Help needed getting back to EBF- please help

[LauraSmurf]

Ok wise women of mumsnet I need your help.
My DD is 4 wks old and has had a bit of a rocky start. She had a week in special care after a breathing/stomach problem straight after birth. Now all fully resolved though. We left hospital with her BF but only with help of nipple shields. After a week of EBF at home we was losing weight so we had to add formula top-ups.

Fortunately she has now regained birth weight and then some. But I would like to get back to EBF without the formula. My problem is she never seems to take enough from the breast to satisfy her. She falls asleep and no matter what I do she won't wake unless I put a bottle in her mouth, at which point she usually starts to suck. When I do the same with nipple or nipple shield she does nothing.

How can I get back to EBF? Or is it not possible?

Should say we have managed to mostly do away with nipple shields unless she is really tired or distressed.

What a tough start :(

Did you get given a strategy to wean off nipple shields or have you been working on removing them yourself?

How often are you offering the breast, roughly? How quickly is she falling asleep at the breast?

Sound like you have made great progress so far!

Have you tried babymooning in bed and letting her latch on and off as she dozes and wakes? She is still very little and maybe feeding is tiring her out.

I'm sure there will be some great advice as there are lots of experts on this topic. Congratulations!

Laura - Has baby had a lot of 'help' to get bfing established? It sounds like she is just switching off at the breast and that can happen if baby has been handled a lot to get them to latch (particularly hands on the back of the head pushing them on to the breast).

A good way to resolve this is going back to basics - lots of skin to skin, cuddling in bed together, co-bathing (need a willing helper for this to hand baby to you in the bath/take baby off you before you get out of bath) and baby massage. The idea is to get baby comfortable being near your breasts and to not switch off and to trigger the feeding reflexes baby was born with.

You won't be able to stop the top up feeds until baby is latching well for the majority of her feeds. As a temporary measure you could start expressing so that the top ups are EBM rather than formula (that way when baby latches reliably for most of her feeds you don't have to build up your supply).

You could also try swapping bottles for cup feeds so her suckling needs have to be met at the breast (or some of the feeds if that is easier).

How much formula is your DD having a day at the moment?

Hi all,

In answer to questions she is feeding roughly every 3 hours sometimes longer (never more than 4 and these are normally at night) and quite often shorter. She has a tendency to cluster feed from 7 til 10 ish. At every feed time she gets unlimited time at the breast and she will suck well for the first 5 minutes (almost painfully strong suck now!) then slowing for 5 mins then sporadically during the rest of feed which is usually another 2mins.
As for formula she takes as much as she wants up to 90mls. It varies greatly how much, sometimes as little as 10ml up to all 90ml.
I have sort if tried babymooning as she is with me in bed when I am resting and watching tv etc.
As for expressing for top ups. We tried this before going to formula and she still dropped weight and so were 'ordered' to use formula.
We are reluctant to drop the formula feeds until she seems to reduce them for herself. Do you think this will happen?
Also I am only feeding from 1 breast a feed on advice from HV.

Hi Laura - How are things going?

Well it's been a tough few days, but we have gotten ourselves to a place where all 3 of us seem happy.

After 3 days of constant feeding with only 1 bottle at about 11 in the evening to fill her up for night, we seem to have found balance. My breasts seem to be producing enough now and they do feel fuller.

We think we are going to combination feed still as she takes forever to BF and seems to need to cluster feed most of the day so we are doing 2 bottles a day. Both at 11 (am and pm) and BF all the rest if the time.

We are happy with this as it means I am not constantly BF but am still mostly BF. it also means DH can feed her which he has really enjoyed for bonding time. She hasn't been screaming hungry like she was when I tried BF last time without a bottle afterwards. She gets weighed tomorrow, so long as she keeps gaining weight we will be happy bunnies!

Thanks for asking and supporting.

Glad you've found a way that works for you .

Just be aware that big gaps between bfeeds can lead to lower supply, so if your DD goes for hours between bfing sessions, you might want to consider slotting in a pumping session to help keep supplies up.

As baby is only 5 weeks long gaps can tell your body to slow down production, if she was older that wouldn't be a problem but production is only really getting going now, pumping sessions can be dropped later so you won't be doing it for ever.

Good luck with the weighing in.

I'm not worried about milk supply as I have always had enough and often more than enough, even when I was just expressing during first weeks. HV has said her hunger early on was due to her not being an efficient water. She was too tired to suck properly. But if I do seem to drop supply I am happy to express again. I find it easy to fill those bottles! It's oddly satisfying, although I can't help feeling like daisy the dairy cow sometimes!

Question about pain though. The first 20 seconds are always painful as she establishes her suck. She doesn't always latch well and I take get off and relatch. She sometimes seems to slip off slightly and then suck which really hurts. Also sometimes the ends of the nipples seem flattened when she is finished. Is this normal,

The initial pain on latching I would say is normal if you didn't have flattened nipples at the end of a feed or the slipping off mid-feed (latching on pain is usually caused by the baby drawing the nipple into the back of the mouth). The flattening is caused by the baby compressing the nipple against the hard palate rather than the junction of the hard/soft palates (which causes the pain).

Has baby been assessed for Tongue Tie? That can cause pain on bfing, slipping off the nipple and compression of the nipple during feeds. Or it could be simply that the positioning and attachment need to be tweaked a little. Have you got a bfing group locally that you could go to for real life help?

Exaggerated attachment (aka 'The Flipple') can work well at getting a deeper latch.