Hi honey, your post quite rightly reminds Erin on my BF experience with DS. Hugs xx It is SO tough when feeding isn't working smoothly, it really is. If you're pretty sure its not reflux or intolerance (it doesn't read like that to me but only because I have BTDT with this issue which looks so similar in the symptom stakes), its quite possibly not that. OS and OALD on their own can cause these issues.
I'm glad you know about the OS and the OALD - that was the lightbulb moment for me. All that remained was to find a way to deal with it. I'll be honest, DS had moments when he struggled with the flow even at 15 months but in general we did get the feeding much smoother and he BF until 2.5yo, after a very rough start.
What I found:
1. Don't feed every time LO cries - keep feeds at least 3hr apart. Feeding cues can also mean other things - gut discomfort which is so common with OS and OALD and is often helped by feeding because of the reflex that increases gut motility when LO feeds. It just perpetuates the problem though. For this, if LO is crying 1-3hr post-feed, rooting and/or pulling legs up to chest, try a tummy massage and pushing his legs up to his chest to help the gut motility without adding more air and milk to the equation.
2. L FREAKED! when the second letdown happened. I noticed it because around the time he'd clamp his little mouth down on my nipple and shake his head like a dog killing a snake, the other breast would spurt milk
I'd say that's probably what's triggering the screaming 4-6min into the feed. What helped with this was to lie back and put DS on top of me. Side lying did not help, it didn't remove gravity from the equation sufficiently. A recliner chair was best in the end because much as he struggled with letdown, he would get frustrated with the slower flow just before it so I used to lie back initially and then sit up when he started to get restless then lie back again when the next letdown happened. This was just time and building trust for him that I would lie back and that would help.
3. You can do something about the OS - block feeding can be very helpful to reduce supply and balance out the foremilk/hindmilk imbalance which causes so much gut pain for LO (start with 2 feeds on one side - you can lengthen the blocks if necessary to drain the breast fully). Likewise, you can remove galactagogues from your diet - taking out oats made a massive difference for me.
4. You can take the OALD and foremilk/hindmilk imbalance out of the equation for a short time by expressing (don't necessarily need a pump, I could just trigger a letdown and squeeze my breast and get almost a litre
), mixing the milk so its uniform and bottle feeding. I did that for a few days out of desperation when DS was screaming his head off and the child health nurse said I had to stop eating dairy. I did it for 4 days, had a desperate appointment on Monday afternoon full of crying (mine and DS') and they asked if I'd swapped him for another baby when they saw me again on Thursday because he was SO much better. I spaced feeds, the feeds were balanced and he gained weight like he never had before (we had massive weight gain issues too).
5. 4-6min can be plenty of time to feed, even at this young age. It certainly was for my DS. Your LO doesn't have to learn to be efficient at removing milk from the breast, he just has to learn how to swallow fast enough without gulping down air
6. Relaxation (you and baby) makes feeding much easier. I sometimes fed in the bath - less expectation and water relaxes me and my LO. I'd just lie in the bath with DS on my tummy and he'd latch on his own and feed very calmly. I think part of helping your DS be more calm about feeding in general will be to reduce that supply a bit so the flow isn't so much and both of you relax.
It sounds like you really don't want to stop but you're pretty close to the end of your tether. Hopefully there's something in there that can help you find something else to try. May the new year be better for you and yours xx
One little question - how are his poos?