Breastfeeding - midwife says one thing, 2 week old does another!

[LordyLady]

Looking for some advice about breastfeeding before I implode!

My DS was born three weeks early and is pretty teeny, so the whole emphasis right now is fattening the little thing up. I've had two visits from a midwife who has very rigid views on BFing, from what I can tell she had a baby whilst studying so is all about the strict routine, measurements etc. I've been instructed to BF every three hours for 40 mins (not happening), top up with 40mls of expressed breastmilk and extra formula if needed, although she wants me to reduce the formula if possible. But my dear little one will not play ball with this! He won't stick to a strict 3 hourly feeding routine although he's generally pretty good about waking himself up; sometimes he skips a late night feed and sometimes he eats loads and sometimes only a small amount, sometimes he wants more only an hour or two hours after feeding. I'm struggling to breastfeed as I've been expressing since he was little to ensure he gets enough milk, and now he's getting comfy on the bottle. When I try to BF he falls asleep, despite me tickling his ear/ foot/ stripping him to his vest etc. So I'm stuck between two feeding methods, not sure if I should give up BFing altogether as we both get frustrated and tired and instead just go with bottle feeding expressed milk. My instincts tell me DS is getting enough to eat as he yells the house down when he's hungry, and this hasn't happened for ages.

Should I give up on BFing and just go with expressing? Is he getting enough to eat?!

Trust your instincts. Do what you think is best. Ignore the midwife.

Ignore this woman!

So you should only feed him every 3 hours? Who's going to tell that to a baby that can't tell the time?

If he wants to feed, let him.

I can't advise anymore than that in terms of mixed feeding as I have no experience but your MW has made me really cross with her silly timetable

Congratulations on your new arrival by the way!

Ignore MW, not Poppy

Congratulations on your baby

Ignore the midwife, just feed on demand and your boobs and your baby will sort it all out by themselves without any thought or timetable needed.

Every three hours is bollocks for any breastfeeding baby but especially for a premie.
So is that set amount of time instruction (40 minutes).

Breastfeed as often and for as long as he wants. Wake him and don't let him miss a night feed. This will both nourish him and keep your supply up. Maybe top up with formula? I hated expressing and never managed to get much despite spending inordinate amounts of time trying.

DD4 was a very sleepy full term baby who weighed 9lbs 1 oz at birth but just 8 lbs ten days later. I was told to wake her every two hours round the clock and do whatever it took to keep her from drifting off to sleep during feeds, including cold water sprinkled over her, taking off her clothes and keeping her cold during feeds, blowing in her face, and a nurse demonstrated a rather rough poke in the stomach which I didn't do for fear of hurting her. I ended up breastfeeding her and then topping up with formula until she gained back what she lost in the first two weeks after birth, then abandoned the formula.

I would feed on demand- of he is hungry feed him.

Ignore her!

Feed , feed and feed some more. Lots of skin to skin, lots of suckling and as little from a bottle as possible- yes even EBM.

I totally get the need to "know he's had plenty to eat" but try to forget that. EBM from a bottle is the downwards spiral to not breast feeding unless you are v careful- 2 reasons- it's an "easy" option for him- bottle sucking is much less hard work that feeding from the breast.

Also expressing doesn't stimulate milk production in the way a good baby on boob feed does, it's a fair artificial imitation I guess but lacks all the other things that feeding a baby does to your hormones , but supply is likely to decrease over time.

You can do it!

I agree with those who say feed on demand but nobody seems to have picked up on what you said about baby 'screaming' if hungry. When a baby cries for food you've already missed many cues - crying is kind of in desperation because you've ignored their other cues (I'm not suggesting deliberately although if the midwife is saying feed every 3 hours she probably is) - google 'baby hunger cues' or check out www.kellymom.com for good support and info.

I don't really understand the 'top up with expressed milk' advice unless your baby falls asleep at the breast before 'finishing' a feed (sometimes they just want a snack or comfort so I don't know who decides this is the case) and there are serious concerns about his weight/growth. Expressing is IME a lot of faff that often isn't necessary; if you offer the breast frequently your baby will know how much he needs and your body will supply it.

It's hard to know what to listen to when you're at the newborn stage, I was there 16 months ago and I'm still feeding whilst 22 weeks pregnant, I can safely say that this time around I will trust my own instincts and body a lot more than I did before.

Another good resource is Dr Jack Newman articles, might be worth a google. The ladies on here are great as well, and I'd strongly recommend seeing if there's a breastfeeding support group near you; this was invaluable to me in the early days and somewhere I made good friends

best of luck :)

I agree about the screaming being the last resort for the baby; maybe investing in a sling and carrying him close to your boobs would mean he would root more and feed more frequently. It also tends to stimulate milk production.

Bab only screamed in the beginning when my milk wasn't in properly; he hardly ever cries now as I feed him when he wakes. He had to have a scan on Tuesday so I couldn't feed him three hours before he was sedated - he was starving so cried loads until I was allowed to feed him again. I never ever leave him to scream himself into that state normally - couldn't stand to see him that upset!

He wakes up on average around 2, 3, 4 hours to feed, for example his last feed was at three so strictly speaking he should've been awake and ready for his next feed 45 mins ago, instead he's just stirring now. I'm tending to go by his lead rather than waking him up bang on schedule and instead keeping a tally of how often he feeds throughout the day. He has wet nappies and lots of poo so I see this as a good sign.

So should I wake him to feed or just let him tell me when he's hungry...? I guess I'm still hung up on the fact he's so small - he was in intensive care for 2 nights straight after he was born so I'm fearful of him not getting enough food

Wet nappies and lots of poo definitely a good sign. Has he been weighed?

I think waking at night might be a good idea -- don't let him miss a feeding between midnight and 3 am. I would be inclined to wake him if he slept more than 3 hours in the day. Carrying him around in a sling might promote more frequent feeding.

So has the MW said 3 hourly because your baby is sleeping when he should be feeding more? And she means you to be waking him for feeds? and giving him a good amount.
Sounds fine, and measurements are her tool to see that he is growing okay.

Yes definitely wake him for feeds.
Changing his nappy might help with waking him.
If he's asking for more often than 3 hourly: yes, feed him.

Hi Sandalwood, yep she's given me this schedule so we can fatten him up, but the problem is he just won't take the boob anymore! Just tried again and if I'm honest it ended in tears...his and mine. I'm getting exhausted with trying to get him to feed - he was really good a while ago but I fear I've ruined our progress as we've had to top up with a bottle - and having to express every time we attempt to feed is wearing me out...feel like I'm permanently rooted to the sofa with something attached to my boobs. I've tried changing his nappy, stripping him, tickling...all of it and he just mucks about and then falls asleep. Perhaps it's my technique - my midwife spent all of 30 seconds showing me how to do it . It takes about an hour to get him to finish a 40ml serving of EBM without any breastfeeding which he won't do, he takes half from the bottle, falls asleep then takes the other half.

Urrrgh, so tired......

Crikey. :( I feel for you.
The bottle is less work for babies than breastfeeding. and they seem pretty hot on this top-ups thing these days. You haven't ruined anything though - you're doing the best you can for him.

There must be better support for you than a couple of quick MW visits.
Breastfeeding counsellor/clinic?

Its so hard isn't it? Its the responsibility for getting it right weighing (pardon the pun) heavily. For what its worth, I didn't wake my dd2 for feeds. She slept through from day one.
I'd be lying if I said I didn't panic about it and I had one eye on weight loss and jaundice but she was fine on both scores. Fed every two hours in the daytime instead! Fed her on demand basically. No formula as she wouldn't take a bottle. The midwives were a little on my back about her weight dropping through the scale in the first couple of months but my dd1 did the same weight drop from birth but then stayed steady on the scale after 4 or 5 months to this day. I'm smaller than average. The charts are based on milk fed American babies by the way and don't take into account illness, but I would try and find a happy medium between instinct/panic/government checklists/common sense.

Oh and both of mine fell asleep after 5 minutes on every feed. My doctor said they get 80% of nutrients in that time, which helped my anxiety about that. They are both strapping healthy kids now by the way.

Lordy, this is beyond a talkboard's help.....there's already info in your later posts that indicate you need decent, face-to-face help from a knowlegable person you trust.

You can find out if there is a bf specialist or a clinic in your area; you can call any of the breastfeeding helplines and speak to a breastfeeding counsellor.

Generally, to enable a baby to gain weight, and to ensure effective bf, you would need to feed a baby rather more often than 3 hrly - most bf babies need to feed pretty frequently, and to have early feeding cues responded to. Can you explain to the midwife you are currently seeing that her advice does not sit well with what you have read and what you understand from your baby's behaviour?

It's a hard situation to be in - small babies seem so vulnerable and worrying :(

Lordy- I think you could really do with seeing some one else in RL.

I'm not sure anyone can tell you to ignore the mw when we don't really know what is going on with your LO. Feeding on cue is of course best for full term, healthy babies but sometimes scheduled feeding is recommended for some cases. (where babies might tire easily for eg.)

That said, you sound frustrated and exhausted and in need of some good advice. Do you have an infant feeding specialist at your hospital that you could contact? Or even a lactation consultant if you're prepared to pay for one.

For now, you could try breast compressions to keep him interested in the feeding (Dr Jack Newman has good clips). Also, have a look at biological nurturing and see if that helps.

How is his weight doing?
hth

Hi everyone, well we had a much more successful night. DS must have been listening to the midwife as he woke pretty much every three hours on the dot plus a couple of times in between and breastfeed for around 30 mins each time! I've been topping up with EBM and formula if he's still hungry but am going to try feeding from both breasts to ensure he's full up, and also to increase supply. At his last check yesterday he had gained weight so hopefully we are on course. He does still faff around a bit though when we start BFing so I think I could do with some help getting him in position and latched on correctly - there are lots of groups around here so I'm going to try and get to one. tiktok and crikeybadger you are right, I think this warrants getting some professional advice so he gets the best of boob, especially as he's getting the idea - it would be a shame to lose it now.

Get in touch with your local lactation expert ASAP!

Definitely go with contacting a professional but just in case you didn't know - you can feed more than 2 sides at each feed if needed (i.e. Left side, then Right side then back to Left, and so on - breast compressions can help milk flow too as crikeybadger mentioned), this is one way to increase supply without having to express/faff with bottles (obv. only works if baby is willing/able to keep bfing though!)

That all sounds positive
And gaining weight :)
Well worth you getting to one of those groups.

I had a bf wobble after DD and I had both been ill and to get us back on track and get her feeding again we spent the day in bed together doing lots of skin to skin and feeding whenever she felt like it. It was a lovely day. Lots of rest for both of us and it really helped with bf too.

I agree with other posters that seeing someone in rl is probably the best idea but thought I'd offer you that idea. Even if it doesn't work you'll have had a lovely day snuggling up together :)

Good luck and keep persevering. It's well worth it :)