Please help me sort out DS's feeding - I feel such a failure

[nomoremagnolia]

DS is 4 weeks old and we've got in a real mess with feeding.

I want to BF him, preferably directly from the breast, but we've had such problems right from the start and I'm now worried that I've made a rod for my own back over the whole thing. I'll try to be brief in summarising where we are and how we got there:

DS was induced at 38wks due to my gestational diabetes, at birth he was away from me for 90 mins and on return I tried to BF him but he was sleepy/unresponsive so because of the GD he was given FF. Whilst in hospital for first 24hr I had to feed him every 4hrs offering breast first then topping up with formula in order to get his blood sugars up. BFing technique seemed ok, baby latched on but didn't suckle so every time we had to FF to top up and get his blood sugar up high enough. At home we followed the same routine and I started expressing after each feed once my milk came in so I was putting baby to breast, feeding EBM, feeding FF then expressing. Took ages for each feed but I wanted to perservere with BF/EBM. Got to the point with this that I had enough EBM to drop the FF. DS's weight at day 3 had dropped but within 10% so MW happy. Around a week old I though he was BF successfully, on the breast for 30-45 mins, falling asleep seemingly content/full afterwards but by day 10 he'd dropped even more weight and I got told he was 'of concern' to the MW and to go back to topping up with EBM and FF. Since the day 10 MW visit I have been using nipple shields to BF and he has started BFing much better since then. My milk suupply is up and he is getting milk out as I see it in the shield when he comes away.
He's finally made up his birth weight now, so we have been told we can feed on demand but not let him go more than 4hes between feeds during the day. I have been trying to BF him but again he is seeming to have what he wants but then never refuses a top up afterwards.
I'm happy he's BFing properly now, just not efficiently. I now know that from day 3 to day 10 he wasn't getting any milk from me, just comfort/dummy sucking at the breast.

Where I am now:
BFing (with nipple shields) then topping up with EBM at every feed. Expressing 2 or 3 times a day, getting about 150 mls/5oz from each boob each time. Taking up to 2.5 hrs to feed on boob and bottle. Not letting him go more than 4 hrs between feeds but feeding on demand if sooner than 4 hrs (he nearly always wakes/cries 3.5hrs since last feed). One of the night feeds is formula, so someone else can feed him for me and I can get a little more sleep. This feed is the only one where DS is not put to the breast first.

Where I'd like to be:
BFing on demand until he's full (preferably in under an hour and without nipple shields) and expressing for convienience (so DH can feed him/we can leave him with a babysitter in due course etc) rather than necessity.

So how do I get from where I am to where I want to be? My biggest wish at the moment is to speed up the whole process as he feeds for 2-2.5 hrs and needs feeding every 4 hrs. My next desire would be to get him exclusively feeding directly from the breast though I could cope with expressing and feeding EBM if we could speed up the actual feeding time. I'm under pressure from various people to give up BFing altogether (supposedly for my own sanity) but i really really don't want to, though I do accept that things cannot go on the way they are either.

As an aside - please don't criticise me for anything that has happened so far, many people have told me that I shouldn't have let the hospital force me into FFing him and while that may be the case what's done is done. I know I have also probably caused some of the problems myself but again I did what I felt needed to be done at the time to get food into him. I feel bad about this but try to remind myself that he is still getting BM and that is what is most important.

:( :( sorry to read this and you have struggled, wow, you have struggled :(

There is often a tension between the long term needs and aims to get bf underway, and the short term imperative to feed the baby.

There is no room for self-blame here - you were aware of this tension all the time and you were doing your best.

Having said that, the help and advice you have had from the hospital and later has been very, very poor - not your fault, it is their job after all to resolve this tension and enable you and your baby to bf without worries, and they have failed - you haven't failed, they have. I am shocked at what you have described - none of it indicates any real knowldge on their part of how bf works.

But this is water under the bridge - what you need now is a PLAN :)

Currently you are feeding in the most difficult and time consuming way - no wonder you want to investigate something better!

First thing is to remember that the only way to improve bf is to remove the milk frequently and effectively - if the baby isn't doing it, it has to be expressed. Milk has to be removed at least 8-10 times in 24 hours inc at night, from both breasts to protect your supply and to build it up. It worries me that right from the start, the notion of four hourly feeds has been sort of normalised :(

This is all hard work, but there are ways to make it doable - one way would be to express on one side while the baby is on the other, for instance.

The baby needs to be skin to skin and close to you for as much of the day and night as you can (bearing in mind your need to have a break and a rest). That way his instincts to find comfort and enjoyment and closeness at the breast are supported.

This can be turned round, but you do need support and TLC from the people around you, and a supporter who knows about bf, in real life. This could be a knowledgable HCP, a peer supporter, a breastfeeding counsellor.

What do you think?

The 4-hrly thing was initially because of the GD - he had to have blood sugar tests befoe each feed and his level had to be over (something) three feeds in a row before we'd be discharged. My attitude was the sooner we ould get home the sooner I could get him BFing so I 'played the game' to get out of there. Maybe I was wrong but it was what I thought best at the time. Then it was part of the feeding offensive after he dropped a lb from his birthweight at day 10.
Peer supporter advice (at about 5 days old) was BF him when he's hungry, take away the top ups, he won't starve, let him csll the shots but that didn't work as he would often go 5-6hrs without feeding and this was at the time when he was just comfort sucking rather than feeding at the boob, so by removing top ups he was getting practically nothing :( I don't think he's the sort of baby who needs this approch, I want to teach him how to feed properly not fight with him by withholding or force feeding.
SSo to your plan - he's currently BF an average of 6 times a dy (he seems to have about 7 feeds a day, one ff at night with no BF first) and i'm expressing 2-3 times is that ok or are you saying i need to do more? he is on the boob for 15 - 60 mins, if it's more than 25-30 mins he gets cross so i move him to the other side, otherwise it's alternate sides each time. then he'll top up with 30-100mls depending on how long he's been at the boob.
Skin to skin - how and when (prcatically speking - i know what to do technically speaking)? we occsionally do it in the evening but the 1.5hrs between feeds are my only chance to eat myself, get showered etc. I don't even contemplate leaving the house most days as it's just too hard. if we do go out it's for a walk for 1/2 hr or so just so i can escape the cabin fever.
with apologies for typing errors/lack of caps, he's feeding right now and i'm typing one handed

Sorry, I meant ot also add thank you for your qukick and comprehensive reply :)

Gosh that does sound hard :(
I went through something similarish except that we didn't have any worries about his weight so we were able to drop the formula by 11 days old. I used nipple shields as well as he couldn't/wouldn't latch properly without them. I saw a breast feeding counsellor who managed to teach us to latch without shields and I stopped using them by the time he was 5-6 weeks old (he's 10 weeks now). Can you find a bfc near you? Or you could phone one of the helplines.
I know the loooong drawn out feeds are exhausting (and boring) but he's still very young and will get more efficient. I think they tend to be a bit slower with nipple shields too. We often had hour long feeds in the first few weeks but by about 6-8 weeks he could drain a full breast in 10-15 mins if feeding enthusiatically.
You can do skin to skin while feeding him - have him in a nappy, you in an open dressing gown or something and a blanket over him if necessary.
Don't feel bad about what has happened so far, it's virtually impossible to work out what to do and do it when you've just given birth, and it doesn't sound like your HCPs have been very helpful. I have some regrets about how the first couple of weeks went but I don't feel guilty because I know that I couldn't have done it any different given the state I was in and the help (or lack of) that i had.

by the way, if you want to exclusively bf him, you'll have to bite the bullet and ditch the formula at some point. I found this quite hard and probably could have ditched it sooner except that it was so tempting to let DH take him away and feed him so I could rest. It's worth it in the end though! Find someone who knows what they're talking about to help you come up with a plan for eliminating the formula - don't want to advise over the internet without knowing exactly how your ds is doing health and weight wise

Don't let anyone make you feel guilty. You did what you had to do in a difficult situation. I felt like a failure at the beginning because it hurt like mad. So I was failing at breastfeeding because it hurt and it shouldn't! You just cant win!

It looks like you have had some great help so far in previous posts. Well done for getting this far and not giving up!