Not enough milk - what else can I do? want to b/f exclusively

[osaenlondres]

My baby is 8 days old. Had skin-to-skin with her immediately after ELCS (and my husband had her on his chest as soon as she was cleaned), colostrum appeared within the first hour, breastfed in hospital all the time. Milk started coming in on day 4 but in small quantities. Never had the much-described engorgement. On day 5 DD got jaundiced and visiting midwife recommended using formula in addition to b/f. We used the bottle for a day and then switched to using a syringe instead. DD is ok now, less jaundiced and stopped losing weight. Two days ago the NCT b/f class counselor came to help me improve the latch. She suggested b/feeding and pumping afterwards - doing this combo every 3 hrs, which I am folllowing. My diet is good, I am getting LOTS of help from my DH and my mum. I was hoping to produce more milk but after DD nurses for about 15' on each breast I get between 3-6ml of milk with the pump (hired industrial Ardo pump). After nursing my DD still has appetite for 30ml of formula, which makes me think I produce tiny amounts only. Has anyone had this before and managed to get their milk supply to a required level. what else can I do to improve the supply? I alternate between being optimistic (thanks to my DH's support) and feeling guilty (unjustified, I know).

advance if your baby has had weigh issues, feeding four hourly is not enough. My DD is now 10 months old and only at about 6/7 months old could she go four hourly without a feed and even then that was rare.

I would also try to get some better RL advice as topping up each time with formula is not going to help you establish a good supply. Every time you top up as opposed to putting baby to boob, it sends the message to the body to NOT make more milk. It works on a demand / supply basis so the more baby is at boob, the more milk is made.

advance, I agree with showtunes that four hourly or thereabouts is w....a....y too infrequent. You need to be thinking about your baby coming to the breast at least 12 x in 24 hours, using at least 2 breasts each time (switch nursing) to build up and maintain your supply.You also need a plan to decrease the formula.

If you post more details or start a new thread, people can help with more info :)

Thanks for advice. Feeling much better today.DD has lots of feeds overnight. Basically been putting her to breast wherever possible. 4 relates to top ups. Obviously want to cut down on top ups but guess I will have to wait until back to birth weight.
Will certainly use both breasts for feeds. That is a good tip.

Glad things are looking up, advance.....it's a poor show you were not told about using both breasts or given any other way of 'fixing' breastfeeding other than top ups :(

I hesitate to say this- and tictok will correct me, I hope- but would you feel confident enough to drop, or at least reduce the top ups? The less you top up the faster your supply will increase.....

seeker, see my previous post: "You also need a plan to decrease the formula."

She does need to reduce the formula, but she needs a plan to do it....not just dropping the formula but working out the best way to do it so her baby does not miss out nutritionally.

:)

I was given similar advice on day 5. DS2 had lost 8% of bw, we had fed pretty well in hospital after CS (compared to DS1 which was a real struggle).

I was feeling quite pleased with how it was going, so was a bit wobbled that MW said top up at every feed and by bottle (had used cup in hospital), and as a result have used some formula as not yet expressing consistent quantities.

Awaiting trial by scales at MW visit today - day 9. I know from DS1 that this isn't the way to approach it really, but that seems, 4 years on, the new MW approach :(.

jollster, it's hard to comment, but on the basis of the info here, the midwife has given you odd advice....8 per cent is within normal limits as weight loss, and topping up at every feed is almost certain to reduce your baby's bf frequency.

Some babies really do need a top up, short term and limited, because bf is not going well and the baby does not have time to wait until it's fixed (and the mother is not able to express).

But every feed is a very drastic measure....if you feel brave enough, how about asking her 'I did what you said, but it conflicts with what I have read - why did he need formula and if he did why so much?'

The use of a bottle is not a big deal. Nipple confusion is not a notion that everyone accepts and there's no good evidence for it. Sometimes babies end up preferring the bottle but that's when they have not learnt to bf well, or the bf is not a good experience for them, not because they are confused. Google it :)

I do accept dd was very dehydrated and needed nourishment/fluids at the time. However, I notice on another thread that IV fluids in delivery can result in atificial weight loss. (something to mention to midwife I feel)
I think that coming up with a plan once back to birth weight is a good idea. Especially as dd not actually taking all the top up. (feeding her by breast 1st)

Sorry, tictok- I'll keep my nose out!

Thank you for the advice and contributing to the discussion. Here is the progress update. B/feeding about every 2.5hrs during the day; 3-4 hrs at night (depends on the night; last night was 3 hrs and then 3.5hrs but the night before she got upset when we tried to wake her after 4.5hrs; we still did and then fed her).
I switch breasts at least twice at every b/f and do breast compression. DD sucks and swallows very well but for short periods only - and then she falls asleep. Changing nappies (or pretending to change nappies), tickling, etc. wakes her up for short periods of time only. I definitely feel there is more milk now but wish she sucked for longer. We have reduced formula top-ups to about 6-7 times a day, i.e. about every other feed; giving in total 100ml of formula per DAY. Sometimes i give her formula before breastfeed to give her more energy to suck. When b/f is not topped up, she is hungry 1.5hrs later but that's good because i put her to the breast again. Today is day 12 after birth; went to children's centre locally where midwife weighed DD naked on digital scales. 3kg (vs. 3.35kg at birth) but midwife said she was not worried, as the baby looked content and not dehydrated or jaundiced....Pumping is still producing low results - with Ardo industrial-grade one I get 5ml maximum (but this is after feeding the baby). Taking fenugreek and fennel tea. Feeling less upset now but still would love to get rid of the formula altogether. ...Any other advice on keeping the baby awake at the breast?

forgot to add that apart from the first day of topping-up, all the formula have been given via syringe, not in a bottle so DD is still very keen to latch on.

osa, thanks for the update. Glad you are hanging on in there :)

""B/feeding about every 2.5hrs during the day; 3-4 hrs at night (depends on the night; last night was 3 hrs and then 3.5hrs but the night before she got upset when we tried to wake her after 4.5hrs; we still did and then fed her)."

Not really enough....it works out at about 10-11 times in 24 hours, though the switching and compression is good. I think now is the time to have someone who knows what to look for to watch a feed and assess its effectiveness.

"We have reduced formula top-ups to about 6-7 times a day, i.e. about every other feed; giving in total 100ml of formula per DAY."

That's good progress, and it is justifiable to give formula ahead of a bf for exactly the reason you say - to wake her up.

By now, your baby should be less sleepy - short feeds are within normal, but I get the impresh. she is hard to wake and hard to keep awake, and that's concerning.

"Today is day 12 after birth; went to children's centre locally where midwife weighed DD naked on digital scales. 3kg (vs. 3.35kg at birth)"

This is quite low - the key thing though is is she gaining now? If she has lost a lot of weight and is now on the way up, then it's not so bad. If she is plateauing, or still losing, then that's more worrying.

Are you managing to keep your baby skin to skin/very close most of the day and night? And can you get someone to really observe you?

Hope this helps.

thanks tiktok you talk much sense. :)

Feeding has improved here, I'm also pumping (was 3 or 4 times a day) am settling down to twice (one after morning bath, one small hours of the morning), and have spent most of the day/evening just feeding and feeding and feeding and I can see improvements. He had only 2 top ups yesterday, one breast milk and one formula at 11pm by DP so that I could get some sleep, and when I woke, breasts felt full and I was leaking, so all good signs, so when I fed baby at 1.30 he was definitely satisfied with no top up.

His latch is still not great but I think is getting better.

And when I looked back at the diary I kept with DS1 we are already in a much stronger position

Good news, jollster - how about asking the midwife why her advice was so unlikely to support your bf and could have easily scuppered it? If you're feeling brave enough to challenge.....:)

oddly the first MW who visited post natally was the one I saw all through my pregnancy, though I was under totally lovely () consultant care, so her role was quite reduced. I think she's rather over cautious, the next 2 visiting midwives have been much more relaxed and raised eyebrows at the first's advice. I probably won't see her again, otherwise I would tiktok...

Hope you don't, jollster. Thing is it is not 'cautious' to recommend all that topping up. It's hugely reckless :(

Yes your choice of word is totally correct in terms of supporting bf, I think her primary concern was a thriving baby, whatever the feeding method and maybe this is a consequence of additional pressures on all HCPs these days.

But I completely agree, her advice would be very worrying with a first time or more vulnerable mum.

My midwife has just told me to only feed off one breast at a time but to increase formula. Words fail me. At least I started leaking today and expressed 60 mils easily. Another 300 gms to go before back at bith weight. Now day 10.