3wks old, told failing to thrive must top up, want to bf but struggling... help!!!!!

[Chuffed]

I had a really complicated recovery from birth of ds on Xmas day and haven't really had established bf yet. First of all he was severly jaundiced so had to do formula top ups as had no milk. Then we thought he was bf ok but he was putting his tongue on the top of his mouth and just sucking until too tired to continue then delatching and started loosing weight. Again told to do top ups. Now have painful nipples a lazy feeder which I partly blame on being given top ups after every bf which seems to have made him lazy. He tends to latch on correctly then take about 2sucks then just slip up the nipple taking a couple of strong sucks while doing that so over time one nipple is agony. He seems to feed OK on one side and not the other but still requires a top up of about 100-130ml of formula after 20mins.
I am trying to express with no luck getting about 5ml after 5-10mins.
I don't want to formula feed but I feel as though my options are being taken away from me as I struggle with him not feeding correctly and am worried that my milk supply with just disappear.
Seeing a cranial osteopath on Wed in the hope that it helps.
Is there anything I can do???? Am getting really depressed about it all.

you need to contact a breastfeeding councellor. it could be a problem with your latch.

I am not an expert. I'm sure a real expert will be along in a moment. But I can ask the questions I know they'll ask ...

How is his weight? Is he gaining now, with top-ups? How much?

Is he producing lots of wet nappies, and dirty nappies too?

How is his health otherwise?

Did you get really engorged when your milk came in?

There are lots of things you can do.

First of all, getting 5ml after 5-10 minutes is normal. Expressing takes practice. It is a good idea to keep expressing, to keep your supply up with the top-ups and the feeding problems.

Second of all, are you seeing BFCs? Do you have support with feeding? Are you trying different positions, to try to sort out the side he's not feeding well on? (People do manage to feed babies successfully on only one side, but two is easier, I think.)

From what I know, you probably should detach him from the breast when his tongue starts going wrong (put a finger in his mouth to break the suction first, otherwise, it will really hurt). Make sure his tongue is properly down before you let him latch on. He can learn that he only gets boob by feeding properly.

I think some people follow the same rules with the bottle, so he bottlefeeds in the "correct" way for breastfeeding. Could you tell if he was bottlefeeding with his tongue up? Or could you give him the extra formula via a cup, to avoid bad habits like this?

Definitely try to contact a breastfeeding counsellor. If your hospital doesn't have one then try the NCT Breastfeeding Line on 0870 444 8708 or the La Leche helpline on 0845 120 2918.

lots of good advice here, and it's all true, you DON"T need to stop bfing or giving breast milk.

Expressing is indeed an art but there are a couple of things that could help you yield more milk; try expressing while looking at your baby, maybe when he is asleep or even a picture of him (triggering emotional bond you have with him, even visually, can help stimulate the hormones needed to produce milk)
Could you hire an electric breastpump - your HV or even your local Boots may be able to help you.

Good luck and don't feel you have to give up just yet

Excellent advice here. Amount you express sounds normal - has anyone told you that expressing is NOT a measure of how much milk you are producing or baby is getting? Babies are more efficient at getting milk than any pump. But given that your baby still seems to be learning, definitely worth contacting a b/f counsellor as WWB says. And ask your HV if there is a b/f counsellor locally you can see in person. Really helped me when I was struggling.

The time you need to worry is if your baby develops a sunken fontanelle - the soft spot on top of his head. Or seems lethargic, floppy, hard to wake. If none of those apply, you are doing fine. If they do, then you need help, fast.

Good luck - b/f can be really hard at first. It's a skill that has to be learnt and it took me what felt like AGES to get it right.

PS I am not an expert on this, merely someone who has been there.

NQC is correct - also it makes it easier to know what to suggest if you give us more info, chuffed. Some babies are in a situation that's desperate enough for formula to be a necessity, and in fact bf doesn't stand a chance of getting going if the baby has no energy to feed properly...so the baby needs calories, in the absence of direct breastfeeding, they would come from expressed breastmilk. In the absence of that, it would be donated milk, and in the absence of that it would be formula.

Sounds like you have had poor support so far - someone should have told you about expressing to make a difference . 5 mls after 5-10 mins is not nomal after 3 weeks of bf....sorry, NQC! I expect this 5 mls is made up of drop after tiny drop....effective expressing gets a let down stimulated and you may need a better technique or a better pump. I do think your milk supply is low, too.

I think your worry about milk disappearing is justified - but you can save it with the right help as soon as you can possibly get it. I think you need to see someone who knows about bf, and this could come from one of the support organisations or a knowledgable hp. You'll need more a phone call to keep you going, I think. You will be effectively re-lactating - 3 and a half weeks without effective bf, and with formula feeds of 100-130 ml means most of his nutrition is formula, and yes, your milk supply is seriously under threat - better to be clear about this than pretend and just jolly you along. But this situation is reversible - it really is

What about domperidone to give a boost while also giving this baby lots of opportunities to breastfeed?
Chuffed, sorry you had a bad time with the birth. Does your hospital run breastfeeding clinics and/or can you get along to a breastfeeding cafe? I think either would really help you right now. Much more than the CO tbh.

How much was his weight at birth and how much is it now?
How often is he feeding? What's happening at night?

Oh heck, another complete non-expert here, but one thing struck me in what you said - that he takes one side well and the other not. I may be on completely the wrong tack, but had same with my ds. He fed well on left side (which I would latch him on with using my right arm - and I'm right handed), but never fed so well on the right boob, to which I would latch him on using my left arm. If it's similar for you, you could try using the rugby ball position, where you'd latch onto the right boob using the right arm; or feed lying down (though I never mastered that until ds quite a bit older). I hope that makes a bit of sense (i'm not v good at explaining myself), but agree with the others: you're doing really well to have managed so far after a traumatic recovery, keep persevering it really is worth it, and contact a bf support. good luck

edam - sorry, but chuffed is not doing fine. A sunken fontanelle may not show up in seriously ill babies and the lethargic, floppy baby is way, way further down the road than we want any baby to be.

We should not be suggesting to mothers that they are doing 'fine' as long as the baby shows none of these signs.

Sorry to sound off like this. I know you mean well. The rest of what you say is helpful

If he's feeding ok on one side, keep him on that side, and let him feed as long as he wants and as often as he wants (more often if you can encourage him).

Quite clearly you want to bf very much, or else you would not be upset.
I was the same.
Please, please don't give up.
My local hospital had a drop in clinic, 3 times a week.
I went three times.
I nearly didn't go, any of those times.
But they were SOOOOO nice, so helpful, so supportive.
I always left feeling totally brilliant.

Please get some advice , through Hv, hospital, or NCT ,and let the nice experienced people, sort this for you - and you will feel brill !!!

Hope that helps.

Hi Chuffed;

Feel a bit fraudulent posting here as I am in a similar place myself - trying to get more boob and less bottle down DD - but am coping better now than a week or two ago so thought I should put down some of the things that are working for me at the moment.

• have you tried any supplements to increase your supply? I'm thinking of fenugreek and fennel tea. Fenugreek did help me a bit.
• I don't know what holds you have tried but you may find that now he's a few weeks older and has better head control, positions that didn't work in week one work now or might work next week. I'm now mostly using the "rugby ball" hold because DD has a latch that sounds like your DS's and if I lean forward a bit as I latch her on it seems to get a "gravity assist" to get the boob in her mouth and past the tongue.
• Also I find her latch is always worse at night: don't have any tips for that but just noticing it has made me more patient and less despairing at 3am when we have boob/baby interface issues.
• I found that as DD got older the latch has improved a little on its own. So it's not necessarily an inexorable downwards slide.

NB the thing that seems to be universally recommended to improve supply is dropping the bottles and going to bed for 48 hours with baby feeding constantly. I haven't done it myself as I know my nips won't survive that process and then I'd be back expressing ... but if you do have boobs that are up to it it seems to work nearly every time. I'm considering an expressing version of this, ie just having a couple of days of mad constant pumping between feeds.

Thanks for all your feedback so quickly. This is no.2 and fed dd till 10.5mths after a bit of a shaky start she had no suck reflex. Saw a lactation consultant for her in uk.
ds was 3.075 at birth so 6 pounds 8 now up to 3.2kg or 7 pounds.
He has had one bowel mvt a week and about 4-5wet nappies per day.
I do try to delatch him as soon as I realise he is not on properly but after a couple of days of 9hrs of feeding back and forth my right nipple is agony. I have tried lots of different positions and he just does the same thing, slips off.
We are using a haberman to formula top up so at least he is continuing with the tongue action etc.
I have been getting lots of support from my midwife as in NZ you get a key support provider basically, have seen a lactation consultant and my midwife has spoken to the other one at the hospital. They are in agreement that if I don't top up he will be pediatrician referred. He has been checked for tongue tie etc.
My midwife did talk about prescription for increasing supply and I might start taking my blessed thistle again which is supposed to increase supply.
At night he sleeps from about 11pm till 6.30 probably as he is so full of formula but that is only if he is in with us.
r3dh3d goodluck, sounds like you are almost there.

Thanks for the further info chuffed.

Glad you are getting help.

What isn't clear is how much formula he is having - if it is 100-130 mls per feed, then he is virtually entirely formula fed.

All the blessed thistle and supplements in the world will not restore your supply unless he starts to breastfeed effectively round the clock....and sleeping through is not good. His lack of poos (bf babies of his age would normally poo several times a day) makes me think he is getting a lot of formula.

To be honest, I think the best thing is to get face to face help with the positioning and attachment, check for tongue tie while you are at it, and alongside any formula you need to give, to breastfeed as often and as effectively as you can.....I wish you all the best and urge you to get real help.

The other thing, Chuffed, is that referral to a Paed might be no bad thing. I don't mean that your DS is necessarily ill and I certainally don't mean that your bf-ing is making him ill - but it might be an idea to get an expert's opinion. If only to rule out other problems and reassure you that he is fundamentally OK. Failure to Thrive is a proper medical term for being quite a lot underweight for your height, I'm a bit surprised that if your midwife thinks he has this he hasn't seen a Paed already. I don't know where you are in centile terms but DD1 (at over 50th for height) went from 75th centile at birth to below 2nd centile in 4 weeks, before she was diagnosed FTT. He may have some feeding problem unrelated to the latch, or a persistent virus or any number of other things which could be making it harder to bf. Again, I don't know how it is in NZ but in my experience Paeds are usually sympathetic to you continuing bf-ing if it is at all possible so referral to a Paed isn't the end of the road by any means.

I agree with red....not a bad idea at all to get some specialist medical help, too.

I topped up dd2 with formula at first as she seemed to be hungry all the time. I would breast feed first and then if she needed a little more gave it to her.

That said it took until about 8 weeks for my milk to come in properly - which no one had warned me about until I spoke to SIL. I was left to my own devices in hospital - as most staff assumed dd2 was my second and I knew what I was doing - well not when it came to feeding but anyway - managed to get the hang of it and the formula disappeared from the house around week 8.

I came close to giving up and putting dd2 on formula a couple of times thinking I was a failure... suprisingly she is now 15 months old and she still has breast feeds.

I was going to see someone but had help from my sil as I mentioned and a good friend who is a member of the breastfeeding association and trained to be a peer counsellor (?) Their help and support along with dh's was so great.

Thought I'd update you on what has been happening. Am on dompheridone, have been for 6days. Not getting any more on pump but feel as though maybe ds is getting more with his bf before I express. Formula is remaining about the same so as he grows maybe he is getting more breast milk. Still really disheartening but lots of support from midwife, and thanks to you all for your support. Good to hear you managed to crack it about wk 8 as that is about my limit I think eidsvold.
Thanks again everybody!

Pls don't feel badly. Breastfeeding can take some practice... but it is totally worth the 'trouble'. Keep in mind that an exclusively breastfed baby needs to have a minimum of 6 wet nappies & 2 soiled ones in a 24 hour period. Also, if baby is latching on correctly, breastfeeding should NOT hurt. Yes, you will experience some level of discomfort for a few seconds, but never more than a minute. If you are, break the suction by inserting your little finger between his/her gums and try again. Try to position baby correctly: his nose, chest and belly should be in a straight line, facing you. Then, express a drop of milk and leave it on your nipple. Tease baby with wet nipple, going from nose to chin, softly in a caressing manner. Baby will smell the milk and open wide to take breast. Wait until baby's tounge is starting to come out of mouth, as this indicates he is fully open. Insert your breast and make sure most of your areola is inside baby's mouth. If in a quiet environment, you should hear swallowing noises. Also, don't get discouraged re. pumping. It can be hard & it also depends on which type of pump you are using. If you have a pump made by a formula company, you are not likely to succeed.... think about it... if you breastfeed successfully for a whole year, they are out of business!
I hope this has been of use. I work part-time helping mums achieve a succesful and enjoyable breastfeeding experience! Good luck!