Please help me salvage (at least some) breastfeeding

[ecuse]

I have a 4-week old daughter who has been exclusively breast fed since birth until 36 hours ago.

She initially thrived, getting back to her birth weight in 10 days but then dropping again slightly and regaining two days later. Community midwives discharged her at 2 weeks old. HV then failed to show up so I had to chase her so the next time she was weighed was at 3 weeks 5 days (Monday) where it was discovered she'd lost weight rapidly, dropping back down below her birth weight by quite a margin (she's now 6lbs11oz compared with 7lbs3oz). HV was worried enough to insist we see a doctor the same day so, as GP refused to see her (not yet registered) we took her down to paediatric A&E, who were worried enough to admit her for 'failure to thrive' (a phrase that made me cry...).

They decided she's fundamentally healthy, but not getting enough milk. They had me expressing every 3 hours then topping up what I could produce (about 40mls) to 68mls with formula, mixing it together and bottle feeding. So each bottle in hospital was about 60% EBM.

I had been struggling with bf, both with pain and with the fact that she wanted to feed constantly, on and off me almost constantly for 6 or 8 hours without really feeding 'properly' or giving good strong sucks. I thought, and was advised by midwives, that she was 'cluster feeding' or having a growth spurt or comfort sucking but it now seems with hindsight she was almost literally starving. I am mortified that I never realised. She also almost never slept for protracted periods; we couldn?t put her down without her waking and demanding food. She maybe slept for a chunk of 2-3 hours once or twice in any 24-hour cycle, with no routine whatsoever.

The hospital discharged us with instructions to continue BF on demand, offering both breasts, then topping up each feed with either formula or EBM as much as she wants after each feed. She?ll be weighed again in a couple of days. I was feeling positive that this was a good plan to maintain BF whilst making sure she has the amount of food she needs.

However since then she?s breastfeeding even worse than before; we can?t get a good latch and she does strong sucks for only a minute or two at the beginning of each breast, thereafter just dozing/nibbling, dropping off the breast, but crying and obviously hungry when she does. My breasts also seem noticeably less full and I?m worried that my supply has been gradually drying up, exacerbated by 36 hours of reduced BF. I don?t know whether she?s not BF because of nipple confusion or that there?s very little in my breast to get out. On top of that, I can only express laughable amounts at home with Medela mini electric pump ? less than 20mls in half an hour from both breasts combined after which it stops. And sometimes nothing. As a result, her last few feeds have been 80-100% formula.

Is there any way I can salvage at least some BF with apparently dwindling supply and latch problems that are getting worse, or should I just make my peace with FF?

Have you rang the NCT or one of the other helplines? This is quite a complex matter for us to adequately deal with online.

Good point, sorry. Was going to call them at a more civilised hour, just wondering whether the combined wisdom of Mumsnetters had anything to add. Appreciate it's not very straightforward, though. Middle of the night woes....

They're 24 hours though aren't they. I would just hate to give the wrong advice due to not being trained and not knowing the right Q's to ask.

One thing I'm sure people on here will ask is whether tongue tie has been investigated. Don't answer until you've spoken to specialist RL support (not just MWs etc. although at this stage their input is still needed)

I can only speak from my experience not from any perspective of training etc but we were in a very similar situation and I'm writing this whilst bf my four month old. At four weeks he was still way below birth weight (7.4 and born 8.1). We were referred to a fantastic lactation consultant who recommended the following 'regime'. Feed every three hours without fail givingbth breasts twice alternately. To start withthis took about 1.5 hours. After each bf I would then express. Usually got half to one ounce max to start with. Would save up each of thr expressed milk to give an extra four oz per day in bottle. In addition we gave one 4oz bottle of formula and when he had this feed I would express. Apparently the ff gve him the energy to bf properly whi h he didn't have before. This was really hard going fo the first week but worked and he began to pile on weight and got back to his birth weight by six weeks. He has gained steadily ever since. We came off the ff at ten weeks. I was also prescribed domperidon which are anti sickness tabs not licensed to improve milk supply butknown for this side effect and this along with the increased feeding saved my supply which had dwindled significantly due to ds 'ineffiecient feeding' . I was told he was 'shutting down' which was helpful in my emotional state so completely understand your distress. I am so glad we persevered with bf, I am stubborn and was determined not to give up and the lactation consultant's advice worked. Good luck.

Orgot to say I switched from a medela swing to an agent manual and it made a massive difference. Still not brill at expressing but can get 4oz on a good day in one sitting with avent - that would have taken hours with swing.

Ecuse - obviously you know you need to speak to/see someone in RL, it is a tricky situation.

In the meantime, things to think about:

• you said bf was hurting & she was on & off a lot, do you think you could both have thrush? You don't have to see white spots in her mouth, sometimes a general tinge of white across the tongue (not straight after feeding though as that's just milk), also possible for the only symptom to have is the pain, did it disappear between feeds? if you counted to 10 just as she latched did it disappear? (ie just a latching on problem/sore nipples getting used to bf)

• other things that can 'up' your supply (allegedly for some of them); fenugreek tablets (from a health food shop), 'mother's milk' tea (available online, try here )

& of course lots of pumping.

• make sure the pumping is efficient though. try out different pumps, often seen the Medela swing recommended on here.

• Now that she's had some formula from a bottle, she will get easily frustrated at the breast as it's harder work to get the milk out. Can you try (not easy i know) to hand express a tiny amount before putting her to the breast so there is some milk there already? Do you feel a let-down? can you get to almost that point then put her on? so there is less work for her to do to get milk from you.

Sure others will be along with better advice than me, but the last thing (the main thing) is do not blame yourself for any of this. Believe me, there will be worse to come in the parenting game (like not collecting your DS from school thinking he's trying to skive off when actually he'd broken his leg for example?!), allow yourself a cry or two (we're still in the post-partum stage remember, hormones are all over the place), but no self-recriminations, ok?

Fave statement about BF: it's natural but doesn't come naturally.
And that includes the babies, they don't know what they're doing either!

Ecuse I posted a load of waffle on the April Postnatal thread and then thought I should actually read your full post on here.

I second the others in that I think it's actually quite a lot for you to deal with, especially when you're in the newborn emotional state. 'Failure to thive' is such an emotive, horrible phrase and it really cuts through to you. It's not suprising that you're feeling so upset. You also must realise that this is not your fault and you mustn't feel guilty. How were you supposed to spot any of this? We all do the best we can and plough on with feeding through the minefield of conflicting advice. Having read your post I can honestly say I'd have done the same thing as I'm not sure what else you could have done in the circumstances. I think you should get hold of a lactation consultant who can come to your house and look at your latch, etc. She'll be able to formulate a good feeding plan that you can follow to the letter. Whereabouts are you based? Your hospital might be able to give you the contact details of one or I'm happy to Google on your behalf if you're feeling a bit frazzled. Equally, I know a very good lady in S London who helped with all my nightmares when we were struggling with undiagnosed thrush.

Let me know what I can do to help.

Failure to thrive is a very distressing phrase. But all it means in your case is that your baby wasn't feeding very efficiently. You were doing everything right by feeding your baby frequently and the feeding pattern you describe is normal and healthy for many babies - it wouldn't necessarily ring alarm bells by itself and if the MWs you spoke to didn't spot a problem there is no reason why you should. Whatever factors contributed to your daughter's weight loss were probably beyond your control.

I'm a bit concerned that the hospital seem to have given you clear advice on how to get more calories into your daughter but very little support for breastfeeding. Speaking to a breastfeeding counsellor on one of the helplines is probably your best bet. If you are still getting pain on latching then if possible find a counsellor who can come to your house and observe a feed. The bf-ing counsellor I saw provided more help in 20 minutes than the 6 midwives who had observed feeds had offered in the preceding three weeks.

Once you have found techniques to improve your baby's latch and position the next thing to do is snuggle up and encourage her to feed as often as poss. She has probably found the last two days stressful too and this may have a short term effect on her feeding behaviour. But like all babies what she will want most is the warmth, nourishment and comfort you can provide.

Mixed feeding works out for a lot of women, but you may want to have a specific plan for doing it (for example once weight gain is resumed for then you can try only supplementing/replacing feeds at a specific time of day).

Please try not to overthink your supply. Feelings of fullness will settle down in the first few weeks. After about 6 weeks I don't think my breasts ever felt full but my DD seemed to get plenty to eat. Expressing does not necessarily indicate how much milk you are producing, and if your baby wants to feed very frequently that can be because she needs extra comforting, or is having a growth spurt. It doesn't mean there isn't enough milk there. So the external factors you describe do not necessarily indicate a lack of supply, and even if that is a problem the solution is the same as for re-establishing feeding, keep your daughter close and feed her frequently.

Oh and be really gentle on yourself. Getting bf-ing established can be a job and a half. It is not important that anything else gets done right now. It will absolutely definitely get easier in the long term.

Very best of luck!

ecuse, your story is very similar to mine (see thread "How to do bottlefeeding")... we were admitted in the hospital last week with DD whose weight was not going up for weeks, did all kinds of tests (scan of stomach, urine infection tests, etc) as well as weighting her up before and after feeding to determine that she has been crying for weeks because I have left her hungry :( I did cry a lot! Same as you, I was told by different "experts" that she is having growth spurs or comfort sucking, or can't fall asleep on her own so she needs to suck until she falls asleep, yet the truth was very simple. What really broke my heart is that she was crying very weakly the days before we were admitted to the hospital, poor little thing :(

I am now breastfeeding, then toping up with formula and then expressing. DD seems much less interested in BF, and clearing not emptying the breasts. She seems fine at the morning feed when breasts are full, but definitely less interested as the day progresses. I manage to get about 10-20 ml per breast after breastfeeding with Medela swing. I was told it is very important to empty the breasts and then pump for 5 min more to give a signal to the breasts to produce more.

I talked to friends to fed their children on expressed breast milk - and I am told that breast milk increases over time even if only expressed by pump (not by a baby). They also said that it is normal to get only tiny amount of milk in the beginning, but you will figure it out with practice. So there is still some hope in our situation. For me the most important advice is to keep calm (easier said than done!)- it really helps for producing and releasing the milk. It's still early days of proper stimulation of the breasts. Most importantly, you now know why DD is crying, and you know how to solve it, and she will thrive from now on. BM is obviously best for babies, but formula is not poison, and we are doing everything we can to get more BM into our babies... Good luck!

Agrumino - you say your baby is less interseted in breatfeeding have yo considered toping up using a suplimentry nursing system rather then bottles? It's a small capilary tube you can attach to the breast (or use to finger feed) this way your baby will get additional milk but also stimulate your breast at the same time. Is supposed to help lession problems caused by bottle prefernaces.

ecuse - it's something you mite want to consider to although you do need reall life help and a good plan to improve things.

Offering a bottle topup is what always seemd to be recomeded for a lot of problem but there are more ways to feed a baby that a lot of people arent aware off.

Thanks everyone, you've said some lovely things and I feel a lot better.

Can kits or anyone anyone help with what exactly a lactation consultant is and how you go about getting referred to one? Is it different from a specialist midwife? I spoke to the breastfeeding specialist midwife briefly in hospital, but she only had 10 minutes to spend with me and didn't say much helpful (although she was very nice) - she recommended I go along to a breastfeeding support session run by another midwife which I'm going to do tomorrow. But I have already been to various community breastfeeding workshops to no avail - everyone just keeps telling me I've got the latch right (when I'm sure I haven't) and that it's supposed to hurt, or she's supposed to want to feed all the time. Is a lactation consultant something different?

Those who have suggested thrush - I wondered that, too. I have intense pain when she initially latches on to each breast - say for the first 10 or 20 sucks, then it settles down into mild discomfort (when we've got a good latch) or pain (when we have a bad latch). The fact that it takes me that long to tell whether we're on right or not is not helping with the state of my nipples! Then as long as we're on right, it doesn't hurt too much during a feed, even feels slightly soothing. But then 10 minutes after a feed I get this 'cold burning' pain in my nipples (a bit like when you've put deep heat on something but more painful) and my whole boob is sore like I've been punched or it's bruised. Can't see anything on her tongue though. My nips are often but not always white at the end - I thought that was dead skin. That's definitely something I'll ask about at the session tomorrow.

Really appreciate the stories of those who have been in a similar position and been able to persevere. I think I'll try to get a hand pump tomorrow and look into hiring a medical grade one. Really helpful to know that pumped volumes can increase too. Even if I have to bottle feed I'd love to get the volumes of formula she's taking down - she's already done two big vomits in 24 hours and she was never a sicky baby before. I'm sure it must be the shock to her system of having a different foodstuff (and so much of it!) when she's used to only BM.

Agrumino - I have done a lot of crying, too, thinking back to all the times she's been crying, suckling and rooting, or waking up 10 minutes after she's dropped off, or when she's been sucking frantically at the initial let down on my breast.

a lactation consultant is a specialist and probably one you will have to pay for and see privately. they are totally different to midwives who seem to have fairly basic training. they should also examine your baby physically for tongue tie etc.

the NCT can hire you a hospital grade pump, hopefully they will have one local for you.

I had trouble both times with my milk coming in and babies losing too much weight etc and it is awful to think of them trying desperately to get food and it not being there. but she will forget this, and although you never forget how it feels, the emotions fade over time.

the pain after feeds sounds a bit like reynauds, google this. I have it and its very painful, but can be improved with management. have a look and let me know whether you think it is.

sorry, typing one handed!

Poor you - I had great success with fenugreek for upping supply, so perhaps get some tomorrow morning. It comes in vastly different doses, so look up the recommended dose on kellymom.com - I can't remember if it is 1500mg or 3000mg.

Good luck, and really, don't beat yourself up. You weren't to know, and now the problem has been caught, it will be solved. Formula is by no means the end of the world (I mix-fed DD1 after similar issues to the ones you're describing, and she is a robust, frighteningly intelligent three-year-old).

ps - another vote for the Avent pump over the Medela Swing. I was terrified about having the same issues with DD2 as I'd had with DD1 but with the better pump and the fenugreek she's not only EBF, I'm putting 200-300ml into the freezer every day.

you can find a lactation consultant here but do try the NCT or other helplines to get the RL help you need.

the white burning nipples could be vasospasm. I have had this both times and the pain has lessened then disappeared with time, as latch has improved and babies have grown.

I hope you get some RL help and work things out, it sounds like you're in a really tough place right now.

I second the vote for a lactation consultant ! They will have more time for you and more experience than anyone else. Also second the vote for fenugreek or alchohol free beer (or anything isotonic) to drink - I went from expressing 20 mls to 150 in a week.

Last but not least, apologies if someone has mentioned this but don't beat yourself up over expressing small amounts at the start - it takes a little while for the body to get used to it and it will increase if you keep at it !

We had no latch to start with at all and I had v little milk - 8 mths later and DS is still being BF, it is all v hard in the first few weeks but you can work it out and you are doing the right thing. Good luck !!

You poor thing, what a worry. It does sound like you might have thrush, your symptoms sound the same as me with DS2, although I have to say I was never sure if it actually was thrush (definitely had it with DS1 and had to virtually exclusively pump for weeks before I could face bfing), and actually it got better with time and persevering with improving latch. I found that applying a hottie or hot water bottle before a feed helped with the vasospasm ( which can be a symptom of thrush, but not necessarily). Other than the pain there isn't necessarily any other sign of thrush.

I always had lots of success with the avent electric pump.

With DS1 we were in SW London and I saw a fab lactation consultant. I could dig out the name if you are in London. I paid a fortune, but she did also do NHS appointments through our GP, but I couldn't wait that long.

I am sure you will be able to bf for much longer than you probably think at the moment ince you get past these problems. Hope your DD has a good night.

You haven't mentioned whether she has been checked for Tongue tie?

She has been checked for tongue tie. One midwife said she didn't have a 'traditional' lateral tongue tie but she might have some reduced movement, but that unless she was losing weight (this was before she did!) no doctor would operate on it. I mentioned this to the paediatrician in the hospital and he said there was no tongue tie. I guess I have to trust them on that, although I have wondered about it because she has a latch that 'looks' good to the observer but feels wrong and shallow to me.

I'm not an expert, but four weeks is still very early days. I don't think I felt completely confident with DD's latch until about six or seven weeks. Now she's 11 weeks and I think I could probably stand up, put my hands behind my back and she'd dangle off the boob like a flamboyant nipple tassel.

Our area offers breastfeeding school - you go along and a community midwife fusses around to make sure you're in the optimum position and so on. Don't suppose you have anything like that near you? La Leche League?

Ecuse - unless your in an area where they are really hot on this tongue tie can be a difficult one to get diagnosed properly, as there can be hidden tie's to.

I think you really need to have a BF counciler observe a feed to see if the latch is shallow.

As no one's put the no's on hear. Hear are the no's for the helplines
National Breastfeeding Helpline
0300 100 0212

NCT Breastfeeding Helpline
0300 330 0771

La Leche League Helpline
0845 120 2918

Association of Breastfeeding Mothers
08444 122 949

You can also find out if you have a local BfN group hear.
www.breastfeedingnetwork.org.uk/support-centres.html
There are other groups other then BfN, if there isn't one near you it maybe there is one run by your local sure start centure but your HV should have this information.

A board certified lacation consultant (which someone has already possted the link for) you would have to pay for BUT some of them are trained to cut tounge tie if that is the problem. They are centainly better trained to spot it then most midwifes I think as it seem's to have gone out of fashion in the UK for having something done about it but that's slowly getting better.

Good luck I hope you manage to get some good help ans support.

my three have all had tongue tie. with my first I wasn't confident to push to get it cut. he took 5 days to latch on and while a bf counselor spotted the tie on day 5, the midwives either claimed he didn't have one, that he'd probably been checked by someone else, or that he had one but it didn't matter. he fed all the time and tracked the 50th centile, but feeding was painful and at 6 weeks I finally found a breastfeeding counselor running a bf group who referred us to get it cut. in the next 2 weeks he fed less, but his weight shot up to the 98th centile (to match his height) and has remained there ever since. he was finally able to suck effectively to get the milk he needed.

with my second I just got a lactation consultant to cut it privately (they aren't all trained to do this, but some are).

I have no idea if your son has tt, but if he does, my experience would suggest that not all HCPs will spot it or know what to do about it if they do, and that finding a breastfeeding counselor or lactation consultant is more likely to be useful.

good luck.

If the latch feels wrong to you that means something is wrong. Observing a feed and telling you it is OK is rubbish if you feel uncomfortable. You need to talk to a proper breastfeeding expert either a breastfeeding counsellor or lactation consultant who will listen properly to your experience and help you to troubleshoot. Obviously tongue tie is something to consider, but a shallow latch may also be the result of problems of getting her into a position where it is comfortable for her to take a decent mouthful of breast, or of her latching on and chomping too enthusiastically too soon.

Helplines are your friend. But in the meantime biological nurturing may help. Google for more into but the gist is you lie down at a comfortable angle with lots of pillows, make yourself comfy, keep the room dim and warm and pop your baby skin-to-skin on your tummy and leave her to root around and find the breast herself. Babies have powerful instincts to guide them to the breast and they may achieve a better attachment without help than with it. I didn't find it practical for every feed (!) but in the early weeks when DD sometimes got very distressed before feeds it was a good way of calming her down (and calming me down).