DS 18 days; I'm anaemic; how to increase milk supply?

[Romilly70]

Hello,
(bit of background - bear with me is a bit long...)

DS, my first is 18 days old. He was born by ELCS as I have a massive fibroid; which haemorrhaged during delivery so my haemoglogin dropped from 12 to 7.5. All under control now (had iron transufsions and now taking tablets, but will take about 2 mths to get back to normal)

DS weighed 2.8kg (about 6lbs3oz) and within 2 days weight had plummeted to 2.4kg (about 5lbs 8oz) After 5 days the hospital wanted me to supplementary feed with formula to help him gain his weight as he had only gained about 20g - at that point. He is almost at his birth weight - nurse is coming to weigh hom today.

Had loads of conflicting advice but basically now I bf between 20mn to 40mn. I reckon he gets about 1ml a minute based on the limited expressing I have been doing once he has finished feeding, (just to check my supply and give him a little boost when he is ravenous at the beginning of the next feed, although I have not done this in about 3 days due to general knackeredness ) On top i have been giving him formula based on hospital & maternity nurse's advice. DS takes between 60ml - 90ml (2-3oz) per feed. (Which is erratic - he used to go 3 1/2 hrs between feeds - which could take up to 2hrs) now he is getting hungry after 1.5 to 2 hrs.

I am happy to bf him as long as he wants; his latch is now strong and sort of sleeps and feeds, however I want him to have enough space for a formula as that is what is boosting his weight and he has been a bit sicky with too much volume, so need to get the balance right between breast milk and formula.

so back to the original question:
I want to keep breastfeeding - a min of 6 mths would be my ideal. He is a hungry boy so have resigned myself to having to suplementary ff. however what can I do to boost my supply? increase quality of milk so it is ore satisfying for him?

TIA for advice!

There won't be anything wrong with the quality of your milk, though obviously keep taking the iron so you get better.
I had lowish supply to begin with as ds wouldn't latch on at all and I fed him formula for a couple of days. I built it up again by feeding (loads) and expressing after feeds. I usually only got a few mls off with the pump but the stimulation helps increase supply - how much you can express doesn't reflect how much the baby is getting as babies are much more effective than pumps.

I would recommend lots of skin to skin cuddles and giving him the breast as much as possible. After a feed, use the pump for about 5-10 mins but don't worry about how little you get. While you're expressing, get DH/DP if available to give him some formula if he's still hungry. Once there's no more worry about his weight I would give as little formula as you possibly can and phase it out quickly.
hth and good luck

Please don't worry about leaving enough 'space' for formula - the formula isn't better for him than your milk. Lots of skin to skin, and unlimited feeding.

Breast compression (google it, Jack Newman is the expert) might help. That helps keep the baby awake longer and feeding more.

He was gaining weight before you were advised to add formula? Was he up from his birth weight then? Was he pooing? If so, how often?

Expressing is also no indication of what your baby is getting - he is much more efficient than a pump. I can't really express anything but my ds is growing fine!

:( Romilly - all sounds exhausting, and I think the people whose job it is to help you bf have been pathetic, actually.

You are currently feeding in the most complicated way know to (wo)man - breast, expressed, formula, and somehow, no one has informed you that expressing is absolutely no guide to the 'performance' of bf, and you have come out with the idea that you can even judge the rate of flow per minute :( :( :( and you are struggling with conflicting advice and a continued concern about whether your baby is sufficiently well-fed and your anaemia.

Call a helpline or get someone in real life who knows what they are talking about (none of the ones you've met so far, from the sound of it) to sort you out a proper plan to ensure effective feeding and a good milk supply.

I would seriously doubt the first two weights by the way - babies do not normally lose that amount of weight by day 2.

It would be urgent to work on reducing the formula. Your baby is having a large amount - a lot more than he would be if he was fully formula fed, and this leaves no room for your breastfeeding.

I hope whoever comes today has a clue - you've been seriously let down, and hats off to you for persisting with all this rubbish advice :(

If it helps, my niece weighed the same at birth, and was hospitalised at day 5 due to weight loss (16%) & needed nasal tube/saline drip. My SIL managed to turn it around and at at 10 weeks she is still EBF and she has caught back up with the weight gain - ie droped to under 0.4th percentile now at 10 weeks almost at 25th. Despite this the only formula her DD has had was on arrival at A&E when they realised she was dehydrated just until SIL had time to express.

SIL was advised that if she wanted to continue to BF she should offer the breast, making sure the baby fed for at least 25-30 mins on each side, and then offer 1oz expressed milk top up. She was told to wake the baby to fed 3 hourly in the day (although to fed on demand if baby was hungry before 3 hours) and wake baby 4 hourly at night. She was told that if she wanted to continue to BF any top ups should be expressed breast milk (to maintain supply) and not formula.

I would have thought that 2-3oz formula per feed is what he would need if he wasn't breastfeeding at all. Feeding him 2-3oz of formula a day will mean that your milk will dry up quickly and its terrible advice if you want to continue.

SIL did end up hiring hospital grade breast pump for 6 weeks from express yourself mums - although she had a pump she said couldn't compare it to the results from the hospital grade one.

As tiktok says not possible to assess rate of breastflow, varies during feed and changes day to day and baby more efficient than breast pump.

Also wanted to say the sickness might just be due to overfeeding. Some babies don't know when to stop. In early days I had loads of milk and DS2 gorged himself and puked after ever feed.

However it might be reflux etc.

thx for your responses.
I am in France and although my french is pretty much fluent, i think I am not getting as much advice as i can as I cannot express myself quite as well as in english.

The breastfeeding nurse did some calculation based on DS feeding about 6 times a day and needing a proportion of his weight (?) for each feed - I need to double check that.

However, when I say each feed; I am referring to a session which would involve about a 30min bf, bit of a snooze for DS, nappy change then some formula between 2oz and going up to 3oz in last couple of days. No feed is really consistent.

He seems to have lots of wet nappies now and a ginormous poo about once a day. Before we increased his formula, he was doing regular small mustard poos in most nappies; which seemed more natural to me.

I have got a hospital grade pump (you get it on prescription here.) I am going to go and pump now to a) see how much I get b) stimulate my supply.

NWmum my advice in hospital was similar to your SIL, I had to wake DS every 3 hours to feed him. in my naivety I though him sleeping for 5 / 6 hours was him being well fed. in fact the midwives said he was sleeping to preserve his energy .

tiktok just checked his notes, DS went down from 2.8kg to 2.54 on day 3, then hovered around 2.52 till day 5 when he slowly started climbing.

also, can anyone recommend a helpline I can call in the UK? thx!

anway, off to express and wait for nurse to weigh him.

I think 6 feed unrealistic at that age for a BF baby, think 8 feed more likely (ie 3 hourly), which means a little less at each fed.

Yes, there is a calculation for ff babies. In imperial it is 2.5 oz per pound of body weight, so a 6 lb baby would need 15 oz of formula a day. Your baby is getting a lot more than that....not a lot of room for breastmilk :( The fact the formula is increasing in amount shows that it is quite urgent to protect your breastmilk supply....speak to LLL in France about this, or you can call a UK helpline (I think they all take calls from abroad).

Your baby's weight loss was well within normal. In the UK, it would be considered poor practice to supplement at that point (less than 10 per cent weight loss on day 3) and of course the supplementing is what has caused the problems now :(

I really hope you get an alternative view on how you can protect your breastfeeding and ensure your baby is well-fed.

I think you can call the NCT helpline from abroad Romilly.- 0300 330 0770. (not sure what code you'd have to put in from of that )

My advice would be to get in to bed and snuggle up with DS, skin to skin. Feed him as often as you can (every 2 hours if poss). The trouble with topping up with large amounts of formula (IMO)is that it fill up their walnut sized tummies and then they don't want the breast milk at the next feed.

You may find this useful information.

Hope you get on well at the weigh in

just a quickie as DS just changed and want to BF him now.
weigh in was good birthweight + 90gms
i expressed 3 hours ago and was a pathetic 5ml
however DS then breastfed not long after for a good half an hour. is this a think question but DP said to me, DS may be sucking away and just getting saliva but i can feel a strong latch and that pulling feeling which makes me think he is getting milk and wouldn't make all that effort for nothing....

Also, why is skin to skin important? i have been told not to let DS get too cold and therefore lose calories, so usually have him a in a bbaygro, hat and covered with a blanket when feeding.

house is warm now so will try nappy only and a blanket against me.
would be great to have some more infor about skin to skin!
TIA!

sorry * thick question

Here you go then Romilly.

Great news about the weight gain

Don't worry about the 5ml- some people just can't express- it doesn't mean that you have no milk.

If you can hear your baby swallowing on the breast, and see the ears wiggling, then your baby is definitely getting milk. Saliva doesn't come out of breasts- only milk

There's more good videos to watch on the above site to see good latch.

Good news about the weight gain, Romilly.

However, I would not be at all certain he's getting the breastmilk he needs - not because of your 5ml expressing as that means nothing (plenty of mothers feeding twins don't get much milk by expressing) as it is a question of technique. A baby will be happy sucking away because they love being at the breast - it's not an indication of effective bf or good supply, sorry. It's likely he is getting something, even so.

You really need some good info and support to protect your breastfeeding and build up from what it is at present - that has to include a plan to gradually reduce the formula and to bf more often and to express efficiently....breastfeeding cannot survive in a baby who's getting this much formula.

Hope you get the help you need.

thx crikeybadger.
Am going to try and express some more now but will read article in full later

That's interesting to see that calculation from tiktok.

Hope you can get to speak to someone romilly so you can keep breastfeeding for as long as you want to.

Hi romilly, in answer to your question about skin to skin it helps to stimulate the release of the breast feeding hormones which increase milk production. It also helps to regulate baby's temperature, heart and breathing rates and makes baby feel secure. It is widely believed that skin to skin contact significantly helps breast feeding to become established and its a good chance to have a cuddle! Hope this helps.

thx for all the support, it is really helping. I am trying to breastfeed him pretty much on demand, is working out about every one to 2 hours although he is currently having a long sleep now 2 hours +.

Have upped the BF to about 45 mins each time and reduced the formula to about 60ml (2oz)

I have been writing everything down re: his feeds since he was born - continuing what they did in the hospital.

tomorrow, I will try an caluclate how much formula he is getting over a 24 hour period, as I think he is "snacking" in the afternoons and having a good long feed in the evening.

I am confident he is getting milk when he is on my breast his, latch is good and strong and I can feel it getting stronger as his weight has gained and he has got more experienced

My breasts definitely feel fuller and more tender after bfing more today. Will see how i get on with slowly reducing DS's formula.
I am just wary of doing too much too soon as he has only just reached his birthweight and is still a small baby.

wizzbit have had him sleeping on my chest a bit after feeds mainly his face and hands against me; but still a bit wary of stripping him off too much in case he gets too cold. Will however do more skin to skin as he gets bigger.

Have been dying to do baby massage on him, but he only gets one leg or arm at a time, as I am terrified of him starting to shiver. he is bundled up straight away after his bath, so hopefully as he gains more weight i can experiment a bit more with the skin to skin.

You could try doing skin to skin with both of you cuddled up under a blanket in bed - remember your body heat will keep him warm too. Or get in the bath with him :)

When you say you've upped the feeds to 45 minutes, is he coming off the breast himself or are you taking him off?

I'm waiting till he takes himself off. I give him "breathers" every 10 - 15 mins, when he comes up for air and then see whether he re-latches and wants any more

will try the under the duvet cuddles. thx for tip

Glad things are starting to get better romilly.

Don't forget you can offer him the other breast once he starts to fuss (and then even back again to the first side).

Re, the skin to skin- if you wear a jumper against your skin, you can pop him down it to snuggle close to you. Good idea about the bath too from MoonUNit

Just a bit of an update; have been following all your tips and increasing DS's breast time. I reackon he is getting about 1ml a minute (from what I have seen from pumping on a good day) and based on my records, I think he is getting about 600ml of breastmilk and formula over a 24 hour period.

Found this article which explains how much he needs very well. As he weighs about 3kg, then the 600 ml seems to be about right. phew!

He seems to sleep for some long stretches (ie 3-4 hours) and then sometimes just an hour. I think by taking a step back and looking at his feeding over the 24 hour period has helped. He has plenty of wet nappies and 1-2 poo-ey ones in that period, so I am less freaked out that he will starve to death.

Also , I have milk and although I have to supplement him for now, as my haemoglobin levels still have a way to go, I've decided not to beat myself up if I can't fully breast feed him at the moment and will just keep slowly increasing the time on my breast, as long as he isn't starving and nothing else but formula will satisfy him!

He sounds like he's doing great, well done!

I'm not sure it's possible to know how much breastmilk he gets per minute though? As has been said, pumping isn't a good indication as a baby is more efficient than a pump, and surely the flow of milk changes throughout the feed and the rate at which the baby takes the milk changes. Sometimes my ds will drain a breast in 15 minutes and be content for hours, sometimes he sucks away for an hour and then wants a feed an hour later.

thats good that you have milk, although I just don't think its possible to gauge breastmilk flow in ml per minute regardless of what you get from the pump because:

-the baby is much more efficient than a pump
-the rate changes during a feed
-the rate varies depending on time of day
-the rate varies depending on how recently the last BF was.
if i gauged how much my DB's drank based on what I could pumped they'd have all starved.

as well as increasing time at the breast look to decrease the amount of formula, although very very slowly, roughly 30ml per few days, which would take i imagine several weeks for you to cut out the formula.

kellymum has suggestions:
kellymom