Correcting a Weak Suck
Kathy Engleman
Paris France
From: NEW BEGINNINGS, Vol. 21 No. 5, September-October 2004, p. 169
Before Grace was born, I meant
to go to a La Leche League meeting, but never got around to it. I was
thinking about attending one in my ninth month, but since Grace came
nine days early, I missed my chance. However, I had read the Sears'
Breastfeeding Book and felt confident I would have no problems
getting started breastfeeding, especially since Grace's birth was uncomplicated
and completely drug- and intervention-free.
I was under the impression
that babies cried when they were hungry, and that they should be fed
on demand. However, the pediatrician at the hospital told me to breastfeed
every two hours. A nurse told me to breastfeed every four hours. I didn't
know who to believe, and Grace wasn't giving me any clear signals that
she was hungry. Mostly, she just slept. I compromised and tried to feed
her about every three hours during the day, with a slightly longer interval
at night.
When Grace latched on, it
hurt. I grimaced and gritted my teeth. I figured my nipples had to "toughen
up" and that it would hurt until I got used to breastfeeding. Grace
would breastfeed for a few minutes and then fall asleep, so at least
the pain didn't last very long.
About three days after Grace
was born, my milk came in. I woke up with firm, full breasts and I decided
I should breastfeed Grace every two hours to avoid painful engorgement.
We continued this way for a day or two. My breasts never seemed to empty
after a feeding, but they never got painfully engorged, so I figured
everything was okay. I knew that Grace should have five or six wet diapers
per day, but I couldn't tell whether the diapers were wet or not.
Soon, however, an obvious problem developed. Grace began to cry
whenever I tried to put her to my breast. The more I tried, the
more upset she became. After several unsuccessful attempts to latch her
on, I was in tears. My nipples were very sore.
My husband, Steve, called
the pediatrician's office and asked if we could come in for some help.
They told us to come in right away. A weight check revealed that Grace
had lost seven ounces since we left the hospital five days before. One
of the nurses spent over an hour with us, helping me soothe Grace and
get her latched on properly. Not only did she stop crying, but it only
hurt a little bit. She stayed latched on and peacefully breastfed for
at least 20 or 30 minutes—much longer than she had ever nursed before.
Ecstatic, I went home confident that all was well.
Three days later, back at
the doctor's office, I was shocked to discover that Grace had lost more
weight (about three ounces). I was very upset, but determined to continue
my efforts to breastfeed. I asked for a referral to a lactation consultant.
The nurse referred me to a board certified lactation consultant named
Jeanine, and even called her for me. Jeanine arranged to visit us in
our home a few hours later.
When Jeanine arrived, she
helped me improve Grace's latch-on and positioning. She showed me how
to clutch Grace along my side in the football hold. In that hold, it
was quite easy to control the position of Grace's head, which helped
me to get her latched on properly. Jeanine told me to breastfeed at
least eight to 12 times per day, for at least 10 minutes of good sucking
per breast.
I followed Jeanine's instructions to the letter and was
hopeful Grace would gain weight. Unfortunately, when we went to the
doctor's office for a weight check a few days later, Grace weighed in at
five pounds, 11 ounces. She had lost another 4 ounces! I felt total despair.
The doctor suggested gently that it was time I supplement with formula.
I cried. Here was this tiny baby and I couldn't even nourish her!
It was time, once again, for a home visit from Jeanine.
When Jeanine arrived, she
explained to me that Grace probably had a weak suck, meaning that she
wasn't getting enough milk, even with proper latch-on and frequent long
feedings. To find out exactly how much milk Grace was getting, Jeanine
weighed her on an electronic scale before and after a complete 40-minute
nursing. During that feeding, Grace barely consumed 30 ml, according
to the scale. I was pleased that she got any milk at all, but Jeanine
said it wasn't nearly enough. She told me that I would need to supplement,
at least for a while, so we discussed the options.
First, we needed to find
out whether I was producing enough milk to meet Grace's needs. It was
possible I had plenty of milk, but that Grace simply couldn't remove
it effectively from my breasts. It was also possible that my milk supply
was dwindling and was no longer sufficient to sustain Grace. Jeanine
had me pump my breasts with an electric hospital grade pump. I was only
able to express one to two ml of milk, which suggested that my supply
had indeed dwindled.
We had three goals. The first,
and most urgent, goal was to get some calories into Grace. Since I was
only able to express a few drops of milk, it seemed most expedient to
supplement Grace with formula in addition to whatever milk I could express.
Although I was resistant to the idea of giving my baby formula, it seemed
like the smart choice in this special circumstance. Perhaps if I got
some quick calories into Grace while I waited for my milk supply to
increase, she would become less lethargic and sleepy and have more energy
for eating.
The second goal was to rebuild
my milk supply. The third goal was to have Grace learn to breastfeed
effectively. It seemed clear that the best way to achieve these goals
was to supplement Grace at the breast, either with a syringe in the
corner of her mouth, or with a nursing supplementer. After trying both,
I settled on the nursing supplementer. I liked it because it was hands-free
and provided a steady drip of milk in Grace's mouth. I placed about
an ounce of formula (plus those precious few milliliters of expressed
milk) in the supplementer and taped the spaghetti-like tube to my breast
so that the end of the tube would be deep in Grace's mouth. When Grace
latched on, even if she sucked weakly or not at all, the supplementer
dripped slowly into her mouth. If she actually sucked properly, she
would get a faster flow of supplement. That way, Grace could get the
nourishment she needed while being rewarded for good sucking technique.
Since she would be fed only at my breast, she would learn that the breast
is her source (and only source) of food.
At the same time, since all
of her sucking would be done at the breast, my breasts would receive
lots of stimulation to help increase milk production.
After each feeding, I pumped
my breasts for 10 to 15 minutes. My goal was to "empty" my
breasts completely with the pump, and then continue to pump for an additional
five minutes after the breasts were no longer ejecting milk. That would
send a strong signal to my body to increase my milk supply. Of course,
all of the expressed milk would go in the supplementer at the next feeding.
Once Jeanine was confident I knew how to work the supplementer and the
pump, she left me to settle into my new routine.
And so began the most stressful
period of my entire life. During the day, I fed Grace every two hours.
By the time one feeding ended it was time to get ready for the next
one. I had maybe 15 to 30 minutes between feedings during the day. At
night, I increased the feeding interval to four hours, which allowed
me to get some sleep. I used my daytime breaks to quickly shower, brush
my teeth, eat a meal (prepared by Steve), or nap.
Grace showed improvement in tiny increments from day to day;
just enough to keep my hopes up. And her weight gain was
excellent—about one ounce per day.
At about that time, we hit
an important milestone. Ten days into the supplementing routine, I was
expressing enough milk so that it was no longer necessary to add formula
to the supplementer. Although this did not make my routine any easier,
I was thrilled that I had built my milk supply back up from almost nothing,
and that I was now able to nourish my baby 100 percent with my own milk.
It was an amazing feeling of accomplishment, and I felt like a major
hurdle had been overcome. Grace started gaining weight more quickly
(as much as two ounces per day), which also buoyed my spirits.
After two weeks, Steve returned
to work, so I had to manage everything on my own. It was tough, but
I had gotten pretty efficient with the routine by then. Grace was getting
somewhat easier to rouse, and stayed awake more at the breast, but I
still only had about 30 minutes between feedings during the day and
two hours between feedings at night. It seemed like there was no end
in sight, but Grace's almost imperceptible improvements (and her steady
weight gain) kept me going.
Occasionally, while nursing
Grace, I would hear a suck-swallow, suck-swallow rhythm that signified
that she was nursing effectively. I had been listening for that sound
for weeks. When I heard it for the first time, it was music to my ears.
Through all of this, I realized
that Grace had grown accustomed to my "enhanced" breasts.
She would latch on, but didn't start to suck until I turned on the flow
from the supplementer. As soon as she felt the milk on her tongue, she
would start to suck. If I turned off the flow, she would stop. Grace
needed to learn how to breastfeed on an unsupplemented breast.
I started a training program
that lasted for about two weeks. I put Grace on the breast, but delayed
turning on the flow from the supplementer for a few moments (not so
long that she would lose interest and pull away). I would also occasionally
turn off the flow while she was nursing, and if she stopped sucking,
I would pause for a few moments before turning it back on again. Sometimes
she would suck for a moment when the supplementer was turned off, and
I would quickly reward her by turning it on. As she seemed to learn
the association between sucking and getting more milk, I turned the
flow on and off many times during a feeding, and kept Grace on each
breast for several minutes after she had emptied the supplementer.
Finally, Grace seemed to
be nursing well and consistently, even when the supplementer was turned
off. By then I was able to pump more than Grace needed and was starting
to build up a supply in the freezer. After consulting with Jeanine,
I decided to go "cold turkey" and stop using the supplementer
altogether. I didn't want to confuse Grace by giving her some "easy"
meals and some not so easy meals, so it made sense for us to stop using
the supplementer all at once.
During the first week of
unsupplemented feedings, Grace gained two ounces. I was a little disappointed
that it wasn't more, but at least she gained! I continued to pump after
every feeding to maintain my milk supply, just in case Grace wasn't
nursing effectively enough. The following week, Grace gained five ounces.
The week after that, Grace gained 10 ounces.
Ecstatic, I started to ease off on the pumping. I pumped
every other feeding and not at all after the night feedings.
The following week, Grace gained a whole pound! The week after that,
she gained another pound! Finally, we had arrived.
I tapered off pumping gradually
(to avoid engorgement) and then eliminated it altogether. I also stopped
setting my alarm to wake Grace for nighttime feedings, and stopped watching
the clock during the day to make sure she wasn't going too long between
feedings. Grace had not only learned to suck effectively, she had developed
a healthy appetite and was finally able to tell me herself when she
wanted to eat. I could trust her to wake me during the night when she
was hungry, and to let me know during the day when she wanted to breastfeed.
I stopped counting feeding frequency and duration and gave in to the
natural on-cue breastfeeding relationship that so many women are lucky
enough to experience from the beginning.
By this time, Grace was two
months old. She was beautiful, healthy, chubby, and alert. When people
asked me how often I fed her, I blissfully replied, "I have no
idea. I just feed her when she's hungry." No more counting! When
people asked me whether she was sleeping through the night, I proudly
answered, "No, she wakes me up several times to be nursed."
Finally, when Grace was four
months old, I attended my first La Leche League meeting because I wanted
to meet other breastfeeding women, share my story, and hear other mothers'
stories. I found the experience so rewarding that I have continued to
attend meetings regularly ever since, and became a Leader before Grace's
second birthday.
Grace and I have reaped the
rewards a thousand fold for the work we put in during those difficult
two months. She is now three years old and still nursing. She is a very
high-need child, and I don't know how I would mother her if I didn't
have the ability to soothe her at my breast, providing comfort, love,
sleep, and food all from one source. And knowing that she is still getting
all of the health benefits of breastfeeding is hugely important to me.
I feel such an amazing sense of accomplishment at what we achieved together,
and I continue to treasure our breastfeeding relationship intensely
as it grows and changes to meet Grace's needs.
Last updated Tuesday, October 24, 2006 by njb.
Page last edited Sun Oct 14 09:30:56 UTC 2007.
