Feeding kerfuffle

[Echocave]

I had my dd (first baby) 9 days ago by c-section and since then have had a lot of feeding problems. I wondered if anyone had any positive thoughts to encourage me as I'm finding it really hard. First of all, the baby was small at birth.

I managed skin to skin in the operating theatre and whilst in recovery gave her colostrum (although from a syringe). We carried on for a couple of days with midwives telling me the latch looked good etc. On day 3 someone noticed that dd was yellow and they tested her for jaundice (negative) and weighed her. She'd lost more than 10% of her birth weight. They then put us on a 3 hourly feeding schedule, topping up with formula.

Dd gained enough weight for us to leave hospital on day 5. The next day the community midwife said dd had tongue tie which we had snipped. I then got advice from a feeding expert who showed me the latch again and we are back on the 3 hourly feeds with me double pumping after a feed. the main aim is to increase my milk supply which is low.

However dd seems hardly bothered when on the breast and does a couple of sucks then just nibbles. I know it takes time to establish milk supply but have I left it too late? I'm committed to the feeding regime I've been put on but I'm a bit tearful each time dd breast feeds as I don't think she can get enough or even anything from me. Any words of encouragement gratefully received and sorry if I'm waffling.

Congratulations on your baby :) Sorry you've had such a tough start.

Has your baby been cleared for jaundice now?

Can I ask why she's on a 3 hourly schedule? Does she have to wait that long? Can you offer her more feeds between these times?

No, you have absolutely not left it too late to establish your milk supply but I would be looking at more feeds than 3 hourly unless there is a good medical reason.

Are you still topping up with formula? How much?

Are you finding feeds comfortable?

How do YOU feel that the latch is?

Also, when you finish a feed what shape is your nipple?

First of all - congratulations!

No, you haven't left it too long. Everyone I've ever talked to struggles to start with, usually for a few weeks at least.

Midwives do freak a little with weight gain and feeding, and they are right to - sort of. All babies lose weight early on, and I would follow your gut and common sense more. E.g. Is your daughter otherwise seeming well? Keep an eye on skin tone and alertness - a baby that young is barely alert anyway, but you will notice improvements in the coming weeks.

Most importantly though is demand whatever level of support from the midwives or whomever you think you need. Once you are confident the baby is gaining weight, you can focus on technique with a breastfeeding specialist. But if you are worried about your daughter thriving, then you might want to keep the medical types around a bit longer.

Do keep expressing, even freezing your milk if your daughter isn't interested.

But struggles to get going are really common (as are the physical discomforts that go with it, and the teariness), so don't lose hope. Good luck!

Thanks for your reply. Dd's jaundice seems to have gone, she had the physiological type rather than the acute type apparently (they did a bilirubin test in hospital).

We're on a 3 hourly feed as that's what the lactation counselor recommended. To be honest, I'm finding even that fairly demanding as there are top ups to be prepared, sterilizing bottles etc and having the odd nap. Also dd hardly seems bothered/awake at 3 hourly intervals and I'm not sure how she would find more frequent feeds. She's pretty sleepy when feeding.

We're giving her a lot of formula top up, rather depressingly. Between 20ml and 50ml. I'm trying to top up with expressed milk but sometimes this us only about 10ml.

I don't find her feeding uncomfortable and the latch looks ok but since her tongue was snipped she seems to slip off the breast more (my breasts are quite small and relatively firm even before pregnancy and birth). Also dd just seems to nibble not suck. I am compressing the breast to deliver milk to her but assume there just isn't much there for her to get at. Poor dd, she gets so excited and almost hysterical before a feed then seems to give it up as a bad job.

I had a section too, dd was a month early and by 1 week went back into hospital for phototherapy. Because she was little/early/jaundiced I topped up with bottle feeds after breastfeeding. Then took me 2-3 months to ditch the bottle completely. Nearly 8 months in and really enjoying bfing.
It's very early days for you. Hang on in there. I know how it feels at 2 am when baby is hungry but won't latch and you just sit there in tears. And the pain...
I'd give up on any kind of time schedule and just feed her when she wants and give yourselves plenty of skin to skin. Drink plenty and rope in all the help you can get to make sure you get some rest. Good luck!

Are you topping up at every feed? What did the lactation consultant advise on this? Midwives are sometimes quick to recommend top ups when they might not be necessary, and very often because they are only around at the beginning they don't tend to give you a long term plan to reduce the top ups, which is hopefully the end goal. You need to get expert advice before changing anything though. I would try and speak to the LC again and see if she has a time frame and any concrete advice to cut out the top ups.

"Nibbling" is not necessarily bad, by the way. Though if she's sleepy that could be a problem. Have you tried just staying in bed with her and having skin to skin so she can feed pretty much constantly?

Hi, congratulations on your new little girl! I just wanted to tell you that this is EXACTLY what happened to us - small baby, milk took ages to come in, tongue tie, >10% weight loss and formula top ups. I felt just like you and, like you, was totally committed to BFing but it seemed everything was against us. Loads of people including doctors told me to just give up and I was shocked how quick they were to shove formula at us (day 2!). It got better rapidly by 1)trying a different hold 2)getting her off formula as soon as I could and 3)pumping endlessly. She's now 8wks and still EBF and doing great, I'd never have believed this in my darkest days at the beginning.

I'm not a BF expert and I'll leave that to other very wise people here, but I just wanted to give you some hope. Good luck!

I think you need some good RL help here. I'd be concerned at someone putting you onto a 3 hourly schedule IF that's what she means (ie as opposed to her meaning a MINIMUM of feeding 3 hourly but more if you can - could you have misunderstood?). You call her a "lactation counsellor". Do you know what qualifications she has? You are best looking for "IBCLC" or a breastfeeding counsellor trained by NCT, LLL or ABM.

Do you have help? Can you possibly do some baby mooning? This means getting into bed with her and snuggling up, full breast access (ie no top) and her just in a nappy to maximise skin to skin. Talk to her, cuddle her, allow her to feed and encourage her to feed but gently and without it being a fight. If she's asleep, sleep. If she's awake, just talk, stroke her, encourage her to latch. A few days of this is idea but any time you can will help. Forget the housework - this is FAR more important.

You can make your formula top ups in advance if you want to and keep them chilled for 12 hours before using. You need to make the feed as normal, ie 70 degree water onto the powder and chill rapidly, then put into the back of the fridge.

Your local NCT branch may be able to hire you a hospital grade double pump which are far better than personal ones.

I do think you need some good RL help though, and as soon as possible. Does your NCT branch have a breastfeeding counsellor?

Been there! Had to top up and pump because DD less sleepy and not latching properly. She would only wake to feed every 4 hours so we the hospital told us to feed her a huge amount (120ml I think??) by bottle and of course she'd never take it all! Anyways, I worked on her latch a lot (went to local clinics)l and gradually she fed more and better. Also I pumped more and was able to store some thus being able to stop formula. When I was confident enough in her feeding and latch, I stopped any bottles, probably around 5-6 weeks. Best wishes to you and LO!!

echocave what a lot to have happened already!!Kerfuffle indeed :(

It would help you to have a second real life opinion on all this, I think....many question marks about what has been told to you so far, not saying it's wrong, but more like worth discssion, at least.

Hope things get better and NO you have not left it too late :)

The LC is accredited and seems very experienced. It is possible that she meant feed every 3 hours as a minimum but dd doesn't seem to wake up in between 3 hourly feeds anyway.

I have currently got dd lying on me, woken up and I offered her the breast which she tried for about 10 minutes, then I gave her 30 ml of expressed milk (all I had to spare) and she seems to have gone to sleep. I would love to have her on me, telling me when she's hungry etc but with the weight loss and low milk supply, I'm paranoid about going with the flow like that. It seems impossible to know what to do. Is she too sleepy or are they always like this at this age?

We had a really similar experience, except our baby was a big girl. She lost 12% of birth weight and didn't regain it for four weeks! However I'm happy to say she is gaining well now (11+5) and EBF. Biological nurturing really helped with latching. I found I was jamming baby on to me and hoping for the best, not great and very frustrating and sore. Now she latches herself on!

I was recommended to feed every three hours in the early days because once I had fed, topped up, winded, settled baby, expressed, and sterilised, it was nearly time to feed again! The idea was that feeding and expressing would take an hour. But it was never less than an hour and a half for me! Of course I fed baby sooner if she was hungry but she was so stuffed with formula she didn't get hungry in between very often. Now I am BFing much more often but I still have more time for other things and we are all much happier.

If you can use the formula cartons rather than making from scratch I would also recommend them. I think I would have lost it without the cartons, it was just so hard.

Congratulations and I hope things get easier soon. Do as little as possible and enjoy your new baby.

BTW our girl was very sleepy at first but got progressively more alert as she gained weight. We did regularly have to wake her up to feed her, which was hard, but once she had regained her birth weight we stopped.

Good luck.

This is very similar to what happened to me and my daughter although her TT wasn't recognised/snipped until 9 weeks when my milk supply was very low and she was on almost 100% "top ups". I also found doctors and some midwives massively unhelpful about me wanting to keep BF. I felt their attitude was "well you can't do it so get over it". Then other "pro-BF" midwives (before I had the TT diagnosed) would say massively unhelpful things like "just feed her more often and it'll be fine", when I had already told them I easily feeding about 18 hours out of 24 and my daughter was still screaming with hunger .

In the end we did get back onto mostly BF although it was a long hard slog. Should be less of a slog for you as 9 days is still really early so don't think all is lost. I know how disappointing and frustrating it is though, to be desperate to get something right and be totally obsessed with it and simultaneously to HATE it because it's so painful and unrewarding and it's making you look at your child who wants feeding and think you can't bear for them even to touch you.

The way I did it was to VERY gradually reduce formula over a VERY long time (like 3 months long). We went from 120ml bottles to 110 then stuck there for a week or so then dropped to 100 then another week or two... Getting her weighed weekly to make sure she didn't lose again. I also got the doc to prescribe Domperidome to boost milk supply and pumped when possible although to be honest not often enough cause I loathed it. She's 6 months now and mostly BF but has one massive bottle of formula before bed (240ml) and the occasional 100ml top up during day or night when my boobs run out and she's obviously still hungry.

Everyone is different of course but that's how it was for us. I would say though that if it doesn't work out for you for any reason then it's really really not the end of the world. I was devastated to give my girl formula but keep reminding myself there is so much more in parenting than the method of feeding. You should not feel bad however it turns out.

And also CONGRATULATIONS on having a beautiful baby. How lovely is that? Hope you enjoy it, don't let this spoil it for you. Oh and babymooning in bed is lovely whether or not it helps with the BF. All those lovely cuddles!

Thank you all so much for your help. It's certainly quite hard to see the wood for the trees at the moment!

Ecuse, your advice chimes with what our midwife advised, except she did say we should drop the formula over the course of the weekend (!). There is nothing wrong with dd's lungs and she would definitely let us know if we let her go hungry....

In the meantime, I have a hot date with a double pump so if you'll excuse me....

Did the midwife give you a plan to cut out the top ups or just say that you should?

She just said I should but I don't think she had any idea how low my milk supply is. I didn't realize it myself until the LC mentioned it. All I can think of doing to improve it is pumping as often as possible but not too close to the feeds or I'll be empty and having dd skin to skin as much as possible.

It's getting to the stage where I'm scared of dd screaming when we wake her to put her on the breast (we darent leave her to sleep in case she gies too long without a feed). I'm pumping but hardly getting anything. I'm drinking gallons of water to try to improve things but after the last feed I feel desperate again and really sad.

Oh echo. Big hugs. Expressing is hard. I gave up at three months because I just couldn't get anything. Some women pump gallons and some women (like me) get max 2oz. Advice given to me was try and pump at the same time as feeding off the other breast (I know, you need at least another 2pairs of hands). I failed at this so used to feed, then immediately pump off the second breast, then at next feed time give her the first breast again. And now I'm breast feeding her with a good supply (but still can't pump, nothing comes out!).

Establishing bfing for me was a nightmare, the only way I could do it was to say, "I'll do this until next week, then we'll see". Or, "one more day. Just one more day".

At the end of the day you are doing a wonderful thing. Hang on in there. But also be kind to yourself. Do you have a good friend who has breast fed? That's who got me through my darkest days.

Hugs.

Oh lord I feel so bad for you, it's not that long since I was there myself and I remember how low I felt, I literally dreaded every feed and would argue with DH when he declared her to be 'still hungry' as I took it as a personal dig.

I also did the "just one more day" thing like Raspberry, and sometimes "just one more feed", it helped me massively psychologically. We bought a tin of SMA for the cupboard so I didn't have to worry about her potentially going hungry at 3am on a Sunday and happy to say its still unopened.

Do you have an electric pump? It's worth investing or hiring one if you can I think?

echocave don't try to drink too much water. You will get contradictory advice on this but honestly, drinking too much doesn't help. Drinking to thirst is important but not over-drinking.

I didn't really mean "go with the flow" and ignore the LC's advice about top ups. It's more trying to encourage the breastfeeding hormones by babymooning, and keeping close, and relaxing together.

Why do you feel that your supply is low? Why did the LC say it is?

Expressing after feeding may mean you get less milk out, but you're not "empty" as your breasts continue to make milk all the time. In fact the "emptier" they are, the faster they make the milk so keeping them "emptied" is better than letting them "fill up". I'm putting all that in quotes because they're not really helpful terms because, like I say, they don't ever just run out. Have you tried expressing at the same time as feeding her, off the other breast?

You are right that frequent expressing will help your supply, although continuing to encourage your baby to feed is really important.

There's a LLL page which might give you some ideas. Bear in mind it's written for breastfeeding counsellors and health professionals so does have information of medical problems, but maybe there will be something useful there. www.llli.org/llleaderweb/lv/lvoctnov99p99.html

Echocave - please drink to thirst not more than this as drinking much more than this can lead to lowered supply see here for more details.

Also, you don't need to worry about emptying your breasts - they are never empty. In fact the less milk in the breast the quicker it is made so pumping then feeding will make you more milk overall. You can do breast compressions during feeding too, to see if that will 'perk' up baby's feeding.

Did the LC talk to you about something called a supplementary nursing system (SNS) to deliver the top-ups? It can help if you have a slow or ineffective feeder as by changing the size of the tubing or how/where you hold the bag you can increase or decrease the flow of the top-up whilst they feed at the breast. You don't even need to be making milk to use this as often adoptive mums inducing lactation give feeds like this to start with while their milk supply develops.

DD1 was pretty much exclusively bottle fed (mostly formula but some ebm) until she was 8 weeks old and then we managed to get her back to ebf. That was with me pumping with a double electric pump 12 times a day (every 2 hours day and night) and I still never made enough with the pump to just give her ebm but she moved over to bfing directly and we didn't need to supplement (I did take fenugreek to increase my supply but there are issues and contraindications to this so please research carefully before using any herbal galactogogues).

echocave I think I could have scaled down the formula more quickly but I was very scared of not feeding her enough after she was hospitalised at 4 weeks for having dropped back below her birth weight. You're really lucky to have had TT diagnosed and snipped so promptly as it took me a further 5 weeks to get it sorted!
I went slowly because that's what made me comfortable that my supply would have time to catch up. I am no expert but would think you'd have much less than me to worry about in that regard cause at 9 days your supply should still be establishing whereas I "missed the window" as it were.

The way I did it was at each feed I would BF both sides until "empty" (i know they're never technically empty but for me there comes a point where she's still trying to drink but I can feel that very little is coming out and it starts to get a bit sore). Id then offer the bottle and if still hungry after that put her back on the boobs to stimulate supply. On the day or two after I reduced bottle size she would be hungry still but that tended to stop in the few days after as my milk supply increased and when I thought she was comfortable I would do it again. Sometimes I would wait a week and a half or more to do so. I'm sure you wouldn't have to wait that long though!

It's a difficult catch 22 trying to wean off formula. The ABSOLUTE priority is that your baby is happy and adequately fed, but if you give them as much formula as they want you'll never be able to establish your own supply so it's about finding a way to let them go a little bit hungry but not too much in very controlled circumstances.

Sending you very Un-m'netty hugs if you want them!

i had a very sleepy baby and in the beginning it was very difficult to get her to feed for more than a couple of minutes before she'd nod off. The midwife recommended stripping her off to nappy and doing plenty of skin to skin which you are also doing, but the other thing she told me was to try and feed her in a cold room - this really worked for us, it kept her awake and alert and wanting to nuzzle in to me instead of flaking out and going to sleep and nibbling. I also woke her every 2 hours during the day to feed but let her sleep as long as she wanted at night. Would the bottle top ups be giving her nipple confusion (not something i know a great deal about i'm afraid)

We saw the community midwife today who looked at the latch again and said it was fine, that I did have a reasonable milk supply and that I should try to cut down formula top ups to just 10 ml each feed.

As a result, dd has fed almost constantly all evening (she does seem to be feeding more actively) but still seems hungry and is almost hysterical before getting on the breast or bottle. We are giving top ups in small amounts but she still wants more. My long feeding sessions seem to have achieved nothing and she might also be very tired too.

I'm going to a breast feeding drop in in a day or two but I'm still really confused about what to do. I dont even really know if its only hunger now. What total confusion.

Feeding constantly all evening is really normal at this stage, echo. However it does seem like a big drop in the amount you're giving her and expecting your body to make it up so fast. She may well still be hungry.

Your feeding sessions WILL achieve something. They will be telling your breasts to up their supply but it will take a few days of this to really push things up.

Are you offering one breast, then the other, then the first again (and keep going)?

If it's not hunger and she wants to suckle for comfort that's fine too if you can bear it as it will continue to build up your supply and is very comforting for you.

It is great news that she's feeding more actively but you may have a few days where it's tough. You might find it very useful to phone one of the breastfeeding lines to talk through the strategy, to be honest, and to discuss whether you might be better to reduce the top ups more slowly. Midwives get virtually no BFing training and unless yours has had additional training you may want to just talk it through with someone who is highly qualified (assuming your MW doesn't have extra training, which she might).

Excellent that she's trying to help you, though.