I know it is incredibly hard but your efforts will pay off..................more
I can understand how nerve wracking it must be to try to trust that your breasts can produce enough milk after difficulty with bf.
I agree with you that a large part of it is habit for both you and the baby.
The best way I can tell you to do this is thru the gradual method in the post that Rhonda gave to you. Start by recording all the bf, all the formula given, and all the poops and pees. Then set it up with the ped to come in for a weight check once per week during this transition. If you see the baby is gaining adequately during the reduction of bottles and increase in bf that should reassure you the baby is doing well.
Even if he doesn't seem satisfied after time on the breast try to gradually reduce the amount of formula as described....gradually being the key! Here's that information again.
If you aren't already I would highly recommend that you start to pump to try to make as much of the supplement to be breastmilk as possible. This will help to increase your supply and encourage the baby to do better at the breast. Get an electric RENTAL pump with a double kit to maximize your pumping. Here is a link to pumping tips too:
http://boards.parentsplace.com/messages/get/ppbreastfeeding98/15/7.html
Every ounce of formula you give the baby is teaching your breasts not to make that amount of breast milk. If you give 10oz a day of formula your breasts will make 10oz less than your baby needs, unless you are pumping 10oz. (and of course if you were pumping 10oz you would be giving that instead of the formula) The breasts know how much to make by how much is taken out of the breast. Even if the baby is on the breast for hours, if he is given formula he will just take less at the breast. He will not take more from the breast until the formula is reduced.
One thing that would be important for you is to distinguish between nutritive and non-nutritive suckling. It's ok for the baby to be on the breast for 30 minutes if he is effectively suckling but many times the baby is just sort of hanging out, not sucking productively and that tires mom and is not helping the breastfeeding situation much. Hopefully the LC showed you the how to tell the baby is no longer being effective at the breast and you should remove him and switch at that time. Put him on the second breast as long as he is effectively suckling. As soon as you can no longer get him to suck effectively on either breast then offer the supplement if he is still fussy. If he is not fussy don't give the supplement. If he fusses a few minutes later try the breast again and if he sucks effectively let him bf. Only offer the bottle when you can not get an effective suck at either breast and he seems to be asking for more to eat.
The fact that he took 4oz after the breast does not mean he did not take lots from the breast. Babies will often take large amounts from bottles after taking large amounts from the breast.
Do not drop the supplements suddenly since that would put your baby at risk for not gaining and would not give your breasts a chance to make up the difference. But if your baby is bf well what you need to do to increase the supply is slowly reduce the supplements.
Here's the method I use with moms in similar situations as yours...understand this is only an example and you should be closely followed by your pediatrician and hopefully an experienced LC too.
Start recording the amounts you give via the bottle and total it each day so you know how many ounces per 24 hours you give via the bottle, record how much is ebm and how much is formula. Also, record the wet and soiled diapers. As you increase the breastmilk and reduce the formula your baby will probably start to poop more since breastmilk will loosen the stools. This will be a positive indicator that you are producing more milk and the baby is taking more from the breast.
After you have an idea how much he gets each day via bottle start to systematically reduce that amount, starting with reducing the formula first(reduce the ebm via bottle last). So, for example: if the baby gets 10oz of formula and 4 oz of ebm per 24 hours via the bottle his 24 hours total is 14oz of supplement. You should of course continue to put him to the breast as much as possible during this process, at least 8 times in 24 hours. On day 1 to day 3 give him only 13oz via the bottles in 24 hours, give whatever you have of ebm and make up the difference with formula..so it might be 4oz of ebm and 9oz of formula. Don't give more keep putting him back to the breast if he needs to eat more. If his diaper count does not reduce from what it has been, on days 4-6 give him only 12 oz of milk in bottles per 24 hours. Say you have 5oz ebm and 7oz of formula each day. Again if the diaper count stays the same or more drop more from the daily 24 hour total of bottled milk, and you can start to increase the rate if it is going well for example to 10oz on days 6-7, maybe 6oz would be ebm and 4oz of formula. Continue to reduce the daily total in the bottles by about 1-2 ounces every 1-3 days as long as the diaper count is good. When reducing the 24 hour total you can reduce the amount in each bottle or reduce the number of bottles or a combination of both...the important factor is reducing the 24 hour total. When you get to the point that it is only ebm in the bottles you can drop the bottles much faster. This is a flexible process, you can reduce the amounts in the bottles faster if it is going well and the diaper count and weights are good or reduce more slowly if it seems as though the diapers are dropping and the weights are not as they should be. But you must keep good records so you know where you are in the process.
I hope this method was clear. You should also get the baby weighed AT LEAST every week or more frequently as the ped recommends until the transition to the breast is complete and then one more weight check one week after the baby is totally on the breast. That way you will be reassured the baby is "getting enough" through this process and have the confidence to keep reducing the bottles.
I'm just curious, what did the LC find as the cause of the weight gain problem and what sort of interventions did she recommend in addition to the supplementation? Is she following up? Did your LC discuss the posibility of supplementing at the breast with a special device?
If you need some help in setting up a reduction plan get back to me with exact amounts of bf, bottles of formula, and bottles of ebm, wets and poops per each 24 hours and I can suggest a plan for you.
I know you are very tired, but don't forget fatigue is a normal part of being a new mom even when everything is going well. Some of your fatique is not related to the feeding problems. Most feedings take about 45 minutes, so your time frame is not excessively long. I usually tell moms to plan about 30 minute for the bf part of the feeding, about 15 minutes for the bottle feeding part and about 15 minutes to pump with the rental pump and double kit. Then they should clean the pump and set it up for the next feeding and lie down. Others should be cooking and doing the housework while you work thru this. Don't be afraid to ask for help.
Keep me updated and get back with questions.
Warmly, Kathy
