Advice request - 'On demand' feeding and increasing supply

[BrownB]

Hi there. This is my first entry on this bf forum and was wondering if anyone had any advice for me? Sorry - it's long...

I have a baby girl who is now almost six weeks old. I have been exclusively breast feeding her and am trying to be demand led. But I am struggling with this.

My DD is a bit of a lazy feeder, and if I'm following her 'demands', then it seems like she would never unlatch. She suckles a little, then falls asleep, and if I detach her, she immediately wakes and wails. I swap breasts, she suckles, falls asleep, is detached, wakes, wails... You get the idea. I've tried swapping breasts, stripping her off, flicking her under the chin, rubbing her hands, ears, feet... Nothing really seems to work and it can go on for hours. I get the feeling that she just likes to suckle to sooth herself. However she doesn't accept fingers as an alternative. My DP doesn't want to introduce her to a dummy and I am agreeing in principle - however, he doesn't have the child attached to his breast for two hour feeds five times a day.

What I have found to work a bit better than following her 'demands', is to feed her, and then just grin and bear her wailing for an hour or two to replenish my milk supply, then feed her again. If she is really hungry she is more efficient at getting it out and if she gets a fair amount of milk she can even detach herself.

Ultimately I want to build up a bit of a supply of expressed milk too, but everything I am currently producing goes into her mouth on the day it's produced. If I manage to express a little during the day, it goes into her in the evening when my breasts don't seem to satisfy her.

Anyway - it's a bit of a rambling OP. I have a healthy daughter who is gaining weight (though dropping centiles), but I am struggling a bit with the bf thing. I will persevere with the breast feeding - but was hoping someone might have some advice about how to make it easier and get my supply up.

Thanks..

Ok the first thing I think would be for you to get some RL help and have your latch checked by a BF counciler. She's feeding a lot which can be normal but if she's droping down the cerntiles then her latch could probably be better. This will also help her go a little longer between feeds.

But milk is produced in the breast on demand by making her go longer between feeds you woun't produce more milk you'll produce less milk. Very little milk is actually stored in the breast. When they feel full then you acutaly produce less milk.

When they feel empty at night you are acutaly producing higher fat content milk but less volume this is totatly normal and the only way you will produce more milk is to feed your baby.

Have a read hear on how the normal couse of feeding goes www.kellymom.com/bf/normal/index.html

and ring one of the helplines or find your nearist drop in group to see if they can check your latch.

National Breastfeeding Helpline
0300 100 0212

The Breastfeeding Network Supporterline
0300 100 0210

NCT Breastfeeding Helpline
0300 330 0771

La Leche League Helpline
0845 120 2918

Association of Breastfeeding Mothers
08444 122 949

Thanks for the advice and numbers MigGril. I didn't want to make the OP any longer, so I failed to mention that I have looked at kellymom etc, and at all the videos I can find on line re her latch. It looks fine most of the time. I've been to a breast feeding support group, and had a counsellor come to my house already. The assessment in both cases was that the latch needs a little work but is mostly there, that I have milk, and the problem is her (falling asleep/not suckling/just playing with a nipple in her mouth). I have just moved house and am trying to gear up a local Le Leche League meeting...

What sort of time span between feeds is optimal? I find that if I have a moment of time (sleeping baby) and express, and she wakes up an hour later and I feed her from my breasts, then she doesn't seem satisfied, and will fuss and fuss and fuss... Compared with if I have two hours worth of milk 'stored' - she tends to seem satisfied and will be happy, alert and engaged. I know the fussing is hunger, because if we give her the expressed milk, we get the same satisfied response. I am finding this extraordinarily frustrating - I don't seem to have quite enough milk for her, and there don't seem to be enough hours in the day for me to boost my supply. I was really hoping that someone had struggled through the same sort of thing and had some magic wand that would make it like kellymom says it should be.

BrownB It's hard. The first few weeks are hard. Very hard, tiring, exhausting emotional beyond belief and just when you think you can't cope something else happens and you have to cope with that too. Yet it does get better.

I found reading Breastfeeding made simple very helpful as it explained how breastfeeding works. Having a good understanding of the mechanics of it might help. They talk about the seven laws of breast feeding and in particular in i think law 4 is really relevant
"More Milk at First Means More Milk Later
During the first weeks of life, frequent breastfeeding primes a mother?s body to produce ample milk for her baby and helps ensure abundant milk over the long term."

Some practical things to help:
Do call one of the helplines they are fantastic.
Do ask for help around the house. somethings that are useful are someone else preparing dinners that can be heated up. someone else doing the laundry.

Get someone to prepare you some easy to grab snacks ( a box of chopped up veg in the fridge with a pot of homous)
Get a few box sets
skin to skin in bed is still a wonderful thing to do

I'm a year into this breastfeeding thing and it does get better!

Hi BrownB,
I agree with everything MigGril said. It's good you're getting RL help already, but I'd keep asking for more - if your DD's latch is nearly there then that's great, but you might find that getting from nearly there to just right makes all the difference, so it's worth getting as much advice as you can.
The quickest way to increase supply is to feed and feed and feed. The more drained your breasts are, the more of the time, the more milk you will make. Expressing could be part of this, but if your DD will cooperate with frequent feeding, then you could perhaps drop the expressing until your milk supply catches up, and think about building up a 'stash' once things are more established?

I agree with hazchem too, just x-posted.

I second the suggestion of having a real life knowledgeable person observe a full feed from latching on to baby unlatching (no 'that looks fine' nonsense).

The trouble with 'storing up' milk so you have more at each feed is that the longer you wait between feeds the less milk you will have - it looks like more to start with but over time it will get less and less and less and you will have to wait longer to feel that 'full' again until milk production shuts down and you don't feel full again*. The emptier the breast the faster it is made and the fattier it is.

There is a whey protein in breast milk called Feedback Inhibitor of Lactation (aka FIL) as well as providing a protein source for the baby it also helps to down regulate milk production. The more FIL in the milk making lobes (so when the breast is 'full') the slower the milk is made.

This is because FIL works by 'plugging' into the lactocytes (the milk making cells themselves) and temporarily switching them off. When the baby breastfeeds (or you express) the FIL is removed and the cells switch back on and start making milk again.

If the lactocytes are switched off for too long (i.e. the breast is left full for too long) then they get the message they aren't needed and shut off milk production (though they can be resurrected if there is demand - though that may take a little time).

If the lactocytes aren't 'plugged' by FIL because baby is removing milk frequently and effectively they make more milk, quicker and fattier too.

If you find baby objects to the slower flow from an 'emptier' breast you can try breast compressions to help speed up the flow. You may find you don't need to do this at every feed just at those where baby seems more reluctant to persevere with feeding or is getting sleepy very quickly.

*(though you do lose the 'full' feeling as baby gets older as feeling full is because there is excess undrunk milk in the breast, when your body gets to know how much milk to make it makes that as milk is full of nutrients/fats/hormones/etc that cost the body to make so there is no point making more than is needed on the off chance that baby will feed more than usual at that feed)

Can I ask why your DP doesn't want a dummy? What is his fear? We've found them an absolute godsend as DD was very into comfort sucking when she was younger. Once my boobs toughened up around 12 weeks it wasn't so bad but I don't think my sanity would have held without one.

Have you tried breast compresion? (google for video's) This can help a baby get more milk and help them become more intersted in feeding if she is dossing a bit at the breast.

As for increasing supply. The best thing to do is to feed as oftern as possible, try switch nursing, so when she starts to become not so intersted in feeding switch side's then switch sides again when she starts to lose interstes again, then repeat untill she full. This could mean offering 3, 4 or more sides per feed. It's a good way to increase supply.

If you still find your sturgaling another thing which you can try is to pump after a feed. (Similar idea to offering more sides) As you are then stimulating your breast to make more milk, you can drp pump for 5-10minutes I think (you may want to double check that). This is just tell your body you need to make more milk, and can help some women up there supply.

TBH if she woun't accept a finger to suck then she probably woun't want a dummy either.

Carry on getting RL help.

You don't store milk, which was what I was trying to say in my first post. Most milk for each feed is made during the feed, so making her go longer between feed's woun't work. You will make less milk as when the milk ducks are full you stop making milk and therefore telling your body to make less milk so it has the opersite effect.

You can't juge if she's had enought by giving milk in a bottle either as even a full baby will take milk from a bottle as the delivery system is different. They can also then overfeed and seem very satified, but that is why bottle fed baby's are at great risk of obisity as they can overide the natural full feeling by taking to much to quickly.

It is normal for small baby's to feed all the time, really you just need to concentrate on feeding her untill you have BF well estabilished. And some are also more fussy then others a good source to read on fussy baby's is DrSears.

how about if you changed your thoughts from ''demand feeding'' with possible implications of Baby as Little Emperor, and thought of yourself as a responsive parent, feeding to your baby's cues? It's the same thing, of course it is, but by changing your mindset you might be able to accept these relatively few short weeks where you seem to be feed feed feeding with less urgh and more yay

another vote for getting latch checked in RL, too

brown, I have been more or less where you are, although my baby started small & struggled with regain of initial weightloss, I felt like I couldn't keep up with her demands, that she was suckling for comfort a lot & there was no time whatsoever for expressing (tbh I still struggle a bit with this part, expressing is my least favourite part of motherhood). She is now soaring up the centiles (well, has gone from bottom centile for weight to between 9th & 25th), with lovely chubby thighs
This may sound harsh, but I'd strongly advise getting the lactation consultant back in (assuming you like/rate them). 'Nearly there' with latch can mean a lot for a small baby. We worked hard on latch and use 'c-shaped' compressions (google Jack Newman) to improve speed and composition (theory being that compressions help squeeze fatty hindmilk down). Also try different positions (lying down on sides or BN helped us get some rest whilst feeding. Wearing a sling can also help with comforting a small baby without feeding. DD has never had a dummy (I am anti them as was a dummy sucker myself until my parents threw it away when I was 2!).
These things helped us come through it, & I can't imagine stopping bf in the near future.
hth