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Struggling but determined to BF when having to FF my 5 day old for jaundice

(61 Posts)
digitalgirl Sat 06-Sep-08 01:48:05

Sorry - this is a bit long.

My DS was born at 36+5 last Sunday. Had started breastfeeding as soon as he was born, but colostrum was very limited so assumed it was more of a practise for DS than a feed. Was told in hospital that I had to top-up feeds with formula as DS is jaundiced and dehydrated - and was kept an extra night. Convinced I wasn't breastfeeding properly and asked for help - was shown how to position and DS has a good latch - but after a night of bottles he wouldn't suckle. Wasn't allowed to leave the hospital until I agreed to 'top up' with formula in order to combat the jaundice. They would have preferred me to stay in order to establish breast-feeding, but my milk hadn't come in and I didn't think staying on a sweaty, busy, uncomfortable post-natal ward would make for a better environment than being at home.

I've been offering my breast before and after every 3 hourly bottle feed. I've been lying on the sofa getting as much skin to skin as possible. But up till today DS refused to actually suckle. He would latch on but fall asleep.

Finally on day 5 my milk has started to come in (after a painful session with a breast pump yesterday). Thought I had a breakthrough this morning when DS spontaneously suckled on my breast after a routine bottle feed. Then he didn't for the rest of the day. Each feed I expressed a few drops of milk onto his lips so he would always get a taste for the real thing before getting the bottle.

If he's hungry he'll furiously root for the breast and latch on, but then immediately get frustrated when the milk doesn't immediately arrive, even if I've expressed a few drops in preparation. He'll push it away, then have another go, then cry and fidget.

The rest of the time he's too sleepy to do anything but accept the bottle and feed whilst asleep.

This evening he did the furious rooting thing. Got very frustrated very quickly so I alternated with bottle and offering breast more often to see if that would make a difference. In the end he finished his feed and was still hungry, but couldn't get what he wanted out of my breasts and had a massive cry, was very upsetting for me. I didn't want to offer another bottle because I thought that would just make it worse - and that this was the best time to get him to suckle again.

It was tough, but in the end he managed 5 minutes on each side.

This was my first day of my milk coming in, will it get easier now or should I be expressing in between feeds to get my supply up so it's easier for him to suckle?

Am off to bed for a bit, but will check for responses in the morning. Thanks in advance!

CantSleepWontSleep Sat 06-Sep-08 05:37:55

Hi digitalgirl. Sorry to hear that you're having a tough time at the moment.

I think that you really want tiktok for this one, but one important point worth noting is that it's not just about the volume of milk in your breasts, but about your ds learning how to feed from them, which he won't do if you continue to offer bottles. Could you spend a couple of days in bed with ds offering the breast lots and lots? This would both help him to practice his latch, and encourage your milk supply.

My fear is that he gets the milk very easily from a bottle, so has no incentive to work for the milk from a breast.

I wonder whether syringe feeding might help to avoid some of the confusion for him too, but am prepared to be corrected by someone better informed.

Either way, if you want to breastfeed then it is important to cut down the bottle feeds and increase the time at the breast asap.

Do you have numbers for the breastfeeding helplines, as it might be worth you seeing a counsellor in RL?

fairibell Sat 06-Sep-08 09:27:57

if he is still jaundice this will mean he is still very sleepy hense falling asleep... keep going though as it will get better!!

tiktok Sat 06-Sep-08 09:34:18

digitalgirl - some good ideas from Can'tSleep there. It sounds to me that things have turned a corner for the better, and you sound motivated and determined, which will help you a lot.

I don't think you have had the greatest help in hospital - sometimes babies born 36 weeks are not the best breastfeeders, but from what you say, the advice has been to bottle feed a lot. Sometimes, in a real emergency, and when the mum is not able to express much by way of volume of milk, and there is no human milk bank, a baby may need formula - but small volumes, and not at every feed over days

So the suggestion to use a syringe (ask the community midwife for support and instruction on this) is a good one, as it gets fluid into him with less risk of large volumes going in.

I think you need to see someone in real life, too, and if the community midwife is good, she may be helpful here. You can also phone the helplines as well, though you can't assume a volunteer will be able to come to see you just yet, esp at the weekend.

Co-bathing is a good way to encourage the baby to self-attach too, and it's a nice, relaxing snuggly thing to do, too.

What else is happening - weight of your baby, wees and poos?

digitalgirl Sat 06-Sep-08 11:09:48

Thanks cantsleep - I think I might try the bed thing today at least until the visitors start turning up this afternoon.
I've got a midwife appointment on monday - but would like to try the syringe thing today too. do you just slowly release drops into their mouths?

tiktok i get a different midwife each visit depending on who's on call. they all agree on one thing and that is to NOT reduce my 3 hourly bottle feeds of 60ml until the jaundice passes. But then I was told that this could take up to 21 days, by which time I can't see him bothering to breast feed at all. he has about 4-5 wet nappies and does one or two poos a day.

no suckling this morning or overnight as he was too sleepy - but he happily let me express directly into his mouth while he was latched on.

I'll call another helpline again today.

lisac Sat 06-Sep-08 11:34:47

digitalgirl, just wanted to offer a bit of support.

DD3 was jaundiced after birth and very very slow to put weight on - I reluctantly agreed to top up with formula, but offered just a couple of ozs after 3/4 feeds a day. I also took lots of fenugreek tablets, drank plenty of water, kept her on the boob as much as possible and rested to boost supply. The jaundiced cleared, and I dropped the top ups with no problem after a week or so. Have gone on to breastfeed successfully - she's currently 7 months and still breastfed.

Best of luck - don't give up!

belgo Sat 06-Sep-08 11:55:52

digitalgirl - I don't have any breastfeeding advice but just wanted to say congratulations on the birth of your ds and I hope the breastfeeding works out soonsmile

Ok, this is what I would advise someone to do in your position. Bearing in mind I haven't seen your DS and can't terefore make any assssment of how bad his jaundice is. However I'm guessing its not that bad as he's not in hospital having phototherapy, so it soudns like normal physiological jaundice.

I would never advise a mum who wants to b/f to give 60ml ff at 3hourly intervals. Your DS will never show any inclanation to bf if he is stuffed full of formula, your supply will diminish. I would never advise a formula top up from a bottle as it will cause problems. To be honest I'm not even that keen on syringe feeding and much prefer cup feeding if there has to be a top up.

I would offer the breast at each feed after doing a small amount of hand expression forst to get your let down reflex going. Spend a maximum of 10minutes trying to get ds onto the breast (be guided by how upset he's getting, angry babies will not latch on). If he latches on and has a good 20minute feed then thats great and I wouldn't top up. If he feeds for 5 minutes then I'd offer him a 40ml cup feed, if he feeds for 10 minutes I'd offer him a 25ml cup feed and if he feeds for 15minutes I'd offer him a 15ml cup feed. These are approximate as I have no idea how much your ds weighs and not sure if there are any weight gain concerns. But this is a similar routine that we would have a Transitional Care baby on if we were trying to establish b/f. Your DS sounds a healthy baby and ideally should not need topping up, but as he is now frustrated with latching on the breast he may be needing a bit more while he works ot how to breast feed effectively.

With cup feeding you need to sit him up straight and get him to lap the milk up from the rim of a plastic cup. Most babies will do this quite well (wrap him a towel as it can be a bit messy). He has to work for it a bit still (which is good) and there is elss risk of aspiration (which I've always been told can be a risk with syringe feeding).

If he doesn't b/f a lot in the early days then you need to pump at 3 to 4 hourly intervals to keep your supply up.

Good luck.

domesticslattern Sat 06-Sep-08 12:14:38

Congratulations digitalgirl!!!

You are local to me, no? Crouch End ish? There is a great local breastfeeding supporter at the Stonecroft childrens centre. CAT me and I'll send you the details.

Also, I was in a very similar position to you with my DD who was also born at 36 weeks and also jaundiced and slow to feed. I had just the same experience at the Whittington of them being quick to whisk DD off to give her formula before I could leave, and me feeling a bit sad and angry about the whole thing. As well as knackered!

It will take loads of time and perseverance so if you can possibly try to spend as much time as possible chilling out with your LO, preferably in bed, and trying lots of skin to skin. (Sounds like what you are doing!) Visitors can get slightly in the way of this so don't be afraid to tell them they can't stay long! I wish I had had the balls to do that more as I was trying to establish bf. For what it is worth, I did have to use formula top-ups as well as "unrestricted access" to the boob (great term!), and it did work fine and DD is now still bf at 9 months- you can do it! but it will take lots and lots of perseverance so make your life as easy as you can, while your DS works to get the hang of it.

If I am local, let me know if I can help in any practical ways.

misdee Sat 06-Sep-08 12:21:44

all of my girls had jaundice. as well as regular feeds, i was advise to expose them to as much sunlight as possible. i know the weather is cr*p atm and grey and overcast, but maybe keeop the baby near the windows, go for walks if its dry.

Tittybangbang Sat 06-Sep-08 12:23:41

"maybe keeop the baby near the windows"

Hmmm..... I'm sure I was told that the light filtering qualities of modern window glass and double glazing makes this a bit pointless.

misdee Sat 06-Sep-08 12:25:02

my windows arent that great! lol.

if the weather was better i would suggest sitting out in the garden feeding. but with all the flood warnings etc i'm sure thats not advisable.

tiktok Sat 06-Sep-08 12:36:14

I am very surprised at this 60 ml x 3 hrly thing....are you sure this is what was said? It is a lot of formula

traceybath Sat 06-Sep-08 12:42:23

i had my second DS at 37 weeks and he spent a week in NICU for breathing difficulties and then had jaundice which required phototherapy.

i breastfed - initially i expressed (hand then pump) and he was tube fed and then transitioned gradually over to actual breastfeeding.

i was under the impression that breastmilk was really good for helping jaundice.

just wondered how do your boobs feel? is it possible to do some expressing to get your supply going a bit?

i'd definitely see a bf counsellor in person and good luck in establishing feeding.

not much advice really but just thought i'd share what i did. Oh and jaundice does make them sleepy so i did wake to feed.

digitalgirl Sat 06-Sep-08 20:59:34

I have spent most of the day in bed doing skin to skin, feeding or expressing.

I spoke to someone on the breastfeeding network who advised me to do the following:

1. Lose the bottle and start feeding DS via a cup, it requires more effort from him and will get him sucking. This seems to work, in terms of him waking up to feed rather than passively lying back and letting the bottle drip feed down his throat.

2. Lots of skin to skin - have been doing this all day and don't know what effect it's had.

3. Co-bath - have not had a chance to do this yet.

4. Start expressing my milk after each feed (up to 6 or 8 times a day) in order to start replacing the formula for the next feed. - This has been exhausting but could be the key to at least weaning him off formula and developing a taste for my breast milk. The first expressing session I got 20ml, which he struggled with in the cup in comparison to the formula. I've since expressed twice and my supply is dwindling - but hoping tomorrow will be better.

5. Keep offering the breast before and after and even midway through cup-feeding. - Emotionally draining as he's really beginning to cry now when I do this. Ocassionally he'll latch on while I express into his mouth but offering him the breast before the cup is now a sure way to upset him. Stripeyknickers 10 minutes max rule sounds like a good one, i'm sure I've spent a lot longer than that over the past few days - no wonder he's crying himself purple. Also, thanks for the 5min BF = 5ml less top-up rule too. Although DS has only ever breastfed for 10 minutes max and that was after a bottle feed. Today he's only BF for a couple of minutes each side, again after a cup feed.

6. Arrange to see a BF counsellor in person. - I've got a number to call on Monday for someone local (she's based on Priory Road DomesticSlattern maybe you know her?)

Well, the 9 o'clock feed beckons. Time to go wake DS up.

Thanks everyone for your support!

traceybath Sat 06-Sep-08 21:17:13

You're doing really well - expressing is very tiring especially on top of feeding too.

Hope tomorrow goes well too.

Mumsnut Sat 06-Sep-08 21:17:28

Digitalgirl, well done for pumping to replace the formula they are pushing at you.

Neither of my jaundiced and ill babies would suck, so I expressed and fed them from a bottle (not a wise choice but i kept choking them when i tried a cup). Anyway, I did find that as they got stronger they would latch on, though it took weeks and weeks for DS to get the hang of it. I found that nipple shields really helped them latch on in the first place, and then I just phased the shields out gradually when the dc got to be strong feeders.

I know this isn't a 'purist' position, but it did mean that I avoided the dreaded formula and am still b/feeding dd 18m later. The key thing is to keep trying with the latch, and the other key thing is not to assume that you have missed the boat if it doesn't happen immediately. Ds took 4m and dd took 6w.

Claire236 Sat 06-Sep-08 21:36:04

My son was early (36+5) & jaundiced. Prior to the jaundice I'd been advised to give top up FF as his blood sugar was low. After the jaundice was identified it got really complicated though. DS was moved to SCBU for phototherapy & during the first week of his life was breastfed, bottle fed, cup fed & tube fed. Was not a fun time. I found BF really difficult once home from hospital as DS couldn't feed enough before he got tired & fell asleep. Then I'd lay him down & he'd wake up again because he was still hungry. The combination of hunger & tiredness made it even harder to BF. Manys the morning I could be found at about 3am with unbelievably sore breasts & a still crying, still hungry baby accompanied by a crying, frustrated mother feeling like a total failure. Well done for persevering & I wish I'd known about this site then as I might have got the support you now have & been able to carry on BF. As it was I started with a bottle (expressed milk) in the night to save my sanity & was exclusively FF by the time my son was about 2 months old. We're currently trying for baby number 2 & I will be pulling out all the stops to BF for the majority of my maternity leave as it still bothers me that I felt I had no choice but to quit BF with my son. That was really long, sorry. Good luck

likessleep Sat 06-Sep-08 21:36:37

Tiktok - there is a calculation isn't there for amount needed to top up, based on body weight but i can't remember what this was?

My DS was 5lbs10ish at his lightest and he was being topped up with my 70ml EBM every 4 hours (might have been 3 hours, can't remember) as well as being offered breast. (my DS was jaundiced/in SCBU/phototherapy when first born. He lost about 11% of his body weight and so had to be topped up, but he was on the borderline as to whether to treat with phototherapy. )

not sure how this compares digitalgirl to your DS?

It can be so stressful when they are so sleepy and all you want them to do is to wake up for a little while for a feed. Just focus on you and your new son.
Expressing is time consuming and knackering, let others look after you and you take care of your baby. You will help to build up a supply. I expressed so much in the first few weeks and am sure that's why I have been able to breastfeed for 10 months. Good luck x

domesticslattern Sat 06-Sep-08 21:45:31

Well done digitalgirl, you are doing brilliantly, and all that advice sounds good.

You will be knackered and emotionally drained by now, I'm sure. Keep up the efforts as they do pay off, but please don't see formula as "dreaded". I found it hard to keep a sense of proportion in my efforts to bf, especially as dd wailed and wailed. (I did get there in the end though!)

Yes I am thinking of Priory Road. In fact, there's a thread about it here:

www.mumsnet.com/Talk/4123/500841

BTW everyone I have ever met who has been to see Jenny has cried (including me!). She is used to emotional new mothers!

Good luck tomorrow.

likessleep Sat 06-Sep-08 21:45:51

isn't it bad how different hospitals suggest different things? claire - practically same experience, but the hospital encouraged me to express very regularly.
i hope all goes well for your baby number 2. (that first week in scbu has put me off another to be honest at the moment) sad

Claire236 Sat 06-Sep-08 22:04:11

I did express with my son but most of it went to waste as I had loads of milk & he wasn't feeding much & the hospital insisted formula was necessary, sounds ridiculous now that I didn't insist he only had expressed milk if I couldn't BF but I wasn't in the most stable of emotional states it has to be said. I'm nervous about another one as I wouldn't want to go through that again. With my son we just dropped everything & dedicated every second to our son but if the same thing happened again I'd have to deal with alot of it on my own as my husband would need to be with our son (he's 3 btw) My desire for another baby has been gradually increasing to the point where it's now stronger than the fear. I'm considerably better informed now which will help if the same problems occur again. My son also needed an op which we were told about when he was only hours old. Now I've thought back to just how hard it was I'm scared all over again about risking putting us through all that. Going to go to bed before I depress myself.

berolina Sat 06-Sep-08 22:12:26

digitalgirl - well done. Hang in there. You're in good hands here on MN.

ds1 born 38+0, sleepy jaundiced etc., dreadful handling of bf at hospital, emotional blackmail to top up from the get-go, given bottles to do so, 8 days in hosp (phototherapy), ds1 started refusing breast, cue despair. I offered breast before each and every feed and whenever he cried, expressed like a mad thing (night expressing is especially important) - I never got much but it all helps with supply if the baby is not feeding -, made sure latch was good, topped up using the EBM and if necessary formula. Eventually (about 3.5 weeks in) ds1 stopped refusing breast and had his last ever bottle at 4 weeks. He was excl bf then until 6.5 months, is now 3.3 and being tandem fed with his 1yo brother. grin

I know first-hand how horrid it is but you need to keep offering breast first at every feed. You also need at least 8 expressing sesions in every 24h.

Hang in there. We are living proof that it can work out - due in no small part, I must add, to tiktok and the other bf gurus of MN

likessleep Sat 06-Sep-08 22:12:31

oh claire, i'm sorry. you weren't given the right support in hospital and that's what angers me, that mums are so vulnerable then. i felt the worst i have ever felt in that first week.
your next precious baby will be totally fine. but i know how you feel about the fear. ds is 10 months old now, so we are at different points.
i am so sorry if i've depressed you. i feel bad sad

macaco Sat 06-Sep-08 22:28:17

claire that's EXACTLY the same as me, minus the SCBU. Exactly.

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