Breastfeeding: is this a problem?

[Thejoyfulstar]

I live abroad but am from the UK. I has a babyb4 weeks ago who was born with respiratory distress. After 24 hours in NICU she was fine but my milk didn't come in until Day 5 and I suffered from dreadful nipple pain which hindered feeding even more.

My baby was 3460g at birth. She dropped to 3165g at 6 days old. They gave me a plan to breastfeed on demand and supplement with expressed milk or formula but this was though as she didn't want anything extra than my breasts. I was syringing in every bit of expressed milk I could get into her and giving her formula in a bottle, which she often vomited. By Day 9 she was 3220g.

Regrettably I decided that I would then focus on just feeding her from the breast. As far as I could tell, I had milk. I've breastfed 2 other children successfully so thought I knew what I was doing.

I leak milk when I haven't fed in a while. My breasts feel hard and full and after she feeds, the feel soft and empty. I can see by the movement between her ear and jaw that she is drinking, and I can hear it too. Afterwards she is contented and is a very settled, happy and alert baby. I change her nappy every 2 or 3 hours and there is always wee or poo. She sleeps a lot but I wake her if 3 hours go by to feed and she is feeding almost the entire time she is awake. My husband and I have been joking that we feel how heavy and chubby she is getting.

I took her to the paediatrician for her 4 week check today and she is 3550g. He says that is not enough weight gain and I have to give formula. I said could I still breastfeed. He basically said what's the point as I clearly don't have milk.

I am so upset and confused. I was certain that my baby was transferring a good deal of milk. The initial latch is still painful but that was the same in the early days of breastfeeding my other 2. I fed my middle child until she was 1 and never had an issue like this.

I feel like where I am, doctors overreact about things that drs in the UK would not. At the same time I don't want to be so arrogant to think I don't need to take their advice. I feel like I have put my heart and soul into establishing our breastfeeding journey and feel totally floored that is has all been for nothing. Am trying to find an English speaking lactation consultant but am really struggling to do so.

Does anyone ahve any experience of this? I have received such little support despite asking for it and looking for it. I dont know where to go from here.

OK! Update.
The consultant came out and she was excellent! So lovely. She went through our notes from the hospital and looked at the various measurements. She agreed that the weight gain is too slow. She stayed for 2.5 hours and was incredibly attentive; observing, asking questions etc . Turns out the Dr was right and I haven't been making enough milk. She watched me feeding and corrected the horribly painful latch that I've been enduring for weeks. I fed without pain for the first time which she said will improve milk transfer. She set me up with a pumping schedule to increase my supply over the next 48 hours and how to incorporate that milk along with a little bit of formula into the supplementing schedule until my supply increases. I have to weigh the baby to closely monitor the weight for the next week or so and once she has gained enough weight she can then breastfeed normally, no supplements or pumping etc. If this plan doesn't work we will try power pumping but this is the first plan.

Light at the end of the tunnel!

So glad to hear that! Fantastic that you now have the support you need.

@CatherinedeBourgh I gave birth at a so-called World Health Oragnisation accredited 'baby friendly hospital' and the breastfeeding support that I received was absolutely dreadful! Me, a third time mum, distraught and begging for help and not getting the tiniest amount until the day I was discharged. Terrible!

Anyway am seeing light at the end of the tunnel but I feel so flipping guilty that I have not been giving my baby enough and she has been hungry all this time.

It's not your failure, it's theirs. You shouldn't feel guilty, you have been doing everything in your power to remedy the situation.

It's incredible how poor bf support can be. I went to a hospital that was over an hour away from my home because it was supposed to be the 'bf friendly' hospital and the paed left me in tears telling me I would never be able to bf. Further, by making it all about me, he made it so we didn't consider the possibility that is was ds who had the problem (which was in fact the case) and this delay meant a horrible downward spiral where he got worse and worse until I eventually managed to get a consultant who correctly diagnosed him (in a different country!).

Human childbirth and bf is hard enough with support (the price we pay for those enormous brains!), and then the support fails...

@CatherinedeBourgh that sounds incredibly frustrating to say the least! These places seem to get some kind of stamp that looks good on paper but they don't have a clue and don't understand the massive consequences their ignorance can have on a breastfeeding journey. Its awful. I'm getting so annoyed thinking about how they all palmed me off and now I'm paying the price, or my baby is.
Anyway, onwards and upwards. Were you able to breastfeed in the end?

Oh that’s fantastic that you got to see a consultant who actually listened to what you want and was prepared to spend the time to sort out a plan that takes your wish to breastfeed AND the need to increase your babies rate of growth. And pain free feeding is much preferable!

@HereBdragons I really felt very listened to and understood! And I definitely prefer not feeling like I'm being tortured!

Yes, he bf for 3 years!

Amazing! Very inspiring @CatherinedeBourgh

I wonder if anyone can give me another handhold!

I started the schedule on Tuesday evening and it is intense! It's a cycle of pumping, breastfeeding, offering baby expressed milk afterwards, waiting for more hunger cue and offering a tiny bit of formula if she wants it. Sometimes she does, sometimes she doesn't. My scales arrived and she had gained 25g which is a good sign that it's working.

But it's tough! I am struggling to latch her on properly as her mouth is so small and she won't open it wide. We both get frustrated and she gives up and falls asleep. I need to strip her to wake her up. I do the whole nipple to nose, tummy facing me thing but she will not open that mouth as she is used to the shallow latch that we were getting by on before. Any ideas on how to get her to open wide? I'm starting to dread each nursing session as it's such a battle.

Washing and sterilising the bottles and pump parts throughout the day is time consuming, as is the pumping itself. Getting the timing right so that the breastfeeding and expressing sessions are adequately spaced is a pain especially when my other young kids are at home and need food or something.

The LC seems confident that I will see a difference in my supply soon and that this is only short term. It's just intense! While she is consuming more calories overall, she seems more lazy at the breast than ever before. Probably because of the bottles she is taking to supplement but she spits out syringed milk and in all honesty, the patience that syringing milk into a newborns mouth requires is beyond what I've got at the minute.

I know that nothing improves milk supply better than removing milk from the breast, but had anyone tried any food or drink that you felt made a difference to your supply? I'm interested in a bit of anecdata to investigate for myself. I have stopped feeling like I'm leaking milk and rarely get that 'full' feeling since I've started the plan. Don't know if that's a good thing or bad thing.

Thanks for listening everyone. I'm not complaining as I'm happy to be rescuing my breastfeeding journey but it's a full time 24/7 job and I feel like I have no idea what I'm doing. Any advice or encouragement would be great. Thank you!

Can you find an NCT group or lactation consultant? They can watch you feed, check your latch and reassure you.

Doesn't sound like the GP was an expert on breastfeeding...

And it sounds like you and your baby are doing great!

@springtimeishereagain I'm under a lactation consultant and she is really great. Our consultation was very thorough and she is in touch with me every day to support me in the process. I just wanted to have a bit of a moan here as I'm so tired 😫
Thank you for your kind words though :-)

Ah, glad to see you have a lactation consultant.

Things will get better, it's early days yet. Your baby will get better and more efficient at feeding and won't need feeding so often. Try to rest when you can, and keep up fluids. And eat enough carbs!

@springtimeishereagain I am insatiable thirsty so guzzling litres of water. I had for breakfast porridge oats made with full fat milk, topped off with a bit of cream and some nuts and seeds on top. I know its all psychological but am imagining my milk turning into some kind of rich ice cream with all the fats!

Not psychological at all!! Eating and drinking the right things will def help your milk. When I was bfing I craved Muller rice pots. Apple with custard, mmm. Had one or two every day. Haven't had one since!

@springtimeishereagain oooh rice pudding!!!! Yes!

Do you have any local English speakers/expat groups that you could ask for advice/referral to a paediatrician who is a bit more BF friendly? I feel like that would be a thing on our local group that people could help with. Also, I wonder whether the breastfeeding support in your country is normally given by a different HCP - for example here in Germany, you'd have a Hebamme (midwife) during pregnancy and afterwards, and you'd ask her for any support with breastfeeding, whereas the paediatrician literally just looks as the child and says weight gain yay or nay. They will be supportive of the idea of breastfeeding, but don't usually have any training in it. I never managed to get a Hebamme, because they get booked up, but there are clinics that you can go to where they give advice and support to the general public. Perhaps there is something like that in the country you're in?

Your breasts not feeling full/leaking is good - it means you're removing milk more effectively and means that they will get the message to make more.

Do you know if your LO is transferring milk effectively at the breast? If not, that could be a cause of the slower weight gain and milk building up in the boob (which causes lower supply over time).

You asked how long it takes a breast to fill up after being emptied - this is not really how breastfeeding works. You don't have to wait for your boobs to fill up. You will constantly be making little bits of milk (think about a dripping tap) which will build up over time and cause that fullness/leaking, but when your baby latches on or you get going with the pump and you get a letdown (that sort of "rush" feeling), that is like your body just got a message "Hey, turn the tap on!" Milk is being made on-demand, in much higher quantities than the build up between feeds. Then when you don't actively have letdown, the "tap" is still drip drip dripping. That's why you will find milk builds up over time in the breast, but this isn't the main milk supply, it's more of an excess.

This is quite helpful if you want a more full explanation:

thefunnyshapedwoman.blogspot.com/2011/01/breasts-feeling-full-good-thing-myth.html

@BertieBotts thank you so much for that link. It was so informative! I always thought the opposite but now I understand the science behind the empty sensation. My breasts however do seem bigger but definitely not full. Previously my boobs would leak through my clothes etc so I assumed that was a sign of a great supply.

The paed definitely loved the idea of breastfeeding but obviously sees it as a kind of luxury that should be the first thing to go in a slow weight gain scenario. I even asked my gynecologist who was with me throughout the pregnancy for recommendedations for a lactation consultant and she basically said surely I didn't need to see anyone when this was my third baby. There seems to be a huge amount of ignorance.

There is no service where midwives come out to your home in my area, but other parts of the country do home visits. It just depends. There are private agencies and my lactation consultant is actually a private midwife who offers several services including the lactation support.

How can I tell if the baby is transferring milk? She has been having frequent wet and dirty nappies and when I had the full boobs they would feel empty afterwards. However I now realise that breastfeeding is full of riddles and tricks so I don't know what to think anymore. I wouldn't be surprised to learn that frequent wet nappies is a sign of dehydration or something else equally obscure:-D Great to get these tips!
How I fed two other children is beyond me, I'm clueless!

Well it's easy when it works :o I also have three children and only one had any breastfeeding issues. Everyone always seems to think you are an expert when it's your third. Luckily my third is one of the easy ones so this suited me as they wanted me to stay in hospital and get feeding established whereas I wanted to get out ASAP since no visitors due to covid.

Frequent wet nappies is great. :)

Do you have any follow up with the LC or ongoing support, as these would be great questions to ask her - whether the transfer is good, how to get baby to open their mouth - someone who has observed you feeding can give much more useful information than people on a forum can.

Has any sort of tongue or lip tie been ruled out? None of mine did the "gaping bird" thing then latching and when they were older and undergoing orthodontic work, 2 out of 3 had minor ties. I did wonder if this had been the problem with breastfeeding.

I went on to breastfeed 2 for over a year and one til they were 2.5 so it wasn't a disaster.

@BertieBotts and @SoupDragon we are in text communication since our in person consultantation. I think she is seeing me through until my baby gains a bit more weight. I haven't asked these questions as I've been bombarding her with other ones so wanted to spread them out a bit :-D but I will. Someone checked her at the hospital and said she didn't have atongue tie but that her tongue is a bit on the large side 😳. Looking back, I always had a bad latch with my other two but as their mouths grew, things just suddenly were fine at 4 week. When the LC was here she just managed to magic my baby's mouth open and I thought that was that!

I found these

www.amazon.co.uk/Motherlove-Herbal-Company-More-Capsules/dp/B000ITVRD2/ref=sr_1_2?keywords=more+milk+plus+motherlove&sprefix=more+milk+plus%2Caps%2C123&tag=mumsnetforu03-21&qid=1646917503&sr=8-2

massively increased my milk supply (to the point I got mastitis, so use with care!)

I found when they latched on shallowly stroking their chin and pulling gently on the lower lip helped the latch improve. Worth a shot?

@CatherinedeBourgh thank you! The LC gave me tablets to take and I'm also on sunflower lecithin but always great to have other tips!
I've been doing similar with the chin and lips, but not too gently :-D just shoving my finger in there and stretching the lips out. I weighed her again and she has continued to gain since yesterday so am pleased :-)

How long did it take to see a difference after you started taking the tablets?