How long do I persevere trying to get off formula supplements?

[haggis81]

Hi, apologies in advance for length!

DS1 now ten weeks old. Difficult birth - induction, epidural, emergency c-section - meant that my milk didn't come in for a while and he lost 13% of his body weight by day 4. We were put on formula top ups for a few days but rapidly reduced this to only 35-40ml per day (given by cup feeding in the evening) after getting help with the latch etc. He regained his birth weight (3.8kg) within a fortnight and put a decent amount of weight on by week three.

However when I had him weighed again at five weeks, he hadn't put on a single gram. Straight away I was put back on the formula top ups (60ml seven times a day so 420ml per 24 hours). Lactation consultant diagnosed posterior tongue tie which we had treated by week six. The 'test feed' straight after the procedure showed that he wasn't transferring milk effectively and so I was told that as well as him needing to relearn how to suck, my supply had probably nose-dived, so was told to go to my GP and request domperidone which I did (30mg/day, now 40mg/day). I am also now taking nine capsules of fenugreek per day.

For the ten days or so after the tongue tie snip we carried on with 60ml supplements, mostly formula but some expressed breast milk. He put on good amounts of weight at the two weekly weigh-ins following the snip (310g and 280g respectively) so I reduced the supplement to 40ml x7 or 280ml in 24 hours. Have done this for the last two weeks and recorded okay but much lower weight gain (140g and 150g respectively).

He had his eight week check a bit late earlier this week where the GP said she was concerned that despite now tracking between the 9th and 25th centiles, he is much skinnier than he should be (based on his birth weight which was 75th centile and also his length - between 50th and 70th - and head circumference - between 91st and 75th). She suggested increasing the formula top ups.

In contrast, lactation consultant has now suggested dropping night time supplements ie reducing total to 200ml/per 24 hours. I am going with her suggestion for now, and will get him re-weighed on Tuesday.

However I'm having a real crisis of confidence - I'm so worried he is so skinny (he still fits into newborn body suits although length-wise is filling out 0-3 month sleepsuits) and can't bear to think that he is hungry. He has recently started chewing his fists and a lot of the time seems to either give up on the breast and start to doze, or gets very frustrated - kicking, beating his arm back and forth and pulling his head back, even when I do breast compressions. I rarely hear the sound of swallowing or milk hitting his tummy although I accept he must be getting some to be putting on some weight.

Whilst I think my supply has increased a bit, I'm really concerned it's still too low to be giving him the nutrition he needs. I hardly get anything when I express, even if I don't do it immediately post-feed. For example I feed him to sleep at 7:30pm but when I express at 9-9:30pm I only get about 25ml max. I manage to express again in the middle of the night and after the first morning feed, and sometimes during the day - but find it so demoralising and struggle with all the sterilising etc. My breasts hardly ever feel full even after three hours which is the longest he goes without a feed at night.

I'm not sure what else I can do on top of feeding on demand, expressing, breast compressions, domperidone and fenugreek! I tried a day of skin-to-skin yesterday but haven't seen any noticeable improvement and found it really hard not leaving the house even once.

I really trust the lactation consultant I am seeing (in case she is reading this!), she has been fantastic - but am just struggling with the regime and worrying about DS being hungry and too thin, so am seeking other opinions and perspectives. Does this sound like an 'upward curve' or do I have a real problem with my supply? Does it sound like I'll ever get off formula completely? And if not, what would a possible mixed feeding solution look like (i.e. could I consolidate current mutiple formula top ups into two more mangeable ones or would that mess up my supply further?).

I warned it would be a long post! So grateful in advance for any suggestions.

[tiktok]

Sounds like you have had some great support and help from the lactation consultant. What a difficult start for you :(

I think with the history you have given, the concern would be that you have never really got breastfeeding production off the ground - for whatever reason, it was not working well right from the start. You may already have read about the prolactin receptor theory, which explains how breastmilk supply is calibrated upwards or downwards in the early days of breastfeeding - and you may have been experiencing those effects all the way through, which makes it very hard to build up to a full supply (there are variations of experience - some mothers find it harder/easier than others).

The amount of formula your baby was having when you hit the crisis at 5 weeks was very high - that sort of volume for a just under 4 kg baby is not far off the equivalent of a fully formula fed amount. So your production would have taken another knock there.

You don't say how often you are expressing (is it three times?), but from your description of what's happening, it sounds like you need to express really often now, to rescue your milk supply - it's a huge pain but you would need to express at least 8 x in 24 hours, switch expressing (going from breast to breast) to maximise the effect. You don't need to sterilise the pump between uses, by the way - hot thorough washing is fine.

If you don't rescue your supply, you won't have the option to continue mixed feeding....it does sound like you will need to maintain some formula feeding, to be honest, to ensure your baby grows, but I don't see any reason why you can't aim to reduce it, if you get your milk supply up.

Hope this helps.

[haggis81]

Thank you so much Tiktok for the very quick response. That's a much more downbeat assessment than I've been getting from my lactation consultant but it does correspond with what I've been feeling based on his behaviour and what you say about calibration makes sense. Do you mind if I ask a few questions? I can then discuss with my LC...

• I am definitely prepared to increase the expressing but that's a LOT - my sanity is already pretty stretched and this may push it past its limit if it's for more than a few days. How long do you think I'd have to keep this up for? And presumably I couldn't then go cold turkey?
  

• I have hired a medela symphony double pump... how would I do switch expressing with this or would I just double pump? Do I continue to express immediately after each feed? For how long each time (have been doing between 10-20 minutes depending on whether the babe is screaming or not!). Can the intervals be a bit longer during the night or is it important it's every three hours?
  

• Should I stick at current level of supplement (200ml/day) while I do this or do I need to increase it again to ensure a decent level of weight gain?
  

• Should I see if I can get my GP to increase my dose of domperidone? I know that some advise up to 90mg/day.
  

Thank you so much for your help.

[haggis81]

Sorry should have said yes am currently expressing three times a day, sometimes four. And he is getting supplement via an SNS.

[tiktok]

haggis don't take what I say as gospel, please....your LC has been with you a while and has observed and understood a lot more than I can. Yes, do discuss what I say with her.

The reason I suggest 8 x in 24 hrs expressing is because I think you need to effectively relactate. I don't know how long you would need to do this for, but you could try it and see - a good option might be to do it for three days and see what happens. I don't think you would need to do this for ages and ages, but to restore and maintain a milk supply is not easy after all this time. If your baby starts to feed more effectively and more often at the breast in response to the better milk supply, then you could cut down and envisage reducing the expressing a lot.

Double pumping is fine - no need to switch express with a double pump. But you could try dble pumping 5-10 mins, stop for five mins and then do it again.

It doesn't matter if you are not spot on every three hours - but you do need to avoid ever leaving more than 4 hours. It's exactly the same way as bf works - close gaps between feeds = more production.

I can't really comment on what level of formula supp you need, sorry - but it makes sense to stick with the current level and then rethink after you reassess.

Don't really know about the dom doses, sorry.

[mrswishywashy]

Sounds a fairly similar story to mine, it's really hard going. Hopefully your family and friends are supportive. What would have helped me at the time is for people to make me drinks, hold baby while I took a nap, clean and cook and just sit with me NOT mentioning the babies weight as it makes things even more stressful. Also asking for help don't be afraid to ask for anything.

I was also told at six weeks my body wouldn't be able to exclusively feed my baby by one feeding lady but I decided to do everything I could.

I spent hours skin to skin and in front of sofa or in bed with baby.
I switch fed and comfort nursed and did compressions.
I'd express when I could through the the day which was hard as baby wanted to be held. In the evenings when my partner returned I'd express 10 minutes, break 10 minutes for an hour. If baby was calm I'd try and express at same time. I've never got more than 40mls per session.
Any bottle feeds I'd breast feed, bottle feed doing paced feeding and then breast feed again.
After tongue tie was snipped at six weeks I used a supplemental nursing system which helped my baby want to stay on breast.
My baby is bumping along her line at the 0.4th.
We managed to get off top ups I think by 10 weeks.

It's really hard work so be kind to yourself, make sure to have some snuggles with baby that don't involve feeding. One of my fav memories is bathing with my baby.

[haggis81]

Thank you both so much for your advice. I think I'm going to give it a go, particularly since it's the weekend tomorrow so husband will be around to help, and have a supportive friend coming round on Monday, and can go to a breastfeeding support group on Tuesday. I think the key will be to set myself a deadline and then to accept that if I don't see a marked improvement by then, then to make my peace with formula (which will be very hard!).

DS currently coming to end of long nap, so have just managed to express 45ml in about 12 minutes. This is much more than I normally get but of course it's not after a feed so presumably should be a lot more....

Mrswishywashy, so glad to hear that you managed it especially after being told your body wouldn't get there. Now that you are off formula, do you have to do any extra expressing to maintain your supply? Or does off formula = no more expressing?

Thank you both again, it is much appreciated - feel like I have a bit more of a plan now.

[mrswishywashy]

I don't think I need to do any expressing however I sometimes do first thing in the morning if I feel uncomfortable, I get 40-60mls and freeze it. If I wasn't doing that I'd leak, not every morning though. I was glad not to have to express.

At one point I decided to that something needed to give because breast feeding, expressing and giving formula is not sustainable- where is the time to enjoy the baby. So here is what I wrote down as my paths to take:

Drop the expressing and just breast feed and offer formula as needed.
Drop the breast feeding and express and offer expressed milk and formula as needed.
Go onto full formula.
Supplemental nursing system.

For me it wasn't the breast milk as such but the closeness of breast feeding so the supplemental nursing system was good in that respect.

You're doing great, keep confidence in yourself.

[Woody16]

I have no advice but can sympathise as am going through the same thing at 5 weeks and am also worried about my skinny baby and whether my supply will ever be enough! Good luck, I hope it works out.

[kamillaw]

I
Struggled to feed both my girls and expect it to be the same this time. I'm not going to express at all this time I don't think as I don't have a pump anymore and I cannot pump for toffee. I am at peace with all this now but it took a long time to accept and I didn't have any of the help with regards to the domperidone that you have had. I decided much like a pp that my pathway was breastfeed,comfort nurse and then top up as many times a day as needed. My second dd fed a lot more from me than my first and often went back to the breast for comfort post bottle.

Good luck OP. What matters the most is that you and he are fed and that ultimately you are both happy. X