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.

I'm not fully up to date on the thread but glad it seems like your little one is cracking on with the weight gain. Just wanted to jump in and recommend the Momcozy hands free breastpump on Amazon if you've got a bit of spare cash (about £60). Hopefully it's available where you are. I ordered it the other week because I was going away for the weekend and been really impressed with it. If you plan on expressing at all once you've got breastfeeding sorted (doesn't seem like it will be much longer) then it will probably be worth it.

Best of luck though, you're doing amazing and your perseverance is beautiful. You will be such an amazing mother even if it doesn't work out the efforts you've went to make breastfeeding is fantastic.

@addler I don't know much about the sns system but have heard about it. Amazing that you worked so hard to breastfeed when you had some issues with glandular tissue. Truly inspiring!

@Arthien I've been checking my nipples out and they seem to be slightly lipsticks all the time. I don't know ifbits because they are massive and get squashed by my bra. Nonetheless, I will see how I get on and consider finding an expert to check if things don't improve.

@Cocona thank you so much for your very kind words. I'm actually really touched! I havent heard of the pump: like the hands free idea!

OK slight update.
I power pumped 80ml yesterday, and in the wee hours of this morning I got 150ml. Then all day, we nursed and did skin to skin. For the first time, I felt a good solid latch and felt my baby empty my breast, along with gulping. I watched her like a hawk and made sure she was actively drinking for at least 20 minutes, normally 30. Sometimes the process took an hour with waking her up, switching sides multiple times, repeating the latch. She fed on me every 2 hours and the sensation definitely felt more like when I was feeding my last child, the one who never tasted formula in her life and fed until 12 months old.

My husband gave her some of the expressed milk while I did another powerpump. Was pleased with my 90ml considering its 10pm here and I've been feeding all day. Starting to think my supply could be rescued? I think as my supply increases, my baby is a little more interested at the breast too.

I've set an alarm for 2 am to either bf or express. I'm not taking any chances when success feels so close. I just have one concern; I started this process when my baby was exactly 4 weeks old. Is it too late to establish a full term increased supply, enough for indefinite exclusive breastfeeding?

Looking back, a big part of the problem was that my.milk didn't come in until Day 4 or 5 and it was so agonising that I didn't go out of my way to initiate feeds. She was a sleepy baby and didn't seem to mind going long stretches. Her hunger cues are very subtle and often she would be doing what I now see as displaying hunger, but would just fall asleep rather than pursue it.

The LC thinks that she should be taking in around 100ml at each feeding and judging by the combo of breastfeeding, expressed milk and formula top ups, this seems to be accurate. I offer each top up very discerningly and gradually and think 100ml is in fact what she wants before she goes all dreamy eyed. I know expressed milk isn't an exact science, but it looks like I'm getting there.

I'm a great believer in prayer too, and if any of you feel the same, please remember me and my boobs during your prayer time 😀

Thanks for the support and kindness everyone.
I was so low a few days ago and my tears were practically dropping on the phone as I read all of your messages. What a lovely community. Thank you all so much for your kindness ❤ you don't know how much I value and re-read every single comment, even if I didn't name check you.

Thank you!

I'm glad you are doing so well!

I don't think it's too late to establish exclusive bf.

My situation with ds was slightly different because he had a condition which meant he was failing to thrive and wouldn't feed (very severe reflux and CMPA). We tried formula but it made him horribly ill, so had to stick to the breast (with me on a strict elimination diet).

Because he didn't feed well, my supply decreased. I started pumping and taking supplements when he was about 6 weeks. I started to seriously relactate when he was about 7 weeks. My supply then increased to the point where I got mastitis, due to ds not feeding effectively and me pumping so much.

Once his meds got sorted when he was 16 weeks, he went from off the charts underweight to the 90th percentile in six months largely on bm. From then on, never had a problem with bf (or mastitis) again.

@CatherinedeBourgh that I'd so reassuring. What a journey you've been on! Im so glad it all worked out!

Yes, your husband can do skin to skin and that will be beneficial, but it probably won't help in terms of getting breastfeeding established. Don't worry if that is one thing you don't feel you can do. You can have baby close in other ways. It's just about stimulating those hormonal responses in your body. Sniffing their head and holding them in general all helps too.

It sounds like you're doing so so so well! And absolutely it's not too late! There was a really good video I found about establishing milk supply that I watched when I was pregnant this time and it had new information in to me. I'll see if I can find it for you.

I had a very similar experience…. Not enough weight gain but I thought he was getting lots of milk from me. I did breast milk and formula top ups and his weight gain increased dramatically in a very short time… I think looking back that he wasn’t getting enough milk from me and needed more. He was settled after feeds etc just like you but I don’t think it was really filling him up enough to meet his needs. I can see now he is a really hungry, chunky little boy! Yes the nappies are good, the soft breasts etc are all good signs but the weight gain is also a measure of their overall growth. I’ve had zero issues with giving him some formula. Do you feel it’s worse for them? Modern formula is very good and there’s lots of research showing it is a healthy option. I’m in France by the way. You might find your supply increases if you can pump or feed more regularly so maybe you can use some formula top ups for a couple of weeks and then only breast again or something. Either way the most important thing is that your baby is getting the maximum milk and growing as she should. Good luck xo

@BertieBotts I must have been tripping with tiredness when I messaged that...of course my husband doing skin to skin wouldn't have any effect on my breastfeeding. At the hospital they wanted me to do skin to skin but my breasts hurt so must it was agonising just having her lie on me. My nipples aren't sore any more so we did a babymoon today: skin to skin, and lots of snizzing and snoozing with her on my chest. It was absolutely beautiful! I'm learning so much in this process. About how much I want to breastfeed my daughter, how out of control we are in so many aspects of our lives, and what motherhood means to me. I know I will never take a breastfeeding relationship for granted ever again!

@sjxoxo thank you. Your little boy sounds like he is thriving!

No I don't have a problem with formula at all. I moved my first child onto formula at 3 months for different reasons and was more than happy to at the time. He gets less sick than his sister who exclusively breastfed for much longer. I was formula fed from birth and have had excellent health my whole life. I think formula is a medical marvel actually! But I love breastfeeding and worry that the formula will derail my ability to do it, rather than a problem with formula itself (ifbthat.amkes sense).

Bless you, no worries, I didn't think it was a stupid question :)

Just another voice saying I struggled to establish feeding DS2 but did get enough milk in the end and was able to exclusively breastfeed him until he was about 2.5 years old (obviously with solids too!) When I stopped because I was pregnant.

You sound like you're doing a great job. Your story sounds similar to mine with DD who has tongue tie. We had it cut quickly but she still struggled to latch well until she got bigger.
The tongue tie lady recommended fenugreek tablets to me, which are supposed to help increase milk supply.

@BertieBotts that is so reassuring thank you!!
@prediction500 thanks for the tip! My LC has me on other stuff so will see how I go with it.

I'm feeling positive about everything and see light at the end of the tunnel finally.

The formula might ‘derail’ your ability in the sense you could reduce your supply IF you formula feed ‘instead of’ putting baby on breast. So you need to either pump every time you give a bottle or pump at times intervals to keep/increase your supply. x

@sjxoxo I have been breastfeeding then watching for hunger cues and giving 20 or 30 ml of expressed milk. After that I carefully watch to see if baby is still smacking her lips and sucking her hands and then give 20 or 30 ml formula on top of that. So while I've been removing milk from my breasts via direct feeding or expressing every 2-3 hours, I worry that my baby's stomach will gradually get bigger from the top ups and my supply won't match. I give her a top up if there is any doubt that she is hungry but every time I do it, I wonder if it will be the kiss of death for being able to satisfy the baby. I never give a separate, full bottle of formula instead of removing milk from my breast, so maybe I'm OK. The LC says that my supply should hopefully be able to cover all baby's needs soon and formula won't be necessary. Am hoping her logic works!

Yes this sounds fine, you don't need to change your approach. That advice from sj is mostly right but it's simplistic, you're on a feeding plan so it doesn't apply directly to you. It would be useful advice for somebody who is having a straightforward time.

You might want to look up paced bottle feeding, this is a technique that allows the bottle feeding to go slower so that you are not overriding baby's hunger cues and gave me enormous peace of mind that I was only giving as much formula as necessary and nothing extra.

@BertieBotts thanks for that. I bought a special Medela teat for pace feeding and broke it by pushing the brush through the hole when washing it! Will have a look at the video...anything that saves my breastfeeding journey!

@BertieBotts this is how a midwife in the hospital showed me to pacefeed but the LC told me not to do it like that in case it gave the baby wind. What was your experience? I have just been taking the bottle of my baby's mouth every minute or so and taking a pause. Am getting obsessed with the absolute minutiae of breastfeeding and all its associated disciplines 😀 Feel like training to be a lactation consultant after this myself (not really 🙃)!.

You can do paced feeding with any teat, it doesn't need to be a special one :) just stick to the slow flow rather than moving onto stage 2, 3, etc.

Actually lots of LCs decide on the path after they have had feeding struggles themselves!

Air in the teat used to be thought to cause wind and it is still a fairly widespread/common belief, which is why lots of people will tell you you must avoid it (I definitely remember being told this when I was younger and feeding someone else's baby!) but there is actually no evidence to support this, we now think wind is likely to be caused by babies feeding too fast either with traditional bottle feeding techniques or due to a fast letdown at the breast. Mine never got excessive wind from air in the teat anyway, I don't think it matters too much.

OP I'm so glad things are looking up! She's had a really good gain and apart from that I think you could tell she was feeding more effectively when you were doing those times of skin to skin and babymoon. I absolutely think it's not too late to establish EBF. It's worth seeing a tongue tie specialist if that's possible but sometimes the baby's jaw structure can contribute to feeding problems. My DD had her tongue tie cut but the Dr said that I might not see much improvement until she just grew a bit. And I think that was true. What you said about her not seeming to open her mouth very wide made me think of that. And also what you said about her being very sleepy at first. I think it's easy to get into a cycle before you know it, with the baby being sleepy and not feeding well for a combination of reasons and then becoming sleepier and on and on. It's no-one's fault but it's very hard. It sounds like there is no intrinsic problem with your supply at all, so it's just about getting it back on track which you are doing absolutely everything you can to achieve. Best of luck to you! Just keep going! Your DD is lucky to have you.

@Nightwithhertrainofstars that made me cry, thank you.
And @BertieBotts your advice has been invaluable too. As have so many others who have contributed, everyone actually.

Update! Baby has gained 50g, totalling a gain of 180g since last Monday!

Fantastic!!
*applauds

Great news!! Congratulations, you are doing an amazing job.

Hmm, a confusing update. I've just message the Lactation Consultant and am waiting for her to respond. Wondering if anyone has any ideas while I Wait.

I thought everything was going great. 170g weight gain recorded on Sunday. Feels like my supply is back as baby glugs away for ages on each side, every 2.5 hours. I set an alarm at night to either waker her to feed or to pump and give her them milk next day. I was sure we were back on track.

She normally has a good drink and falls asleep. If she seems hungry afterwards I top her up until she seems satisfied. Happens once or twice a day. She seems satisfied the rest of the time.

She hasn't gained a gram since Sunday.

I weigh her at around the same time each day, always before a feed between 1-3, wearing a vest and no nappy. She hasn't put anything on at all in 3 days. Her output is still good, with lots of dirty and wet nappies.

Can anyone tell me if they have been through this? Or suggest what they think is the problem? I know that noone can give me medical advice but I just need to chat.

I thought we were doing so well. Finally I could see light at the end of the tunnel but nothing has changed despite my supply appearing to be increase.

I'm no expert, but have breastfed two babies till 18 months ish, after very rocky starts both times - including stays in SCBU, and being mainly bottle fed on discharge home, expressing round the clock and so on.

I think that weighing daily is perhaps generating more stress and anxiety rather than being a reassuring tool. Did the lactation consultant, or another HCP ask you to weigh daily?

@Thejoyfulstar my DS lost weight after birth a took a good about 8 weeks to get up to birth weight being purely breastfed. Although I had fluids during the birth which can inflate their weight ( I've been told) He was absolutely fine and like yours alert and progressing and I stopped getting him weighed as soon as I could get away with it. I could see he was growing, needed new clothes. He is now a very tall 5 year old !