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Okay, so I have been exclusively breastfeeding my son for a month now (I'm so proud to have made it this far after our struggles!), and we seem to have hit a barrier that has me completely frustrated and bewildered and discouraged.
Ben is very, very gassy and he has started fussing at the breast over the last few days trying to push out the gas. I think he's gassy because I have a super fast let-down and he ends up sucking down a lot of air when he nurses, he gulps and sometimes coughs and makes choking noises when he first latches on. Up until the past few days we were dealing with this just fine - when he'd pull off, I'd be literally spraying (without touching the breast, my let-down SPRAYS, and it sprays farther if I'm holding my breast), so I'd spray into a towel until it slowed down and then latch him back on. The past few days, and tonight in particular, he has started to pull back while still latched onto my nipple (OUCH!), latch/unlatch repeatedly, and fuss at the breast. Then he latches on lazily and I can hear the clicking sound of him sucking in air. Tonight he was screaming so much at the breast that I had to give him a bottle of expressed breastmilk (not his first, and he has done fine going between breast and bottle), which he sucked down happily with no fussing.
I don't know what to do. I've tried laying in the positions that are supposed to have my milk work against gravity (nursing leaning back, etc), but my breasts are large and just end up squishing his face and he still fusses. I burp him constantly (like every time he unlatches) and he does let up some good burps. I already express the extra milk into a towel so it doesn't spray into his mouth with as much force.
I'm at my wits end, seriously. I do not want to give up breastfeeding, and I don't think I could pump exclusively...but if I have to start giving him a bottle at bedtime to cut back on gas and get him to sleep, that will just be one more feeding I can't do myself once I go back to work.
I'm planning to call the lactation consultant tomorrow, but thought I'd see what you ladies had to say.
I have an overactive letdown too and my little guy gulps and chokes, only it doesn't spray unless there is some suction so the "pulling him off and letting it out into a towel" trick totally doesn't work for me. What I do is pump off a bit before putting him on (I actually have this problem much worse on one side than the other). I just pump off the initial let down, after that hard spray stops I stop pumping. I can pump about 4 oz in less than 5 min this way, who knows what I'd get if I kept going! It makes a HUGE difference and he has no problem initiating another letdown pretty quickly after that but it's more controllable.
The other thing you really should do if you're not doing it already is block feeding. I have found that really I only have to pump initially at the beginning of the block, so I pump and feed him off that boob until he starts to get fussy and can't get another letdown when he wants it and then I switch him, usually 3-4 hrs. They recommend you start at 2 hrs on one side and then switch to the other and go from there. Block feeding is probably the easiest and most useful way of dealing with oversupply/overactive letdown issues. My letdown is MUCH harder if my breast has had several hours to fill up than if I feed off the same breast a few times in 3-4 hrs. My little guy feeds pretty often during the day.
I also have big boobs and I agree that the positioning thing really is difficult and doesn't seem to help much. I gave up on that pretty quickly with no results, he still choked.
We also are dealing with reflux and my little guy has a really hard time giving up the burps - the pediatrician recommended giving him a dose of gas drops (mylicon) BEFORE every feeding. I did that for a while (but no more than every 2 hrs) to get over the really bad hump and have been doing it less and less now that he's better and not as gassy. It sort of prevents the gas from forming as much and seems to prevent it from getting down into the intestines, which in my experience is the REALLY tough gas to work out - but bicycling the legs seems to help that.