WWYD? - Breastfeeding/Expressing/Bottle Feeding

[Itsaplayonwords]

My daughter is 11 days old. She was born at 33 weeks and came home from Special Care 2 days ago. I was adamant that I was going to breastfeed fully this time as I was only able to combination feed my first daughter (born at 28 weeks).

With my youngest being small she was given NG feeds and I expressed milk from day 1 to help my establish my supply and for her to have via NG. I resisted giving her a bottle of expressed breast milk at first but with a toddler at home who I was missing desperately I caved in and gave her a bottle 2 days before she came home. She took it well and it meant she could be discharged home (it satisfies the nurses because they could quantify the about she was getting). We were alternate breast and bottle feeding but they felt she wasn't getting enough from the breast so told us to give bottle top ups afterwards.

The problem is that this isn't sustainable long term. I'm expressing 7 or 8 times a day and the feeds that I'm breastfeeding are taking over an hour because I breastfeed, then give a bottle, then express. At the moment it's doable as my husband is on paternity leave so he either does the bottle while I express or looks after my eldest while I do all of that. But when he's back at work I just don't see how I can be expressing and bottle feeding every three hours with an additional breastfeed every six hours. I did it with my first but I didn't have a toddler to look after then as well.

Sorry this is so long! I just wondered what you would do in this situation? In an ideal world I'd get her fully breastfeeding as then I wouldn't have to express/do the bottle feed. But I don't see that happening because for one thing she's small and doesn't have the energy and the doctors are more concerned about her putting on weight than they are about her breastfeeding. In the absence of full breastfeeding I feel formula is the only viable option but I don't want to give up on breastfeeding either.

[Batteriesallgone]

For starters, are you pumping the most effectively breastfeedingusa.org/content/article/pump-more-milk-use-hands-pumping

What pump do you have? Have you rented a hospital one? Also are you pumping on one side whilst feeding from the other? That can encourage let down.

Do you leak at all? Are you catching leaks in breast shells?

If you can maximise the amount of milk youre getting that should hopefully take some pressure off

[CelticPromise]

In a rush but making place. Totally doable to get back to full bf, but it needs to be a gradual process.

[Batteriesallgone]

Are you paced bottle feeding? YouTube it. Should help prevent bottle preference.

Also are you and baby fully engaging in cluster feeding (lots of fussy feeds from 7/8pm - 12/1am)? If not I've heard there is some research to suggest cluster pumping for two or three hours during that window can really boost supply. Obviously might be uncomfortable to be hooked up to a pump all that time so you could try hand expressing (which can be really productive if you get it right).

The key thing to increase milk production is milk removal, there is no point your breasts making new milk if there is loads in them already. The good thing about cluster feeding is it removes milk in small quantities over the evening so provides a strong 'make more milk' signal.

[Itsaplayonwords]

Thanks for the link Batteries I hadn't seen that before but I am already doing most of that to maximise the milk I'm able to express. I started off hand expressing but I'm using a pump now - the Medela Swing which seems just as effective as the Medela Symphony they had in SCBU. I don't pump while I'm feeding - I have quite small breasts and my nipples point up so I kind of have to lean forward in order for the milk to pass down the funnel while I'm expressing so I've never been able to figure out a comfortable way of doing both simultaneously. I do leak and I might look at getting some nipple shells - thanks for the tip!

I'm not too concerned about supply at this time - although I'm obviously wanting to at least maintain what I'm currently getting. The issue is more the time it takes to pump, breast and bottle feed and look after my toddler too.

I had a look at paced bottle feeding and, although I didn't know it by name, we are in effect doing that already. The amount she was having in SCBU was 42ml every 3 hours and we're still working on that amount, however after a breast feed we offer her 20 ml and if after that she is still showing hunger cues we'll offer another 20ml. Same with the bottles - last night she was still hungry after the 42ml so we offered another 20ml and then another 20ml but we judge it based on how she's acting.

As for cluster feeds/expressing, I'm not doing this but will definitely give it a try. Is the intention just to pump for 5/10 minutes at a time? Regardless of completely draining all milk from the breasts?

[cazzamiss25]

Hi, I don't have any solutions but I do think you are doing brilliantly to be still trying. I'm doing exactly the same thing as you and feeding time is taking around 1.5hours and it's only my first child! i don't think I would be able to do it with a toddler! Well done to you X

[Batteriesallgone]

This might be useful and discusses cluster pumping and power pumping if you scroll down kellymom.com/hot-topics/pumping_decrease/

[Batteriesallgone]

Also bear in mind even if you found breastfeeding relatively straightforward it's still very demanding in the early days and toddlers can feel a little left out. Telly, colouring books, iPhone app games might be required pretty frequently! But if you get baby EBF it will get much better and easier.

Do you have a sling? Being topless and wearing baby naked (with nappy!) can help with supply and more importantly encourage baby to latch. Being close to the nipple makes them more 'aware' of it IYSWIM. Feeding in the sling might be possible giving you your hands at least to play with the toddler

[CelticPromise]

Hello. I've bf my prem baby and I know how tough it is. Well done.

I know they have been worried about baby being enough but she will get better and more effective at feeding as she grows. It's partly about having the confidence to get out of that 3hourly scbu routine and be baby led. I would seek out a local bf group for support through the process, there are many where you can take toddlers and they might have a peer supporter who has been through similar.

Most people have one time of day when they feel 'fuller' and the milk seems to come easier, often first thing in the morning? If so I would start by reducing or dropping the top up from that feed. Offer both breasts, allow her to feed as long as she likes, express after and see when she wakes for the next one. I would try gradually cutting or dropping top ups over a few weeks, mindful that she will probably start feeding more frequently and that's normal. If she doesn't wake for feeds or have plenty of wet and dirty nappies them you would need to go back a step.

I'd try skin to skin for a few hours on a day when you have help with your toddler and let her have free access to the breast. She'll probably feed little and often. As she bf s more you can drop a pumping session each few days.

Spend a bit of time finding your own pattern, and paced bottle feeding will be useful as suggested. Best of luck to you

[CelticPromise]

Sorry only just clicked on you are not bf with every feed - I would put to breast every feed without a doubt and be guided by how well she has fed as to top ups. There is a list somewhere about how to judge bf and select top up level. I will have a look for it and post it if I can.

[Itsaplayonwords]

Thank you so much for your replies and the words of encouragement as well as the advice and suggestions - I'm taking everything on board and will be sure to read all the links provided.

We went for a weight check today and she has put on 40g since she was discharged two days ago so that's encouraging that she's finally going in the right direction! She's not quite back to her birth weight yet but getting there.

The reason we're currently alternating breast and bottle feeds is because it was thought that she doesn't yet have enough energy to breastfeed at every feed, especially not on demand, as she is still small and she still has jaundice, although not at a level that is requiring treatment, it just makes her more sleepy. We are sometimes having to wake her fit feeds although sometimes she does wake herself. For that reason we'll stick with the alternate breast/bottle for now but we have discussed going to 4 hourly feeding at night which will hopefully help her to recoup some energy.

There are times that I think "sod it" and just want to give up trying to breastfeed but I had PND last time and I can feel it happening this time too and I know that if I didn't breastfeed it'd be another thing to beat myself up over. I've been trying to figure out why bfing matters so much to me, and I think it's because both babies have been premature. I've always felt as though I failed at being pregnant and I don't want to fail at this too. I know, logically, that I did nothing wrong and I shouldn't feel guilty but I do feel that I've let them both down and I owe them this.

[CelticPromise]

Bless you. I can totally relate to prem baby guilt.

When you feel she is ready you can introduce more bf.great news about the weight gain, you are doing an amazing job.

[chillipopcorn1]

I came on to post about my situation and this is remarkably similar so thank you! The advice here has been helpful so far. My twin girls were born at 36 weeks and spent a week in SCBU. I've expressed for them since day 1 and like OP the hospital preferred bottle feeds so they knew how much they'd had so encouraged top ups or breastfeeding after bottle feeding. The first few weeks we basically force fed bottles to get their weight up. Each feed took hours and was miserable but they did put on the weight. The girls are now 6 weeks old and at home and feeding has been a total nightmare. The paediatrician initially insisted on sticking to the three hour SCBU regime. Obviously this didn't work with transitioning to fully breastfeeding as when breastfeeding babies take different amounts At different times and so resulted in fussy babies going hungry between feeds. I've also had each baby breast refuse for up to a week at different points meaning I was having to express 1.6l a day without having he stimulus of baby suckling at me and my supply floundered. I totally sympathise with you OP With regards to timings. Mine regularly do long, ineffective (but tiring) breastfeeding sessions where they fail to latch on, then I pump, bottle feed, clean and sterilise and then it's time to start again! I bought I'd nailed the latch with my bigger twin and moved her completely off the bottle,..with the result that she's now not gained any weight in 4 days. Meanwhile the smaller baby had lost weight so I upped her bottle amount and reduced the time at the breast and she has started to finally gain. This makes me feel totally useless / they only gain when NOT feeding from me directly. I also feel so so bleak about a future of being tied to the sofa feeding and pumping in a never ending cycle and never getting more than an hourLs sleep. I feel totally rubbish about it all. I just want to live to ebf so I can have that bonding time and also so I don't have to do the ridiculous process of taking something out of myself, putting in a bottle, then giving the bottle to the baby, then cleaning everything involved and starting again. But it looks like they just can't feed properly from me! I can always see areola under the bottom lip and although I feel a let down and get the lovely gulps there's not a lot in between and the small twin in particular will just grasp my nipple in her gums and chew for hours. It's demoralising and shit and i now feel like a total failure.

So sorry for hijacking OP but I would love some advice!

[BunloafAndCrumpets]

Hi ladies

I really struggled to bf for various reasons. Eventually managed to mix feed to six months. At the time I felt so guilty I couldn't ebf but now (baby 14mo) I'm proud of what we managed.

I just wanted to say - pumping and feeding is exhausting and you're brilliant for doing it for so long with a toddler /twins!! I can't help with tips for establishing bf BUT one tip: the HV and lactation consultant told me at 10 weeks that actually you don't need to sterilise the pump after every feed. You can sterilise it once a day and keep it in the fridge in a freezer bag between feeds. This was literally life changing for me! I also bought a spare medala boob set for £10 which helped with the washing too. Bottles (buy lots, small cost for easier life even if not needed for long!) can go in dishwasher and then sterilise. You might want to check with your own HV in case advice has changed.

[Batteriesallgone]

Yup I've heard the not sterilising every time thing too. Breastmilk is totally different to formula and doesn't need the same precautions.

Chilli Have you heard of breast compressions? Basically you manually massage your breasts in advance of latching baby to get a quick letdown (easier for baby) then once they are latched squeeze slowly and regularly, like you are hand expressing straight into their mouth IYSWIM. Can really encourage babies to latch.

I didn't have a prem baby so this might not sound right but itsa you made that baby all yourself. Your body didn't let her down it made her, every lovely inch. And now you are producing milk to feed her too. Your body isn't weak it's fricking awesome.

Breastfeeding is important, for you and for baby. I definitely felt a primal need to feed mine.

[Itsaplayonwords]

Thanks for all the supportive replies everyone. It sounds like you're doing really well Chilli and I'm glad you've found some of the advice useful too.

I've had a look and found a breastfeeding support group which I'm going to go to on Monday - my eldest is at nursery on Monday so I'll be able to fully concentrate on the advice. I think that she's latched on pretty well now - I'm still using a nipple shield on one side and she seems to be doing okay with that and on the other side her latch seems good too. My concern is mainly about her efficiency. I know I've got milk and I know she's getting some because I can see it in and around her mouth. She generally falls asleep on the breast but is that because she's full? Or is it because she's just too sleepy? Would it be too much for her to feed on demand at this stage? She's just over 4lb and still showing some signs of jaundice. She's not waking for every feed. I just don't think that she is yet in a position to dictate what she needs. I don't want to push her too hard. Do I just need to persevere with the current routine of breast, bottle and expressing until she gets bigger and stronger? Am I just being impatient?

[Batteriesallgone]

I think those questions can only be answered by someone who's actually seen your baby.

Have you contacted LLL (La Leche League)? They may be able to send someone to your house to help

[Itsaplayonwords]

I know, you're right Batteries. I'm just wondering out loud more than anything. The midwife is visiting tomorrow so maybe she can help answer some of those questions.

[Itsaplayonwords]

I'm becoming more and more disheartened. My daughter is constantly hungry through the night, even with bottle feeds. We're having to increase top ups after breastfeeds as she's obviously still hungry. It's getting more difficult to express regularly as well what with looking after DD1 and trying to wash/sterilise bottles, breast pump etc, eat and generally exist. And that's even with DH here. I so don't want to go to formula but I'm so close to giving up with breastfeeding because I just don't see a way of it working.

[CelticPromise]

You have had a tough night itsa. Tonight might be better. One feed at a time. Stick it out until you can get some real life advice on Monday. If you do decide to use some formula don't forget it's not an all or nothing decision, it can be a temporary solution.

You can start feeding on demand for part of the day if you think she's ready, but if she is still sleepy and jaundiced you will have to wake for some feeds. In the night if she's still hungry after top up do you put her back on the breast? It's a good sign she's demanding extra herself.

On a practical level how are you sterilising? Easiest way is cold water sterilising with milton tablets or similar, l would do that for now to save a bit of hassle.

Chilli there is a Facebook group called breastfeeding twins and triplets, you'll get good advice there.

[FurryGiraffe]

It all sounds very tough OP. Well done for toughing it out this far.

If you can manage it, I'd really recommend a lactation consultant. Not cheap but expert help from someone who also understands and supports your desire to EBF.

[Peasy1]

Hope you get some good advice tomorrow. Get them to check her latch and see if they can suggest some other feeding positions. I used to feed my prem daughter lying down as she seemed to find it easier that way. She wasn't very efficient for months and I went to see a bf counsellor three times over the course of a few months.

Expressing as often as you are is exhausting and I felt like I was on a hamster wheel of feeding, expressing, offering top up, sterilising then sleeping for about an hour. Only people who have been through that will truly understand how difficult it is. Make sure you are drinking loads and loads of water and eating too (oats are good). Not looking after yourself will affect your supply so try to think of yourself too (even though it's hard between feeding, pumping, sterilising and looking after a toddler!).

You are still very early in this journey with her and there is nothing to say she won't ebf in the future. For now, take a day at a time and don't stress if you need to offer formula to get her weight up as 4lbs is still very small

[Itsaplayonwords]

Thanks everyone for taking the time to reply.

I went along to a breastfeeding drop in clinic yesterday and she's now back to her birth weight (2040g). The HV running the clinic said she's latching on well and positioning is good. She said to try not topping her up for some feeds and see how she goes. I'm finding it really difficult though as she just never seems satisfied after breastfeeding and I know that if we give her a bottle she'll take it well and it will fill her up which means she can settle and get some decent sleep which is just as important for her. I'm also trying to express but with breastfeeding without top ups it's far more on demand but that's difficult because I can't judge when to express - it keeps happening that I express and then she wakes up hungry!

My husband thinks that persisting with trying to breastfeed is making me unhappy because it's making me really anxious and I keep getting really upset about it all. I just feel so inadequate but because I always feel like I failed at being pregnant I don't want to fail at breastfeeding too. There is a strong possibility that if I were to give up on breastfeeding and go to formula it would make me feel better - the hormones would calm down, I wouldn't be as exhausted and I'd be less restricted (I wouldn't have to plan my life around pumping) but there also the strong possibility that it could make me feel much worse because I'd be disappointed in myself. If I were to make that decision there'd be no going back if it were the wrong one.

[CelticPromise]

It's brilliant she's back to birth weight. You should be so proud of that.

2 things - your breasts are never empty. If she wakes after you have pumped you can put her back on. Or you could just decide to embrace cluster feeding at certain times of day.

It's not all or nothing. There is no reason you can't mixed feed if that's what suits you. You could cut down to say two top ups a day and give formula for those. If you want to.

If HV is happy to start dropping top ups you could try that one at a time, think I posted about it above but phone is not playing for me to look over it. One feed at a time. Is there a more social type group where you can get ongoing support? Best wishes whatever you decide.

[Orsono]

Yes, just to echo what CelticPromise said, you can still breastfeed her even if you've just pumped - your breasts may feel 'empty', but they're not, they're producing milk all the time, so she'll get milk. In fact, the 'emptier' the breast, the fattier and more calorie-packed the milk is, so it's a good time to feed her!

[Itsaplayonwords]

Thought I'd continue on this thread rather than start a new one as I'm still struggling with this. Firstly, I've been absolutely rubbish at expressing regularly so now I'm starting to worry about my supply. I haven't expressed in the night for the past two nights as I've been up with both DDs for hours at a time and when they've finally settled I've been so shattered I've just needed to get some sleep.

I contacted a breastfeeding counsellor but I've decided not to go ahead just yet at DD2 is still very sleepy and possibly a bit jaundiced so I don't want to push her to do more than she's capable of and I don't want to waste money with the BF counsellor just for it being bad timing. I have however spoken to SIL who is a midwife and she's going to come over tomorrow and see if she's able to help. I do feel a bit weird about having her help me in this way but I need to get over that weirdness for the benefit of successfully breastfeeding (I hope!)

For anyone who has made the switch from bottles to bfing, whether with s premature baby or not, can you tell me a bit about what it was like when you first made the switch? Obviously with a baby that is BF from birth they usually feed really often but then the milk supply is different because it's just colostrum in those early days. Should I expect the same when I go to demand feeding? Or will she try to take bigger feeds as that's what she's used to from the bottle? If I know to expect pretty much continuous feeding then I think I'll stress less, what I've found when I've tried just feeding on demand is that she falls asleep after a while but the second I lay her down she's wide awake and rooting. She never seems full from breastfeeding which is what makes me question my supply/her ability to get enough milk. But then if I hold her she'll sleep just fine so maybe it's just the comfort she's wanting? I'm so paranoid about her not getting enough calories and it's that that makes me get her a bottle because I can see exactly what she's getting and it makes me less anxious to know she's well fed.

Do I just need to condition myself out of this and instead trust my judgement and go by number of wet nappies etc?

Sorry for the rambling - exhaustion is getting to me!