Expert: ruth kraft - 2/23/2011

Question
QUESTION: Hi Ruth,

I'm have a huge dilemma deciding if I should continue pumping and bottle feeding my son, as no matter how many times I pump a day I never get more than 20-50 mls. Is there a benefit to my son if he only gets 1/6th of his daily intake in breast milk? how long should I continue this to give him nutritional benefits? he is now 7 weeks old and I could continue for another month before really going crazy. The combination of pumping and topping up with formula means I barely leave the house.

My son was born with a big overbite/pushed in chin and was never able to suck properly at the breast.  Breastfeeding was very important to me and I took all efforts to make it work. In the hospital i pumped colostrum which was cup fed to him and continued pumping until my milk came in.  We moved to nipple shields to assist him in latching on which appeared to be working. He was having soiled diapers and seemed satisfied. After we came home things seemed to be going ok. I hired a lactation specialist who came by and said he was latched on properly and drinking. He kept falling asleep on the breast and I learned ways to wake him up. I attended a breastfeeding support group every Wed for the first 4 weeks.

After two weeks he was weighed and was down even more weight and I panicked which allowed me to eliminate the nipple shields. I followed advise of the consultant and pumped after ever feed.
He then began having screaming spells for several hours every night which was diagnosed as evening colic.  

After three weeks he was down so much weight we had absolutely no choice but to start topping up with formula. I was told to feed at the breast, top up with 50 mls formula, then pump.  I tried this for two days but he was taking at minimum 100ml of formula  after which indicates he was getting basically nothing from me even after 40 minutes.  I could not keep up with the breast feed-bottle feed-pump and was not getting time to eat or sleep, it was impossible.  I started pumping more frequently and not putting him to the breast.  I also hired a medical grade double breast pump which allows me to express the same amount in 15 minutes that was taking me 40 with my own medela swing.

I have NEVER been able to express more than 20-50 mls even if I increased frequency, increased time on the pump, etc. I don't think my milk was ever in properly as I've never been engorged or felt like they were really full. Then again I don't know what it feels like as this is my first experience.

I have been beating myself up over not being able to breastfeed no matter what I do.  I need to know if he is actually getting benefits from the little bit I produce or if I am wasting my time.

I was told by my pediatrician at my 6 week check up I could never really go back to trying to breastfeed exclusively again because his weight was an issue. I am terrified myself as we were effectively starving him to death. His "evening colic" disappeared as soon as he started getting formula and gaining weight. He is brilliant outside of when I was starving him to death.

Not being able to breastfeed is depressing me and I get embarrassed bottle feeding in public. People don't really believe that you've tried your best and think you are lazy. All the research I've done all starts out with 6 months breastfeeding exclusively is best. So does that mean I should give up trying to express at all? Even the formula containers tut at you that breast is best. Obviously I know that and I know for the rest of my sons life every time he gets sick I'm going to wonder if its because he wasn't breastfed.

I would be grateful for any advise you can offer.

Leah

ANSWER: Oh goodness you have been through a LOT. Please give yourself credit for having such an uphill battle and doing so much with such a young baby!

It certainly looks like you have been doing all the right things along the way. I do believe that there is benefit in your baby getting ANY breastmilk rather than none at all. THe studies show that long term benefits are increased by longer term nursing. However, for right now benefits are for right now. And it will help fight off colds, help balance his gut and build his immune system at least a little. Not to mention, the connection you are able to have with him.

SO, I will give you permission to let it GO. Take a load off. the stress alone can make your milk go down. the constant pressure. KNOW that you are doing and have done every possible thing that you could think of up until this point and that you are NOT a failure.  Take the pressure off YOU. the standard you are holding YOURSELF to. reguardless of what anyone else is saying. You are a good mom. Most moms never try this hard.

There are women who relactate after years, or who relactate after adopting a baby that can make their milk supply come back . So, after you have decided to let go and regroup and trust yourself again that you can do this, or at the very least, the best that you can do. for now. every day take it day by day. feeding by feeding. for right now, I will do what I can.

I don't know your pediatrician and I cannot tell you to go againt what he said but most of the peds that I know are not trained in breastfeeding. If you get your milk supply up enough you certainly may go to only breastmilk. try to feed the baby your expressed milk even through an SNS ( supplemental nursing system ) so that the baby nurses but gets the extra through the little tube WHILE nursing, and if you have to top off with formula you can until your supply gets more efficient.

Rest a little and eat fiber. the more gastric motility you have, the more milk you will make. if you can spend the next 3-5 days "power pumping" once every hour during the day and every 3 at night for 10-15 min, you should see a good increase in your milk. Take it for however it is going to work as the more stress you have the less let downs you will also have. easier said than done I know. Having the better pump is going to be great for you as well. drink some mothers milk tea, take a warm bath and snuggle with your new sweet little guy. this is going to be a retraining for both of you that breastfeeding is good. It can work if you are both patient ( and there is no medical issue I am unaware of  :) You CAN do this just be patient with yourself.

You say you can go another month with the great stress. so let the great stress go and change it up a bit and do it NOT stressed. It will either work or not. you are doing all you can. Sometimes life throws us curve balls. you just have to weave through them in odd ways to get through it. but either way you know you worked it the best you can.

after a few days feel free to email me at Ruth@honoringwomen.com and let me know how the power pumping went and we can go from there :) IF you choose to do that. Do what feels best to you. and lots of good emotionla off the hook rest for you over the next few days :)

---------- FOLLOW-UP ----------

QUESTION: Hi Ruth,

thanks very much for your prompt response and very kind words. I tried the power pumping once and it was very stressful as he doesn't always settle after I feed him and I have to spend a couple hours with him and therefore miss a session trying to do it ever hour.  I will try again but I don't have any help as my partner is a pilot and away a lot.

I am willing to give it another try but it still leaves the main problem that he has never seemed to get much from me at all and was unable to suck properly. I'm not sure that has changed??

I could probably rent a SNS as well but the double pump is costing me 125 Euro a month. I think the reason I'm really stressed is deciding to pay for another month (it expires on 1st March).

If I take a break for a few days will that make things worse to start again on Monday?

Thanks again.
Leah

Answer
You can try to have his latch evaluated again by a lactation consultant and see if she thinks it is any better or not. She may recommend nursing or she may recommend pumping and then giving bottles of expressed milk.

If you can get the supply up enough to continue pumping over long term, then you should not have to rent the pump but buy a good double electric pump to continue with a fully established milk supply. You can try hygeiababy.com or amedaegnell.com and see if they make adapters for where ever you are located if you need the electric outlet to be different.

IF you take a break completely from pumping and nursing it is likely that your milk will go down from where it is now. However, it doesnt mean you wont get it back, it will just take longer to regain what you already have. You shouldn't have to power pump for more than a few days to get it really going. You should know by then if you can make it work, after you get it really going you can wean off and go every 1.5 hours, then every 2 and eventually every 3 if you were exclusivly pumping and feeding from a bottle or SNS.  If baby can latch, then you wean the power pumping with baby latching on at the same time.

Good luck!