Help! A Breastfeeding Quandary

[charliestirling]

Hi all,

Firstly, a belated thanks to all of those kind folks who posted a few weeks ago when our DS had just arrived.
Summary: DS Charlie (sounds like a police officer!) arrived 26-7-10 against a EDD of 28-8-10 ? 4.5 weeks early. Weighed 6lbs 2 and spent 2 weeks in SCBU ? a little jaundiced and getting his head around feeding. Had exclusively breast and EBM through NG tube. Came home 2 weeks ago to ecstatic parents and was able to BF.

Current ?challenge?: We had a ?scare? when he didn?t put any weight on for a week and this was exacerbated by one ?very dark? evening ? where he ?fed? consistently at DW for 3 hours and wouldn?t stop crying etc. Very harrowing. As Charlie?s dad, I suggested he was still hungry ? which was proven by him taking 70ml of EBM with relish, followed by a good burp and 3.5 hrs sleep. We have continued with breast during the day and using EBM overnight whilst DW expresses ? as we (including the HV and outreach nurse) came to the same conclusion ? he feeds well-ish but loses energy towards the end of his feed and goes into ?suck but not swallow? mode ? i.e. comfort sucking. Thankfully, the ?good? feeds overnight of EBM, plus breast throughout the day have seen him add some weight.

Our latest problem for which we would love some advice and perspective: DW is still troubled by her inability to ?measure? how much DS has taken from her via the breast ? and whether she should ?top up? with EBM afterwards. He is also now struggling to latch on in the morning (after the overnight bottle feed) ? he becomes grizzly and fidgety, losing concentration and becoming exhausted. This morning was a good example ? he had his vitamins and Sytron, then simply ?gave up? ? falling back to sleep ? 4 hours after the last feed. Attempts to get him to latch on were unsuccessful. He snoozes as I write this...

DW is doing an unbelievable job and sadly getting little practical advice from the ?professionals? who are ?helping?. Everything is caveated with ?your personal choice? and ?you have options to...? rather than ?In my experience, X is better than Y? etc. She is sadly at her wits end and considering buying a double Medela pump to ensure she can quickly express, then feed with solely EBM (having a carton of Aptimil 1 ready for emergencies only). Her logic is that overall it would be quicker and DS would get the same nutrition. It would also enable her to be confident that DS had received the minimum 150ml per kg per day and give her confidence a boost. Sadly, her confidence is not being boosted by the ?professionals? who are seemingly unable to offer pragmatic advice ? they simply list options.

We are both very committed to feeding DS breast milk but as a Dad, I find it harrowing to see DW trying so very hard and then, after DS not latching on or ?comfort sucking? at length, me giving him a bottle and him gulping it down. This makes DW feel terrible and as if she is not being a proper Mum ? which couldn?t be further from the truth. She is amazing.

Help please ? should we continue (after weeks of trying to establish a pattern), go to EBM only for speed, convenience and confidence ? or other. Sorry for the lengthy post, but its probably that time where the next few days will help make our mind up as to the next course of action.
Thanks,

Charlie?s Dad

Didn't want to leave your post unanswered, but have to rush off to work in a minute.

I'm no expert by any means, but would advise you to find your nearest sure start childrens centre and see when the next breastfeeding support group is, and go to see the experts there. I found mine so helpful, and it was run by the top bf person in our area.

Roughly where in the country are you? We might already have that info between us!

I have no idea if this advice is relevant for an early baby, however pumping and feeding ebm may cause supply issues - by far and away the best way to regulate supply is to feed as much as possible, following your baby's cues. Unless there are particular health issues (and this is where I am unsure for an early baby) there's no need to do anything else.

Yes, with bottle feeding you can see how much they're getting, but without knowing how much they need on that particular day, how does that help?

You sound very helpful and supportive but is there a reason why your DW couldn't come on here and then she will have your support and the support of MN??

where has the 150ml per kg per day come from? Is that a formula thing, or advice you were given by the hospital?

Hi, I have had a similar dilemma. DD2 was born at term but needed two surgeries on her bowels within the first three days. I expressed for the first week and she had some feeds down an NG tube and then went on the bf successfully.

This lasted for 5 weeks and then she failed to gain much more than 1oz per week and sometimes lost. This has went on for 6-7 weeks with me trying different methods to increase supply - co-sleeping, removing the dummy and waking her at night for extra feeds. Nothing worked and so I decided to give formula top-ups after each feed, she will now take 2-3oz 4-5 times a day after a bf. It was either this or more invasive tests at the hospital to find out why she wasn't gaining. As a result she's put on 12oz this week. :)

The hv thinks I'm producing enough milk to maintain her weight (say 125ml) but not enough to gain (150ml). I felt like a failure at first and can completely understand where your wife is coming from. My advice would be to try and get some support in your home, I used a bf advisor from SureStart, to see where things are going wrong, but if you decide to go for top-ups then it's only for the benefit of your ds.

Best of luck with the feeding and I hope your ds goes from strength to strength.

Hello - I just wanted to offer my support, so much of your post resonated with my own experience of the early, very difficult, yes harrowing, BF days - literally driven mad by not knowing how much they've had, failure to gain weight, (in fact, losing weight in our case), the HCPs giving a list of possibilities but no-one is able to give you the solution to the problem, baby falling asleep during feeds, the dark nights.

It's so frustrating when the HCPs can't just tell you what to do.... but they just can't! No one knows for sure the solution for each particular baby, all anyone can do really is give you a list of possibilities and you just have to go through them until it starts working.

If it's any use I can say what happened to us, although again it is just another list of possibilities to add to the long list:

Kept trying to BF. Baby kept losing weight. Kept falling asleep instead of feeding. In the end took the HCP advice to top up each feed with formula otherwise she was going to send us to the GP (I am not suggesting you do this AT ALL, its just what I felt I had to do in the face of daily weighings with the HV which showed daily loss of weight).

Expressed whilst baby asleep. Became completely obsessed with expressing (borrowed an 'industrial-style' pump from the NCT breast hire service). Spent every waking hour either expressing or trying to BF. I too suffered from the anxiety of not knowing how much he'd had, which was one advantage (in my mind) to EBF. Again, not recommending you do this at all.

Top ups became a mixture of formula and expressed milk (separate bottles) and finally, after about four weeks, somehow we both got good enough at BF to stop the formula top ups, and gradually reduce the EBM top ups and move to exclusive BF at about six weeks.

So basically I think I just wanted to offer a story of how we got to exclusive breast-only breast feeding in the end and best of luck to your DW.

Charliestirling - it's a difficult situation, but the HCPs are understandably discussing options and possibilities rather than giving you dogmatic instructions.

Your baby is fine. He is no longer causing the concern he was in SCBU. From what you say, there is no reason why he should not breastfeed direct now, all the time - I don't know why the HCPs are not saying this to you, but they are probably averse to putting pressure on you and don't want to say pumping and giving EBM in a bottle is 'wrong' 'cos it isn't, but they also see (probably) that this hassle is not necessary.

That 'dark night' where he fed for 3 hrs felt awful, but this was not necessarily a sign that bf was not working. Your baby has had a difficult start. He was separated from his mum for 2 weeks (I know she and you would be there, and giving as much contact as possible, but being cared for in SCBU and being tube fed is not the way babies 'expect' to start life on the outside.) He needed time to make up for that and staying close to mum, feeding a lot, objecting to sleeping anywhere but on mum's chest, and feeding more or less constantly, is a normal reaction and one that shows he was coming out of the difficult times.

Yes, he may have been hungry - at the breast was a good place to deal with that! On the other hand, he may not have been as hungry as you think - he may have just needed to suck and to get the comfort of feeding. Taking 70 mls in a bottle does not prove anything at all, it really doesn't. There may be some basis to the idea that he is feeding but not very effectively sometimes - this needs to be addressed, for sure.

One of the after-effects of having a baby whose had a difficult start is that everyone wants to measure their intake - perfectly understandable, when measuring intake is critical to daily survival and well-being, but anathema to happy breastfeeding beyond that stage.

When breastfeeding is going well, measurement is just not necessary - there is no exact amount the baby needs each feed/day anyway, and trying to get to some arbitrary amount is horrendously anxiety making.

So....one option (!) rather than 'the' answer is to work on improving the breastfeeding so it works beautifully and smoothly most of the time, and to work on understanding, too, that babies do not need their intake measured, and that cluster feeds (on and off for hours and hours) are normal in most babies, getting an understanding of comfort sucking as a necessary part of a baby's life as well as effective and sufficient transfer of milk.

For all that, I think someone needs to be there in real life for you, observing a feed, listening, helping you both decide for yourselves which is the best option and which will make you and your baby happiest and most comfortable. Expressing long term is normally not easy, convenient or speedy. And it doesn't remove anxiety.

Hope you get this good, real life help.

How are things today, charliestirling?

My dd2 is now 13 weeks and still cluster feeds a couple of nights a week. It is very easy to deduce that an evening of fussiness, crying and constant on/off feeding is a supply issue but it's completely normal and part of babies way to regulate supply. Best response to cluster feeding for dad is to supply mum with the Tv remote, cake and regular drinks.

The best things I have done to keep bf going well despite a very fussy baby is not time feeds in terms of duration or frequency and go by nappies not worry about quantity of milk. I have learned to trust my baby and my boobs to do what nature intended.

I would also be concerned that if you're expressing overnight that mum's breasts are not getting stimulated frequently enough at the time when it's most important ie midnight to 4am.

Other than my tuppence - listen to tiktok

Far from being an expert, but could the dark night have been linked to a growth spurt?

As I understand it, when the LO has a growth spurt, they have to suckle more to stimulate more milk production - this being totally normal. So to start with they'll be suckling more but not getting more milk as the Mum's body needs the stimulation of extra suckling to produce more milk.

Obviously, taking a bottle is easier for the baby than suckling to stimulate the extra milk production! So LO may end up preferring bottle just because it's easy.

And switching to expressing could mean that Mum's breasts are not getting to signals from the LO to produce more milk, so could lead to supply issues.

Why has OP not returned???

Bit worrying. I worry he has read out all the stuff on the thread and his wife is even more overwhelmed...

Firstly can I thoroughly recommend the NCT breastfeeding line 0300 33 00 771. I have found their counsellors to be really helpful, and able to offer a larger range of solutions than the midwives, possibly because they have the time to. I spent over an hour talking to one of their people when BF was getting rough on me and it helped no end.

Non-stop feeding isn't unusual, although it is exhausting. My LO was feeding nearly constantly for 22 hours earlier this week - he was growing and it triggered much more milk to come in the next day.

This may be teaching you to suck eggs, but if he gets "lazy" at the breast, have you tried giving him a short break, a nappy change, winding or whatever, then putting him back on. This helps a lot with mine, he will often come off the latch 3 or 4 times before a breast is "empty", but will go back on after a break of 5-20 minutes. This makes sure he gets the better milk of a long feed, rather than giving more short feeds. If he falls asleep, because of the way a baby's sleep cycle works, he will wake easiest after about an hour, so if he is genuinely sleeping and you need to wake him to put him back to the breast, that is a good time to do so.

I don't know anything about breastmilk but ooh don't you sound like a lovely chap?!

Come on, OP - give us an update :)

Lots of kind people have posted here and need to know if things are better.