To ask for your help with breastfeeding?

[NeedMoreMilk]

Any advice would be greatly appreciated. I’m sorry it’s so long. And I know it’s not an AIBU, but I could do with the traffic.

My daughter is 3 weeks old tomorrow and was born by elective c-section due to being breech. We were in hospital for 4 nights, 2 of which were due to the difficulties we had establishing breastfeeding and the 4th was because they miscalculated her weight loss so made us stay for an extra night.

DD had a posterior tongue tie (which has now been snipped) and was really hurting me when trying to feed due to her poor latch- lovebite type marks on my areola, bleeding cracks on my nipple, etc. On day 2 a midwife brought me nipple shields to try and since then we’ve been reliant on those. I have never been able to get her latched on without them on my own, and have only managed it once with the help of a midwife. I also couldn’t get any milk from my left breast until day 6, so until then she was solely feeding from my right breast. She had 3 small formula top ups in hospital as they said she was hungry. The rest of her milk intake came from breast feeding and expressed milk top ups.

So weight loss. She was 3605g at birth, and 3270 on day 3. She was still 3270 on day 5 and on day 6 was 3260 so we were put on a weight management plan of a 3 hour feeding schedule with a 67ml of top up (whatever I could express plus formula to make it up) after every feed. She did gain weight on this (unsurprising given the amount of milk we were getting her to drink!) and by day 16 (last Friday) she was above birth weight at 3680. So we stopped the formula top ups and went back to breast milk top ups. She seemed fine over the weekend, plenty of wet and dirty nappies (which she always has had, never any signs of dehydration thankfully) however when the health visitor weighed her yesterday she’d lost 20g again. The HV wasn’t too concerned, said feed/pump as much as possible to increase my supply and she’ll weigh her again on Monday. However if she’s lost more weight on Monday it will be another feeding plan.

So it’s obvious to me that my current milk supply is not enough for her. I’m trying to express as much as possible, but as I’m trying not express to close to the beginning/end of a feed I’m not having as much luck as I was a week or so ago- I seem to be getting less milk at each express, especially the middle of the night ones. I’ve ended up giving her formula top ups today as I hate the thought of her being hungry and the HV said if she’s fed from me and then drinks all of the expressed milk then she needs more as she’s still hungry. I feel like I’m in a Catch 22 situation as I don’t want to limit my supply by giving her formula, but I can’t let her be hungry either and I really don’t want to get put on another weight loss plan. She doesn’t ‘seem’ hungry to me (falls asleep at the breast and seems content most of the time, sleeps well in her Moses basket but not too much, HV and midwives have commented on how alert she is) but obviously she should be gaining weight, not losing it so she must not be getting enough.

Has anyone had a similar situation and managed to resolve it? I really want to fully breastfeed her but I’m wondering now whether I should just switch to ‘officially’ combination feeding and stop expressing.

Thank you if you got this far.

I'm sure others will be along with more direct experience, but I wanted to say most importantly - getting breastfeeding established can be the toughest thing ever, but you are doing great! It's so relentless at the beginning, isn't it?! and so hard to know what choices to make while you're in the midst of it all.

Do you know if you have any local support groups? If you give a city people may be able to suggest resources. For instance, in my city you can contact the local bf support group and in your situation they would absolutely offer you a one-to-one appointment to discuss your situation, and support you either in combi feeding or building your supply for EBF, whichever you preferred. Don't be afraid to ask for help, there are lots of lactation consultants freely offering their expertise.

If you want to talk it through with someone, the NCT helpline 0300 330 0700 is open 8am to midnight and the national helpline 0300 100 0212 9.30am-9.30pm.

You need to speak to the infant feeding team.

As long as when you give her formula you're pumping then it won't affect your supply.

Thank you!

Yes, I might try some of the helplines. There just seems to be such a lot to remember it’s easier to write it all down! There is a breastfeeding support group in a nearby town, but unfortunately I don’t feel hugely confident going out on my own at the moment.

My eldest had loads of weight issues.

First off - what you can express is no indication of supply. Even the best pump is no match for your baby.

If nipple shields are working for you both then crack on with them. Often you have to wait until baby is bigger and feeding more established before trying to wean off them.

In the early weeks there are lots of growth spurts during which they can feed more and lose a bit of weight as they are working really hard at growing. Weight loss once they are at birth weight is usually only a concern if they drop more than 1 percentile or they seem unwell with it. That would be why HV wasn't too concerned given her age and likeliness of a growth spurt.

Finally have a look if there is a breastfeeding group local to you. They can be a great source of support.

When my partner was on paternity leave I was expressing every time she had formula as he was giving her the formula top up. Now he’s back at work I am trying, but it’s not as easy as it was. I need to make a conscious effort to try and express more tomorrow, definitely.

Thank you for the advice.

The advice I was given by a private location consultant, tape an NG tube to your nipple, beneath the nipple shield, place the other end in formula so if you can get baby to latch, then they'll stay at the breast because there's milk. It'll help you to get your supply up, and see theyre fed without spending double the time feeding them then expressing.

Also to get more milk, Domperidone from the Dr's.
My right nipple never gives much more than 1,2 drops. Domperidone has helped greatly still not upto an ounce between both breasts, but its helped me get more milk

I have been in a very similar position, vaby lost loads of weight and was on a feeding plan. It was grim, I barely slept between feeding, pumping, sterilising. I managed to stop the formula top ups completely after a few weeks, stopped nipple shields maybe around 2 months (but if you keep using them they are not the awful thing my midwives thought).

I rarely express now, just breastfeed.

What the HV is saying sounds logical, but I got on better with breastfeeding when I stopped thinking what seemed obvious and learned more about the process. So my baby took a lot from the bottle as it was instinct to swallow, and easier than breastfeeding.
I got in touch with a local support group and lactation consultant, without whom I'd have stopped sooner.

It sounds like you want to keep going so see what face to face support is available and good luck.

Maybe contact the local group and see if they will offer support over zoom? You may also find some helpful written advice on the kellymom website, for instance
kellymom.com/hot-topics/low-supply/ or kellymom.com/ages/newborn/nb-challenges/decrease-formula/

It's really easy to feel like choices you make now will set you on a course you can't change, but your body is resilient and flexible, and with the right support you can increase supply / wean off nipple shields / whatever you need to do later. (if you want to - plenty of people happily find a combi feeding set up that works for them, or happily continue use nipple shields for a longer time, there's no problem with that either).

Don't be afraid to do what you need to do to get through the days and reach out for support to get through the weeks and months. The more time you can spend skin on skin and/or feeding, the better, but don't beat yourself up about it if you're not managing as much as you'd like - new babies are full on!

That is useful to know about the growth spurt, thank you. The HV did initially say she’d weigh her again in 2 weeks, so she can’t have been too worried. The scale did spend a very long time fluctuating between 3680 and 3660 before it was stopped on 3660, so I guess it’s possible she’s the same weight as she was on Friday!

Mine was a mixed feeder - problems latching because she was prem, and I was hopeless at expressing so the top-ups were formula. I did express in hospital, but I could never actually produce enough for her needs. I was told that if she started with breastmilk at each feed, that helped to line the gut, so better than a pure formula feed. Once she started being able to feed direct I gave up on the expressing.
We did drop the formula at one point, but she lost weight, so we were told to top-up after each feed. In practice, though, she only took the top-up a couple of times a day so we stopped bothering at every feed.

We were also reliant on nipple shields to start with. But I did keep trying her without, and suddenly she got it - so do keep trying - it did take a while, and I'd almost given hope. It was so much easier once we were shot of them.

When she started weaning, we dropped the top-ups - it was quite funny, as friends were desperately trying to get their babies to take a bottle so they could go back to work or out for the evening, and there I was, delighted that we could stop using them!

Hi op. Just wanted to say well done for persevering. You’re doing great.
her weight loss has never actually dropped below 10%, it’s a shame you were encouraged to top up so soon. Also, weighing her on day 6 was too soon to see a difference (plus 10-20g loss is neither here nor there really). A couple of tips
try fenugreek supplements. Great for encouraging milk supply. Also look at your own diet-ensure loads of healthy protein and fats (dairy, nuts etc).
don’t panic over expressing. Your baby will always drain your breast more effectively than a pump, pumping isn’t indicative of your actual supply.
local breastfeeding peer support groups, if you have any, are a fantastic help. Not only the peer supporters but other experienced BFing mums too.
Pace her feeds so she doesn’t become used to not working for her milk and it flowing quickly. Babies who guzzle bottle feeds can become frustrated at having to work a bit harder for breast milk. There are loads of videos on YouTube if you search paced feeding.
plenty of skin to skin as much as possible. Good luck xx

@Missscarletintheconservatory the first paragraph of this was my experience also. Baby lost weight, bad jaundice and sleepy, flat nipples on me made it harder to latch.

Feeding plan was 2 hourly schedule which is insanity.

After 5 days I stopped it, stopped pumping and stopped formula top ups and just put baby to feed on the breast every 45 mins to an hour as she was a snacker so would only do one breast at a time for 5-10 mins usually. Supply increased but it was hell feeding so frequently with such painful nipples.

Anyway, she started gaining as my supply increased rapidly due to all of the natural stimulation and feeding. Still bf now at 22 months.

I've heard good things re domperidone, and see if you can get a private lactation consultant (if affordable for you) and infant feeding team were helpful to me also

I fed both DSs with nipple shields until they were 6 months old. My nipples were simply too flat. Never interrupted my milk supply. I also expressed quite a bit so that others could feed them. I know people who used nipple shields for the entire time. My grandmother fed all 7 of her children for a year with metal nipple nipple shields!

Definitely contact someone of the helplines people have listed for further advice and support.

It sounds like you are doing brilliantly so well done.

I used nipple shields for the first few months and really stressed about weaning him off them but it was absolutely fine and he did it when he was ready.

The only thing that I spotted was you said she falls asleep on the breast, is it worth trying to keep her awake a bit longer so she takes a full feed from you? (I know it’s not possible to tell). Tickling her feet and swapping sides/ changing a nappy half way through could work. Depends how early on she’s falling asleep mind.

Good luck, whatever happens you’re doing a great job.

I used nipple shields for a good 8 weeks with DD. My best friend who's a very experienced NICU midwife advised me to express in between feeds, as the nipple shields stop your breaths from producing as much milk (something about it not being as full on suck as without shields). The expressing encourages additional milk production.

So I did that and it was fine, I breastfed exclusively for 6 months. Its worth a try. Also make sure you have plenty to drink and Google foods that help.

If the baby is miserable, never happy after a feed, isn't sleeping at all, never seems content etc, then I would take the feeding plan. FWIW I did formula top ups with 2 of mine (mostly only in the evenings, and after a good 20 minute go on each boob) and we naturally moved to ebf after a few weeks- I found that the baby just lost interest in the bottle. It wasn't the beginning of the end in terms of bf, it allowed me to carry on.

If the baby seems basically well apart from the small weight loss, then I would carry on as you are, if that's what you want to do.

Hi OP, loads of hugs, I've been where you are and it's really tough, my heart goes out to you.

I have 2 kids, BF was very tricky with them both. With DS1 I got very stressed and upset by all the weighings and visits and felt like a failure. Got mild PND. Took Domperidone for 6 months and pumped everyday but he was 90% formula fed after refusing to latch post frenectomy and today he is a big, hearty, clever (loving and handsome!) 5 year old.

With DS2 I felt much more comfortable and confident about my instincts. I fed him whenever he seemed hungry, started on the boob and then topped up with formula if he would take it. Didn't stress. Didn't set any alarms or count anything. No PND! :) He is now 18 months old, still mix-fed, he chooses boob whenever offered which is usually comfort and sleep at this point but will happily chug a bottle of formula when thirsty. He's a very different build to his big brother and slim but full of beans, has been running around with the big kids since 10 months old and is thriving.

All of which is to say - your baby will be fine, however this pans out, and one day this will all be a distant memory. Please do whatever is right for you and your baby, be kind to yourself, remember doing your best is always good enough! And try not to worry. xxx

Yes I had a very similar situation (emergency csection, baby with tongue tie) and for your mental and physical well-being please do not be afraid to top-up with formula alongside normal breastfeeding.

I cannot say this strongly enough.

Your baby will start to move up the weight chart again and be content, you will worry less and get more sleep and therefore be more relaxed not being under a stressful feeding plan, and your milk will regulate.

In not too long you'll be able to switch back to full breastfeeding and your supply will match this.

My son then breastfed until 18 months when he decided to stop on his own.

Good luck.

She was definitely falling asleep before she was full in hospital, I just didn’t realise it at the time. She’d cry so I’d feed her, she’d fall asleep after a few minutes so I’d put her down- and repeat. It makes me feel very guilty now that she was obviously hungry and just wasn’t able to get enough before she got too tired, but I can’t do anything about it now.

I’m hopeful she’s doing better now, she’s certainly feeding for longer and seeming more content. I offer both breasts with a nappy change in the middle if needed- tickling her feet isn’t enough to properly wake her up unfortunately!

Lots of good advice here. The one other thing I’ll add is, you’re doing an amazing job looking after your DC… try to remember to look after yourself too! You may even find that a healthier, happier you produces more milk. And if not, that’s also ok. Nothing wrong with combi feeding!

I’ve found with my 3 DCs that even when breastfeeding was extremely well established (e.g., feeding toddlers 😳) my health and stress levels had a noticeable impact on my milk supply, particularly pumping. I think you could consider dropping some of the night pumping sessions in favour of getting more sleep (assuming you’re still BF through the night every 3 hours or so). During the day, do lots of skin-to-skin, even when you aren’t feeding. Drink looooooooooads of water, then drink some more. Sit down with a good series on the TV and let your DC feed one side, then the other, for as long as she wants, even if she drifts off to sleep (unless your nipples are hurting). All these things will stimulate supply without you needing to spend hours chained to your pump, and will allow you to relax a bit.

Good luck and hang in there. It really does get easier.

Thank you very much. No, she never dropped below 10% loss but from my understanding my community midwives start a feeding plan if weight loss drops below 8.5%.

10g is nothing really, you’re right. She had a wet and dirty nappy just before that weighing, so we might have been ok if she’d held on for a bit longer!

Ohhh I had a sleepy baby too. The midwives told me to strip her down to her diaper and feed her naked, and even dab her with a wet washcloth when she was falling asleep on the job and tickling her feet wasn’t working. You can also gently blow in her face - that would get me another 30 seconds of proper feeding. Then the final trick (and this one still amazes me!) is to slightly bend her arm and lift it by the elbow, basically making her flap like a chicken in slow motion with one arm. This stimulates the sucking reflex. My DD could be almost completely asleep and would still get a proper “glug” of milk every time I did this. Absolute witchcraft. 😂

Thank you so much for the advice and kind comments everyone- I really appreciate it!

Have you tried beginning the feed with the nipple shield and then removing it halfway through?

I did this when my baby was small and the pain of the initial latch was too bad. I'd get him to latch on with the nipple shield and then once he was feeding OK, I would quickly unlatch him, remove the shield and latch him back on.

I did it for the pain, but it might be helpful for your supply because you'll get direct contact between the nipple and your baby's mouth.

Those feeding plans are fricking torture. Not really any practical advice here apart from to hang on in there - combi feeding isn't the end of the world and you can drop it off later on. Expressing is the worst of both worlds imho.

Stress is a big factor in breastfeeding, watch your body language (try to sit back instead of being hunched over), rest as much as you can, have a few walks somewhere green, enjoy good food. Take deep breaths.

C-section and a hospital stay can feel a bit like a car crash, you need to give yourself and your baby the message that there's no need to freak out. Easier said than done. Good luck and congratulations!