Milk supply and expressing advice for a mum and baby in hospital

[ChairmumMiaow]

My brother's wife (his ex still feels like SIL to me) has just had a baby and after struggling with feeding asked me for advice. I told her what I could and their DD seemed to be feeding better and they were all more relaxed when we left. I left the BF helplines etc and the midwife was coming into them later that day.

Unfortunately she had already lost a lot of weight and has been back in hospital being treated for jaundice and some dehydration. She's been tube fed for a while and is now being cup fed a mix of formula and breast milk.

They do really seem to want to breastfeed so on top of my advice about lots of skin to skin etc (have leant them slings etc and advised that baby spends as much time on mum as possible, rather than my brother taking her when she stops feeding, to give the mum a break), while the top ups are continuing she obviously needs to do as much as she can to increase her supply.

So, any tips please? AFAIK she is expressing 3 hourly and the midwives etc seem very supportive (although she feels they didn't help her much before she came out of hospital on the BF front). Apart from regular expressing and skin to skin, is there anything else they could/should be doing?

TIA!

[tiktok]

How old is the baby, Chairmum?

All you are suggesting sounds spot on.

Whenever a baby is re-admitted for jaundice and dehydration, I'm afraid it normally is the midwives' fault. It is their job to ensure that bf is effective and to take steps to fix it when it isn't....and to let the mum know the signs to watch for. So your SIL may be correct to be sceptical of their support.

She needs to know how to recognise when things are going better, and to ensure her breasts are stimulated on both sides by bf or exp at least 8-10 times in 24 hours.

[ChairmumMiaow]

Update - its got a bit harder for them too - the baby is not interested in the breast at all because she is being filled up with breast milk. Also expressing has become painful. I've suggested trying hand expressing but any other tips?

Am currently suggesting they have a chat to the midwives about a plan to reestablish breastfeeding and if they can't help I have said they should ask if they can bring in a proper trained breastfeeding counsellor (i.e. not me !)

[tiktok]

How old is the baby, Chairmum? How long since discharged from hosp?

[ChairmumMiaow]

tiktok - She must be 6 days old. She was home (after a CS) on saturday and back in on sunday.

When I saw them on sunday they didn't feel like they had been told much about breastfeeding at all

[tiktok]

'Tis early days, then, CM....so all could turn round and become OK pretty quickly. Agree with your suggestion to get someone else in to talk or meet them.

Is this in the UK?

[ChairmumMiaow]

tiktok - yes in the UK. So no rush to get her back on the breast so long as the mum is expressing?

Do you have any advice about the expressing pain?

They're talking about sending them home tomorrow so it would be nice to know they've been sent off with a plan to re-establish feeding...

[tiktok]

Painful expressing - needs someone to watch and ask more Qs. Where's the pain? Nipple or breast?

Skin to skin is essential - more crucial than whether she actually takes the breast or not. Main thing at the moment is to protect the milk supply and to keep the baby well-hydrated.

[ChairmumMiaow]

Its all nipple pain apparently. They reckon it might be the hospital pump but don't seem keen to try hand expressing.

[tiktok]

Sorry, that's crackers - if the pump is causing pain to the nipple then she needs to express in some other way. If she really does not want to try hand, then she needs another pump pronto. She risks damaging the skin of her nipple and that would be very bad news for getting her back to full bf.

It's poss she has turned the action of the pump up too high, or is using an inner flange which she does not need....worth exploring both those options.

[ChairmumMiaow]

ahh apparently it is only painful initially now, and has lessened when the mum is relaxing. Have suggested they keep an eye and inform the midwives if it gets worse again (even if they seem very busy).

Will leave them alone to relax for a while now!

[1stMrsF]

I would say that baby should be put to the breast first, before any cup feed and before any expressing - then baby always feeds from breast when hungry and hopefully takes more from breast and less from cup.

[bethylou]

Hi, I used to apply Lansinoh before expressing - I know people use it for sore nipples but I used it to prevent them and it helped me. I think different pumps suit different people so she may have to try a different one. Personally, I found a manual pump didn't hurt but an electric did - we're all very different though.

One friend recently struggled with BF initially and was given breast shields. There are lots of pros and cons I understand, but she ended up breastfeeding for 8 months after a similar start to the one you have described. I'm basically saying don't rule anything out at this stage.

Another friend paid for a private breastfeeding cousellor to visit for a day. While it was expensive, she felt strongly that it was what she wanted to do and that the money was very well spent as the lady could stay for several feeds and get it well established.

Hope this helps.

[ChairmumMiaow]

thamks for the advice all. It all went quiet from them and they're mixed feeding now so not much more I can do to help them!

[tiktok]

Thanks for update, CM....mixed feeding at 10 days, even accounting for the difficulties at first....doesn't look good for continued bf, does it?

[ladylush]

Dd was mixed fed whilst on SCBU as she was born 10 weeks early and despite frequent expressing my milk supply was poor. I then tried domperidone and within 2 days my milk supply was much better and I was able to give her solely my milk (was being supplemented with bank milk, then formula for 1 week). Though she is now home I am still giving her expressed milk. We're trying to establish bf and she has breastfed once each night for past 2 nights. However, my milk supply has not increased in line with dd's increased requirement. I've raided the freezer and am almost out of expressed milk. It seems to have got worse over past few days - possibly due to sinusitis. I could only express 40 ml an hour ago There is a box of formula in the back of the cupboard and I am dreading having to open it Hope all goes well with your sil and her baby. If she is following all advice re. expressing and it's still not working, maybe she could try domperidone. It's a last resort option but honestly without it dd would not have had breastmilk for the past 2 months.