Breastfeeding/Lactation Consultant

NAK

Baby needs about 25 ounces in 24 hours. http://www.kellymom.com/bf/pumping/milkcalc.html

SO the rule of thumb is 1 ounce per hour. BM digests in about 2 hours and most babies would nurse every 2-3 hours. (from the start of one session to the start of the next)

Try to keep paced bottle feeding as explained by Kathy here and ALWAYS use the slowest flow newborn nipples with a BF baby.

"The rule of thumb is the baby should take about 2-3oz per 2-3 hours. The amount is good up until the baby is about 6 months old. The breast milk fed baby should not have to increase the amount he takes the same as formula fed babies do. Ask the dc provider to use paced bottle-feeding so the baby drinks slowly and takes an appropriate (not too large) amount. With paced bottle-feeding the baby takes about 5-20 sucks on the bottle then the bottle is taken out of the mouth for a minute or so while the baby takes a break, sucks on a paci or clean finger, then a little more bottle (5-20 sucks) and a little more break, a bit more bottle, and a bit more break….etc. to slow the baby’s pace of drinking. "

As for pumping in general you want to pump every 2-3 hours (from the start of one session to the start of the next) for about 20 minutes or 2-5 minutes AFTER the last drops of milk. This has more on maintaining supply: http://www.kellymom.com/bf/supply/maintainsupply-pump.html

Certainly pumping in the day and BF at night is an option and if you are happy with that, that is fine. That said are you interested in BF during the day? We would be happy to try and help you figure things out. Have you seen a local LC or local LLL leader for BF help? You said baby fusses in the day when nursing. When does he fus during the nursing session? Sometimes that can help pinpoint the problem. Here is some info on fussy nursing: http://www.kellymom.com/bf/concerns/baby/fussy-while-nursing.html

Also keep in mind that you are right at the peak age for normal infant fussiness. http://www.kellymom.com/babyconcerns/fussybaby.html

Follow up with additional questions and we can go from theere.

I would prefer it if we nursed day and night with the occasional bottle of breast milk when I leave the house. I am going crazy with all this screaming. I am constantly crying over the fact that even though I have milk I can't feed my baby. I just want him to nurse and be happy! Here's what I think are the problems:

We have thrush. I tried treating it with gentian violet and it started to work then got worse, then I stopped treating it and it got better, then a week later it was back. I have an appointment with my OB/GYN tomorrow for my 6 week PP check up. I will talk to her about getting medication. He only has one spot on his gums so I really don't think he's in pain.

I have a fast/forceful letdown. When my milk lets down it is quite painful for me and baby often chokes. He pulls off and lets the flow slow down before re-latching. Then he will only suck for a few seconds before he is screaming. He continues to scream after that but I know he wants to eat. I am constantly offering the breast and he will suck a few times then scream. I have to practically force him to eat or he won't. His poo has also been on the green side so I'm worried that he is only getting the fore-milk.

I have not seen an LC because when I was in the hospital they told me there were none available after I was discharged. They also wouldn't let me see one while I was in the hospital because I asked to be discharged early. They said that if I stayed over night one could see me in the morning but not if I left that night. We had no issues with breast feeding until he was about a week old. He is five weeks old now.

Since kellymom says they have growth spurts between 4-6 weeks now I think he might be having one. But I don't know the signs of those so who knows.

I am now thinking that he might be cluster feeding or want to cluster feed. He gets fussy between about 6 or 7 until 9 or 10. Sometimes he gets over stimulated and just laying him down in his bed helps and he'll fuss for a minute then go to sleep. Sometimes he wants us to hold him, pat him, talk to him, burp him, hum, shhhhhssshhh him, whatever it takes to try and calm him. It seems that every night all we are doing is trying to calm him. At this time I am constantly offering the breast and he will latch suck 3-4 times then scream bloody murder. Then 30 minutes later he'll do it again.

I am really at my wits end with this, it has been a month of pure hell trying to just feed him. I don't know what to do at this point. There is a part of me that just wants to give up and give him formula so I don't have to worry about pumping and keeping up a good enough supply to sustain him, but a bigger part of me says no I want to be the only one that can nourish him and comfort him. Am I being selfish? I pumped yesterday and the day before every 3 hours or so and gave him bottles but I also tried to nurse him so I was either hooked up to the pump or nursing or holding a bottle for him. That is hard work! I have other kids that I have to care for so I just can't keep that up. I can already tell that my supply is going down. I was super thirsty all day yesterday and drank a ton of water so I thought I would have a ton of milk and for the first time at night I didn't wake up in a puddle of milk. I was disappointed that I didn't wake up in a puddle!

Thanks for your help. I really do want to keep nursing him but if all this continues I just don't know if I can. I am to the point where I think I have PPD and I know this would be a huge cause for it. Also if my Dr gives me meds for PPD are there any that I can take while nursing?

Just based on your original post (baby cries during day feeds but nurses at night ... presumabely lying down), I thought you might be dealing w/ oversupply/ overactive letdown.

Are you doing anything to address the overactive letdown at all?  Uphill nursing, block feeding?  Have you tried laying down for daytime feeds since it helps him so much at night?

Here's some good starting info:

http://www.kellymom.com/bf/supply/fast-letdown.html

http://breastfeeding.hypermart.net/toomuchmilk.html

http://messageboards.ivillage.com/iv-ppbreastfeed/?msg=39705.16

REad the above and see what you think.  I have had overactive letdown w/ both my girls, and it can certainly pose it's own set of problems.  Do keep in mind you are in peak fussy period for newborns ... they are really just sometimes very fussy, regardless of what's going on or how mom is feeding them.  Don't be afraid to allow the cluster feeding (but do block feeding if you cluster ...).  The block feeding can also help baby get more hindmilk, which can help him to feel more satisfied and begin spacing out those feedings all by himself.

HTH