BF with FF top up :( what's the best way to make it a success?

[SwivelHips]

Midwife came out again yesterday for DS weigh in (4 wks on Friday), good news is he's nearly back to birth weight so I'm delighted.

Anyway long story short she has suggested (as a mother and not a midwife) that I consider FF top ups, say twice a day, when he's had both boobs and is looking for more. This has been happening a lot previous 3 days, he pulls off the boob and becomes very frustrated, say after 40 mins feeding, and my boob is now soft. I offer the other one and the same things happens.

I tried it yesterday afternoon and he seemed very content afterwards. 2 hours later BF again with no issues. He hasn't seemed hungry until this morning, so again i gave him both boobs followed by FF top up. Again very contented.

I know from reading everything I come across that I can affect my supply, so I'm giving him breastmilk as often as I can and I wont give FF during the night. I haven't started pumping yet - would there be any merit to this to keep my supply up? E.g. an hour after feeding?

Its been such a difficult 4wks, I dont want to give up breast feeding, any advice to keep my supply up greatly appreciated?
Thanks

Hi -

the way we did it was BF only all day as it gets the supply building really well - FF last feed before bed, baby sleeps/settles a bit longer , rested mum = better daytime supply...... a vicious circle I guess - it worked really well for us...

Hubby felt "included" too as he did the feed late evening when I was knackered and got his bonding time with the babe....

I've 'topped up' two babies.

The first was after each feed, and he soon learned that FF was easier, went on nursing strike at 9 weeks and the whole business was pretty unsuccessful.
The second, I gave one FF of around 4oz each day at lunchtime, although to be fair she was a far better feeder to start with, just took 7 weeks to regain birthweight. I found this one bottle didn't affect my supply at all. She's now 8 months and I'm still BF her, and now she's on solids I find I don't even need to give her FF every day anymore.
So my advice would be, if you do top up and want to keep your supply up, do it in one whole feed, rather than small amounts throughout the day.

i think that you have been given bad advice actually. midwives don't always know a lot about breastfeeding, they don't get much training.

if he has had both sides and is looking for more then you can offer the first breast again.

babies will often down a bottle after a breastfeed, not because they need it, but because it's easy to drink and very hard for them to stop the flow.

if you did feel that there was a need to supplement him (which i am not sure there is given that he is gaining weight and otherwise happy/healthy?) then there is nothing wrong with expressing and giving that.

my advice to keep your supply up would be not to offer formula, but to feed on demand!

Hi There

Well done on BF thus far, it's not easy :-) I BF my DD exclusively for the first 5 weeks (it was far from easy) and then used FF top ups a couple of times a day until she started to drop milk feeds around 9 months. We continued to breastfeed morning and night (with FF top up at bedtime) until she was 18 months old when she went (her choice) completely onto bottles (cows milk by then) and then she gave up milk all together at 22 months. I expressed every evening when she went to bed but rarely got more than a few ounces even after almost an hour of expressing. It is true that it all works on supply and demand and I did sometimes take to bed with her for a whole day and just let her feed to increase my supply but I never felt we got there. There were other issues for me though (previous breast surgery which affected let down, PND and DD was tongue tied) so it was always a rocky road. If you're determined though, then you will do fine in the end. I know it's really hard but try and find what works best for you both. I was always being told/reading about feeding off one boob for as long as possible because of hind milk etc etc but what actually worked for me and my DD was to switch sides regularly (as soon as she lost interest or slowed down to almost stopping) and just keep feeding for as long as we could. Anyway, what I'm trying to say is yes, express when you can, top up if you need to and keep BF if that's what you want, it is possible to do both for as long as you want :-) Hope that helps a bit. Do you have any good BF counsellors in your area? An NCT one perhaps? You don't have to be an NCT member to access their services. x

A 'full' breast is one with excess milk in it (often low fat) and is making milk much more slowly, a soft breast is one which is making milk quickly and has high fat milk in it.

If baby is pulling off and seems frustrated try switching sides and perhaps consider breast compressions (this helps the milk flow so can assuage a fussy baby). Switch feeding - swapping sides as soon as baby slows from active feeding to more leisurely feeding - may also be helpful.

Agree with thisisyesterday that you have been given bad advice.

Your baby may have seemed more satisfied as formula is hard for a tiny baby to digest and sits in the stomach longer. The best way to get more milk in is just to offer the breast more. As op said offer the first side again and if need be switch sides a 4or even5 time. The problem with adding in formula is it will reduce your supply.
Its important to understand a breast is never empty of milk, most of the milk a baby takes is made during the feed. So the best way to get more milk into a baby is just feed more.
It can be very relentless in the early weeks, and feels like your doing nothing but feeding. But it does seteal down and baby is putting in her order of milk now to established your long term milk supply.

Look and truthsweet got there quicker with a slightly better explanation. :-)

Just keep swapping sides every time he comes off. If you top up your supply won't increase like he obviously wants it to. My daughter's switch fed since 8 months (now 15) and goes back and forth every 30 seconds till she settles on one to go to sleep.

Well done on breastfeeding so far.

I had exactly the same concerns as you re soft breasts, baby seeming unsettled etc but luckily someone gave me better advice when DD was about 5 weeks old. (Btw, by 'better' I absolutely don't mean that you shouldn't FF if you want to):

Settle in with tea, cake and box sets and keep feeding for as long as it takes - it really is hard at the start and so much of it is mental attitude. Trying to relax into feeding, in the knowledge that you CAN feed your baby from your own body and that somehow it WILL all work itself out, I found made a massive difference.
Keep changing sides during each (long) feed.
Remember that newborns can be incredibly fussy, for no apparent reason.
Listen and look for baby actually swallowing, not just sucking.
Press firmly onto the top of the breast (compressions) if baby seems fussy or if the swallowing stops.
Change positions every now and then to make sure that each boob is being emptied properly.

Someone on Mumsnet described the process of a baby breastfeeding as someone drinking from a river, not a pond. That made so much sense to me and made me feel much more confident.

HTH. Keep going if you want to - it will all fall into place quicker than you think.

OP I sympathise, I was you and it was not fun. I agree that you have been given bad advice, I was given the same advice and now look back knowing what I know and am very frustrated. However I'm sure plenty of women make topping up work and will swear by it so you'll only know if you try.

DD lost more than 10% of her birth weight and struggled to put it back on. I knew nothing of growth spurts when she was born and on night 3 she screamed all night long when not feeding, I thought I wasn't producing any milk which the midwife 'confirmed' the following day when she asked me to express and there was nothing there, of course there blooming wasn't you daft mare, she should have known that my boobs weren't ready to start expressing but told me I should have been able to get at least 3oz off on day 3. I of course didn't know this at the time and so when she told me to immediately top up I did. We did this from day 3 until she was about 9 weeks old I think. Think about this logically, they say it takes 6 weeks for BF to become established, so by not EBF you are not upping your supply to what your baby requires, after all they are getting the rest of their requirements from the bottle. I'd finally had enough of topping up/expressing/BFing and decided that I would crack it. I moved into our bedroom with DD for a week and I just let her feed on demand, I hated every second but it worked. My supply started to increase and eventually she was happy with what she was getting. Don't get me wrong I had to feed her more than I did with topping up, that's because when you BF you can feed up to 10 times a day, maybe even more. After a couple of weeks we introduced a bed time bottle and I found this helped her to settle at night and DH could feed her too which was a bonus.

Around 4 or 5 months old she stopped napping and so I started topping up at nap time. By the time she was 6 months old I was so sick of this that I started introducing 2 full bottles a day at nap time. She is now 7.5mo and now a FF baby (for the last 2 weeks) and I'm more relaxed.

The age old debate is that BF is easier because you don't have to sterilise bottles etc, but I feel that for me FF is easier because I know I am giving her the right amount and it's quick and easy. I hated BF BUT I strongly believe that had I known how BF worked and all about growth spurts and establishing BF in the early weeks then I would have stuck with it and not introduced formula. I believe that I wouldn't have had any of the problems that I'd had and I think that DD would have been a EBF baby.

It's up to you what you do but make your decision quickly, once you start topping up it's ever so hard to stop.

Thanks for sharing your stories and the advice, blimey where would I be without mumsnet :)
I'm torn, I've found these 4 wks so difficult and I know another few weeks of this intensity is nothing but at this point its a mountain. I think I'm just going stir crazy with being at home these past 4 wks.
Anyway today has been more positive, he's been cluster feeding all morning, hasn't been pulling off me as yet but neither has he had that drunk milk look and neither does he seem very settled.
My mum is nursing him now so I have a break/shower/eat/brush teeth. I wont rule out topping up with FF at some point today, but for now I'll keep going.
I'm going to order a pump, sleep deprivation is a big part of how I'm feeling, if I can get some expressed off DH could take the evening feed and let me sleep a while longer.

I have read this thread with interest as I've been having my own issues with breast feeding.

DD is 3 weeks old now. We ended up in hospital at 3 days old because we couldn't establish breast feeding and she was dehydrated. First night in hospital she was given formula with my minuscule pumped colostrum. Then once it was agreed she wasn't dehydrated any more we had great support from the breast feeding expert on the ward. Ended up using nipple shields (she worked herself up into a mad frenzy when going straight on my breasts) to feed on demand and then express to top up her feeds. We came home after 2 nights and have been carrying this on. Unsurprisingly she's getting more and more used to the bottle and now gets frustrated at my boobs despite still using the nipple shields. Sometimes my breasts are so engorged she doesn't even need to work for the milk, it's just pouring out. Yet this doesn't make her happy either.

I pump during the day when I can and easily get 60ml from 1 breast at a time. I don't mind pumping but I've started to become really anxious over breast feeding her because of how cross she gets.

The sleep deprivation isn't helping plus still recovering from the birth.

Have found myself wondering about formula feeds to get her to settle for naps. She has to fall asleep on me or DP and will only sometimes stay asleep when we move her to her pram/Moses basket etc. Would a formula feed get her milk drunk and enable her to sooth herself to sleep?

I suppose it's really early days for us, she's only 3 weeks old!!!! Just all quite difficult right now to know what to do for DD's best and also my sanity.....

Hi Mamma, I dont have much time but just to say that even though DS was more content in appearance after the FF top up we are still having the same difficulties with the moses basket - so no improvement there. I downloaded some white noise today though - I demand BF for nearly 5 hours this morning and finally got him down in moses basket at lunchtime. I put the white noise on and he slept for nearly 2 hours in the moses - unheard of in the afternoons here. I'm hoping he grows out of it before I go slowly mental from lack of sleep.

:( Mama you have ended up doing a very complicated feeding method....bf direct, expressing, and shields :(

It's exhausting - each feed becomes a matter of judgement and assessment (has she had enough? Should I give a bottle? Have I got enough expressed? Should I pump now or feed her?Will she settle? Should I leave her/wake her/try her again? Is she cross or just irritated? Is she hungry or just tired? etc etc etc).

Is there any way you can speak to someone in real life to formulate a plan? And talk about what your baby might be expected to do? It is normal for a baby of this age to only sleep in arms/on chest....just as you say, 'she's only 3 weeks old!' She will not be like this forever.

I am not sure why you are still expressing and supplementing with ebm - could she not just go back on the breast when she appears to want more? A skilled person may be able to help you latch on without shields (which are a nuisance) - you could try BN positions, for example (google biological nurturing), and keeping her close so you can respond to every little feeding cue. My guess is you give her the bottle when she is upset and fractious, but does not want to breastfeed or to sleep, and this calms her? Making breastfeeding easier and comfortable for her might help with this....but you need someone in real life to go through your options with you and help you work out what suits you best.

Shields can have massive drawbacks - they can be useful short term, I know, but they are a pain for many reasons.

Got it in 1 tiktok. We breast feed until she's so cross I need to calm her in some way and give her a bottle of ebm. I have googled biological nurturing and it looks really interesting. DD's arms flail all over the place, she pulls her head away and then screams to get back on etc. in the cradle hold that perhaps a different position will be better for both of us. I'm going to approach this evening's feeding with a fresher mind and will try this position out to see what she thinks and how I feel. I have tried feeding laying down too which was fairly successful but she still pulls away and squawks. It's as if she's never finding the breast feeding very enjoyable or relaxing. And I hate seeing her get so upset doing it....

Ooh nappy change time!

Ok, nappy changed and giving BN a go. Initially tried with no shield and she got quite upset. Stuck the shield on and she's feeding and staying and omg...... No arms everywhere, staying on the boob and she seems relaxed. Will keep trying this with this evenings feeds.

Am going to head over to a breast feeding clinic next week for some help with the shields.

But for now I got to say a big thanks for letting me know about a new position

This is progress, mamma.

Sounds as if it would be better not to try to get rid of the shield just now. Your aim is to help her realise the breast is a lovely, snuggly, calm place and this is one of the aspects of BN that helps mothers and babies turn a corner.

Your baby is essentially in control when you do BN. Her instincts come to the fore and take over.

Getting cross and flailing with arms actually makes things worse. She becomes distracted and upset, and she cannot calm down sufficiently to co-ordinate latching, sucking and swallowing.

You can do BN in the bath, too, and lots of babies love it :)

Big progress tiktok. Not had any BF tantrums this evening while doing this, it's a big achievement. It feels very natural too, I can feel more of her body, I'm not having to constantly put her head to the boob, she's calm and so am I.... Big turn around. Are you a BF expert?

Yes shields can stay put for now

Thanks once again

I'm a breastfeeding counsellor with NCT, mamma.

Glad the BN is helping - bfcs suggest it a lot . It's a good way of feeding/caring and has a good, logical basis to it.