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.

Ah, sleepy baby. Lovely in some ways, but yes, tricky when it comes to feeding!

that might be behind slower weight gain - the start of the feed is the thinner foremilk, and the longer your baby feeds the more of the fatty hindmilk she'll get.

You're doing brilliantly, OP. Well done. After the first few weeks, once bf is established, all will ease up and become so much easier.

Great advice here, most of all, do be kind to yourself and take it easy.

Nipple shields should only be used temporarily under the guidance of a qualified lactation consultant. They reduce supply which is likely why you are struggling.
There is no need for supplements or medication the only things that increase supply is feeding baby and plenty of skin to skin.
If you've been advised to top up then do so until good supply is established.
It sounds like you need help with positioning and attachment, latching baby shouldn't be painful, if it is then it needs adjustment.
See if there is a breastfeeding network support group in your area or any peer support groups. If your willing to post your general area I can try to find a group for you. If you're anywhere near me you'd be most welcome to our drop in.
You can also call the National breastfeeding helpline for support.

Hi OP,

Firstly, you are doing great.

You've had loads of brilliant advice. But I just want to reiterate that it is ok to use top ups if needed.

My DD was very poorly and in NICU after birth so we didnt go home for 2 weeks. We really struggled to get breastfeeding established. She dropped to the 0.4th centile (and she was only 2.5kg at birth so not a lot to lose!) so we had a feeding plan from the infant team, that meant expressing 6-8 times a day then topping up with 40ml every feed. And it worked! DD was happy, slept well, got back to her birth 9th centile and stayed there (since weaning, she has now gone back to her more natural 25th centile too). But it nearly killed me. All the pumping and the night pumping. At 4 months, i reduced to pumping just twice a day. At 6 months i stopped pumping and just did top ups. We breastfed every feed until 6 months and then slowly dropped to all formula at 9 months.

I'm so bloody proud of myself for what we achieved and you should be too!

Couple of things i learnt:

• i would do 20mins one breast and 10 on the other, then alternate which breast i started with each time. I also capped pumping sessions at 20mins. That way, i could do a whole feeding cycle within 1hr. If you want to move to EBF, then this might not be the best approach, but i was happy to stick at combi feeding.
• are you hiring a hospital grade double pump? Medela do them for £47 per month. Much quieter and more efficient than my home pump.
• I've heard mixed things about domperidone so i didnt bother.
• water and oats were good for me. I was drinking about 4l per day! Fenugreek is supposed to be amazing but made my DD super fussy so i stopped bothering.
• if baby is sleepy, do a nappy change halfway through the feed. In this weather, you can also gentle rub an ice cube on their feet to help them stay awake. They will get better at this as they get older and bigger.
• if you continue to mix / combi feed, buy a prep machine. Takes all the hassle out of the formula bit at least.

I will say my mental and physical health MASSIVELY improved when i stopped bfing. Take all the supplements you can because I didnt appreciate how much it would drain me having such a stressful feeding situation.

Good luck! Its so hard having a baby that won't gain weight, but you will get there 💪🏻

Hi, thank you for your message. I am hopeful we’ll be able to stop using the nipple shields soon and will keep trying to latch her on without them, although I’ve not had any luck so far. They were given to me by one of the midwives, but if I hadn’t had them I would have stopped trying to breast feed on day 2 or 3, so they saved us really!

I don’t have any pain when she latches on using the nipple shields, but I’m sure her latch could use improvement. In the 5 days I spent in hospital nobody could get her latched on without it hurting me, and for the first few days I was the annoying person pressing the buzzer for help almost every time I wanted to feed her!

There is a breastfeeding support group in the next town (I’m in Suffolk, this post is probably outing enough if anyone reads it!), but I don’t drive and I’m not sure I’m feeling confident enough to take her out on the rural buses at the moment. Perhaps next week we’ll give it a go.

I have emailed the person who snipped her tongue tie to ask for some advice/support from her, as she is a lactation consultant 🙂

Have you seen a lactation consultant? In your situation it's probably the best idea as they will be able to observe a breastfeed and give good insight into what you are doing whether rightly or wrongly.

I had a similar situation with my first and seen a lactation consultant which was extremely helpful.

First step is I recommend calling the The Breastfeeding Network on 0300 100 0212. They will be able to run through the issues you have had and give good advice whilst you wait to see either a peer support or LC at home.

For what it's worth I had quite a few issues breastfeeding DS1 in the first few weeks and despite a lot of pumping in those early days i always struggled to produce much milk and always produced more from the right boob than the left.

Once we ironed out the initial issues I exclusively breastfed him until he was almost 12 months and had no issues with DC2 who I also fed until 12 months.

Breastfeeding can be so tough in the early stages but rest assured you are doing a fantastic job and giving your baby an amazing start in life. Good luck