Breastfeeding advice/reassurance after poor start

[Woody16]

Hi all, would appreciate advice if anyone has been through something similar.

My son is 3 and a half weeks old and we've really struggled with feeding. He was born at 37 1/2 weeks and was low birth weight, 5lb 7. We were in hospital for 3 nights as he was struggling to latch and had to have most of his colostrum given by syringe and also had a couple of formula top ups when he had low blood sugars. He was able to latch by the time we went home and as far as I could tell breastfeeding was going well, however it was agonisingly painful and causing bleeding. Fast forward to day 8 and we were readmitted to hospital as he was losing weight and needed treatment for jaundice secondary to poor feeding. He had a tongue tie which was cut, and I started expressing and giving bottles of expressed milk and formula in hospital (as I wasn't pumping enough milk). For a week at home I expressed 3 hourly and gave him my milk + formula, after trying to breastfeed first, but following the tongue tie division he wasn't able to latch at all. Saw a breastfeeding councillor at 2 weeks who advised a nipple shield, and using it finally managed to get him back onto the breast. She advised to continue top ups until breastfeeding was better established. We had an exhausting week of breastfeeding (he feeds for a minimum of 40 mins), followed by expressed then formula from a bottle, followed by 30mins of pumping to provide for his next feed. It really pushed me to the edge as left almost no time for sleep at all. He reached birth weight at 3 weeks.

Saw breastfeeding councillor again a few days ago and she was really pleased with his progress. He is apparently latching and suckling well. I expressed concerns at the length and frequency of his feeds, which she said was probably cluster feeding due to a growth spurt. She advised cutting top ups to 3 per day and eventually weaning them down completely, and has discharged us.

Obviously that was reassuring but I still feel desperately worried that it will go wrong again and I won't realise. Since cutting back on the bottles he has breastfed almost constantly for the last few days, particularly in the afternoon and evening through til about 4 am. He is feeding hourly most of the day, with one or two longer stretches of 2.5/3 hours. Today I was literally stuck on the sofa all day. He will feed 45 mins- an hour (though is sleepy a lot of this time) and still be desperately hungry and at night will scream if he is taken off the breast, unless he is given a bottle. His face just lights up when he gets the bottle and he instantly calms down and guzzles masses. It breaks my heart and makes me feel like he can't possibly be getting enough from breastfeeding. I've read a lot about cluster feeds and scoured these forums and it does seem like 3 weeks is a common time to feed round the clock due to a growth spurt. So I suppose my question is, does this seem like normal behaviour for cluster feeding or is it possible he's still not breastfeeding properly and is just desperately hungry now the bottles have been cut back? I'm so worried he will lose weight again. I feel like such a failure that he had to go back into hospital before. Also concerned that my supply will dry up if he's not feeding well. I'm only expressing 3 times a day now, to provide some breast milk for the 3 top ups, and I can't possibly fit anymore pumping in when he feeds constantly (today I pumped one side whilst he fed from the other!)

Sorry for such a long post. I'm just desperate to get breastfeeding to work. I never imagined it would be so hard!

[Worriedscaredbutstrongish]

Wow what a busy 3 weeks. Well done for still standing and being able to write so well..

From what I've read and from experiencing issues myself, it all seems normal.

He'll show pleasure at the bottle as it's easier and he'll feel Fuller more quickly, little minx but you're doing a great job. Week 3 is a killer and I remember just giving in and not leaving the bed!!

A few pointers, in amongst all this make sure you're eating and drinking lots. Try to do as much skin to skin as you can as it'll settle him and support your ever changing supply. Remember to take photos of your little beauty as in a few weeks, I promise, you'll laugh albeit hysterically trough sleep deprivation at your worries.

You can always go back for breadth feeding counselling, is there a peer support group near you or hotline?

You are doing so well, relax a little and snuggle that cutey...

Hope that helps

[Woody16]

Thank you, that's just what I needed to hear :) It probably sounds irrational but I've been sitting through my all day feeds constantly second guessing myself, panicking and wondering whether to pack it in and go back to topping up every feed, but I know that would be a slippery slope to giving up breastfeeding altogether. Currently sitting here expressing whilst husband gives him a 4am bottle- we've kept this top up as he's inconsolable at this time of day and I can't stay up much longer without any sleep!

Thanks again. He's got another weigh in next week which will hopefully be good news. There are local breastfeeding groups but haven't managed to get to one yet as they're in the morning and at the moment that's the only time he sleeps so I catch up on sleep too and keep missing the groups!

[MooPointCowsOpinion]

Well done Woody, you're doing amazingly well! He's doing his best to increase your supply by feeding around the clock. I really hope the sleep deprivation eases off soon because after all your hard work you deserve some rest.

I fed my eldest with nipple Shields to 4 months until we managed to get rid of them. The milk transfer isn't quite as good with a shield on so that might explain the longer feeds, but he's still getting all he needs.

Well done again, you're super woman.

[Worriedscaredbutstrongish]

Hope you had some sleep. Have you tried expressing one side whilst feeding the other? Apparently try that works really well.

As for the irrational, yes, irrational, but also normal. God, I used to post on here in the early hours so concerned that lo was not getting any milk whilst my boobs were leaking. You wait till you're complaining that your boobs are too full because lo will have dropped a feed!!!

Well done, use the support, post the irrational and don't weight too often, a content baby(well, as much as newborns can be) with many wet nappies equals a well fed baby!!!

[Monkeymonstermum]

Firstly, I'm not qualified to offer advice but just wanted to give a few words of support. Oh bless you - please don't feel a failure that he had to go back into hospital - that's why they weigh them and keep a close eye on you early on so that they CAN admit them and support you if they need to - much better than not monitoring and not realising they need support.
I know much easier said than done though as we always blame ourselves. I had a little one readmitted at day 5 in renal failure as my milk hadn't come in and we didn't realise as first baby..,,it was just awful at the time (and my husband, who is a doctor, still totally blames himself 4 yrs on for not realising what was going on - which is just ridiculous but human nature I suppose).
The best guide is the wet and dirty nappies so keep a close eye on that. We did get back to EBF for a bit but it involved a lot of pumping, particularly after the night feeds to up supply - it's so tough though. In the end though we introduced a single bottle of formula at bed time between 5 and 6 weeks as his wt gain was slow and although he probably would have been fine it just gave us some sanity knowing he was getting that bit extra and he thrived on it (the HV told me I was going to make him obese as he used to take 13 oz formula at that feed, straight after a BF (!) but he's a solid but lean 4 year old now so pfa to the HV).
Try to follow your instincts as much as possible - if you can speak to the BF counseller again, even if just a phone call for a bit of reassurance would that help? Also, if you can get through it every thing got so much easier for us at 6 weeks - I think as they get older and their mouths are a bit bigger they just feed better and more easily. Also, after 6 weeks hopefully your milk will be established and they are just that bit more robust so can go a bit longer between feeds without you freaking out (again, take note of the wet and dirty nappies and if they seem happy).
Really hope you get some support. I know at the moment it seems like it's never ending but you will get through it - if you need to give formula it is really not the end of the world - and when you're packing him off to Uni in 18 years time there will be no thought of these long hard nights!!
Sending hugs xxx

[Junosmum]

As a previous poster suggested - try expressing whilst he feeds- I can only express if I do it that way, plus it reduces the time doing stuff!

You are doing really well, can't believe that you've kept it up so well!

[tiktok]

:( woody, what a struggling, painful start :(

Not sure who you mean by a breastfeeding counsellor. I don't think it can be someone from one of the volunteer groups as we don't 'discharge' ever....it's up to the mum to drive the length of time of contact. Personally, I don't think you are ready to be 'discharged' from the help and support you have had so far. The proof of this is you are writing to a talk board for input.

Can you keep in touch with the support you have had? You need to be sure your little one is maintaining his weight, especially as you are reducing the formula.

Your description of his feeding behaviour now sounds within normal, but I do think you need the reassurance of an assessment of his weight and well being. I'd expect things to go well from now on, though :)

As an aside, BF which causes bleeding and serious pain is always an indication that things are not going well. Also babies who are born a little small and a little early sometimes take a while to get feeding going well. Someone should have been observing every day so you did not get to day 8 with a crisis :(. It's a testament to your persistence and courage that you met the struggle head on and worked so hard to overcome it.

[Woody16]

Thank you all, really appreciate the kind and helpful responses. Got him to sleep for an hour from 04.30 before needing another feed. From 7 I slept with him in bed with me as he refused to be put down and we both slept for over 3 hours! Luxury! I know you're meant to be careful bringing them into your bed but I was at my absolute limit of sleep deprivation and it was the only way he would settle.

I have tried pumping whilst feeding. I found it a bit too difficult to coordinate but managed to do it for a few minutes with my husbands help.

Monkeymonster, I'm not militantly against formula and don't mind the idea of keeping the bedtime top up long term as I just can't see him going down at all otherwise, but I'm just mindful of not slipping into habits where he gets more and more formula until he ends up having hardly any breast milk.

Tiktok, the breastfeeding counsellor was someone the health visitor referred us to. She said we wouldn't need to see her again unless he loses weight at his next weigh in, but she was very friendly and approachable and I've got her number so I'm sure I could text her again. We also have health visitor coming this week so the support is there, I'm just panicking in the mean time while I wait to find out if he's gained weight! I think he has, he does seem to finally be filling out his "tiny baby" sized clothes. We did have support on leaving hospital, midwives came on the first day after discharge and day 6 and 8. They asked all the right questions, but being new at this I didn't know the answers if that makes sense. They asked if my milk had come in and, as I was able to squeeze a bit of milk out, I thought that meant it had come in, I didn't realise the difference between a few drops and huge, heavy boobs full of milk. (I think it now has come in, milk was flooding out in the shower earlier, such a waste!). Equally when they asked about nappies I thought they were wet, but with the benefit of hindsight, now that he's soaking his nappies I realise there was barely a trickle in there before. So I still sort of feel at fault for not knowing that things were going wrong, though realise that's silly given I've never done this before.

Thanks again :)

[Monkeymonstermum]

Woody - it is NOT your fault for not knowing - the pre birth advice about breastfeeding in my opinion is very bad - I still feel very angry that our NCT session on breastfeeding did not mention anything about how to know if they are getting enough - in fact said that they always DO get enough and basically gave the impression that if you don't succeed at BF that you're just not trying enough (this mad American awful woman ran the session....) - grrrrr - still makes me so angry 4 years on! I think they are so militantly pro breastfeeding that they never want to admit at these pre-birth sessions that there could possibly ever be a problem as they think it will put people off - when in fact if people were given more info they would be better informed and would reduce acute problems like yours and ours.
I repeat - my husband who is a doctor didn't realise the nappies weren't wet enough either as so many people had said "oh the modern nappies are so efficient they don't seem wet" so it was only in retrospect we realised (like you) that they were barely wet. He still beats himself up about it. The paediatrician who saw us spent time with him resassuring him that it wasn't his fault and pointing out that they don't teach about babies nappies at medical school!
Definitely get back in touch with the support numbers you have - seems like you definitely need some reassurance and someone who knows the ins and outs of your case to support you.
Thinking of you.
Xxx

[tiktok]

Not your fault at all woody. Hcps did not do their job well, sorry. Making sure the mother understands the question you're asking so she can answer it is pretty basic stuff. Which they did not do.

[Woody16]

One final thing. I'm confident we're getting enough heavy, wet nappies now, but he still only poos every 3 days. It's been like this his whole life and I've been told that its within normal range and to only worry if it's more than 4 days. It is the right colour now, it stayed dark well into his second week but is now pale yellow and soft. Everything I read about breastfed babies though seems to suggest they should poo several times a day. Perhaps as he gets some formula as well things are different?

[Woody16]

Thank you both! Monkey the paediatrician we saw in hospital the first time before we took him home said the exact same thing about nappies being very absorbent so they might seem dry, when I said I wasn't sure if he was wetting them or not! Now he is peeing they are definitely not dry they're soaking!

[daluze]

So sorry to hear about the lack of support in hospital. But also, not surprised, unfortunately... When DS2 had a bit low sugar on day 1 check up, the pediatrician told to give 40ml of formula at every feed. When I asked how baby can take this amount on day 1, with tummy size of 8-12 ml, I was told it was a standard protocol for babies with low blood sugar, and if I don't follow it, they take my baby to NICU. Even if his blood sugar was just before the norm at the time. Then midwife forced fed him 40ml every 3 hours, which he projectile vomited every time (obviously, it was too much for him), and his blood sugar still didn't go up. They banned me to breastfeed for more than 5 min before givong formula, saying that he gets too tired from breastfeeding and that's why his blood sugar is low (he really want to breastfeed though, all the time). I was just sobbibg and couldn't even talk to HCPs when all this was happening, because my DS1 was in NICU due to low blood sugar (although very different circumstances), and wven mentioning of NICU made me cry uncontrollably. All this nonsense lasted overnight, until a different midwife finally said that he obviously cannot take 40 ml at the time, and gave him a bottle on demand, I think he took about 20ml, then did not vomit for the first time and got good blood sugar reading. However, that absolutely messed up my supply, and milk was not coming in and DS2 lost interest of beeing on the breast. So we continued top ups and I was crying because majority of his nutrition was coming from formula.
However, we did manage to get him back on breast within 2-3 weeks, luckily, because we already had experience with DS1... So we followed roughly the same plan... (breastfeeding support worker in hospital said she won't help us, if we do what pediatrician was telling us to do and stormed out from the room, btw). It was roughly breastfeed, then give top up of expressed milk, then if needed formula. Top ups were given by my DP or my mum, while I expreeses for 15-20 min with hospital grade double pump. Supllementary system helped to get him interested in breastfeeding again (by the time we got out hospital, he wouldn't feed for more than 5 min before crying for a bottle).
Anyway, if you can, get all support you can for at least few days, make a plan and stop blaming yourself.
I wish pediatricians were more wducated about breastfeeding. Another example, after DS1 came out from NICU, a pediatrician told we will not be discharged until he is exclusively breastfed in schedule every 4 hours. Well, if not a good experienced nursery nurse who talked him sense in private, we would still be in hospital 3 years later... (he was EBF eventually, but of course not on 4 hour schedule)
And both my boys were born in top teaching hospitals in the country...
Sending you hugs and strenght!

[Tribblewithoutacause]

Oh Woody what a time you've been having. Well done for getting this far though. I think you're doing amazingly well.

As for the sleeping together, as long as you follow the co-sleeping rules (look at the lullaby trust) I don't see why you can't sleep with your baby.

[Woody16]

Wanted to give an update after everyone was so supportive and kind. The week after reaching birthweight he gained another 2.5oz which HV was happy with so we dropped back to just one bottle of formula before bed. Been to breastfeeding drop in support every week and been assured that he is feeding well. Has continued to feed round the clock so was expecting a good gain this week. Sadly he has lost weight again and gone back to birth weight (now 5 weeks) :(

I feel heartbroken about it, have tried so hard. The specialist midwife I saw at the hospital today said he isn't feeding at all well and thinks at present his mouth is too small and his suck too weak. Advised to give a bottle of expressed + formula for every other feed and not stop the bottles until he has gained large amounts of weight for several weeks.

I'm determined not to give up, but the confidence I gained the last couple of weeks has been shattered again.

[MooPointCowsOpinion]

Oh no, so sorry you've had a knock to your confidence. I have no experience to pass on, but I wouldn't always trust a midwife with what to do next. I hope your breastfeeding group continues to be supportive. You're doing so well to persevere.

[MooPointCowsOpinion]

Actually I've just remembered being told that weight gain is so small and can be affected so easily by how recent a feed or wee/poo is, that it is only one of many factors to consider.

The more important ones are bright eyes, seeing and pooing regularly, and general wellness of baby.

[MooPointCowsOpinion]

*weeing

[RedToothBrush]

It took my son, roughly 5 weeks to gain his birth weight. He was a normal birth weight and did not have the same issues as your son but they were slightly concerned about his slow weigh gain and we were lucky to avoid more monitoring and pressure to use formula. I had lots of problems with breastfeeding so ended up expressing only. It was a battle to get him to feed and gain weight and I worried about every single feed. It was awful.

Please if you are beating yourself up over this, remember when you are thinking about this, please remember that a 'weight loss' at this age can equate to having just done a poo or just having had a good feed at the wrong times when you are weighing in, if you are weighing weekly. To put it into perspective 2.5oz is 70ml. Or a feed or two at that age.

I found the whole weighing in process ending up, often being counter productive because it played on my anxiety. Obviously in your case there has been a cause for concern and your son was a low birth weight, but I want you to be aware of the problems about weighing a baby so young. What is important is a gradual upward gain of weight rather than one disappointing weigh in. What they actually advise in cases where a baby has no feeding concerns is the fact you SHOULD NOT be weighing them too often for this reason unless there is cause for concern as its misleading. Of course no one told me this, and in fact I was encouraged to weigh in every week...

Your son is being monitored closely for a reason, but at the same time this also means you see the ups and downs that other people who are doing weigh ins less frequently, won't see.

What I'm saying is, perhaps you should be seeing more of a weight gain - or maybe you shouldn't as its part of a normal dip up and down in weight. I don't know as I'm not a professional and can't make that judgement call on that. However at the same time this is just one weigh in that doesn't look great. It is not the end of the world. It could be inaccurate for any number of reasons. Don't put too much stock into this one weigh in. See how the next few are first before drawing too many conclusions.

One of the things I found hardest was because I wasn't just purely breastfeeding or purely giving formula (I exclusively expressed for 16 weeks) that advice about how much food I should be giving was simply unhelpful and inaccurate which also made me doubt myself. I think advice about expressing / mix feeding is generally confusing.

You talk about breastfeeding in terms of time and formula in terms of amounts which is somewhat problematic. When you express or mix feed, it messes that all up! The amount of food, becomes more difficult to measure. Eg amounts of formula vs expressed milk for the same amount of calories vary enormously and if you express, you visually can see how much your baby has had and it looks like nothing next to a bottle of formula. In addition if you express, you mess up how long your baby feeds for as you breasts might be emptier (this isn't necessarily meaning your baby isn't getting enough btw and could mean the opposite).

Keep doing what you are doing for the time being as I suspect there isn't much more you could do anyway. I found it incredibly hard to do this without questioning everything you are doing and asking what you are doing wrong. Its a battle mentally. If you think he has been feeding well, then trust that you are. You can see how much he's feeding unlike any advisor or midwife. Don't be adverse to the idea of formula if you need to, but don't necessarily let one weigh in get you down either.

What it can down to for me, in moments of self doubt and the odd weigh in that 'wasn't good', was being able to tell when my son was full (he didn't want anymore no matter how much I offered) and knowing that I was the best person to judge that and to wait until the next weigh in before getting too upset.

[Woody16]

Thanks for the messages :) Good point about the weight, it's all such small values at this stage that going up and then down 2oz is probably fairly irrelevant. I suppose the worry is that over the 5 weeks the overall trend is that he's not moved on from his birth weight. Which is probably a particular worry as he was small - he's still not even on the 0.4th centile line! I'm really trying not to get obsessed/anxious about the weigh-ins, but he's got to continue to have them weekly so it is a source of anxiety.

red you are so right about the mental battle, that is the hardest bit. I'm constantly second guessing myself and just have no idea if I'm doing the right thing or not. It doesn't help that advice from professionals has differed wildly to the point of being contradictory so I don't really know what is right. And it is a minefield navigating the different types of feeding! I can't express enough for a full feed so topping up with formula until he seems full.

Will keep trying for now, though resolve started slipping at the sight of the pump. I hated spending half the day and night attached to the thing!

[mrswishywashy]

Woody, your story and mine sounds so similar. My daughter born at 38 weeks weighing 5lb5oz. Advised to express and top up with that and formula which in reality is a pain of a plan for more than a few days as no time to rest. After exhausting the advice from the hospital feeding ladies I saw a IBCLC who really helped. Posterior tongue tie was cut at seven weeks (hospital feeding ladies said it wouldn't make a difference) this started the improvements on feeding. I also used a SNS to help baby stay on, did compressions and switch feeding. Tried to feed the most at night as that helps milk production. All top ups I limited to 60mls so at times baby breast fed, had top up and breast fed again. Did lots of skin to skin. Made lactation cookies and took fenugreek as my supply I think was low. My breasts have never felt "full", I can only express 60mls tops however I've been exclusively bfing from ten weeks and my baby is now 17 weeks. She's alert, healthy and active and bumping along the 0.4th percentile. If you can get to a IBCLC I'd really recommend it.

I'm still struggling with the mental side and am having talking therapy for the sense of failure. But you're doing great.

[RedToothBrush]

What pump do you have? It really does make a difference. Are you hiring one? If you aren't and you haven't got one and can afford one, get a medela. They are expensive, but if you are committed to breast feeding then the cost will cover formula in the long run. I used several and it was more effective, took less time and produced more milk.

I found getting into a routine with the pump was the key. The pump was the thing that I found hardest. Getting into a routine made it easier to bare. Get through the routine get through the day. You are doing the hardest type of for feeding - combining the worst bits of formula and breastfeeding.

I had a big wobble with it at 6 weeks and again at 10 weeks over how hard it was. Lots of tears and I felt like giving up because I didn't think he was ever going to gain enough weight. I only managed to carry on due to support from my DH with bottles and generally just getting other stuff done.

In the end I managed to get to 16 weeks exclusively pumping, at which point DS decided he didn't want bottles and he suddenly improved his latch which meant I could breastfeed properly. From all the googling I did at the time, this apparently isn't uncommon between 12 and 16 weeks old. (In short as he gets older and bigger he'll get better at feeding and it will get easier. DS was only 9th centile, so whilst no where near as tiny as your son, he was small.)

I am not a professional - and I do stress this - but based on my experience if you are topping up with formula until he is full and expressing then you ARE doing everything you possibly can by the sound of it. I'm not sure what else you could do! Your son's stomach is only so big and he is only going to be so hungry. You can not put more food into your son than he wants. I don't know how you can force feed a baby milk. Getting this into my bed was also a hard thing as you are so pressured to feed more, more, more. I really did think at times that I was supposed to force feed. If your baby is hungry and there is food available, he will eat.

The argument against mixed feeding is that your breasts are not stimulated enough to produce more milk as more feeding increases you milk supply. BUT if you are expressing as well then it will probably mean you are compensating for that anyway (but this is where carrying on with the expressing is key if you do want to breastfeed long term).

My understanding of breastmilk v formula for weight gain breast milk is more calorific than formula ml for ml. You have to drink a lot more formula for the same weigh gain compared to breastmilk. Therefore substituting formula for breast milk ultimately won't improve weight gain (key point if you are being encouraged to do this). Topping up with formula will help as it will help expand his stomach and your son will get more calories in addition to the breast milk. (Note the difference).

I got so much advice that countered this. If he's still not gaining after this, then what else can you do? If this is the case then they will advise you of other steps that need to be taken, but clearly you are not at this point yet. I'm guessing that will require medical intervention (again not a medic and I didn't have a low birth weight baby so don't know) but I don't think the logic on feeding can be terribly different for your circumstances.

Honestly, you can't do more than you are from the sound of it. I got annoyed as I was treated as if I wasn't and this was really not good for MY health and in turn wasn't really helping me feed DS as it ate into my confidence. The assumption and tone was that I was not trying to feed my son enough. I was. It sounds like you are too.

Make sure you are looking after yourself as well.

[Woody16]

Sorry for slow reply, relatives have been visiting.

Thanks both for sharing your experiences. And well done for getting back to breastfeeding after so much effort. It's what I really want but feels so far away at the moment. I did only BF for the last week or so (apart from one bottle at night) and perhaps the problem is I stopped bottles too fast (took advice on this, didn't just stop of my own accord). Also stopped pumping during that time as he was on the breast almost constantly! Realise now he must have been so hungry, he has slept much better between feeds since yesterday when I have been topping up again.

I have an avent electric pump (single). I have since read that medela are much better, but I had already bought mine when pregnant. I could find the money to buy another one if it really would make a significant difference. Is it the medela swing which you used? Single or double? With the avent I pump for about 15 mins a side and get between 20-40ml in total. Anything which reduced the time taken or increased yield would be great. Would be nice to be able to feed him purely breastmilk top ups, not least because it's one less type of feeding to have to worry about. Can I ask what your pumping routine looked like? I haven't re-established a routine yet, have just done a couple of pumps since yesterday and couldn't face doing it in the middle of the night last night as I was so tired, but realise I do need to suck it up and commit myself to a proper routine again!

Thank you. Doing best to take care of myself and luckily have very supportive husband who is helping with bottle feeding and also keeping me gong every time I break down in tears and feel like giving up on BFing.

[RedToothBrush]

I thought it was worth the money. I had a double swing, but tbh only ever really used one at a time in the end because that left me able to do at least some other things. I thought it was faster and increased yield. I bought after being advised by the collective wise of MNetters! But I obviously can't guarantee it will be as effective for you. I had used the old version of the avent and the tommy tippee one before and they just were not as good for me.

My routine was roughly, one pump in the morning, one in the afternoon, one in the evening and then one in the early hours (but I was not breastfeeding at all which will make a difference). If I could fit in an extra one then that was a bonus (I think the logic was you are supposed to do after each feeding session at least 6 times a day, which I found was unmanageable tbh. Apparently pumping after feeding is supposed to increase yield most, but when I did manage to breast feed, I found this disheartening as I would be empty then so didn't see the results as much in the bottle - the benefits were later in the day).

From what I can remember 20 - 40ml in one go, at 5 weeks when you are breastfeeding too, is a decent haul. It WILL increase. (By the time I quit I was doing about 1250ml a day - but this was without DS breastfeeding - in 4 sessions. He wouldn't drink all that, and I built up a huge stock in the freezer. Just remember if you are breastfeeding you won't necessarily see the results in the bottle as it will be direct in his belly!).

The one pump that I hated was the night one, but feeding in the middle of the night is supposed to increase your yield most. If you can do 15min then you will reap the benefits in the morning.

My best pump was always the one first thing in the morning so this was the one I tried to do most. I did 10 to 15 mins each side if I could. It made it easier to have a target to hit. I wasn't too strict on times, apart from going between naps. (eg I need to do a pump before this nap time). It just broke the day into manageable goals which psychologically was easier than thinking 'I need to pump X amount at some point today'. You got past each target which helped me to get through the whole day.

Make sure you are eating well, and sleeping as best you can as that also makes a difference. (Easier said than done). And chocolate. Chocolate is helpful!

[Kennington]

It took me 6-8 weeks to get the hang of it.
I had cracked bleeding nipples and nipple thrush for the first few weeks.
I cluster fed and used one bottle of formula at night - but with a poor flow NUK teat. In the end I did this for over 2 years. Good luck - it does get easier.