Baby getting enough?

[modelvirus]

My baby had a really hard time getting used to the bottle after being exclusively breastfed for 8 weeks.  Now that she's used to the bottle, I am trying to re-incorporate breastfeeding back into the mix when I am with her.  After about 10 minutes of being on one breast, she'll un-latch and will refuse to latch back on to that breast or the other breast....  she is very resistant.  How do I know if she is full or if she won't latch on bc the flow is too slow and she associates teh breast with slow flow after it slows down and that's why she won't latch back on?  The other breast has plenty of milk too, so if she latched, I know i would have enough... I just want to make sure i'm not underfeeding her.  Can baby get enough from just one breast???  Also, I've tried giving her the bottle after a feed once, and she took 2 more ounces easily.  How do I get her to latch onto the other side??  Even if I drip milk into her mouth, she'll still arch her back and pull away after she unlatches initially.  Oh...she is 15 weeks. 

Any thoughts would be welcome! Thanks!

[First Time Mom]

I don't have experience with the bottle but my first thought is to try a bottle nipple that has a slower drip so that the milk doesn't flow as easy and it won't seem easier for her to have the bottle over the breast. As for giving her 2 ounces after bfing, most babies can gulp down liquid from a bottle after bfing just because it flows so easy, regardless if they are hungry or not. If she is flat out refusing the second breast but you have been regularly bfing from both sides I think your system is used to making milk for both sides (vs. making enough from one side). If expressing some first doesn't work I would try waiting 10-15 minutes to offer her the other side. If she's hungry (which I think she would be) she will take it as the wait will make her realise that her tummy is not yet full.

[modelvirus]

She was always a one sided breastfeeder, but I haven't breastfed her exclusively since 8 weeks.... and I've been pumping more than feeding, bc she was so bad at the bottle....  and prior to last week, I was onl ybreastfeeding her at night.  I double pump though every 3-4 hours.  But now, I'm trying to breastfeed her when I am with her, since she is fine with the bottle now.   if she does refuse it after 10-15 minutes....does that mean she's full, or refusing bc of her association with the slow flow?  How do I know?  What are other signs I can look out for?  Also, I am using the newborn nipple with the Avent bottle....so it's as slow as it can be for Avent.... 
Thanks for your reply..any other thoughts would be great!

[modelvirus]

Sigh....I've resorted that she's not getting enough.... she's not having as many wet diapers.  I've resorted to giving her EBM in a bottle tonight and she sucked it down, bc after sucking for 6 minutes on one breast, she pulled off and refused to get back on...she was screaming when I got my breast near her.  I tried pushing my nipple in, she would do a half suck and then latch off and start screaming when I put my nipple near her.  But I could tell she was still really really hungry.... and after a full day of breast feeding her, and a lot of dry diapers....  I had to give her the bottle by the evening.  Most times she's willing to latch on, but after the first breast and the initial let down, she won't get on the other... I think she associates the slow flow with the breast, and won't latch back on, thus not getting a full feeding :-(  I'm not sure what to do....  does this mean I need to exclusively bottle feed??  I'm not sure what else I can do.... feeling a bit depressed about this right now. 

[Samuel's mum]

 
My first reaction from your first post would be that 10 minutes or even 6 minutes could mean quite a lot of milk. And it could easily be that she is getting enough and simply getting full however if you are saying you are really noticing dry diapers then that doesn't sound the case here. And your later posts suggest that she's not getting enough and something else is going on here.

How long was she off the breast for? 
If it was a while then perhaps she needs some practise 'milking the breast' (i.e. stimulating the breast to get a letdown is something she may need to relearn) and it might be that your supply needs a bit of a boost too. Even very focused exclusive pumping can still mean your supply hasn't quite been maintained. The best pump in the world doesn't stimulate supply like a baby (as it likes the baby's lower jaw 'wave' action which stimulates the prolactin hormone).
If you are really keen to return to the breast I would really suggest you try and find a breastfeeding specialist in real life to guide you through the process.
There are several things you could think about:
1. Using an SNS ( http://www.medela.com/NewFiles/specialtyfdg.html ) or a 'lactaid' which is a similiar system. This allows you to increase flow and gets her used to the nipple again at the same time AND stimulates your supply.
2. Using breast compressions (see the FAQs) to speed up the flow and reward her for being on the breast.
3. Starting a letdown with a pump before you put her on and then keeping her on with breast compressions.
4. Switching your bottle to a Haberman feeder and using the zero flow option so she relearns 'working for the milk'.
5. Focusing on general supply boosting stuff - drinking 2 litres a day. Do you take galactalogues e.g. fenugreek?

How hard it's going to be is going to depend on how long away from the breast she was.
Offer lots of skin-to-skin time as well.

Good Luck. Don't give up hope. 'Flow confusion' (which is sounds as though she has) can be overcome but it is a real problem. It was one of the reasons that Tracy was such a fan of the haberman feeder. Normal bottles are so so different. The milk 'pours' out and the baby unlearns how to breastfeed. Some babies can switch between the 2 methods with no problem but sadly not all.

[rinajack]

I was also going to say from your first post that the best indication is if your lo is settled between feeds, lasts all the way to the next feed, and and is napping fine, then she is probably getting enough.

The dry nappies is a little concerning though.

[modelvirus]

Thank you both... It's 3am right now where I am at, and I just fed her.... she is willing to breastfeed in the middle of the night without a problem, but she still won't take the other side.  She fell asleep at the breast just now after 20 minutes of feeding...only half the time was she really sucking nutritively though.  My supply is good if she took from both breasts.  With one breast though, I am pretty sure I do'nt have enough, especially since the diapers are showing it.  During the day, most times she can last through to the next feeding juts by eating one breast, so I thought that she was getting enough, until by the evening, I noticed that her diapers were getting drier and drier...the drier diapers are what is really concerning me.  If her diapers were consistently wet, I wouldn't be as concerned. 

Also, I noticed that my right side lets down faster and in general produces more than my left (at least within 10 minutes)....and so if I feed on that side, she is more willing.   Do you think if I take fenugreek or other supplements, boosting the supply will help on one side, and keep her more willing to breastfeed?

She started training on the bottle pretty aggressively at around 9 weeks.  So from 9 weeks until now, she was doing mostly bottles with only breastfeeding in the middle of the night.  So 5 weeks of a lot of bottle and a little breastfeeding. 

Oh....when I am with her (I work from home three days a week), do I just feed her and if she gets off, just leave it at that???  Or should I supplement with a bottle afterwards to make sure she's getting enough??  Even after two hours after I initially fed her last night, she refused to get back on and was really really getting upset every time I tried, but took 4.5 ounces of the bottle pretty easily two hours after I fed her....

Also, will she get used to the fast flow of the SNS and get frustrated when I don't have it on??  I'm scared of that as well....

Thank you so much...back to bed...

[Samuel's mum]

The SNS is a hassle so it sounds as though you are not quite there yet. If you did use an SNS you could very gradually reduce the flow and use it less.

It's really common to have one side a better producer. I think taking supplements will help overall so it's definitely worth a go. You could also try more focused pumping on the left - particularly after a feed where very little will come out but you are sending those precious 'make more' signals. And you could use breast compressions on the left more too.

As Marian mentioned babies WILL take more from the bottle. It just glugs out. If you think about it the effort it would take her to refuse the bottle would be a lot greater than simply accepting it and letting her sucking reflex kick in. How would she even refuse the bottle? It would take quite a bit of effort - she's going to take some.

Do make sure you are drinking plenty as that can cause supply to dip later in the day. You are only looking at 6 wet nappies over a 24 hour period - not every nappy if you are a regular changer may be very wet.

I would suggest you have a go at not supplementing after every feed and having the confidence to give the breast a chance. If that feels too scary then at least work on gradually reducing the amount you give in bottles over a 24 hour period. It might be you have too high standards with the diaper thing. Everytime you supplement you are reinforcing the 'flow confusion' message. At the end of a feed when a baby is feeding on an emptier breast is the most precious time for boosting your supply.

By all means keep an eye on the diaper thing but drier as the day goes on might just mean you are someone who changes a lot of diapers.

[NoelleChristine]

Sorry you're having a bit of a time.     I just wanted to encourage you that short times on the breast don't mean your lo isn't getting enough to eat.  My lo takes an average of 5 minutes to drain one side.  Sometimes he'll feed off both, sometimes not. 

If I went by only his feed times I'd be worried too that he wasn't getting enough.  His sign to me that he's had enough is his pulling off and not taking the other breast, or just eating for a minute or two on the second side.  I'm sure if I kept at him to latch on when he didn't want to he'd probably react a lot like your little one is when done.  Like the pp's said, it's the other signs to look for to know if your lo is getting enough to eat.

It hits right to the heart when we are worried about nourishing our lo's.  Your doing a wonderful job!  Trust yourself, trust your body, trust your instincts, relax, and ask for help when needed.   

[modelvirus]

Thanks....I'm taking another go around at the breast today.  I noticed this morning....that she only took the left side for 6 minutes.... and I think my letdown is slower there and overall the flow is slower on that side, so maybe I should pump a little bit in order to get the let down going first for immediate gratification??  The only thing is, if I do that, will I continue to have to do that on that side every time I feed her?  After she un-latched, she refused to get back on.... but i pumped an hour later and got 4oz.....  so I'm pretty sure that she didn't take in that much....

I change her diaper after every feed...so every 3-4 hours during the day.  At night, it's after 4-6 hours.... So yesterday, during the early part of the day, she had really good wet diapers (good bottle feeding the night before and good breastfeeding in the morning, bc my breasts are full in the morning), but towards the late afternoon into late evening, she had very very little wet diapers (from 3pm - 9pm).  If she had enough from breast feeding, shouldn't she have had better wet diapers?

Ideally, I just really need her to take from the other side.....  I have enough milk for her from both breasts....but not always just from the one breast.  She just refuses to latch and try....

I really want to continue breastfeeding and making this work...but if I have to pump 24-7..... I"m not sure I can continue for a long time....   It's also a very emotional thing for me to keep trying and have it not work :-(

I will try getting some fenugreek supplements, drinking more water, and anything else I can try.....

Thanks for everyone's encouragement and help.....

[Samuel's mum]

The only thing is, if I do that, will I continue to have to do that on that side every time I feed her?

 

No I don't think so. For a couple of reasons: you are teaching her more patience at the breast and after all the bottle use she'll need to get back into the habit but she will relearn. Secondly, if you do the supply boosting stuff then that should also have an effect of speeding up your flow and letdown.

After she un-latched, she refused to get back on.... but i pumped an hour later and got 4oz.....  so I'm pretty sure that she didn't take in that much....

I don't see that at all. You are obviously an experienced pumper but even if you weren't 4oz after an hour seems fine to me. Remember milk is made continously even during the feed. Those 4 oz could easily have been 'made' mostly after the feed was completed.

I would ask yourself - why is she refusing to get back on? If it's not wind/gas (which you are giving absolutely no sign that it is) or discomfort for another reason then the absolutely most logical obvious reason is that she's HAD ENOUGH. If she was still hungry/ dissatisfied why would she just accept the end of the feed? - doesn't make sense. It sounds like she's full.

Wet diapers - 6 hours of 'very very little wet diapers'? I don't think that's reason to panic. You do change quite regularly and I'm pretty confident from what you are saying that there was 6 wet diapers over the last 24 hours.

I don't think you'll have to pump 24-7 by any means. Maybe a few days of using the pump to develop your supply on the left AFTER a feed or perhaps as you mention a moment before a feed. (to make it easier remember you DON'T have to wash and sterilize every time. You can 'wet bag' your pump and the bottle and pop it back in the fridge inbetween sessions over 24 hours or even longer. Milk has antibacterial properties and in the fridge the equipment is fine.)

[modelvirus]

Thanks for the quick response.  My gut instinct is that she's not getting back on, bc she's frustrated with the slow flow and associates the breast with the slow flow again and not bc she is full.  Sometimes I do think she is satisfied...but that she would take in more, had my breast flowed more on that one side.  But once the flow slows down, she doesn't seem to go back on, even if she is hungry.  There are times that I agree that she is full....but other times, I think she is still hungry, as she will suck once or maybe twice on the other breast (if I can get my nipple in her mouth), but that's not enough to get let down, she gets frustrated and upset and refuses the breast.  Then she will start sucking her hand vigorously and looking for food...

In terms of diapers...when is it time to be concerned?

THanks again...

[Samuel's mum]

I can see what you are saying. If she's frustrated at the slower letdown that is something she could get over with more breast experience though (and the pumping/supply stuff I mentioned) so it's not hopeless. When switching to that second side you could always have a go with nipple tweaking/ hand expression to see if you can get letdown started without having to get out the pump inbetween sides and then once she's there have a go at breast compression quickly.

On the nappy thing - I would suggest you put a dry tissue in a diaper and then you really will see if there has been a pee. It's easy to miss them. Many LCs will say 4-5 wet diapers in 24 hours is fine. But 6 in 24 hours is often the guideline. I would go by the urine itself. If you've got the tissue in you may be able to see how pale/dark the urine is. You want it to be pale and not particularly offensive in smell.
Have a look at this. She's an LC. Notice her reference to wetter diapers in the morning being very normal:
 http://www.kellymom.com/bf/supply/enoughmilk-older.html

[modelvirus]

I just bought fenugreek...so i'll give it a shot....  let's hope for the best... i'm hoping that i can continue breastfeeding... i'll keep you all posted....  in the meanwhile, if you have any other thoughts, please let me know!

[rinajack]

My lo also cries when I try to latch him on to the other side at times, or when I try to rlatch him on whichever side.  He will do the couple of sucks thing then pull of crying.  For him, it actually means "no, I don't want that" and he settles very quickly if we stop the feed.  I believe he wouldn't settle if he was still hungry, he would look to latch on, then cry in frustration, then look to latch on etc etc etc.

I honestly think (whilst you are watching the nappy situation) that your best observation will be if  you lo is content and napping as normal, and lasts 3 hours between feeds...

Good luck, try to relax and snjoy your lo, not being relaxed can affect your letdown, so try to relax and enjoy the moments as much as you can