Trying to increase milk supply after terrible mastitis and really difficult start to bf

[MollyDefoe]

My DD is 4 weeks old, and we've had a really difficult start to bf. I have very inverted nipples, and it's been a real struggle to persuade her to latch on, and it's extremely painful when she does. I also had a pretty traumatic birth, with an enormous haemorrhage (I lost 90% of my blood), which delayed my milk coming in, and meant we had to formula feed for the first few days as well as hand-expressing colustrum and feeding her that through a tube or syringe. After that, for the first weeks we did a combination of bf and tube-feeding her expressed milk, and that was going OK - my supply was really good, and DD was increasingly happy to latch on, with the help of nipple shields (I know they're not recommended, but otherwise she doesn't really know what to suck on). I was feeling pretty optimistic.

Then, 2 weeks ago, I got a terrible bout of mastitis, and was hospitalised - the ward wouldn't let DD visit (I was on a high risk infection ward), so I kept trying to express very regularly to keep up my supply and give her something to feed from while I was away from home. But the mastitis has almost entirely killed off my milk supply in one breast (annoyingly, the one with a more abundant supply). I've been doing everything possible to try and increase the supply in the other breast - bf on demand, expressing at about 2-3 hour intervals as well as after each feed, and taking More Milk Plus supplements. But I'm still not even producing half of what she needs - she's still starving hungry after each feed, and every lactation consultant I've spoken to has told me to give her formula after each feed. She drinks up to about 100ml of formula each feed, which means she's probably only getting about 30ml of breast milk, I think.

I'm really at my wits' end as to where to go from here. I still dream of EBF, but I don't know if that's at all realistic. DD still won't latch on with nipple shields, but even with them it's excrutiatingly painful. She's getting less and less tolerant of bf, as she has to work much harder to get the milk than with a bottle. Because I'm only bf on one side, that nipple is pretty shredded. And I don't know how to increase my supply to provide her with enough milk. I'd be so grateful for any advice! Lots of posts on here suggest that formula feeding reduces supply, but I'm worried that if I go cold turkey on the formula, and go straight to EBF, then she'll be ravenous and unhappy. What do you think? Sorry for the very long post! But I'd be so grateful for any advice re. where to go from here...

No advice sorry but would like similar advice, hope someone can help you.

I think your topping up to much to go cold Turkey on the formula. You probably need to reduce the formula if your worried she preferring the bottle you could try giving her this another way other then a bottle. Some people find a supplemental nursing system useful you can attache it to your nipple or finger feed with them. Spreading to a breastfeeding couciler to put a plane in place and get help with your latch is probably the best way forward.

Molly - I'm sorry it's so tough at the moment. I too don't think going cold turkey on formula is going to work as the gap between how formula you are giving and how much BM is too great (btw the 1st rule of bfing is 'Feed the baby' be it formula or BM so that's not a judgement!). MigGril's suggestion of a Supplementary Nursing System may help increase baby's acceptance of bfing (it's a way of delivering EBM/FM while the baby bfs).

Has anyone mentioned Sheenan's Syndrome? I am NOT trying to diagnose via t'internet but the 90% blood loss trigger a dim memory of a reason for bfing difficulties post-birth. This possibility would need to be investigated by your GP/an endocrinologist though.

The mastitis may have caused something called 'pressure involution' where the pressure caused by the blockage/insufficient removal of BM (for what ever reason - baby not bfing well, plugged duct, etc) can trigger the milk making cells within the affected duct to shut down production. A IBCLC/BFC would be able to give you more guidance on this.

Basically what I am trying to say, is that professional help and support is needed. The bfing helplines are all open to all types of bfing/formula feeding queries and you will get help (or get 'signposted' to a more appropriate source of help if necessary).

Wishing you all the very best.

Switch-nursing. But if I were you, I'd probably stop if it's getting too hard with all you've been through. xx

Hi Molly. You've been through such a massive amount and you're clearly a brilliant mum for doing all this and trying so hard. Please don't be down on yourself.

I didn't have nearly as difficult circumstances as you, but my DD had an undiagnosed tongue tie and was hospitalised at 4 weeks for weight loss and dehydration. I of course then had to bottle feed her and my supply dwindled to almost nothing by the time she had the TT diagnosed and snipped. I spent months, lots of tears pain and heartache trying to get my milk supply back up from almost nothing - expressing every 2 hours, domperidone, fenugreek tablets.

I think going cold turkey is probably a dangerous thing to do. As TruthSweet says, your first priority is to feed the baby. Everything else is secondary to having a full happy baby who is growing. Formula feeding does reduce supply but when it's a choice between that and your baby going hungry it's a no-brainer. When your supply is that low it's not like someone with normal milk supply where their baby is hungry and they feed a lot for a day or so and then the milk just whooshes in. It could take weeks or months to get up to the level where you can EBF and, honestly, it might never. Mine didn't. I did breastfeed her until her first birthday, but I never managed to EBF again after she was hospitalised. I was devastated for a lot of the first six months about it, but I've made my peace with it now. And, honestly, with hindsight, I should probably have given it up. I spent so much of the first six months of her life agonising over it that I didn't really enjoy her.

Of course that's my situation and yours is different, but it sounds like you really need to give yourself a break whichever way you go. You're a good mum now, and you'll continue to be a good mum whatever you do.

Since you asked for actual advice, here's how I (partially successfully) did it:

• domperidone from GP to boost milk supply. Go armed with printed out information from Jack Newman because they may never of heard of it used that way - it's actually for digestive issues and bloating I think. Bless the young inexperienced locum who I saw - he actually went away and read up all about it on the internet after prescribing it to me and said he was going to recommend it to the midwives in the practice!
• I took fenugreek on top for good measure, although it makes your sweat smell like curry. Not lovely.
• reduce formula milk very slowly in increments, leaving your supply time to catch up. I was giving her a breastfeed, then feeding her 120ml bottles at first. First week I reduced the bottles to 110ml then if she was still hungry at the end putting her back on the breast. Left this a day or two, until she stopped demanding to go back on the breast, then dropped another 10mls. It took a long time, and a lot of cross baby at being put back on an empty breast. Sometimes I'd wait a week inbetween reducing bottles. Once the bottles got to 60mls ish I started only giving her a top-up at every other feed. I got to the point where she was almost EBF but still having a big bottle (240mls) at bedtime and sometimes one other bottle during the day if she seemed to need it. But I never got back to EBF - never managed to get past about 5pm in terms of having milk left! *sporadic pumping although with fairly rapidly reducing dedication as I HATED it. And on a practical level it is almost impossible to do. I hired a hospital grade pump from NCT but you need both hands on the suction cups and when you're trying to feed every 3 hours and you're doing a breastfeed then a bottle top-up then a breast top up there's not that much time left before the next feed to put her down for long enough to do some pumping.

Hope that helps

Thank you so much for your fantastically useful advice! My partner and I have decided to throw everything we've got at the situation, and if there's no improvement in a couple of weeks then we'll "give up" (ie. continue with the current status quo) and stop killing ourselves over it.

So. I went to the GP yesterday and got a prescription for Domperidone. I went to a Breastfeeding Clinic where the counsellor diagnosed DD with a tongue tie that she thought was almost certainly affecting her latch and stamina for breastfeeding (as if we needed another challenge to deal with!) - so we've booked her to have it snipped (poor little mite) on Tuesday. Ecuse - your description of how to incrementally reduce formula was fantastically helpful - thank you! I think we'll try exactly that and see how it goes. At the moment I'm pumping after every feed (I was advised to do this to avoid risk of recurrence of mastitis, and also to boost supply), so I think I'll continue with the regular pumping although I really like the idea of putting DD back on the breast at the end of every feed - that's a really good idea!

So we'll see how it goes. I feel so much more positive and optimistic at the moment. I don't really mind if we never get to 100% EBF, but I would love to change the ratio of bf to ff, and ideally EBF during the day. I kinda like the fact that my partner can take his turn with feeding at night. But I loathe all the washing of bottles and sterilising with an absolute passion, and would do anything to try and reduce all that.

One final question - has anyone used a supplementer? The bf counsellor suggested that I try one to try and persuade DD away from bottles, but she wasn't sure how it would work with nipple shields - and my heart sank at the prospect of yet another item to wash and sterilise! It all looked a bit of a faff, really - but do you know anyone who's had success with a supplementer?

Thanks again, so much, for all your advice and support!

I reckon that sounds a very smart way to go about it. Good luck with the snip!! It's not as bad as I feared. I think she was more cross about being pinned down than actually snipped. I wish you best of luck xx

By the way, I reckon you've got a fighting chance if your DD is only 4 weeks. Mine didn't get the snip until nearly 10 weeks by which time she had been almost exclusively fed with bottles for 5 weeks. So hopefully you'll find it much easier than I did.