Breastfeeding and conifdence has been badly knocked by health visitor (sorry a bit long)

[Pinkseren]

I had some problems getting breast feeding established until dd was 5 weeks old. My nipples are flat, I had mastitis, badly cracked nipples etc It is still painful to feed from one side as nipple is flatter than the other one, and I manage this with ibuprofen. I was also having to use formula on occasion when I was unable to express enough milk for a feed.

I resolved my problems by seeing a breast feeding counsellor however due to the amount of time it took me to get hold of one (dd was 4 weeks old), my supply had been affected. I resolved this by using domperidone and my supply became not dissimilar to when my milk first came in (breasts very full and leaking if I did not feed) after a few days.

My GP would not prescribe the domperidone as I was requesting it for an off licence use, so I was was buying it over the counter. To get the recommended dose for increasing lactation, I was having to use over a box worth a day. The problem I had with this was that many chemists would refuse to sell me more than a box at a time (I didn't tell them what I was using them for in case they wouldn't sell them to me at all), so this necessitated picking up a box each time I passed any chemist.

I cut down my use as I was in fear of getting mastitis again, and we seemed to be doing well with the breast feeding and not using any formula at all. We saw the health visitor on Wednesday and felt quite proud to say that breasfeeding was finally sorted. HV told me that dd was not putting on enough weight (had put on 3oz in two weeks) and maybe I should consider going back to the combintion feeding I had been doing.

I have not enjoyed breasfeeding at all, but have persisted with it because of the benefits to my daughter. The HV is also aware of the financial cost of using the domperidone (at a cost of over £5 a day beacause I couldn't get it prescribed-much more expensive than formula) as well of the aggro of touring pharmacies to get enough, this is not something you would do for the fun of it. I am now paranoid about feeding my daughter as she seemed satisfied after breasfeeding and feel bad that I have not been doing enough for her. I'm loathed to use formula again, but have been today because the last thing I want to do is deprive her of food. Any advice greatfully received. Thank you.

I cannot offer any practical advice, but just wanted to say don't feel bad that you have not been doing enough for her. You have done wonderfully well, and been an absolute trooper by the sounds of it!

Whatever happens you have given her a brilliant start. Don't e so hard on yourself!

That sounds such hard work, well done you for persevering!

How old is your DD now?

What you ideally want to happen now is that you establish a natural, un-interfered with BFing relationship with your DD. Keep feeding on demand and your supply will regulate itself to what she requires.

If you haven't come across it before, the website kellymom.com is well worth reading. It has loads of info about all aspects of BFing and is particularly detailed on managing supply.

Thank you for your quick responses. DD is 8 weeks old.

Well according to the WHO she shouldn't be weighed more than once a month now - assuming she is back at birthweight?

I would just carry on with the feeding. Your supply will never have a chance to sort itself out if you keep including formula. As long as you are happy that she is alert, well, lots of wet and dirty nappies then carry on as you are.

Have confidence in your body, it is designed to do this :) The quickest and easiest way to increase your supply is to switch feed - ie. swap sides regularly during a feed.

Have you discussed expressing to get your supply up? I had mastitis, cracked nipples etc and ended up pumping because it was too painful to have him latching on as often as he needed to eat. So I expressed and bottle fed sometimes, bf directly others. When expressing, I was told to keep expressing after the milk had stopped flowing freely, to increase my supply. Maybe you can feed her, then express for a couple of minutes, to try to increase your supply a bit?

I had a horrible time, which finally eased up after about 9 weeks. Stick in there! DS is now 6 1/2 months, and we're still bfing as we start to wean. It was really tough, but I'm so glad I stuck it out.

Hi, I'm so sorry you have had such awful feedback from your HV. You have done so well getting this far. Can I ask how much your baby weighs at the moment? What was the birth weight? Lots depends on how she appears as well. I can understand her concern if she is around the 2nd centile but tbh now you have increased supply and things are going well I would continue. Lots of skin to skin / baby mooning in bed naked together, lots of demand feeding/ bonding and your supply will naturally increase. Definately don't give formula though because then dd will be full for longer, demand decreases and therefore supply decreases. HTH

Thank you for your encouraging words and support. My baby was 7lbs 1oz at birth and is now (at 8 weeks) 9lbs 12oz

Ok so she has droped down the centiles a bit, but I take it as you had a rocky start then she lost a bit to start with?

I think it would be best to see the breast feeding counciler again. Adding formula at this point is just going to mean you end up back where you where.

If your DD is having plenty of wet nappies, seem's satified after a feed and having awake allert periods then there is no urgancy. It mite have been only a small gain but it was a gian.

Please see the BF counciler again there maybe more you can do. You've been doing great and have come a long way.

:( pinkseren

It's UK guidance about weighing frequency - no idea what WHO says, but it is crystal clear in the PHCHR ('red book') that babies should not be weighed more frequently than once a month unless there is a reason to weigh more often. There is no clinical benefit in frequent weighing as the results from it are misleading.

However, in your case, pinkseren there might be a reason because of the difficiulties you had at the start, and because you have needed meds to boost your supply. The HV seems a bit useless, though, and needs some training in how to support bf mothers and what can help sustain a good milk supply. She can't draw any conclusions from a fortnightly gain of 3 oz, so she should not be suggesting formula - unless she thinks your baby is truly undernourished and needing formula urgently. I cant imagine this is the case from what you say.

(Domperidone hasn't been well-studied for effectiveness and long-term use for bf, so it's not surprising your doc was reluctant.)

Can you go back to the breastfeeding counsellor and get an overview of your options? Seems like this would be a good plan for you, esp as this was helpful before.

Poor you, that sounds really tough. You've done really well though to get through so many difficulties
I had lots of problems to begin with and wasn't pain free on both sides until 12 weeks and didn't enjoy bfing...BUT...DS is now 13 months, still bfing and loving it. Just saying this to try and give you hope :)

I needed to up my supply early on cos I had used some formula at the beginning. I used a breast pump after feeds for a few minutes (only getting a few drops but giving my breasts some more stimulation to produce more). That worked really well for me.

Definitely talk to the bf counsellor again. As long as your baby seems well and has a good nappy output then I wouldn't worry that she's not getting enough from you.

Good luck

I had similar difficulties establishing BF - over-sized nippes and small baby, mastitis, poor supply etc etc. It's 15 years since I was where you are now, but I remember the hassles only too well! You have done brilliantly to get this far - you're over the worst now and I would just carry on as you are doing.

FWIW, BF didn't really go smoothly for us until DS was about 12 weeks old. As his mouth got bigger, he found it easier to latch on. I also found I needed to hold up and support the boob he was feeding from with one hand underneath, and cradle him in the crook of my other arm. My boobs are were large and floppy, so I literally had to "point" them in the right direction. It was my mum who suggested I do this after watching me struggling to latch him on, and observing the angle his head was at when I was feeding him. No-one else ( hospital breasfeeding advisors, HVs etc) had picked up on this!

I did introduce one bottle of formula before bedtime when he was 12 weeks old, but I continued to BF until he was 20 months (quite unusual back then!). I found it guaranteed a 4-5 hours unbroken nightime sleep for DS and myself which made an enormous difference to my mental and physcial well-being.

I just wondered whether your lo has been checked for a tongue tie incase that isn't helping? We do only weigh babies more if there is a problem or significant drop in centile. 3oz in 2 weeks is less than would be expected per week iyswim - usual is between 4-7oz per week so 8- 14 in 2 weeks is significantly less. That said I certainly never jump to formula feeding unless all avenues have been explored first.
Are you getting at least 5 wet nappies in 24 hours, some soiled ones?
Is babe alert sometimes? Smiling? Settled?

Far better advice on MN than from most HV's - if she's constantly this negative I'd be asking her not to visit again. It sounds like you are doing really well with the BF and I would continue solely with this if you are getting enough wet/soiled nappies.

Thank you for your kindness and advice. I am getting the dirty nappies and have no concerns regarding her alertness. I have had a number of people say that they are surprised how alert she is for an 8 week old. HV did not express any concern qbout malnourishment. I will contact the bf counsellor on Monday.

Just wanted to say a big Well Done for getting this far, and to ignore the HV's negativity. Just keep going day by day and as long as your little one is gaining some weight, is alert and is making a lot of wet nappies, you should be congratulating yourself on doing a damn fine job in difficult circumstances.

My own HV gave me no end of confidence knocking and I was technically doing absolutely bloody fine (good weight gain, no pain after day 2, non-painful latch etc etc). She insisted my latch was wrong, dragged me to breastfeeding groups and got me so stressed that my baby and I would cry at every feed as I struggled to correct a latch that wasn't wrong. After a few days I decided to go back to my instinctive way of feeding and my DD is now a hefty 5 month old lump.

I'm not knocking support groups but I do think the HV was wrong to get me to the point of doubting my own ability and for making my first few weeks as a mother so horribly stressful for no reason at all. And I think yours could do with being a tad more optimistic too.

Carry on, you're doing great.

And by the way, my DH topped up my DD with formula once or twice when I was working long shifts and hadn't made enough milk for her. She was fine and it didn't affect my supply either. Do whatever gets you through the day with the least stress, I think.

Sorry for the ramble!

We done, you have done really well. And I'm not surprised you aren't enjoying it, yet [wonk]

I would carry on bf at the end of the day the hv has recommended something it's your decision. Review it again at her next weight in. Has she asked to see you in another two weeks or back to 4 weeks?

Leonie, I don't think it's weird that a GP does not want to prescribe domperidone - there may be good reasons why not, in any individual case. Read what it does:

www.netdoctor.co.uk/medicines/100001754.html

While its milk-stimulating properties are sometimes exploited for good reason, it's not something to be taken lightly, from the sound of it.

Maybe the OP's doctor felt he/she could not give confident medical supervision when prescribing it; maybe the OP has a medical history that precludes taking it. In the majority of cases, improved technique and greater bf frequency boosts milk supply and/or the baby's intake - it's a shame not all GPs or HVs are aware of how to support mothers to do this, I know.

Not weird just professional opinion?

???

You mean you think all patients should be treated the same?

There may be individual medical histories that influence the doctor's judgement - fair enough.

Some GPs may be more pharmacologically confident and knowledgable than others, too.

He wouldn't prescribe it simply because it's not licenced for use to increase milk supply. Thus if a GP prescribes something 'off licence' when there is limited research into it's use for the purpose they are prescribing it for, they are taking responsibility for prescribing with limited information. I don't blame him for not doing it but the nuisence factor is buying over the counter when they limit how much you can buy coupled with cost (domperidone is a relatively cheap drug which I have been paying top whack for because I've been forced into buying a branded over the counter one).