progress in nursing

On Tuesday afternoon, we all packed into the car with our new doula E and went over to Beyond Birth for our latest lactation consultation. I'm feeling a lot more confident... here's why:

Shoghi

3 weeks ago, Shoghi was getting almost 3 oz of supplement, 8 times a day, and now we're down to giving him just 1.5 oz 6 times! His weight gain is still at the top of the desired range, so he's clearly tolerating the drops well. His second cold is finally receding; what a relief!

Max

We are in a learning-to-nurse process with Maxwell. He's latching on much better since his second frenulum clip for a posterior tongue tie, so as much as I can, I offer nursing to him. Many times it ends up being nursing to sleep, but increasingly, I'm able to nurse him before he takes his supplement. The new plan is to give him 1/2 ounce formula or donor breastmilk when we have it, then offer to nurse, then give the rest of the bottle. I'm not using the lact-aid with him yet - I just don't think he's ready for it. We were given 3 exercises to do with him to strengthen his tongue and improve his latch. In addition to the above, this time we learned more about infant paced feeding.

We've been learning about this and bottle position for a while - it really seems like it's one more way to really engage the baby's instincts about hunger and eating. The more I learn about it, the more I eonder if there could be a connection between typical bottle feeding (baby lying down/milk pouring into mouth) and later eating disorders/ obesity. Here's a snippet about bottle position:

To avoid undermining breastfeeding, it is important to help baby maintain breastfeeding behaviors while he feeds from the bottle. One way to do this is to approach baby with the bottle in a way that makes bottle-feeding similar to breastfeeding. This means that the bottle nipple is not poked into his mouth, when it is barely open. Instead, point the nipple up toward the ceiling and lay the side of it across the baby's lips, stroking downward, so he has to open widely to accept it. This helps preserve the wide open gape he needs for a good latch at the breast. It may take a minute or two for him to do this, but by consistently waiting for him to open his mouth wide before giving him the bottle, you will teach him what he needs to do in order to be fed. Once he opens his mouth very wide, place the lower part of the nipple on his lower lip with the nipple pointing straight up and then roll it into his mouth so that it goes in deeply.

And here's a bit about paced feeding:

Many mothers also find that babies feed better when the bottle feedings are paced so that they are more like breastfeeding. Bottle feedings are paced by stopping and gently withdrawing the nipple after four or five sucks or whenever the baby expresses tension through facial expressions. The nipple stays in contact with baby’s lower lip, allowing the baby to draw the nipple into his mouth again when he is ready. This helps the baby retain control of the feeding, reminding him to stop when he is full.... Holding the baby so that he is more upright allows him better flow control. There is no need to keep the nipple full of milk; he will fill it when he sucks.

~from LowMilkSupply.org

Seems like the more these basic instincts are suppressed, the more likely it would be that later in life a child might be out of touch with his sense of hunger/ fullness. At any rate, it's surprised me how much there is to know just about giving a bottle, and I really wish I'd known this from the beginning.

Building Supply

This week, we focused mostly on Max's learning, but there are other overall changes, too. I've switched all my herbs to blends from Mother Love Herbs. That makes my life a lot easier: instead of taking 9 capsules 3 times a day, I just have to take 5 now. I've also increased the amount of domperidone I'm taking - I'm almost at the maximum dose.

Last week, after a particularly hard day, I also decided that succeeding at getting the boys to exclusively breastfeed is only going to be possible with more help. I bit the bullet and hired a doula, who is now coming in 3 days a week for 5 hours each time. Combined with my sister's help on Mondays, that means I have 4 days a week of helpers. Of course, Korin helps me every day, but I don't want to have her continue to have to focus on us when her daughter needs her attnetion. It just makes for a (more) tiring day for her! Anyway, the addition of the doula really means that I can pump on those days I have extra help, something I really can't do when I'm alone.

So, there you have it. Steps closer to the goal! I meet with the lactation team again a week from Friday, so I'll update again after that appointment.