Bottle, Breast and Pump!?

[babymom23]

(This has been posted in infant feeding too I'm new here lol)

I am having a bit of a supply issue at the moment. Peds have suggested that I feed DD at the breast for 10 minutes - this is just to stimulate milk production. Then top her up with 2-3oz of formula or expressed milk. I have to do this three hourly. That's fine, but where on earth do I find the time to pump?
Has anyone else had to do this before? I did ask the HV about pumping and if I feed her from one breast should i pump the other but she didn't seem too sure,. I haven't actually spoke to a doctor in the 6 weeks that we have been having these feeding issues (despite asking to) so I'm not sure what they have said verbatim.
I'm also working with a lactation consultant so I will ask their opinion too.
I'm a single mum so finding time to do all this is a bit hectic at the minute. I just wondered if anyone has been in this position before as I'm feeling a bit overwhelmed and unsure what to do, thank you!

Sympathy!

You can't do everything at once. And at some point there's a time when it's just too hard, on you, on your body, on your mental health, and you can stop trying. Baby is fed, baby will cry if baby is hungry. There's no wrong answer for you here.

You need to pick one person's advice and follow it. A lactation consultant is most likely to say keep feeding baby at breast, let baby feed then stop and feed again. That could see you feeding every twenty minutes though. If you can't manage to do that then yes, you can switch to combi feeding like the peds say.

Having supported women with insufficient glandular tissue (breast shape is apparently an indicator) I saw feeding in parallel. You have a tiny silicone tube taped to the nipple and baby got breast milk and formula at the same time. Best of both worlds.

Pumping doesn't work for everyone but I used to do feed one side, pump the other. That worked for a few months but then baby got hungry and needed both at night. Sometimes you need to try different pumps. I couldn't hand express early on at all.

A doctor can prescribe to bring milk in. You might also check for tongue tie. NHS is terrible at that.

Good luck. You're doing a great job!

Is there a reason that dd isn't feeding for longer than 10 minutes? Would she, if given the opportunity?

This is only my opinion from personal experience. But I found the advice to limit breastfeeds, top up with formula and pump instead was a slippery slope that decreased my supply even more. Babies are (generally speaking) much more efficient at stimulating milk production and feeding effectively from the breast than a pump is.

What if you fed at the breast for as long as she would feed, then switched to the other for as long as she would feed, and then offer formula as a top up if weight gain is a concern? I found more time at the breast better than anything. So not waiting 3 hours between feeds. Mine was feeding every 1.5-2 hours at that age. Literally plop yourself on the sofa with the tv and snacks and feed as much as possible. Formula is great for getting weight on if weight is a concern, but it won't help with your supply. For supply, it's really just feeding, feeding, feeding - and lots of food and drinks for you. Don't underestimate how much liquid you need to be consuming.

@mindutopia yes she would certainly feed for more than ten minutes. We had previously supplemented 3 feeds a day for a 4oz bottle of formula and that worked as I just pumped 3 times a day. The 10 minutes is just to stimulate milk production, according to the peds.

Weight gain is the concern here, she's putting weight on but slowly. I tried to feed her constantly from the breast but unfortunately her weight didn't increase, hence now combination feeding.

So really it's a supply issue and a weight gain issue all in one. I reckon it might be time to reconsider methods. Thank you

@ehb102
Thank you for your kind words. It's really hard and I have had a million different suggestions from a million different people. It will be beneficial to follow one persons advice and look into these other methods, thank you again

First of all you are doing an amazing job! I read this post and really feel for you as I was in a similar situation with my baby at the start. It’s so hard and stressful, but you can only do so much.
I rang the breast feeding network and found them helpful. She said “is it working, is it sustainable” - I kept asking myself this each day, just to check in and make sure I was reviewing.
I combi feed for about 3 weeks - I would pump whenever I fed my baby formula. I had a lot of support though so if this really isn’t do able please don’t put pressure on yourself. Pump as and when you can. Even if it’s just for 5 minutes - it’s better than nothing. You’re just stimulated your breasts and that’s something.
I also found putting a sock over the bottle I was pumping into helpful… I never got very much out in the first few weeks and it can be really disappointing. I was told pumping doesn’t get as much as baby’s get so really try not to worry.
I also bought galactogil. I couldn’t say for definite if it helped but even as a placebo it made me feel better. Not the nicest tasting.
You could also try a haakaa pump - put on the other breast whilst feeding. Saves some time. I haven’t tried this but know other mums who did with success.
Hope some of that’s helpful - fed is best. Sending positive vibes xx

I cut a hole in my bra to attach my pump so I could get on with other jobs whilst it was doing its thing! 😄 Pump for way longer than you think. I'd get lots of milk for 5 or 10 mins, then just a few drops for another 5 or 10, then I'd get the second let down and get as much all over again. You're doing an amazing job!

Agree with this… letting baby stimulate your boobs is definitely the best method to get supply going.
Also early hours - I think between 1am - 4am is a vital time to get boobs going so try to breast feed as much as you can then. Something to do with the hormones that are released during this time.
good luck xx

Sympathies @babymom23! We are going through similar - slowed weight gain following tongue tie issues (she just had a second division after a posterior tie was missed the first time) and also she started sleeping through the night so I inadvertently dropped the 2-4am feed that I now know is so important for supply.

I found this link helpful: breastfeeding.support/supplementing-an-underweight-baby/. It says you should try and limit the process to an hour - first feeding on both sides, then topping up until baby is sated, then 'settle baby and pump'. My issue is the times she won't settle enough for me to sit back down and pump - I've got a wearable pump that I need to get working and hoping if I pop those on then I've still got hands free for baby.

Interesting to read though from a PP that this regime can affect supply for the negative. My baby often has very long feeds, 45 mins to an hour and sometimes 90-mins or even two hours on one side so I do think I need to start time limiting the feeds when she's stopped actively swallowing as she's not getting any nutrition - but I hate taking her off when she's so happy snoozing and suckling! Trying to do it without any formula but will depend on the weight.

Hope it goes well for you! I've basically given up leaving the house for most things while we're going through this period.

A baby at the breast will of course trigger milk production, but it is the continual emptying of a breast that is what stimulates continuous milk production, not a 10 minute breast feed that is then stopped.

Read up about the Feedback Inhibitor of Lactation.

Stopping a baby who is actively breast feeding in order to give them a bottle, and to then pump is nonsense.

Why stop a baby who is feeding and use a pump to get milk out when the baby was doing it anyway?!

A baby who is feeding well is FAR better at getting milk from a breast than a pump is and so effective breastfeeding with no supplementation is the best way to improve milk supply.

However, this is only appropriate if the baby is feeding correctly - I.e the lactation consultant is happy with the baby’s latch and is confident the baby is transferring milk well.

One thing to hear in mind though is that at this stage there is always the possibility that you will never be able to build up your milk supply to the point where you can exclusively breastfeed. The lactocyte cells that specifically make the milk close off if they are not required (usually associated with low milk supply) and once they have closed up they cannot be opened again so your supply will be dependent on how many functioning lactocytes you have.

I think the first two weeks post birth are the most important for priming the lactocytes to be able to provide a good and consistent milk supply so if there are initial difficulties within that window then it’s likely lactocyte cell death may have occurred which is why you are having continued supply issues.

This is something your lactation consultant can discuss with you in more more detail.

How much milk are you expressing? And in terms of increasing expressed milk volume it’s always better to express from both breasts within the same pumping session so a double breast pump would be recommended.

Finding find time triple feed (breast, bottle and pump) is extremely time consuming and being realistic, impossible to maintain long-term.

I think you should speak to your lactation consultant ion and have a really frank discussion with her about what you want and whether she thinks it is possible due to how many weeks post birth you are? Is it that you want to return to exclusive breast feeding or are you happy combination feeding?

In situations like yours, if you are happy to combination feed then I would let your baby breast feed for as long as she wants to as long as she is latched well and taking milk properly, and then offer her formula afterwards.

@HeadAgainstWall0923

Thank you for that information. I was extremely unwell the first two weeks after giving birth - and during labour. So this probably has had an impact on my supply, which the lactation consultant had informed me of. It's a shame but it's just how it goes sometimes.

I did not agree with the paediatricians idea of 10 minutes etc either so that has now been scrapped.

I appreciate your help thank you

@Writerscompanion
Yes that was my problem too, I do not have time to pump when I'm feeding and running around getting bottles made etc!

I have wearable pumps now too and they're handy but not as handy as I had hoped - unless DD does settle (rarely).

I hope you work it out and all goes well for you 💜

Update:

I rang my lactation consultant today and she agreed that what the paediatricians had suggested was just too much for me to be doing on my own.

She said that we will switch to bottle feeding DD for now and I will continue to pump as and when it suits me - but to try and do it when DD is having her bottle which makes sense.

At this point I'm less worried about my supply and more worried about making sure she is fed.

Thank you all for your advice and kind words, its nice to know that I'm not on my own 💜