Please critique my plan to help boost my supply, help DS thrive and eventually wean off nipple shields!

[MrsCog]

Ok - here is where we're at with my determined attempts to bf DS1.

DS is 3 weeks old, for the first week due to latch issues he was fed from syring then cup - mainly expressed bm but some formula as required. We finally got DS to feed at 1 week, with nipple shields which are still prooving essential to get him to latch - although i try every day to latch him without them. Week 2 then, I basically just fed him on demand with the nipple shields, which went well to start off with but by the end of the week I had some blocked ducts and the early stages of mastitis, DS had also gained weight that week, but not as much as expected (3oz IIRC). The com mw then advised me to feed feed feed, and express to help clear the blocked ducts and also to top DS up to help him gain a bit more weight (he was still a little off his birth weight). We did this, and he got back to birthweight quite quickly and my blocked ducts are gone, so we are kind of back on the straight and narrow.

However, I think that due to a combination of the top ups (some of which i've caved and given to prevent 2hrs of middle of the night feeding, which I now know is bad for supply), and using nipple shields my supply isn't quite what it should be. DS is doing well - plenty of dirty wet nappies etc, but sometimes doesn't seem satisfied even after 3/4 hours of feeding. I am learning to try and distinguish cluster feeding from 'fed for ages but still haven't had enough' as I don't want DS to struggle on and on - he has done both so far.

So here is my plan:

• feed DS as much as possible myself - If i have to give a formula top up (we are weaning off them) then try and express the same amount or more off asap.

_ learn to feed lying down so I can keep my sanity whilst letting DS to get his milk order in between 1am and 5am.

• offer both sides

• take fenugreek

-wean off nipple shields - when this will be i'm not sure

• if DS has a long nap, express at least 1 side while he's down.

Any comments/advice? Thanks :)

What you could do first is just take a day when you stay in bed with him- surround yourself with supplies, delicious snacks and drinks, books, magazines, the remote and the phone and just spend the day cuddling and feeding. This will almost certainly do wonders for your supply, you'll learn to feed lying down and he may learn to manage without the nipple shields. And you'll have a lovely restful day. Don't worry too much about actual weight gain- if he's peeing and pooing and gaining a little and loping alert and bright eyed he's fine. Then re evaluate after that. Do try very hard not to tip up at this stage- your supply is still establishing and it's a delicate balance! Oh and just feed. Don't worry whether it's for comfort or hunger- they are just as important at this age.

Sorry that should have been try not to top up!

seeker gives some good ideas about babymooning - if nothing else it is a lovely way to spend a day or two!

Have you heard about breast compressions? It's a way of getting more milk into baby/making it easier for baby to get more milk by sort of hand expressing into baby's mouth as they feed.

If you are going to give formula and then express the same amount you might as well bf directly (cutting out three jobs - make up feed, express and then clean up pump & bottles to boot) if baby is getting bored/slowing down on one side switch to the next (using breast compressions if baby is getting frustrated) and keep switching - each side can be fed from many times and the 'emptier' you keep your breasts the quicker the milk is made. This also increases milk supply as it tells your breasts baby needs lots and lots so get cracking!

Also, do look into fenugreek carefully before taking, yes, it is herbal BUT it's contra-indicated for asthmatics, diabetics, those with blood clotting disorders as well as if you take other meds (it can effect absorption due to the high fibre content of fenugreek) - there is a big list of drugs that interact with fenugreek here and more info on bfing & fenugreek here.

Thank you for your replies.

I have been semi babymooning, but just not in bed, but I've been feeding on demand, for hours at a time. I did go to bed with DS this evening to practice the lying down latch which seemed to go well.

I think the main problem (which is very chicken and egg) is that I feed DS until both sides are completely empty (well just producing small drops of the high fat milk) and DS will still be a bit unsettled and wanting a bit more - normally between 20-50ml. It means he doesn't settle, so that's when I've been topping up here and there (again with expressed milk if I have any or with formula, although I have been prioritising 'real' feeding over expressing to help boost my supply).

For example, DS has fed from 7-9 this evening, almost constantly, but now I feel like he's getting nothing and I need a 30 min break to help 'restock', he was a bit unsettled though so DH has given him 30ml of formula in a cup. What do you think the best way to wean off these top ups is - is it just to bite the bullet and stop them, resulting in a couple of days from hell and probably a small weight gain but hopefully a supply that matches DS? Or is it better to just cut them down - so give a smaller top up knowing that DS will be hungry again sooner, but that's fine as he'll be demanding the supply.

In some good news, DS is definitely not that far off from learning to latch without the shields - I am in contact with a breastfeeding support worker who is going to help me with this and I'm planning on going to my first 'breastfeeding cafe' this week if we can get there.

I have been doing some breast compressions - they do seem to help quite a lot towards the 'end' of a feed, but I just need to keep all these habits up all the time. I feel like another couple of weeks and we might just crack this bf malarkey which would be great as it's not been easy but I'm still determined not to give up!

Thanks for the fenugreek links - I will double check it's not going to have any untoward effects before I get going on it!

You are doing really well and it is tough in the early weeks, and it can take time to iron out the wrinkles

Unfortunately milk supply doesn't work by 'restocking' by taking time out between feeds - the more frequently you feed and the less milk in the breast the faster the milk is made.

There is a whey protein in breastmilk called Feedback Inhibitor of Lactation (aka FIL), it feeds the baby AND it tells the milk cells to stop making milk.

The more milk there is in the breast the more FIL there is, the more FIL there is the more of the milk cells are temporarily switched off and the less milk is made (they get switched back on when BM is removed).

Conversely, the less milk there is in the breast, less of the milk cells have been switched off, and the more milk cells that are working to make more milk.

Even if you don't think that there is any milk there will be and as long your DS is happy to be at the breast (and you don't need to run off to the bathroom!) keep him there, perhaps switching sides if he slows down his suckling or breast compressions to keep him interested.

How many top ups is he having a day, by the way?

Re the weight, is he back to birthweight now? What is the plan for getting him weighed next? It's just that you say "resulting in a couple of days from hell and probably a small weight gain " which implies his weight is still being closely watched. Is it?

I would totally dump the top ups from tomorrow, if he is back to birthweight. You can always reintroduce them if it really isn't working, but unless you bite the bullet at some point it will get harder and harder to stop them and catch up with your supply. Your boobs really don't need 30mins to restock, I know it can feel that way but milk will be made in empty boobs very quickly. In the times you would usually give a top up, get DH to walk round the block with him in a sling, or to the shops for a replenishing cake for you, and he may well have settled. If not, your boobs will be ready for more action.

Re the babymooning - are you nekkid on the sofa? Only, that constant skin contact makes a huge huge difference, it's not just about feeding on demand but your baby being kept close to your naked breasts that will stimulate your supply and his demand. Also, it's just lovely and so replenishing and restful.

FWIW, I think most babies would take 20ml from a cup if offered, cupfeeding is a nice oral experience for them. Doesn't necessarily mean he is unsatisfied at all - 20ml is a very small amount for a 3wo. Barely a few swallows.

Hi thanks so much for the resaaurance. Generally the top up has only been for 1-2 feeds a day and only approx 50ml. It was probably a bit more than this when we were getting him backup to birthweight (which he got back to at 2.5 weeks) plus I naughtily gave up on a few middle of the night feeds due to sheer exhaustion/mastotis temperature etc.Ihave now strictly stopped doing this as I've read how important the middle of the night feeds are for supply.

I think you're rright and I should just stop toping up and feed feed feed - he was actually 1oz over birthweight last weekend, I'm not sure when he's being weighed next (hv meant to ring me today) but
I think I just need to match his demand and see what happens - we have lots of good nappies, he has alert periods, his nails are growing etc.so I'm confident he's well - it might just be that weight gain is a bit slower while my supply catches up.

We did have a good night last night - he woke at 2am, fed vigorously for 40 mins then settled immediaely, did the same at 5am as well - I figure if he wasn't satisfied he wouldn't settle?

Thanks again - this is very helpful.

Oh and one other thing - I think we're on the verge of losing the nipple shields as I've managed to latch him for 4 short bursts of time over the past 24 hours. He still gets a bit annoyed so I'm not going to push it, but everyday his mouth seems to be opening wider so fingers crossed the shields will ber gone soon!

Oh no! Just when it was going well/I had a plan and I now feel very stomach bugish (stomach ache and err the d of d&v). Feeling so weak and tired just caved and couldn't carry on feeding fs (he had been on and off since 4pm though) so got Dh to give him a small ff while I rest so I feel up to bfding again later. Can this get any harder? No latch, poor advice, exclusive expressing, nipple shields, mastitis, low supply now stomach bug! All in 3 weeks! Blimey - I must carry on though!!!

If you feel sick/have the 'd' then very very frequent but small sips of water or dioralyte is a good way to not get dehydrated. You may experience a small dip in supply BUT nothing that is unfixable.

DD1 was bottle fed for 8 weeks while I expressed 12 times a day until she was able to bf exclusively though I still had a pretty ropey supply. When she was about 12w we went to a barbeque and got food poisoning. I remember lying in bed feeding her with a bucket next to her head so I could be sick into it she did feed far more frequently than she normally did but it didn't permanently effect her feeding as she fed until she was 3.6y! (though not so frequently!)