Breastfeeding/Lactation Consultant

I don't blame you for feeling frustrated. Using the SNS is not what you planned for your bf experience. Gadgets can be mighty helpful but also detract from what most moms want for bf.

I have seen baby's become 'attached' to the SNS. I think it's b/c of the faster or more consistant flow. Also, if the baby isn't sucking well they can get the milk from the tubing without sucking correctly at times. Sometimes they suck on the tubing like a straw.

The necessity of taking the two weeks at work also exposed her to the faster, more consistant flow of bottles which may have contributed to the problem

Tell me how many times per day is the baby feeding. How many ounces per day is she taking via SNS. Divide it up between ounces of abm and ebm.

A few thoughts on weaning back from the SNS is to follow the general guidelines suggested in this post only reducing the amounts in the SNS slowly over time:

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=63103.3

Also, your SNS should have come with three sizes of tubing. If you are using the medium tubing see if you can get away with the smaller tubing for some or all of the feedings.

I agree you may want to hold off on solids for a bit until you resolve this problem as long as she is doing well weight wise and health wise.

Get back with some answers for me and I'll try to help more.

Thanks for getting back to me. First an update and then I'll rattle off some more questions for you.

She is feeding about every 1 1/2-3 hours. Usually my experience has been that the fuller I am at the time (i.e. the longer between feedings), the better the feeding goes, probably for obvious reasons. I try to start every feeding just at the breast (without using the SNS) and then I watch her to see if she looks *done* at the end and for a good 20 minutes afterward.

I have to tell you that I have seen a little improvement over the last few days. She is pulling off less. What I find is that she will nurse for 3-5 minutes on a side, and stop for other reasons (5-month old distractability being the main one). Then I'll offer the other breast and the same thing happens. But I remember reading that as they get older, they become more efficient nursers. So I try to really observe her to see if she really truly is done or if she needs a little more (at which point I pull out the SNS). I use the small tubing only and try to make sure she's latched correctly.. (she does try to pull off and drink it like a straw).

Then after about 50 percent of all feedings, I will pump for about 5-10 minutes.

Currently Sadie gets anywhere from 5 to 8 oz of supplement a day (like I said, I try to read her cues and give her what she's looking for, rather than a set amount). For the past three months, I've been in the habit of waking up once per night and pumping. I usually get about 4 oz, but sometimes 3 or 5 oz depending. So I use as much as possible of my ebm and then the rest formula. If she wakes up at night, instead of pumping, I take her to bed w/me and nurse and the next day I have to use all formula to make up for the missed pumping session.

Also, we may be up against some teething issues. I've been seeing some of the classic signs (slight fever, runny nose, more drool, gum ridge, etc...she is also being hyper sensitive and wailing at the drop of a hat :)) Plus last night, she used me as her personal teething ring <ouch> LOL

The link you attached regarding supplement weaning looks very helpful and I'm going to give that a shot.

Now some questions:

>Is it ok that I'm not giving her a *fixed* amount of supplement? She is stooling normally (every other day) and has about 4-5 wet diapers in a 24 hour period (I usually need to change her every 4-5 hours). I haven't weighed her lateley (since 1/6), but do you recommend doing that soon?

>Currently I'm pumping only once per night. I tried pumping in two separate sessions, but I end up yielding the same amount of milk, whether I pump twice (once at say 11pm and once at 3am) or if I just pump once at 1am. Do you think it would be greatly to my advantage to do two pumping sessions instead of one (more stimulation)??? I only want to do it if its really going to be beneficial to my supply - as it is very difficult from a tiredness standpoint to get up twice per night (I also work part time from home during the day).

>What's the best way to increase my pumping output during my day pumping sessions? When I pump right after nursing, usually I barely even get a 1/2 oz out. Should I wait a half hour or more to pump??? Or is it more beneficial to my supply to pump immediately after the feeding?

TIA for your help.

-Lisa

(P.S. Sadie is actually my dd's name, but I realized I only used my initials on the last post...OOPS)
(P.P.S. - Now I know how those poor cows feel!!!) :)

-Lisa

P.S. I think I confused more than one person by just using my initials "LK" in the last post instead of my name... Sadie is actually my dd's name. :) LOL

Sorry guys.... I'm new at this. :)

I'm glad to hear she is taking the breast at times without the SNS. That's helpful.

Tell me what happens if you don't offer the SNS. Can you get her back on the breast again? What signs are you seeing that lead you to offer a supplement after bf. If she is fussy after a bf session will she take the breast again?

What I might try might take a small leap of faith. Try to bf as much as possible. Pump after as many feedings as you can without worrying about the amount you get. I'd recommend pumping right after feedings rather than waiting. 

Try to hold steady on an amount you give each day with the SNS. Since you are currently giving about 5-8oz try to start at about 6oz per day and hold on that for a few days. Of course make as much of that as possible ebm. Then do the gradual reducing of the SNS supplement from there. So if the baby is ok with just 6oz (meaning the right number of wets) then reduce to about 4oz for several days, etc.

I don't think you need to get the baby weighed unless there have been weight concerns recently.

Don't forget you can put the baby back on the breast as much as you like. Try to resist the urge to give more from the SNS than the days designated amount. Trust your breasts will work and the baby can get the milk from the breast ok.

keep me posted

Usually I assume she's still hungry and pull out the SNS if she does the following during or right after (1/2 hour to 1 hour) a feeding:

>Shows signs of frustration at the breast (after switching sides and burping a few times) and keeps pulling away or moves her arm back & forth in that "Its-not-coming-out-fast enough" way.

>Continues fussing after other methods of soothing have been employed or sucks on her hands frantically, etc.

I've been paranoid for a few months about accidentally ignoring hunger cues, so I might tend to overcompensate now. I really DID misread them in the very beginning, and she slept a lot, which is what caused our problems initially.

At these times, she often gets very frustrated if I keep trying to offer her just the breast, but will take it with the SNS and finish the supplement.

One more thing (I know its a lot of questions). What do you think I should do about my night pumping schedule? She sleeps about 8-9 hours so I'm currently pumping about 4-5 hours into her sleep cycle. Should I do 2 pumpings every 3 hours instead, or just stick to the one? Oh, and by the way, I'm using a PIS.

Thanks you so much for your help. I'm hoping this works. :)

Lisa