My name is Karen and I am the proud new of Brandon Garrett who was born 3 weeks early on June 14th. He weighed in at a whopping 5lbs 4oz. Long story short, I had gestational diabetes, high blood pressure and a rather large amniotic fluid leak. Brandon's "womb with a view" no longer offered the top notch accommodations he had become accustomed to so my doc decided to induce me.

Here we are at day 10 and boy are we having some problems. Brandon has failed to gain a single ounce in the last week . He is a VERY, VERY sleepy baby. (He still has a touch of jaundice) and I am a VERY, VERY sore . My little man has managed to crack both my nipples. I have had absoultely no support from any lactation consultant I have seen. One lady came to my house to watch a feed and left before he had even latched on.
I have now been instructed by doc to pack in breastfeeding for at least week and to put Brandon on nothing but formula. Nothing could have devestated me more. My ped is telling me that I am not able to provide for my own child. ~ For the record, I nursed my now almost 4 year old daughter for 19 months. ~

I so desperately want this to work but my boobs are just killing me. The right side had cracked and bled twice and the left one is in pretty rough shape as well. My toes curl every time he latches on. I am pumping the scabbed over right side every 3 to 4 hours as it is right now. I can't imagine having to feed him a bottle then pump everytime after that. While I really want my baby to grow, I don't want to jeopardize our future nursing relationship. His first growth spurt is just around the corner.

I am wondering if anyone else has been through anything like this. If so, what did you do ???

Do you have any lanolin? I had the same problem you're describing with my son. I know you said you nursed your daughter successfully for 19 months, but maybe he's latched on wrong. I honestly don't know anything else other than try the lanolin. I remember that feeling too well. Nothing like the feeling of sandpaper run over your nipples.

Are you using Lansinoh or any other type of lanolin? My doctor also suggested just hand expressing a little milk, rubbing it on the nipple and letting it air dry.

For your nipples to be cracking and bleeding so soon makes me suspect the latch. Can you or your doctor check to see if he's tongue tied?

Find a new lactation consultant or a La Leche league meeting and look into a supplemental nursing system. That way your little guy can get the calories he needs and you won't be giving up on breastfeeding. Your breasts will still be getting the signals to produce, but you won't be so stressed about him being slow to gain.

Has your milk come in? I highly recommend the Avent Isis pump. I had a Medela Lactina with ds#1 and I get more this time with the Avent than I could with the other one.

My second ds is almost 4 months old and in the first few weeks the let down and initial latching on was much more painful than it ever was with ds#1.

I am using lansinoh after almost every feed but it really doesn't seem to be helping.

My milk is definitely in. I am able to pump close to 3 ounces off of each side. (I have a rental pump from the hospital). I have a little mini freezer stash started already. (with the right side being cracked and so sore, I pumped exclusively for a 48 hour period. Just the thought of him latching on was enough to make me cry)

I would like to try to continue nursing him at every feed first before offering him a supplemental bottle of EBM or formula. The stuff his ped gave him this morning is high in calories. He is almost 2 weeks old and has yet to get back to his birthweight. Only problem is, he falls asleep after 10 minutes of nursing and doesn't wake up again until his next feed. I don't want to jeopardize our nursing relationship by giving him a bottle first but I also don't want him to not be gaining weight.

His ped essentially wants me to stop giving him breastmilk, period. For the next week, he is to get nothing but formula. If that isn't jeopardizing our nursing relationship, then what the hell is ???

I know it's easier said than done, but you are going to have to wake him up. It's so hard I know

Born 3 weeks early on June 14th, right? So he hasn't hit his edd yet? And he's having a hard time getting enough calories. (Forgive me for restating the obvious, just trying to organize).

What about cup feeding him? That way you can get the calories in him without jeopardizing your bf relationship. Or a sns? But with cracked and bleeding nipples, I know its really hard to keep latching him on. For a while, I too would curl my toes, cry, and grimace at every single feeding. With DS#2 my nipples both cracked and bled, so I know what you mean about the pain.

Ibuprofen for pain. I was taking it round the clock, 3 and 4 at a time. Lansinoh.

Lactina is good for pumping, you need the stimulation to build your supply. (I don't know enough about the Avent Isis to know if it is a hospital grade, double pump). With DS#1 I pumped and bottle fed, using the Lactina for the first month. I really made sure that any time he was hungry, I pumped after he ate.

OK. I just reread your post and had one other thought. Consider another ped. I realize you said that your baby hasn't gained a single ounce. But he hasn't LOST any! (or has he???) With ds#2 he had jaundice (totally different problem, bear with me) and had to be under the billi blanket all the time, round the clock. This made him very sleepy. And he kept loosing weight. Babies loose during the first few days. At 2 weeks, he was on the border for needing re-hospitalization because he had lost almost 10% of his body weight. His ped is totally pro-bf. She just kept telling me to try and bf more often, and hang in there. We went for weight checks every other day. But the ped had faith that he would turn it around and now he's a chunky 9 month old. If he hasn't lost weight, maybe he just needs a chance to get a little bigger.

I really don't like your peds advice to exclusively formula feed. I might quibble about supplementation, but I understand teh logice behind it. I don't understand the advice to stop bf altogether. If you can't get an explanation from the ped that makes sense to you, look into getting a new ped.

I've had 3 preemies out of 4 DC, and have experienced some of the same problems as you, and BFed all but one successfully. Here's what worked for us with our last DS: I pumped every 3-4 hours, and used gobs of lanolin. I used a standard shape preemie nipple at first. Our ped prescribed Regalan and human milk fortifier. We used a 3 hour feeding schedule because he didn't wake up on his own to eat; when he started waking up for more frequent feedings we fed on demand--it didn't take long. I only fed him 10-20 cc at a time and burped him a lot--he was taking 35 cc total when he came home. You should check with your ped, but I would think a 5+ lb baby should probably getting between that and 40 cc at least. The bottles will cause a lot of gas and make him feel full and even more sleepy. It's a good rule of thumb to burp often when nursing a preemie, because their inept sucking can cause more gas too. I increased the amount that I attempted to feed him by 5 cc every other feeding. I used those volumetric bottles from the NICU because they were soft and could be squeezed a little to get drops in. I would rub the nipple on his palate, and gently massage under his chin to try and stimulate his sucking reflex. This is hard to explain; hopefully you can get a LC to help you. I had no luck with SNSs and finger feeding. As soon as he was sucking well, I switched to the NUK nipple because it require a little more effort and more closely resembles the shape of it's flesh counter-part when compressed in the mouth. (I tried the Avent and other gimmick nipples and the NUK is the one that worked the best for us--he transitioned from bottle to breast very easily) However, he still needed the HMF so I couldn't nurse yet. I did put him to the breast at least once per day, and gradually increased that time as he grew and became stronger. It seemed like an eternity, but it was really only a few weeks before he was BFing full time. Just don't let small set-backs discourage you. Within a few days of regular feedings, you should notice a big difference in his level of alertness. The cracked, sore nipples should heal in a few days. HTH. Good luck.

Well we just finished a feed in which I nursed first and bottle fed second. He stayed latched on for about 9 minutes which is normal for him and came off once he fell asleep. I burped him and handed him to my DH who had a 1 ounce bottle of EBM ready to give him. He managed to suck back about 1/2 an ounce before he gagged then spit it up.

Here is what I don't get. He is pooping after almost every feed, has at least 4 wet diapers a day, nursing on demand about every 2 1/2 - 3 hours during the day and 3 to 4 hours at night and is content when he is done. How is it that he is not gaining weight ???? We have him propped up in his car seat right now as we are afraid to move him just in case he bursts. He so did not want to take the bottle when he was done nursing. My DH was literally force feeding him.

His next feed is about 9:30 at which time I am going to give him a bottle of EBM. At least this way, I can measure how much he is getting. Note, I did pump when he was done eating and nothing but a few dribbles came out.

Off to hook myself up to the milking machine. ( I am using the Ameda Egnell double pump)

Ow I was there a couple of months ago and it hurt so much! I would nurse down in my bedroom so my two other daughters wouldn't see mommy crying. This was after very sucessfully nursing my older kids.
I would get another dr's opinion on this for starters and a new lactation consultant. I saw 3 before we got things figured out. Our problem was a bad latch, it looked great from the outside but when she would come off my nipple would have a ridge down it which usually means baby isn't getting the nipple far enough back into her mouth. We fixed the bad latch by me using the football hold (better control of where the breast was going) and by me holding my breast so that the nipple was pointing upwards. This "perky" position helped Vanessa get her lower jaw really open. Think of taking a bite of an apple or a big burger, you don't come at the food straight on, you come at it from an angle so you can get a nice big bite
Because of the latching issues, I had cracks that wound up infected. I got a prescri[tion for antibiotics and it improved very quickly!!
Good luck to you!

I don't think 4 wet diapers is good. I've always been told 6-8 or more. The last thing I want to do is give you advice that hampers BFing, but when your dealing with a preemie (even a 37 weeker) you don't have a lot of room for error. What concerns me is that he is jaundice, sleepy, having only 4 wet dipes, only nursing for ~9 m. every 2.5-3 h., and not gaining weight. Since he's already tired, and you offered the breast first, he may be too worn out to eat any more. Not getting anything when you pump doesn't always mean he's getting enough. Most preemies eat more often than a full term newborn because their tummies are so small, and a sleepy baby usually takes longer to eat. 9 m. is pretty fast even for a full term infant--not that it's unheard of.

If I'm understanding everthing correctly, I think your on the right track with trying the EBM in the bottle next time. Some peds scoff at this one, but if it's warm enough, you may want to take him outside in just a diaper a few times during the day to expose him to UV light. Just be sure it's not during peak sun 10 am-2pm and you don't have him in direct sunlight for more than 15 m. each time. It helps with jaundice. If you're going to supplement, I strongly suggest asking your ped about the HMF (they tend to resist for bigger preemies for insurance reasons) and using the NUK if your little guy has a good suck-reflex. I hope your ped gave you some guidlines, i.e., if your baby is taking less than 30 cc every 3 h. CALL! I really hope this is helpful and your little guy starts gaining soon. I also hope you take this for what it's worth. I'm just a parent who's been there, but I can't possibly know your exact situation. Your best source is your ped and your local LLL. I hope you have one in your area and check it out.

I just wanted to say that I have always been confused if 6-8 wet diapers a day takes into account the super duper absorbancy of todays diapers. I use cloth, so I don't know.

The only advice I can really give you is that you need to get a second opinion. Doctors are not people that you AREN'T allowed to disagree with! TELL him that you disagree about the formula feeding exclusivly. Ask why this is his opinion. If he gets defensive, you need to see another doctor, pronto.

My babe was born at 37 weeks, BTW. We had a few sleepyness probs, and my process for waking her up went something like this:

Nurse her for the 6 minutes it took for her to fall asleep on one boob. Sit her up, burp her, google at her, talk to her bounce her a bit. Switch boobs, nurse for another 3 minutes before she fell asleep, AGAIN. Repeat process. It was exhausting.

And if he hasn't LOST weight, and he's only 10 days old, I don't see why the doctor is making a huge big fuss about it. It really sounds like an unsupportive doc to me.

Wow. You just described my baby to a tee!

She was born three weeks early, was severly jaundiced (we had to do the billi light at home)very sleepy, and STILL only nurses for about ten minutes. (I was also GD)

My first advice to you, is to change ped's. Now. If it weren't for our Ped, I probably would have given up bf'ing Gabby after a week.

Jaundice tends to make babies very sleepy, and they don't want to wake up to nirse. Therefore, they don't gain properly. (Is his poop green?)

I honestly think that if you get the jaundice out of his system, he will start to gain weight.

Has he not gotten back up to birth weight or has not gained anything since you left?

Are you nursing on demand and through the night? Would you consider pumping instead of giving formula? Perhaps taking fenugreek to increase your supply?

I would second the lanolin suggestion and maybe even a nipple sheild.
I wouldn't give up on bf yet. Maybe you could get a SNS (supplemental nursing system) and put formula in it. If you aren't familar with it here is a link
It would allow you to keep nursing and to make sure he's getting plenty to eat.

good luck to you

Look at his tongue.

If it looks like THIS then he is tongue-tied and will not be able to nurse. He will need to have the frenulum clipped. This is the problem I had with my son.

I would suggest you take 1/4 cup of water and put it in a diaper- this is all that is considered one wet diaper. It really doesn't take much. Then check every hour and see if his diaper is wet. You could also put a tissue in the diaper. But check OFTEN.

Also I would suggest moving to a 2 hour schedule. If you feed him at 7 am, feed again at 9, 11, etc. Or you could even try feeding him every hour. It won't hurt anything except your nipples. I would second or third finding a LLL group somewhere that you haven't been and see about getting soemone to check his latch.

I realize your nipples are sore, cracked and hurting. Mine were the same way. After every feeding express bm and rub on nipples and sit topless in front of a window that has sunlight coming through so that your nipples are exposed to light, if you can't do that sit under a bright light. It helps to air dry them. After you do that then put Lansinoh on. My dd has only eaten for 5-7 mins since she was born and she was 19lbs 10oz at her 9 mos. Triple her birth weight.

And last find a new pede. This one sounds very ignorant about bf'ing. Find one that will work with you, maybe a woman that has bf already.

Good luck and keep up updated!!

Oh and I forgot the sleepy part. My babe was really really sleepy too the first 3-4 weeks. I had to constantly get a cool wet washcloth and put i on her neck, cheek, back, etc. Undress baby and put skin to skin. Co-sleep. Gently blow in his face. Try everything you can to wake him up and latch him back on. Even if he only stays awake for 2 mins.

I just got off the phone with Brandon's ped. His bilirubin levels are back to normal so it looks like the jaundice is finally gone.
I also told him that I was not going to be supplementing with formula only. I have 48 ounces of EBM stock piled that I am going to use up first. His response - "That sounds great". I was like, ??? His tune seems to have changed considerably since I was in his office yesterday. Giving him EBM was not one of my options.

I really do wish that finding a new ped was an option that we had. I live in Canada, Ontario to be exact where there is a huge doctor shortage. Because my dd Kayleigh was a patient of his he was able to take Brandon in otherwise we would have been left to run to the pediatric walk in clinic anytime something was wrong.

I have been in contact with our local health unit and they are sending out a different LC to my house tomorrow morning. I have also gotten the contact name of the LLL gal in my area. They are actually holding a meeting tonight that I am going to attend.

Now as for his feedings, last night he took 2 full ounces of EBM then nursed for an additional 8 minutes when he was done. I had to wake him up for both his night feeds which were breast only. Out of his two feeds this morning, the first was breast the second was bottle. Only problem is, his bottle feed was a measly 1.5 ounces. I stopped to burp him which he does wonderfully just like his and he refused to take anymore. After 10 minutes, I managed to get him to suck back a little bit more before he gagged and spit up. In the 30 minutes since I have fed him, he has spit up twice, something he almost never does. I think I am going to wake him up after the 2 hour mark and try to feed him again.

Thank you for all the wonderful information you have provided. It is nice to know that I am not alone in all of this.

I pumped exclusively for my son for a whole year. He had very different issues from your son (refused to latch), but I just wanted to say that it is very possible that if you just keep pumping for a couple of weeks, the baby's mouth will grow, the latch will be better, and he won't be so sleepy.

Just concentrate on maintaining your supply as best you can using both pump and nursing, and I bet in 3 or 4 weeks it will all be normalized.

You have a HUGE advantage that you've already successfully nursed one baby.

Oh and P.S.--advice to switch to formula for a whole week shows a total lack of understanding of nursing, so take the pede's advice with a grain of salt.

If you need any info about exclusive pumping, PM me.

One more thing--Rosie was REALLY sleepy. Like cosmically sleepy for about two weeks. We had to strip her naked, sponge her down, flick her feet, and dunk her hands in water to make her wake up to nurse. She also only nursed for about 7 minutes per feeding.

She was not a preemie and gained fine, but I just wanted to tell you that your baby is not the first to be so incredibly sleepy! You just have to be careful about your son's particular special issues and all will be fine.