Feeding exclusively expressed breast milk - can anyone give me some advice?

[cordiality]

My LO is just coming up to 6 weeks old and despite best efforts (battling flat nipples, slight tongue tie, used nipplettes, nipple shields, seen loads of bf counsellors, etc) we have never got the hang of breast feeding.

I have been pumping milk for DD since day one, and am still feeding her exclusively with expressed breast milk. I'm pumping about every 3 hours, including through the night, and it's starting to get a little bit tiring to be honest!

I've tried to introduce formula feeds (aptamil) but she's always very sick about an hour after them and then is constipated for about 48 hours. Is this normal when you start to introduce formula?

I was wondering if anyone else has fed their baby like this, and how long did you manage to do it for? I read lots of advice for formula bottle fed babies, and lots for breast fed babies, but we don't really seem to fall into either camp.

I'd like to be able to start going out for more than a couple of hours at a time, and not to be awake pumping when baby is asleep! I reckon I can carry on like this for another couple of weeks, but long term? Not sure.

Any help or advice would be hugely appreciated, I think I'm starting to feel a bit low about the whole thing.

OH poor you. That sounds hard. Firstly, has the tongue tie been snipped? If not it should be done pronto IMHO. Slight tongue ties can mean big feeding problems - the extent of the tie is not always a guide as to how it will affect BF. Once it's snipped you may just find that she can latch much better. Your milk supply is still there, you've done so well to carry on for this long, and I am sure it might be easier for you actually to directly feed if you could get going on it. Flat nipples are not necessarily a barrier at all - they tend to pop out during feeding and in any case it's the areola around the nipple that your baby needs to get into her mouth. If she slipped off frequently, that was likely a result of the tongue tie, not necessarily your flat nipples. I succesfully BF my DD1 with flat nipples. DS2 a different story but....that's because he had an undiagnosed tongue tie!

Re the being sick and formula. It could be that she is drinking more than she needs - it's easier for the baby to gulp too much when bottlefeeding. Or, she could have an issue with cow's milk protein (not lactose intolerance) of which vomiting is a symptom. If so, there are non- cow's milk based formulas but palatability (and getting someone to prescribe them) is an issue - we are having terrible issues persuading Ds to drink any of them. In this case the very best thing for her would be breastmilk, but that might not be as straightforward as you would like it to be!

I really think you need to get the tongue tie re-assessed by a lactation consultant, or just go straight to your local tongue tie clinic (I think many hospitals have a weekly one - they usually do private snips for a relatively modest cost, or, if someone will refer you (lactation consultant or mabye BF counsellor, midwife??) you should be entitled to have it done on the NHS. It's not very traumatic or painful - they use local anaesthetic gel - and is over in seconds. My son barely noticed his being done.

hi - i did the same as you with dd2 having quite happily bfed dd1 and ds1, as dd2 was born with no suck or gag reflex and spent a long time in scbu tube fed. when she eventually developed a weak suck she couldn't latch (well, she did once ) so i continued to express. i set the alarm for every four hours and expressed through the night (and dh fed her whilst i expressed).

with an 18mo and a 3yo, i managed 6 weeks after she was out of hospital, but tbh it was exhausting. expressing for hours, then all the sterilising and nonsense. she also had lots of appointments and therapies (she has cp) and i barely got time to just be with her or the other two, so made the decision to switch to ff. i think we introduced it by mixing the two to start with gradually reducing bm and increasing formula to prevent constipation etc. i felt v guilty, as she was the one that 'needed' bf the most, but it was just too much.

second the advice to check tt etc, but you have to do what you have to do. happy mummies and all that... it hasn't made a jot of difference in the long term - she's 7yo now and doing fab.

Have you seen this site for EPing mums? Especially good are this and this.

Kellymom.com also has good info on EPing here.

I expressed for DD1 for 8 weeks but she was mainly formula fed with some EBM and the occasional bf until she was 8 weeks old when we managed to get her back to EBF. For me fenugreek was essential to getting my milk supply up to a good level so she could feed from me with out a top up but obviously it doesn't work for everyone. I also had to teach her to stick her tongue out as she latch with her tongue back like a bottle fed baby does (and as she was a bottle fed baby is there any wonder she did that?).

Good luck and remember every single feed is good for her so even if she never has any more milk you have still done a great thing for her. Though it doesn't sound like you want to give up right now just get a bit more life back

Codiality- you are doing really well. I pumped for eight weeks and found after then than my supply started to drop off dramatically as I was too tired to pump through the night. I pumped at 10pm then fell into bed knackered. The washing and sterilising on top of the feeding took so much time so I sympathise.

I'd second trying to sort the tongue-tie if you can. Direct feeding is faster and easier if you can achieve it.

I did a gradual changeover to FF, but when I was 100% FF DD did not poo for about five days, but did eventually and then was more regular. (Against advice!) I used to put in an extra ounce of water in her bottle as she would drink the whole bottle I hoped that would make her less constipated.

Yes I fed my first lo like this for 6/7 months (flat nipples too and some other probs), I'm not going to say it is easy but over time it got easier. The speed of expressing got much quicker as time went by. I dropped the night expressing when DS started sleeping through the night (about 11 weeks) and the supply did drop off a bit but I still had enough. I needed to eat a lot to keep the volume of milk up. If I had lots of sleep or lots of calories I could see the volume of milk was much higher. Once I had a stock of milk in the freezer when I was out and about I could pump and dump. You need a decent electric pump, preferably a double and one that can run off batteries so you can use it in your car.

Looking back, it was hard and I am sort of glad I did it but I probably would have enjoyed my DS more if I had found some other way to feed.

FWIW when I had my DD I successfully fed her after initial problems but I found a fab group of bfc that helped me no end. I sat with them 3 times a week for 3/4 weeks. The ones I saw when I had DS didn't work for me so might be worth trying someone else. When I had DD2 she fed like a dream, like a baby on a film or a leaflet and even though my shape changed a bit after feeding DD1 (she drew the nipples out a bit) I don't think it was all me that had changed, just that different babies are different.

Good luck. Hard to know what to do when you are in the middle of it all and no one can tell you really.

Hi,

I am exclusively expressing for my DD who is now 19 and a half weeks old as she was premmie and very jaundiced, tube fed and we just never got the hang of breastfeeding.

I now pump 5 times a day (occasionally only 4 times in 24 hours if travelling etc), for 10 minutes each time and get about a litre a day - but it was hell on earth in the beginning as I didn't get great advice and until it was clear DD wasn't feeding well after discharge my supply had dropped and I had to build it up - every 2 hours for 48 hours and then every 3 hours day and night for a while.

My salvation came when I bought my Medela freestyle pump - by far the best pump I have used including the hospital grade Medela pumps that I used in the hospital ( I'm guessing because it was brand new) but it has been amazing, and built my supply up to the point that it is at now, very quickly. I do still tend to pump once in the night, but sometimes DH does the night and I sleep in the spare room so I pump late at about 11pm and then sleep through until about 7/8am and then have a monster pump :-)

Since I have dropped down to 5 pumps a day it has been manageable, but I confess that once I get her to 26 weeks, I think I will reduce the pumping and then suppliment with formula as needed and just keep going as long as my supply continues with 2 or 3 pumps a day...............

Anyway, just wanted to wish you good luck - really don't feel guilty if you have to give formula occasionally, I sometimes use the ready made sma cartons if we are out and about for a long time but mostly she has EBM.

Hope some of this is helpful to you!

I've just stopped at 24 weeks, after getting so exhausted (not just due to the pumping but the 4 month sleep regression and multiple wakings, poor napping etc) that my (lovely) GP told me to stop for my own health. We have been weaning my DS and I simply did not have time to do five milk feeds a day, five or six pumping sessions, and also feed him three meals a day.

I believe that at 8 weeks or so when my supply was established I dropped from eight pumping sessions a day down to six. Then, at some point around twelve weeks I think I stopped pumping in the middle of the night. My supply was established enough by then to cope with a six hour gap of midnight to six am. My DS is utterly massive (98th centile for length and weight) and with a voracious appetite so I was still having to supplement with formula.

I would consider doing it again for any other children - so many benefits and although in some ways much harder, it does take the stress out of the situation as other people can feed the baby and you know how much the baby is getting.

Good luck - takes dedication and commitment. You don't realise the full extent of this until you stop, IMHO.

Thank you all so much for the replies, it's so very kind of you guys to take the time. I must say I feel far more positive hearing stories of others who have done this for months, it makes me feel like far less of a freak for even thinking about doing it!

Great to see there's a dedicated website as well, will have a good read of it now.

I really feel now that we can do this and I'm going to just try to keep going for as long as I can. Once I've made the commitment to do this then perhaps I can justify the cost of getting the freestyle pump (currently using a swing). I reckon if I just focus for the next two weeks or so on pumping frequently, getting a good supply up and also getting some emergency rations into the freezer then I can start to take it a bit easier and also start introducing some small formula feeds and see how she goes. It does make sense that the puking may just be from being over full as opposed to any intolerance.

I'm going to look for somewhere to take DD to assess this tongue tie as I would like to carry on doing some breast feeds as well if possible.

Thank you again for your support and words of encouragement. You guys have really helped me understand and make sense of some of the issues, well done to all of you who pumped for months and months, I'm totally in awe of your commitment.