Baby is not emptying breasts

iVillage Member
Registered: 01-21-2013
Baby is not emptying breasts
8
Mon, 01-21-2013 - 5:31am

Hello :)

I have a lot of trouble breastfeeding our 6 week old son. He is our third kid, the first two I have breastfed till around 1 year of age, so I have a bit of experience with how things go, but with this one I am really at a loss what to do. Thing is, from the begining I could tell that he sucks weaker than his siblings were used to do, I know that he latches correctly, but he just does not seem to manage to extract the milk that well. First two weeks we tried to keep to breastfeeding exclusivelly, which did not go that well, as he did not gain any weight and hovered at the lowest point after the birth. Then we decided to start suplementing, and there I can see that the issue is his lack of effort to get the milk out - I noticed that I pumped lesser amount (I did try to pump to increase milk suply, even though now I think that was not an issue), also after breastfeeding he drinks the full amount of what he should from the bottle, as if he had nothing from the breast. It is rather frustrating, since breastfeeding now turned into more of a snack and nap, and real feeding goes through the bottle - and now he is gaining well. I thought well, ok, he will gain a bit, then maybe he will have more energy to feed from the boob - nope, he just seems to be not a big fan of sucking (he is uninterested in pacifier as well, when our first two kids were ready to suck on anything that ended up close to their mouth). Keeping him hungry does not work either, since he either cries his lungs out and spits the nipple in frustration that the milk is not dribling itself, or falls asleep after the tantrum and does not drink from the breast either... He does not have trush, actually it does not seem to be any logical reason why we have such a huge issue breastfeeding.

Any help/advice how to make lazy baby work harder? I would like to exclusivelly breastfeed, but pumping 6 times a day does not seem like a very enjoyable experience, besides that I have sensitive skin and from so much regular pumping with the pumps my breasts tend to get sore, so I have to do it by hand (which I am fairly good at after two first kids, but still). And I also still have to care for the older children, so the life can't just stop and evolve around breast milk for a year.

iVillage Member
Registered: 12-21-2009
Sat, 02-02-2013 - 7:34pm

I’m glad to hear you’re making progress. It sounds like the baby likes the faster flow. You might really see some improvement with continuing to take him off when he’s not sucking effectively and ‘teasing’ him with some bottles doing the breastfeed, small amount of bottle as needed, more breast, more bottle etc.

Don’t forget to keep track of how much you give in the bottles each day. That way you can see what your starting point is and reduce gradually from there. I think that will also encourage you as you’ll be able to see the progress. Do you know what you are currently giving per 24 hours in bottles? It would be better if you can increase pumping but even if you can’t you can still slowly decrease the formula you give in bottles. If you gradually increase your body will adjust and make more milk. Pumping just helps the process go faster.

Try to notice when in the feeding he pushes the nipple out. That might give you some clues as to what is bothering him. Is it during a let-down, near the start of a feeding? If so maybe a fast flow is bothering him. Is it at the end of the feeding, maybe the slower flow is bothering him.

By nibling I mean a few short and weak sucks and then sleeping for a minute, then again a few weak sucks. Jaw does not move with that almost at all as much as I can see.

I would remove him if he’s doing that. If it’s the start of a feeding try to wake or rouse him to suck better or give him a little from the bottle and then try the breast again once he’s awake and sucking well.

Sometimes then he either falls asleep for half of an hour - an hour, or gets annoyed and cries from hunger

Do you breastfeed him then when he wakes crying? It’s ok and probably appropriate to go ahead and feed him again then. If he takes the breast great, that will help you increase supply. As he works to increase supply he may want to have ultra-frequent feedings at the breast. If you can hang in there with that it should settle down after a bit of time to allow the breasts to respond and increase supply.

Hang in there, you’re making progress

 

Warmly,

Kathy Kuhn IBCLC

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 01-21-2013
Fri, 02-01-2013 - 7:47am

hey and sorry for not getting to this sooner, but you know how it goes, some weeks are just a blur. :)

We are still strugling with the feedings, the good news is that at least milk suply is not going down and slightly crawling up even, the bad news is that we are still far away from being anywhere close to suplementing with breast milk only. I try to focus on increasing milk suply for now with pumping and see if that helps with his feeding habits. I am also trying to eliminate the bad breastfeeding habbits, by removin him from the breast if he is not doing anything useful there, which I think is helping a bit, at least if I start breastfeeding when he is still not very hungry. Also messing up his bottle sessions seems to help a bit, in a sense, removing the bottle and giving it back, making him search for it and so on, so he gets unused to plug-and-milk-flows-free kind of thing.

The red questions:

The less favorite breast is not nessesarily flowing slower, but it is bit different than the other one. The less favorite one seems to have more thiner streams rather than the one thicker one (that's how it looks when I pump), also when I pump the milk flow stops more abruptly from it. I had inflamation in it with the first kid, nothing bad, just too much milk gathered, but since then it seems to produce less milk than the other one, and a bit harder to empty.

With the finger, with the tongue he does that kind of wavy movement and I did not get it to push the finger with the tongue. But what he sometimes does with the breast - he breaks the vacuum, pushes the nipple a bit out, so he has only nipple in, and not the rest, which then I break up, as it is a wrong latch as much as I understand. I think he is a bit particular on what he wants to suck, by now he almost never wants to suck on the pacifier, and would rather suck on his fingers...

By nibling I mean a few short and weak sucks and then sleeping for a minute, then again a few weak sucks. Jaw does not move with that almost at all as much as I can see. Sometimes then he either falls asleep for half of an hour - an hour, or gets annoyed and cries from hunger.

iVillage Member
Registered: 12-21-2009
Thu, 01-24-2013 - 9:31pm

No there is really no research comparing bottle nipples to show which one is best when breastfeeding. It would be nice if there could be one that would not have the potential to interfere with breastfeeding. We usually recommend slow flow nipples but I have to acknowledge that there is no industry standard for slow flow vs faster flowing. So it’s possible one company’s slow flow is faster than another company’s fast flow. I think the opinion of most LC’s is that the best we can do at this point is recommend a slower paced feeding style to allow the baby to have somewhat better control over the flow of milk or a slower flow similar to the breast. Another issue with bottles is the sensation in the baby’s mouth. A baby knows to suck when they feel the breast in the roof of the mouth. When a bottle is in the mouth it’s usually much firmer than mom’s nipple and therefore sometimes babies have trouble b/c the breast is softer or the nipples are shorter than the bottle. I remember one bottle company developed a bottle that actually looked like a breast and was supposed to feel like the breast in the baby’s mouth. It was a huge failure and dripped faster than most slow flow bottles. So there’s a project for you………..haha………come up with a better bottle.

Anyway back to your issues.

You’re right if your nipples aren’t sore the latch is probably ok. It’s also reassuring that the shape is normal when the baby is done the feeding.

Does the ‘least favorite’ breast seem to flow faster or slower than the other side?

Do you think he’s tongue thrusting (pushing his tongue out) when he does the popping off and on thing?

See if he’ll suck on your finger, skin side up nail down on the tongue. Allow your finger to go to the back of the roof of the mouth. When I do this my finger generally goes in the baby’s mouth to my first knuckle. Feel if the baby’s tongue cups the finger like a hot dog bun around a hot dog. You should also feel a sensation like the baby is drawing the finger into the mouth or a little wave like motion of the tongue from front toward back. Slide your finger in or out a little from that position to see if it changes the baby’s suck. See if the baby seems to push your finger out at times. If the baby is pushing your finger out get back and I’ll try to give ideas to help with that..

When you say nibbling do you mean the baby’s suck is sort of shallow, short, or fluttery, rather than the jaw moving up and down very widely and rhythmically?

If you are able to get enough milk with hand expression, that’s fine to use rather than a pump. However, it would be best if you could use all breast milk as the supplement rather than formula b/c when you use formula and not breast milk you are encouraging your supply to dip and that will likely create more difficulty moving toward all breastfeeding.

If the baby is just nibbling or flutter sucking the compression really might help. I would tend to remove the baby from the breast if he’s not doing anything effective and use that time to express milk from the breast if you can. Also, when a baby knows how to breastfeed effectively at times and then other times does stuff that isn’t effective it often helps eliminate the ineffective behavior if the baby gets removed from the breast when not effective.

Usually when moms are having difficulty with breastfeeding and needing to supplement I recommend expressing milk after each breastfeeding session to keep the supply up. This would apply to pumping or hand expressing.

I agree that the breastfeeding should occur according to the baby’s desire to breastfeed, it’s just that if he’s spending a lot of time flutter sucking, nibbling, your supply might do better with expressing milk during that time. The more milk you take from your breasts the more you’ll make. If you increase the frequency of milk expression you might initially get less at each expression time but overall your daily total will increase over a few days to a week. So more frequent vs longer pump/expression sessions, will work better to improve your supply. As your supply improves its possible the baby’s suck will also improve.

If he is screaming for a bottle, try to give him a smaller amount than you usually would and then try the breast again after a bit of the bottle. So you can feed breast, a little bottle, breast, a little bottle, etc. That way you might get him to take more breast and less bottles gradually.

It sounds like you are trying to let the breasts get fuller b/c he breastfeeds better then. But if you express/pump after each feeding your overall volume will increase and he’ll likely do better overall.

See if you can stick to a similar amount in the bottles each day rather than giving lots one day and not much the next. That will make it easier to cut back gradually.

Get back when you can and answer the questions that I have highlighted in red. I’ll try to help but I’m really sorry you won’t be able to see an LC since that would really be the best. Maybe check with the hospital where you delivered to see if they have a nurse who is especially experienced in helping with breastfeeding.

Warmly,

Kathy Kuhn IBCLC

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 01-21-2013
Thu, 01-24-2013 - 3:18pm

Thanks for the answers. :) I looked through the links, compression seems to be something we could try, I got the principle, now just will have to practice a bit and see if that helps over a few days. I am also wondering if there is any brand of bottles which would simulate the breastfeeding more than the usual bottle (we use Avent ones atm) - one would think someone should develop some kind of magic bottle which would not screw up breastfeeding in the first months.

LC is not going to happen unfortunately - I checked - and since we are stuck here at least for another year due to the work commitments, searching up things online seems to be the next best step. :)

About the latch, I still think it is ok - I do not have the nipple sores (actually mild discomfort was gone in a week), it feels comfortable, nipple is in normal shape after the breastfeeding and so on. The only thing that might be somewhat of an issue, is that the baby tends to break vacuum and spit the nipple, then latch again, rinse and repeat. He started doing that on his less favorite breast around age of 2 weeks and after a few days he started doing it with the other breast as well (that's before the bottle, the less favorite breast). At first I though he does that when there is not enough milk (as it looks like what my other kids used to do when the breasts were empty, and they needed more milk, during growing sprees usually), he also does do similar things with the pacifier, take, suck three times, spit out, cry to get it back, rinse and repeat.

I do not think that the tongue is an issue actually, he can stick his tongue out of his mouth (very annoyingly when I had to give him his vitamin D in the first weeks), so I suppose it is ok, also he has it curled up quite well, when I check if he has to burp.

He was inclined to nib instead of normally drink from the beginning though, and it seems that instead of unlearning that and starting to drink more, he went the opposite way and started to nibble more. It is really frustrating, as sometimes he can have a perfectly normal breastfeeding session, but that is rare and far in between. I do not expect him to drink fast and efficient as the older baby would, but I have to make him unlearn the nibbling somehow.

Regarding the pumping, the issue I have is that pumps make the nipples sensitive after a few days of use, and that interferes with the normal breastfeeding - it is ok for solving the overflow issue so now and then, but not when I have to use it for prolonged time. I had the same issue before, for that reason I looked for a method of expressing the milk without a pump (I place the breast in a cup, with the aureola touching the cup wall, and pressing with a thumb down, works really well once you get a hang of it). Since my goal is to sort out the breastfeeding rather than exclusively pump, I would rather avoid sore nipples issue. Also from my past experience I get the same amount of milk out with a pump and by hand, just by hand takes a bit longer, obviously, since I cannot do both boobs at once, and strains the thumbs a bit.

About how many times per 24 hours baby breastfeeds, that sort of depends. He gets one night feeding of formula or my milk, depending if my milk is available, for the rest we stick to 5-6 more feedings in the day. By that I mean the big feedings, which usually involve the supplementing with a bottle. In between there usually are another 2-3 minor feedings, when he either falls asleep without drinking much, or gets distracted after a minute, or just wanted pacifying, generally what I would not call a normal breastfeeding session, but he was on a boob for sometime. Also sometimes he stays on a boob for an hour, or has some sort of cluster feeding of a few hours, usually nibbling, but not drinking properly. I am sorry if it is not very clear answer, as we do not follow a very strict routine (which worked for me in a past, giving the boob when the baby feels like drinking). I am not sure if I should not increase the time between the feedings, to reduce the nibbling issue and encourage drinking.

At this point baby is gaining well, but he is getting somewhere around 5-15 ounces of formula per 24 hours. If he has a more normal breastfeeding day, I pump less times, so he gets more formula as supplement, if he does not cooperate, he gets more of my milk with a bottle. In a bad breastfeeding day I pump around 3-6 ounces per 24 hours, which he normally drinks with no problem from a bottle. It used to be more earlier on, but his nibbling does not seem to do good for the milk supply, time wise he is on a boob frequently, he is just not effective by the looks of it. If I do not pump in the evening, lets say from 9 pm, till 6 am, at 6 am I can get as much as 4-5 ounces from both breasts, but not more, usually closer to 4 or even a bit less. I haven't tried pumping after each breastfeeding in the last 2 weeks, so I am not sure how much I would be getting then, but by the feel of the breasts, probably somewhere around 1-2 ounces per feeding at the best.

The diaper wetness is not an issue, it wasn't even when he was not gaining weight, but without supplementing his weight dropped almost 10% and stayed there. He also was much less alert before formula, the change was significant after two days of extra formula. I think part of the problem might have been his nibbling habit, not getting the fatter milk out, and either falling asleep, or getting angry when the milk flow got slower.

I pump about 2-3 times per 24 hours at this point (it a bit depends on how he was breastfeeding that day). I probably should do more, to see if he gets better with more milk available - I sort of was hoping that putting him more awake and more often to the breast will do the trick even with a nibbling (as generally babies are better at it than the pumping), but it does not seem to work (we tried that for last 5-ish days, no improvement so far).

When baby demands a bottle, he generally goes into an air alarm mode and won't shut up till he gets his milk bottle. He would accept the breast, but spit it few moments later as if there was not enough milk (usually he has been breastfeeding before that already). By that I mean that he has a normal cry, which is well, mostly whining about too hot, too cold, wet, lonely, cramp, whatever, and then the scream my lungs out one, which usually means "OMG I AM HUNGRY FEEEEEED ME NOW!!!!" He does not normally pull that one out if my breast was full before he got to breastfeed, but he still drinks his 4 usual ounces if I give a bottle when he is done with a breast. By done I mean that he starts breaking vacuum after a few nibs at some point, and can go on like that for hours. I do not think that at that point he is actually very hungry, but he also is not fed, and will whine that the milk is not flowing well enough (so that whiny cry, not the air alarm). If I really cannot play with that spitting at that point (there still are 5 and 3 year olds in the house), sometimes he would settle for a pacifier and a rocking in his child carrieer, which makes me think that if I breastfed instead, it probably is a comfort that soothes him crying rather his actually getting fed.

iVillage Member
Registered: 12-21-2009
Wed, 01-23-2013 - 8:23pm

Ugh, mommy, I’m so sorry you’re having so much trouble. I agree with Dana this type of issue really warrants a visit to an experienced lactation consultant. Does the hospital where you delivered have one? If so, maybe she can see you or refer you to someone in your area. Also, check your local La Leche League.

Here’s how to find an LC:
www.Ilca.org

Sometimes if a baby isn’t latching well it can cause a poor suck. Again that’s something best evaluated by an LC in person but in the meantime here’s some information to help you begin to check your latch:

How do I know my baby is latched correctly?

http://www.ivillage.com/breast-feeding-latch-information-ivillagecom/6-a-127400

Description of latch:

http://forums.ivillage.com/t5/Newborn-to-6-mo-Questions/Description-of-latch/m-p/116388185/highlight/true#M129660

Sometimes when babies get used to bottles they don’t do well on the breast. Your instincts are good, sometimes if the baby isn’t gaining well that may impact his ability to suck well. However, even as a baby starts to gain well sometimes he may have gotten so used to bottles that he doesn’t do well at the breast.

Some of these tricks to help babies transition to the breast from bottles may help if it’s related to a preference for the bottles:

Bottles to breastfeeding

http://parenting.ivillage.com/baby/bbreastfeed/0,,b0z780pm,00.html

Weaning from supplements:

http://parenting.ivillage.com/baby/bbreastfeed/0,,9w8tjqsd,00.html

I’m adding this refresher on how to judge if the baby is getting enough milk

Is my baby getting enough milk?

http://parenting.ivillage.com/baby/bbreastfeed/0,,8rr83zjm,00.html

Remember it’s important not to judge how the baby does at the breast by giving a bottle after. It’s not uncommon for a baby to drink a bottle after taking enough milk from the breast. Babies have less control over the flow from the bottle so they are often drinking from the bottle b/c it flows so fast, not b/c they ‘need’ the milk.

It’s also common for babies to cluster feed. So it’s ok if the baby breastfeeds and wants to breastfeed again very soon. That’s an expected pattern for part of the day for most babies.

Here’s a description of an expected breastfeeding routine.

http://parenting.ivillage.com/baby/bbreastfeed/0,,8n69dpmw,00.html

I think the reason your breasts feel full may be because you don’t have a high quality pump. I’m interested to know more about your problems with a higher quality pump. A high quality pump isn’t necessarily ‘stronger’, just better. So do you feel the rental pumps were more uncomfortable? I worked with a mom who had a rash from the pump. She did well after she saw a dermatologist who prescribed steroids to reduce the inflammation.

When working toward exclusive breastfeeding it’s important to pump enough to supply all of the baby’s milk as expressed milk to ensure the supply is adequate. So resolving the pumping issues would likely be a big help. Again, seeing an LC in person would be the best way to help with that.

Do you fit into your pump flanges ok? The pump flange should fit your nipple the same way my wedding band would fit on my pinkie finger (with a little air space on all sides).

I’m not sure I clearly understand the baby’s feeding routine. Sorry for more questions but can you tell me:

1.       How many times per 24 hours the baby breastfeeds?

2.       Is the baby gaining well at this point?

3.       Does the baby make at least 5-6 wets per 24 hours

4.       How many ounces of formula does the baby get per 24 hours?

5.       How many ounces of expressed breast milk does the baby get per 24 hours?

6.       How many times per 24 hours do you pump?

7.       When you say the baby demands extras in the bottles, will he ever take the breast at that point? Will he settle other ways?

8.       When expressing your milk do you mean you use an Avent hand pump or you hand express (meaning just taking the milk out with your hand, no pump)?

Breast compressions are used like this. When the baby is breastfeeding, squeeze your breast when he pauses. Just cup your breast near your chest wall and squeeze and hold a bit and then release. Keep doing that whenever the baby slows or pauses as long as it keeps the baby sucking well.

Read the links and give me your impressions and let me know if that helps give you any other ideas and please see if you can find an local LC or even consider a bit of travel to meet with one.

Warmly,

Kathy Kuhn IBCLC

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

Community Leader
Registered: 06-10-2008
Wed, 01-23-2013 - 2:04pm

Breast compressions might be helpful as a way to keep the flow going a little more quickly to jam some milk into him and keep him interested longer. Here are a few links that might be helpful to you to understand how to do compressions: 

http://www.nbci.ca/index.php?option=com_content&view=article&id=8:breast-compression&catid=5information&Itemid=17

http://www.youtube.com/watch?v=HJrBRYxDNSE

The frequency that he's currently nursing feels pretty light to me as well. Is there an option for you to offer the breast more frequently? Most infants need to nurse at least 8 times per day.

Are you sure there are no LCs in your area? Here's a directory you might want to check to make sure there's no one local who could help: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432  Also, might there be a La Leche League group in your area? Here's a place to check that: http://www.llli.org/webus.html

How much formula are you currently needing to use? Is everything on track with weight gain and diaper output at this point? How much are you able to express from your breasts with the hand pump? Most moms whose babies aren't nursing well do need to maintain their supplies using a double electric pump.

Finally, (sorry for all the questions!) do you know if baby has ever been evaluated for tongue tie? Have you ever noticed if he is able to extend his tongue beyond to lower gum ridge? That could potentially be a reason why he's not able to transfer milk terribly well.

Hang in there!

Dana

 

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iVillage Member
Registered: 01-21-2013
Tue, 01-22-2013 - 12:43am

Sure, about the questions. :)

Nursing schedule for now is more or less this:

5-6 am for about 20 min if he is willing to cooperate, otherwise pump to keep up milk suply. Sometimes he still is deep asleep at 6 am, and then is when I have to start my day preparing other children for school. Trying to breastfeed him when he is asleep is a waste of time really (same for night feeding), since he won't drink almost anything and wake up hungry when he otherwise normally would wake up. That's actually normal for our children, the other two were sleeping through the night since they were a month old.

9-11 am. Here I let him nurse as much as he is willing before he gets hungry and starts spitting the nipple. It can happen in 10 min, or in 2 hours, sometimes he will nurse a bit, take a nap, nurse some more. Then usually he will get hungry around 10-11 and demand extras in the bottle.

1-3 pm. This one a bit depends on how cooperative older children are and what we eat for lunch, but I usually get about an hour for brestfeeding, same story, he will nurse untill he gets really hungry.

4-6 pm. Time a bit depends when he was fed last time, usually he takes about 2-3 hours break before he is willing to nurse again. Same story, nurse, get hungry, drink whole bottle.

8-10 pm. After older children are to bed I usually let him have enough time on the boob, which again depends on how hungry he is (and he usually is fuzzy between 6 pm and 11 pm). Sometimes he will nurse up to 10 and then get his night bottle, sometimes he will get annoyed about milk not going fast enough and drink 2 bottles in that period of time.

He still wakes up between 1-3 am for night feeding, though wakes up is a big word - he starts peesking so I cannot fall asleep, but to wake him up for real I need to put his butt under the water and that helps for like 5 min. So he sleep drinks a bottle and goes offline till 6-7 in the morning.

Also between those feedings I usually pump at least twice a day. Trouble is, I can feel that there is milk left in the breasts after he is "done" and demands his extras, and if I do not pump, eventually I end up with too full breasts. Normally I pump in the evening (not to have to do it in the night for the too full breast issue) or in the morning if I haven't done that in the evening, and somewhere during the day when I feel it is too much milk (somewhere between 1 and 6 pm usually). So he gets about 2 bottles of my milk and the rest formula, plus whatever he manages to get himself from the breast. I thought about maybe keeping the breast full to the point of overflow for all of his feedings and see if he likes that better, but my big concern here is that he won't empty the breast and without pumping, milk suply will dip down, making him even less eager to nurse.

Regarding pumping, at the moment I have Avent, which I hardly use, during the previous children I tried a few hospital grade ones (don't remember the brand anymore, the kind you can pump both breasts at once and rather strong ones, so you feel like a dairy cow a bit hehe). The issue I have is that my skin gets issues if there is something synthetic material rubing it repeatedly, especially if combined with wetness. In a better case I get a rash, in worst - watery blisters or watery wounds. That was also a reason why I did not look for a stronger pump this time, it did not work in the past and I got used to pump by hand using the cup method (actually did it for half a year instead of the evening feeding with our second child, once she slept through the evening feeding).

Haven't used breast compressions. How does that work?

I had LC for the first week, she did not mention anything out of ordinary. LC now is an issue, because the previous one moved and there is none available at the moment in a reasonable distance from where we live.

Community Leader
Registered: 06-10-2008
Mon, 01-21-2013 - 5:51pm

Hi, I'm Dana and I'm the CL of this board. Thanks for reaching out to us. Would it be ok if I asked you a few questions?

- How often are you currently nursing? For about how long?

- How often are you currently pumping? What kind of pump? Pumping should definitely not cause you soreness. Is there any chance you might benefit from a larger or smaller pump horn?

- Do you ever use breast compressions while he's nursing to keep him interesting longer?

- Have you worked in person with an LC at all to make sure that there's not some kind of anatomical issue like tongue tie that's preventing him from transferring milk well? If you haven't, is that an option for you?

Hang in there!

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