly.” In India, it’s garlic, tamarind, and cottonseed; in France, powdered fennel; and in Nepal, chicken soup, buffalo milk, butter, and rice. In the U.S. vitamin B complex, brewer’s yeast, and the herbs fenugreek (also called fenugeek) and blessed thistle are sometimes recommended, as is the controversial prescription drug domperidone, which has not been approved for any use by the U.S. Food and Drug Administration. (See Chapter 10 and the Websites Appendix for more about drugs and lactation.)
  Cheston M. Berlin, Jr., M.D., a professor of pediatrics and pharmacology who has an interest in drugs and lactation, has concluded that the effects of such potions may be largely psychological. The mother thinks that a certain substance will increase her milk supply, so she relaxes and has a good let-down reflex, thus “proving” its value.
As we have stated, though, the best way to build up your milk supply isn’t what you eat. It’s what—and how much—and how often—your baby eats. The cutting edge research of Dr. Peter E. Hartmann’s Australian team (discussed in Chapter 3) has  confirmed what many breastfeeding experts have known for years: that emptying the breast is the best stimulus to milk production. The more often you nurse your baby and the more vigorously she nurses, the more milk you’re likely to have.
• Believe in yourself and trust your body.

Note: Do not offer your baby formula while you’re building up your milk supply. A few ounces soon turn into a full bottle, which soon turns into several bottles, until you find that you’re producing even less milk. If your baby is drinking from a bottle, he is not stimulating your breasts and thus not doing the most effective thing that will increase your supply of milk. In most cases, a breastfed baby should not be offered a bottle until nursing is well established—by at least six weeks of age.
  The only exception to this is if your baby’s doctor (not your friends or relatives!) feels that he absolutely needs a supplement. Your doctor may be worried if your baby is sick, dehydrated, so small that his health is endangered, or if he is not gaining enough weight. Any one of these conditions may leave him without enough energy to nurse vigorously and thereby stimulate your milk production. If you do supplement with formula, you might try offering the bottle first before nursing him. Christina Smillie, M.D., a pediatrician and board-certified lactation consultant, recommends this reversal of the usual order of breast-followed-by-supplement so that the baby’s immediate hunger will be satisfied and that he will receive necessary nourishment – but that he will get his final sense of satiety from breast milk, and associate this good feeling with his mother.
  Once breastfeeding is well established, you may want to give your baby an occasional bottle of breast milk or formula. Ideally, you should wait until your baby is six months old to feed anything besides your good breast milk  (see Chapters 11, 12, and 17).