Expert: Sally Wendkos Olds - 12/5/2003

Question
I need some advice about what to do...I apologize in advance for the length of my story I will try to make it brief.
I delivered my daughter via emerg. c-section and although I said I was planning to bf it was at least 8-10 hours before I even was awared enough for her to latch on. It then was evident that she was tongue tied. I was in the hospital for four days ( severe blood loss and high fever) and during that time my milk never came in, I was not offered the opportunity to pump, or see an LC. My dd was given a few ounces of formula in the hospital via a bottle because her 8 lb 13 oz. body needed more than a few drips of colostrum - she was HUNGRY! So, I went home with a starving baby and the only advice I was given was feed her often. Well, it took another 4 days before I had any milk to speak of and even then it came in pretty slow. I was concerned about the tongue tie and both the ped. in the hospital and the doctor at our two week check said it shouldn't be problem. So I tried my best to keep this baby happy. I should mention that my dd had lost over a pound in the hospital and by her two week check she had only gained 4 ounces.
We had plans to visit family when dd was 6 weeks old in Germany. So before we left I went to see the doc again...baby was extremely fussy and tired. Slept through the night after screaming for 2-3 hours each evening. Doc suggested cut out dairy and was a bit concerned taht weight was only up to 8lbs 10 oz but said to come back in when we returned.
During the trip the baby seemed to calm down...slept a lot but seemed to be feeding the same. She always came off and on again...losing latch often. She had wet diapers...and poopy ones. I have to admit Ididn't keep track of how many during our trip.
We returned and I was worried that babe wasn't well...she didn't look alert...soft spots had sunken and few wet diapers...sleeping a lot. Turns out she was dehydrated and we needed to start supplementing right away...I was given a prescripton for domperidone and a referal to a ped. about the tongue tie.
We supplemented using a SNS system. Ped. says the tongue tie is not a problem...supply is. Either switch to formula or continue supplementing. "Stop blaming the tongue tie." Were his exact words.
LC in the area helped with latch and we looked to get a second opinion....to make a long story a bit shorter we got the tongue tie snipped and it has been a month now. My baby was not gaining weight after the snip. She was gaining maybe an ounce or two per week and then losing when we backed off on the supplement a bit. So, we have been unable to find a happy medium...supplement and breastmilk. We have tried to increase my supply using herbs, pumping, water, oatmeal, massage, domperidone, and anything else we heard might work. I am not sure what the issue is any more. It seems like we keep having to add more supplement instead of lessen it,even though the tongue tie is cut. HEr latch has definitely improved but she still loses it at times. I was so ready to give up last week that I started makeing the switch to bottles but I am now having second thoughts...there seems to still be milk there that she wants. I had been bf first then offering a bottle of supplement after- getting away from teh sns. Now, my dd is starting to refuse the bottle and only will take supplement from the sns. I am not sure what to do. I would love to exclusively bf my baby but I am not sure what is going on with my supply. Is it possible that I have more milk after relaxing about pumping and herbal remedies?
Do you have any ideas for me...any encouragement? Should I keep trying to nurse my dd or just accept the fact that we got off to a horrendous start and bf is just not possible for us this time?
Here is a list of her weights since birth ( same scale - only clean diaper since 4 weeks)

Birth- 8lbs 13 oz
discharge 7 lbs 12 oz. ( Supplemented on Day 5-8)
2 weeks - 8lbs 7 oz
4weeks - 8 lbs 10 oz
8 weeks - 9 lbs
2 months- 8 lbs 15 oz. (Began supplementing 1-2 oz per feed)
10 weeks - 10 lbs ( up to 3 oz. per feeding)
11 weeks- 11 lbs
12 weeks- 11lbs 13 oz
13 weeks - 11lbs 10 oz ( supplement as much as she'll take)
15 weeks - 12 lbs
16 weeks- 12 lbs 2 oz ( started giving formula in bottle - up to 24 oz. per day **offering breast first**)
16 weeks 4 days.....refusing bottle and using sns again.

YEs, I am still taking domperidone 30 mg. 4 x a day. And I am taking fenugreek 3 pills 3x a day.

IN a typical day Anika will take anywhere from 15 to 24 oz of formula. She is not very consistent.
I was using the Medela Lactina double electric pump and had little to NO success with pumping. I would get maybe an ounce or two from the Right side and only a few drops from the left. Even when I pump and Dh feeds her I get about the same as if I pump an hour or so after a feeding. I have had my thyroid level checked (TSH) 1.63.
ANy other ideas?

I should add that Anika sleeps through the night...by that I mean she sleeps from 11-7 and has done that from the day I brought her home. I have tried to wake her up and feed her at three but she won't drink. I have also tried to wake up and pump but I don't get much from the pump then either.
 I should ALSO add that I took Tylenol Cold and Flu the last week of October for a flu. I noticed a dramatic decrease in milk production since I was EP before her tongue tie was snipped. It took only three doses before I noticed I had little to no milk and then I stopped taking it. I am still trying to get my supply back after that blow.
My breast grew from a 36B prepregnancy to 38D during pregnancy.  My nipples are small (the size of a pencil eraser)  My right breast is a tad bigger than the left.  There is about two finger width space between my breasts.  
Hope to hear from you soon!  

Answer
Dear Denise,

First of all, congratulations for all your efforts to breastfeed your baby. I'm so sorry to hear about all the problems you have had.

At this point, it seems that because of the problems you faced after delivery, you have not been able to develop a satisfactory milk supply. You realize that Anika has to receive more nutrition and gain weight, so she must be supplemented or switched to formula. It also seems apparent that by this time she is confused with the SNS, your nipples, and the bottle. So I would advise consistency, e.g. either feed her with the SNS at every feeding or bottle feed only, either way with formula. If you are not too harassed, you can pump and add whatever amount of expressed breast milk you produce to the bottle. The baby should adjust in a few days to your enhanced sense of calmness and the single kind of feedings.

Good luck. Let me know how things go.

Sally Wendkos Olds
author, THE COMPLETE BOOK OF BREASTFEEDING