Using EBM; exclusivity or duration? Thoughts please.

[Glimmerberry]

Previous thread:

www.mumsnet.com/Talk/breast_and_bottle_feeding/1336852-9-weeks-of-BF-time-to-add-in-formula

Unfortunately things just didnt go well. Great help from la leche league, a local BF counsellor, HV etc but the green poos continued until this was all we saw and his weight dropped off the centile chart. A significant problem seemed to be that he just didnt have the energy for consuming enough calories by BF. He'd come off the breast exhausted and fall asleep but looking far from satiated. As we increased feeds to 2 hrly it only seemed to get worse.

It was suggested that continue to BF him 2-3 hourly and offer a bottle at the end when he'd no longer suck at the breast. So we've been doing this with EBM and, reluctantly after 3 months of exclusive BM, formula. The good news is that even when he has been utterly exhausted at the breast he's been able to take 1-2oz of a top up afterwards and he's putting on some fat and producing healthier nappies again.

As the formula top ups were just because I didn't have enough expressed milk, we decided to hire a hospital grade pump to get more milk in a shorter space of time. My little medela swing pump was only getting me 1-2oz in 45 mins of expressing. The hire pump is good. In ten minutes i get around 4-6oz depending on the time of day. But we've now got a wee bit of a dilemma that i'd appreciate opinions on.

Do we:
A) Continue as we are (breast fed predominantly with formula top ups) since he is looking well and happy, and freeze EBM to help extend his breast feeding beyond 6 months when I go back to work....OR

B) Use the milk I'm espressing for top ups to return to exclusive breast milk asap, to ensure as much as possible of his first 6 months is breast milk only, but accept that this will probably shorten his time with breast milk after 6 months as I haven't been able to build up a stock.

So basically what would people prioritise more, exclusivity or duration? Husband would like duration arguing that the longer he is getting immune complexes etc from me, the stronger and healthier he'll be.

We're probably being a bit PFB about this and overthinking it, but would value some opinions!

I do remeber your previous post have you seen the ped yet?

Personaly I go for exculussive BF. Mainly because it will help heal his gut if there after the problems you had early on. But it is probably a personal prefference rather then anything else. unless the formula is causeing a problem.

If he's gaining well now could you not consdier trying to drop the topups?

You'd need to see the BF counciler again if you wanted to do this.

You can carry on feeding when you reture to work even if it's only one or two feeds. Which would extend the duration.

I'm sure more knowledgable people will come and advice, but I would rather give the ebm now, as a topup rather than keep it for a few months later. You can still supplement with formula if your milk isn't enough.

The reasons for this are:

• the ebm will be easier to digest and shouldn't cause constipation like formula
• if I remember correctly, you produce the right milk for your baby's age, plus you'd be giving your baby the antibodies for whatever you get in touch with right now. So any season specific germs will be tackled straight away.
• if all goes to plan your baby will be able to revert to exclusive breastfeeding, and when he's 6 months you can still express in the evening or at work for him.

My baby also was losing weight and was getting topups after each breastfeeding. Some were breast milk, lots were formula.

Putting on the weight allowed her to regain strength and for the last two weeks shes been almost exclusively breastfed.

I would recommend also expressing after each feed, to ensure your supply remains plentiful, mine really dwindled when my lo was too weak to suck properly.

Good luck, you're doing the right thing!

We have a few medical appts coming up for him, the first is Paeds on Tuesday. Very anxious about it.

When i go back to work i'll be aiming to feed first thing, after work, after his bath and dream feed i.e. 7am, 6pm, 8pm, 11pm. I won't really be able to feed thru the night (husband will do this) and expressing will be difficult during the day; i just have a job that won't be compatible with these things. I expect that after a few uncomfortable weeks of long spells without feeding my supply will start to dwindle.

I suppose we could try dropping the top ups although the plan was to keep doing this until, ideally, he seemed to pick up the energy for BFing and started to refuse the additional feed i.e. be led by him and keep offering meantime.

Thanks metalelephant, that's crystallised what i'd like to do, will pass that on to hubbie.

If I may add that I dropped the topups once she started to refuse them, and she was also putting weight on so wait for your baby to let you know it's the right time. Have a lovely weekend and enjoy your little baby, sometimes we worry too much and forget how special these first weeks are!

If you carry on feed with those 4 feeds espicaly the 11pm one there is no reasion why your supply should dwidle espically if you manage to get to 6months whithout adding any more formula. ie your feeding and expressing enough for every feed.

Is there no way you could fit even just one expressing seasion in at lunch time while your working. You employer has an oblication to find somewhere for you to express and store milk while your working. As you would only be missing 2day feeds then maybe only 1 as you'll have started solids by then.

Yes you do probably need to keep the topup's untill he's gaining well and has more energy.

Good luck you're doing a fab job.

I'll definitely try (to express at work) and know "my rights" but i just have the kind of job that will be extremely difficult to work around it.

Had a chat with DH. He is feeling a bit scared about changing the status quo (bf plus ff top ups), moreso than i realised. Its been a really anxious few weeks and now that our boy is looking a bit healthier (amazing how quickly that happened really) he is terrified to change anything. We're going to wait and discuss with the paed on Tuesday.

Your DP sounds exactly like mine! He was also worried about changing something that was working well already... I think you should do what you feel is right, and listen to your paediatrician.

What tiktok has mentioned in other threads, and you can confirm this by more research, is that formula is not more calorific than ebm so breastmilk is perfectly fine for topups and comes with all the benefits you already know. If you're expressing already it makes sense to use that milk for feeds. When mine wasn't enough, I would offer more formula at the end.

Initially I was offering the breast, then a bottle of ebm or formula (or both) and let the baby have as much as she wanted.

When she started putting on weight, the lactation consultant recommended I offer her 30ml, burp her and then offer more. If she was still hungry, she'd have more andif she was already satiated she would refuse...

I'm not trying to convince you by the way, I thought I'd share my experience because I had the same worried reaction by my DP as you did...

It's worth starting a thread asking for tiktok's advice on supplementing with ebm versus formula... she's one of the most knowledgable and helpful posters. I've learned a lot from her.

Good luck!

Thanks. I think he's lost confidence in my breastmilk. I can't blame him, I kind of feel the same.

Please don't doubt your milk, it is the best thing in the world for your baby! There are so many factors involved in feeding and weight gain and they aren't all within your control. It sounds as if you are over the worst of it and hopefully the progress will snowball until you can stop topping up. I've been there and it's a pain, good on you.

flame is right glimmerberry, your mill is the best your baby could get! He just needs more of it, you've been doing just what's right for him by expressing.

Just to say you really are doing a fantastic job.

And here's a Kellymom link on milk calorie content if you're interested.

Thanks everyone. We keep chatting about it and are using a bit more ebm today. I make up all the top up bottles in the morning (8x 2oz) and they've all been formula in the past week, todays are 6x ebm and 2x f. Paed appt tomorrow. We have however agreed that if we just get a dismissive, "oh just use formula" that doesn't sound thought out we won't necessarily accept that. Of course we will take their advice if it is more reasoned than that. Hope that makes sense.

Sounds like you're doing very well Glimmer, and well done for such successful expressing!