Expressing assistance please

[LisMcA]

My 6 day old DS has a moderate tounge tie which has made BF almost impossible.

1 - He does latch but it's incredibly painful for me. Have had the skin grazed off one nipple already.
2 - He doesn't latch for more the 5 minutes and then won't go back on.

Also, I had a CS so I'm quite uncomfortable sitting in certain positions. Rugby ball position is the only one we can get into comfortably.

With advice from the Infant Feeding advisor in hospital I made the decision to express my milk for him and feed by bottle. I've hired a Medela Symphony pump which arrived yesterday, which is 100x better than the hand pump i'd been using for the previous 2 days. However, I'm not producing enough to satisfy him. I'm pumping every 2-3 hours and getting between 60-80 mls between both breasts. I know my supply will increase with demand, and it will sort itself out eventually, but I'm concerned I might not be using the pump correctly. We had to give him top up formula feeds while still in hospital and have had to continue to at home maybe once or twice a day, 30mls or so. Each day he seems to want more each feed.

we are going back to the BF clinic next week when i'm less sore to see if we can get the latch right, if not they will refer DS to have his TT snipped. And I am still offering him boob 2-3 times a day, but very rarely will he latch for more than a minute or 2 at a time

Any hints or tips from anyone who has exclusively expressed would be gratefully received.

sorry for any typos, doign this one handed while on the pump!

Congrats on your new DS!

I don't have much experience with expressing, but my DS had a v high palatte and we had the grazed nipples etc. We found nipple shields worked for us - not sure if they would help in your situation.

Am sure someone with better advice will be along soon.

thanks zimbo, sheilds do protect my nipples, but he still wont latch with them on.

That's a real shame, they were the only thing that saved bf for us.

More knowledgeable people will be along soon, I'm sure.

Bump

Do you massage your boobs whilst expressing? I tend to gently run my thumbs down my breasts in time with the pump and find this makes a massive difference to the speed with which the milk flows out. Massage all the way round, including underneath.

Also, I tend to have more than one let down so, after the flow seems to have tailed off, I keep going for a while longer and then there will be another fast flow.

I also found that if I turned my attention to something else the bottle would seem to fill up faster than if I sat there watching each drip plop down. Whether this was just an illusion or was because I was more relaxed which allowed a better flow, I don't know.

Good luck. I had a horrible time for the first 11 weeks and only managed to feed by expressing or using shields. At 11 weeks I think DD had got bigger and could latch on better and I tried biological nurturning and somehow it became plain sailing. DD will be 7 months next week and we're still bf happily.

Hello

I am expressing using a Medla Swing because 10 day old DS simply refuses to latch on and just screams whenever I put him anywhere near my breast. He was quite small at birth and I also had a C-section which made it very hard for us to get comfortable in the early days (we are going to BF clinic on Monday to see if they can help). I pump for about 10 -15 minutes each side 3 -4 times a day and manage to get roughly 2-4oz each time but it has gradually increased to this over time and DS is taking 4oz per feed (he's very hungry!). He still has a formula top up at night because I'm not yet pumping enough to do all 6 feeds per 24 hours.

Have you got the pump at the right intensity for your let down and are you doing enough stimulating before switching the pump to "let down"? The instructions on mine say that to get the right intensity you need to ratchet up the suction until it hurts and then come down one notch to maximise your output. I also find that sometimes if you adjust the pump over your nipple from time to time you sometimes get an increase as if the shield bit of the pump had been squashing an area of the nipple and preventing the milk really escaping so adjusting it slightly from time to time might help.

I also find that massaging the breast as you pump helps.

The only other thing I can think of is to make sure you are drinking lots of water. My midwife kept emphasising to me how important this was for milk production.

HTH!

Good luck and stick at it! Expressing can be really miserable but it is SO worth it if you persevere. I expressed exclusively while DD was in NICU/SCBU for 6 weeks, and then continued to express for a month after she came home while we got breastfeeding established. I found that:

• the flow was tiny at first and the only thing which helped mine increase was to keep expressing, every 3 hours, day and night (every 4-5 hours overnight, if I was too tired it affected the flow as well)

• I could only get the milk to flow by concentrating on the baby - nothing happened if I read, watched tv or listened to the radio while expressing. I literally had to look at a photo of DD, smell a babygrow that she'd worn and think about her. It made a massive difference to the amount I could get in the early weeks. Odd but true!

• when I expressed, the flow would tail off after a while, swapping breasts could get it going again, after the first breast had had a rest for a while it sometimes started flowing again.

• It used to take a while for the flow to start at all - I found that I could get things started much more quickly by hand-expressing (massage, squeeze, milk yourself!) and then pop the pump on once it's started.

• To get DD to learn to bf, my regime was to try her on the breast for 10 minutes at every single feed, then to give her the ebm top-up from a bottle, then to express. The whole cycle took 2 hours and it took her over three weeks to start doing any sucking on the breast at all. I was bloody-minded about it, never thought she'd learn but one day she sucked and I couldn't believe it! Now she is 6 months and bf has been so convenient and I'm so glad I persevered even though it was such hard work and so tiring and demoralising at the time.

Sorry that was long, I hope it helps, stick at it and get your DP/mum/anyone to do Everything Else for you! Good luck

Thank you so much for all your advice here, slowly my supply is increasing. We had visitors all day yesterday so had to keep taking myself off to the bedroom to express, but the results are so worth it. He only needed one very small top up yesterday, aiming for none today.

I'm glad you are getting there. it's really hard work isn't it. I've discovered cuddling my baby while expressing works magic ( I made holes in my bra to hold the flanges). I can't see the pump which seems to help and she gets cuddles. Everybody wins. :D

How did it go yesterday, LisMcA?

Glad your suppy is increasing. I was completely amazed that my body could produce food that DS would like and that it would make him grow and thrive, silly I know. Its just really special being able to feed him myself

no top ups yesterday or today! We are cooking with gas on the pumping! Nice little stock pile of milk in the fridge!

BF clinic is on Wednesday, so hopefully we will re-master the art of latching. If not, I think I will be able to keep pumping. But PMa and all that, we will have him latched and Bfing the "normal" way!!

Hurrah! Great stuff.

Hope your appointment with the BF clinic goes okay tomorrow and you get the latch sorted out :)

Lis can you send me some of your milk!!! Am still struggling to get enough!! Sitting close to DD helped te first 2 times but limited success since. Sometimes getting an oz between both breasts and other times maybe 2 but not enough to keep up with demand!!

I exc. expressed for different reasons a few times (DD1 had jaundice and didn't ebf until 8 weeks/DD3 had bronchiolitis multiple times and I was in hospital at different times when DD3 was small too).

The things I have found that work for me are:-

Expressing every two hours, including at least once between 12-3am so you get 8-12 sessions in a 24 hour period (a longer stretch over night would be ok once supply is established)

Massage breasts before starting to pump (towards the nipple)

Breast compressions during pumping can help too

Double pumping - can make hands free by clipping bra back up or doing this

Not looking at the bottles - even covering up the whole pump with muslin/pulling top back over the pumps

Distraction - read a book, play with baby, make a phone call to a friend, watch TV, MN....

Block pumping once a day - pumping both sides for 10 minutes, resting/reading book/going for a walk/what ever for 10 minutes, pumping both sides for 10 minutes, resting for 10, pumping for 10. This is a technique designed to mimic cluster feeding in baby and really can boost production so don't worry about how much milk is made by doing this it's the signalling to breast that is what's the point.

Drinking to thirst not X litres of water a day (sorry flaurenoko - drinking water to excess is linked to lower milk supply not greater)

Looking at baby when I expressed, smelling a babygro, looking at a picture of baby

Thinking of waterfalls of milk coming out of my breast - weird I know but it did help at times.

Hand expressing as soon as I have stopped pumping - this seems to get the 'last' out. Not that breast are ever empty but this seems to get that little bit more out.

If baby is full term and healthy, you don't need to sterilise the pump each time you use it just once a day. You can place the pump flanges (breast parts) in a zip lock bag and put it in the fridge until next time or rinse out with very hot soapy water and air dry. The bottles/teats should be sterilised though.

This is a good site for exclusively pumping/expressing mums here.

Good luck and I hope it helps.

Sloathy - have you spoken to a BFC/bfing helpline about your pumping regime? I'm just concerned that 3-4 times a day on each side is just not enough to continue to produce milk long term especially when your baby is 10 days old.

The usual recommendation is at least 8-12 times a day from both sides until supply is firmly established and then some mothers managed to continue to produce enough milk on less pumping sessions but some still need to express frequently to maintain supply.

The less stimulation to the breast, the less milk produced, the less milk removed the less milk produced....it's a bit of a ever decreasing cycle unfortunately.

I hope you don't mind me discussing this with you.

Well went to the BF clinic yesterday. I came away no better off than when I arrived. They advised to do more skin to skin and hope that B remembers what the boob is for. Like I haven't been doing that. They didn't get me to try and latch him, so I dont know if I'm doing it right. Granted he was sleeping, but thats only because we had been waiting 2 hours to see someone. I was nearly sleeping. They seemed to think because I am expressing then there is no probs, he is still getting the BM goodness, but DH goes back to work on monday. I cant look after B and pump every 2 hours by myself. I have been in tears most of the morning, pumping is so time consuming I just cant carry on like this and waiting until next week to go back to the clinic seems forever away. I want to give up but my inner stubborness is winning on that front.
All i want is someone to help me understand if it's my issue or Bs. I think my boobs are too big and floppy. My nipples point down which means I need to wrangle B and the boob to meet to attempt any kind of a latch. B just refuses now wont even open his mouth. I was so looking forward to BF my baby when I was pregnant, but its turned into a nightmare.

LisMcA, I'm in exactly your position, but 6 weeks on: I've been expressing milk, supplementing with formula, and trying to get baby to latch on all that time. I know exactly what you mean: if you're expressing milk then folk don't seem to appreicate that BF is still the goal. It is so time-consuming to express milk and you have the constant supply worries.

You'll be amazed at how well you can manage when your DH goes back to work. I was convined that when mine was back, I would have to stop expressing milk, but not so. Though I do find that I can't stick to as rigid a schedule re: expressing as I would like.

BUT I really regret not getting more help with BF earlier on as now I feel it's a lost cuase: I don't have enough milk for a start, and she doesn't seem to understand why boobs don't work the same as a bottle. She very seldom latches on at all, and when she does she doesn't get enough milk to satisfy her. I really do think thaqt if we'd got more help sooner then we'd've had a far greater chance of success.

As it is, I don't know weather to persevere or give up.

Lis/bumperella - I'm not saying this to brag or be all 'na na look what I did' but to show you that starting off eping doesn't mean the end of bfing directly.

DD1 would bf for the first 18 hours of her life but after 9pm on her first day she just stopped bfing and started screaming, she only stopped if I walked her and I wasn't allowed to as per ward MWs. I got out of hospital the next day after literally begging for a bottle of formula.

DD1 had jaundice and stopped even being able to bottle fed by herself, it was a 2 person job - DH to pry jaws open, me to milk the teat and stroke her throat to get her to swallow. I started expressing with a Tommee Tippee hand pump but go tnothing so we hired a Medela Symphony. By day 4 she was readmitted and was almost exclusively ff as I was only allowed to feed her every 2 hours and it had to be 2oz of fluid at each feed which is really difficult to achieve when your milk hasn't come in.

On her release from hospital on day 6 I continued expressing every 2 hours (I did overnight too). That week DH went back to work (had a 4 day induction so wasted a lot of DH's leave on that), I managed but only with DH doing the night feeds/sterilisations whilst I pumped so we both slept no more than 1 hour at a time.

The majority of her feeds were formula, a few were ebm, with the very occasional bf when we could tempt her - lots of skin to skin, used nipple shields to aid transfer between bottle/breast, bottle fed her a bit of milk to take the edge of her hunger and then tried latching, took fenugreek to up my supply (which worked thankfully), brewers' yeast/cal-mag didn't work for me though. I harrassed our local NCT counsellor lots and spent a lot of time on the internet looking at Kellymom, Jack Newman videos, La Leche League, and any other bfing resource I could find.

I continued with the 12 pumpings a day for about 8 weeks when DD1 got back to bfing. As soon as she had a good no. of feeds at the breast we stopped bottles and just went with bfing.

She was then ebf until solids at 25w 5d and then continued to bf with foods until she was 3.6y/o when she self weaned. We also had reflux and very slow weight gain thrown in for good measure so for me once we were bfing directly I still had issues to deal with.

Basically, it is sometimes a case of plugging away and sometimes you need professional help - whether thats a TT snipped, an hour with a bfing counsellor going over positioning and attachment or phoning a bfing helpline for the 3rd time that day to have someone talk you through latching on baby.

No-one in the bfing 'business' minds being asked for help that's why they do it - to help. They also don't mind being ask for help on how to continue eping long term or how to transition to formula or how to grieve/mourn for the loss of bfing (in a sense it is a loss - the loss of a mothering expectation you may have had from before you even got pg).

I really wish you both all the best.

TruthSweet, I think that's the kind of thing i need to hear! I kind of feel I'm at "crunch time" now in deciding to keep going or give up.

bumperella - if you don't mind me asking a few questions?

How much milk are you making and how much is your DD having?

Have you tried any of the galactagogues - domperidone, fenugreek, blessed thistle, oats?

Have you tried having a babymoon or co-bathing?

Has your baby been checked by a BFC/IBCLC for Tongue Tie or other oral abnormalities?

How much milk - now managing around 300-400ml per day; she has about 900ml per day. So barely worth continuong? I've not tried galacragogues, I defnitely will do though.
Co-bathing - tried that - same thing as "re-birthing" I think (v cringeworthy name, "re-birthing")? Was lovely, she went to sleep after a while, but it didnt get us anywhere re: breast feeding.
What is babymoon? I guess I've not tried that (but so many different names for same thing!).
I also try to carry her around in a sling where practical, skin-to-skin as much as possible, expressing milk before trying to latch her on, dripping milk from a bottle over my areola when she's trying to latch (terrible idea, almost impossible to acheive and she just icks it off without attempting to latch).
I've not had her checked for tongue tie by BFC, but I was in hospital for 4 days (trying to sort out feeding!) and midwives did quickly check her mouth. So I'm guessing there's unlikely to be an issue there.
All tips gratefuly received!

300-400ml a day is still a fantastic amount though! I was making about that and still switched to ebf (was about 400-600mls a day over 12+ pumping sessions).

When you said up-thread you were 6 weeks on do you mean your DD is 7 weeks old? 900mls is at the top end of what you would expect a 1-6m bf baby to take (570ml-900mls with 750mls as an average). Have you seen this or this as they have some great information on how to bottle feed and how much milk a baby fed ebm needs a day.

A babymoon is you (naked) and baby (just nappy) hanging out in bed with lots of skin to skin, cuddling and very low key attempts to bf (by lowkey I mean not actively sitting up and getting baby in cradle hold but trying to trigger baby's own feeding reflexes to initiate bfing on their own - lots of info here).

How was her birth? Was there any problems/ventouse/c-section/pethidine?

I would say a quick check of the mouth is not sufficient to rule out anything but the most obvious heartshaped, stuck to the floor of the mouth TT so there may still be some unidentified issues there (though probably not).

Whereabouts in the country are you (vague as you like!)? I wonder if you were to see a BFC/IBCLC they might work with you through the options (one of which might be using a supplemental nursing system to increase milk taken at the breast - they can be filled with ebm or formula).

I started another thread as am hi-jacking the original one here:-). Really appreicate your help!

However, a quick answer: will try babymoon, birth was an elective c-sect under general anaesthetic (so absolutely not the start I wanted but it kept us both alive and healthy!). I have an SNS but barely used it as find it incredibly fiddly, as find getting her to latch onin firstplace difficult enough wthout the added complication of the tube. But am going to a breastfeeding help centre/cafe thingy tomorrow so will see how that goes...