Delayed initial let down - can anyone share their experience and/or advice?

[dizzy77]

I had breast implants 5 years ago and have been assured by everyone, including my surgeon, midwife and various bf counsellors, that this will not affect bfing.

My DS is 8 days old and at his 5 day check was admitted to hospital with dehydration. I had been EBF for those first 5 days but it seems my milk did not satisfactorily come in on day 4 so he was effectively starving (it wasn't just the weight loss, but that he spent 24hrs sucking my poor shredded nips & DH's little finger fruitlessly, and then slumped into an exhausted sleep).

On medical advice I'm topping up w ebm/ffs after putting him to the breast for approx 30mins, and then pumping for 15/20mins per side (barely covering the bottom of a bottle with the output) to help stimulate flow, with the aim of cutting out the top ups.

I'm obviously disappointed things aren't quite going to plan and would love to hear encouraging stories from others who were "slow starters", for whatever reason. Can you help?

[TruthSweet]

Dizzy - congratulations on the birth of your son.

What support are you getting at the moment? You mention BFC, are you still in contact with them? Which organisation are they with (NCT/ABM/BFN/NHS/??)?

Has your latch been checked by a suitably qualified person as a baby spending 24hours attached, whilst shreding your nipples doesn't sound like it was a spot on latch (not your fault of course).

Have you seen these videos before. Good drinking, really good drinking and nibbling are probably the best ones to watch to see if your son is feeding effectively when he is at the breast (you don't want to see nibbling though). The videos entitled 'baby 28 hours old....' might help you with latching if you are finding it tricky or just want to check how well you have done it.

How much formula is baby having and how is baby being offered the top ups? Has anyone discussed cup, finger or syringe feeding with you?

Hope you are still under the MW and they are giving you lots of care and attention but a call to one of the bfing helplines to discuss your specific situation mightn't go amiss. The more support you get the better.

[dizzy77]

Thanks TruthSweet - support from NCT and NBF helplines so far. All my conversations were at the point of day 3/4 so most of the support was helpful and supportive, but also couched in terms of "when your milk comes in you'll be fine". The 24 hrs was on/off, I've not had any direct in-person support. Now they've healed, and MW and the more experienced nurses in hosp were happy with latch, it can take a couple of goes but in scooping up with DS's bottom lip it looks like the pictures and feels pretty good - no worse than being attached to the industrial milking expressing machine in the hospital.

Top ups are being offered by bottle after initially tube feeding. DS is having about 50mls formula per time, we're going about 3.5/4hrs between feeds: I've welcomed the stay in hospital to institute some sort of pattern to the day. I'd love someone to come out and spend time with me, at home, with my chairs, cushions and pillows. Can I just request this? We ended up in hospital before I was able to get to the BF clinic at the hospital or attend any of my local drop-ins but I do plan to do this next week.

[dizzy77]

Just watched the videos - thanks for these, they are encouraging. I don't have as much breast to squeeze but the cross cradle latch with compression does reflect the technique I'm trying to learn...

[TruthSweet]

Are you bfing more frequently than 3.5-4 hourly? As that seems a very long time for a newborn to go without nursing. Also 50mls is a big amount for a top up given that he is only 8 days old. At 10 days the stomach capacity is 60-80mls And at day 3 a newborns stomach is 22-27mls. The more formula you give, the less stimulation to the breasts, the less milk made. It really is a delicate tight rope act between enough for baby and enough to get mum's milk supply up.

Have you been given a weaning plan to get off top ups or a regular contact set up to talk you through it as you make more milk?

The bfing helpline might be able to organise an at home visit but call from your andline so it routes to the bfc in your area not on the national hunt group.

If you don't mind me asking which area/town/county you are in I might be able to find someone local to you.

[dizzy77]

Thanks TruthSweet this is really helpful. I had wondered about capacity as some milk does come up after the formula, I try to leave a gap between my attempt and the formula. DS does yomp away at my bosom so I hope they're getting stimulated, I nudge him to ensure he nurses but he doesn't suckle continuously whilst he's on like the good drinking video - maybe a dozen sucks, then a rest, and so on. I've been using a shield on one nipple as it was a bit damaged which was full of milk when he came off after about 20mins this morning. After the late feed last night, he slept for about 5 hours, whilst I welcomed the rest I'm a bit concerned as this does seem odd.

No, no weaning plan, nor regular contacts. I'll try the bf helpline from landline to ask for this help at home. I'm Medway in Kent - if you do know someone that would be a great help.

[dizzy77]

BTW just had a great conversation with someone on the NBF helpline who (among other things) gave me some practical help on stimulating flow to express more effectively as well as explaining that it can take up to a month to get fully established. She wasn't very local, but I will absolutely prioritise getting along to a local group this week to sort this left hand latch (dang the bank holiday) and to find out what is available closer to home.

[Cosmosis]

I agree with truthsweet that 3-4 hours is much too big a gap - ideally you need to be doing 10-12 feeds in 24 hours in the early days I believe. My DS didn't do 3-4 hours till about 5m for example. I don't think your supply will be getting enough stimulation at 3-4 hours. Appreciate that you're exhausted as you've had so much going on, I suggest going to bed with baby and getting some rest and also letting baby latch on as much as possible.