BF difficulties after Csection

[NanoNinja]

Hi,

This is my first time on the bf forum - sorry if this has come up before but I'm getting a bit desperate.

I had a Caesarian (at 38 weeks) a week ago due to breech baby. DS had low blood sugar and has been having formula since birth, given through a syringe. Blood sugar is now ok, but I'm having real problems feeding.

I want to cut the formula out, but at the moment I am struggling to give him enough milk in a feed. I've been pumping after feeding and topping up with that but he generally needs more milk after that and so third step is formula.

When I pump, I get 20-30 ml out the left breast, but next to nothing out the right. Also, the drops i get out the right breast are much deeper yellow than the milk from the left breast. Is this assymetry normal, and what can I do to improve it?

I'd really welcome any help - I only ever imagined breast feeding and I'm getting upset by the thought that it might not work for me and my baby.

Thanks!

Congratulations on your new Lo and welcome to the breast & bottle section .

I'm not a trained BFC but do know that the amount you express in no way represents the amount of milk you produce or the amount that baby is receiving. I could not express one drop with DS but he grew to be a right chubbier so he was getting the Bm from me.

If you do want to cut out the to ups, I would recommend ringing one of the bfing helplines and talking to a BFC. Have you heard of kellymom.com too? It's a great, evidence based website on bfing. Can't do links ATM but if you google kellymom reduce formula some information should come up for you .

When you say you are struggling to give enough in a feed, how long does he feed for? Do you offer both sides at each feed? Did you know that you can just keep offering each side again? You do have to wait for the breasts to fill back up, you will always have milk.

What have your MWs said? Have they checked him for tongue tie and have you had your latch checked?

The same happened to me with DS, I had borderline GD, he was born with low blood sugar and my milk hadn't come in so hospital insisted on supplementing with formula.

I managed to get my supply up to a point where I could bf exclusively but it took about 8 weeks in our case. That said, I had an infection after the birth and was ill so that affected supply.

The amount you can express has no bearing on what baby gets out, I would run 'dry' with the pump then put him on the boob and hear gulping! Baby is much more efficient than pump plus your body reacts to their suckling in a different way.

All you can really do is have him on the breast as much as possible, let him suckle for comfort as well as milk and know this stage will pass! Your supply will catch up, reduce the formula slightly every day.

Different colours of colostrum/milk are absolutely normal.

La leche Leauge can be very helpful if you are well enough to go to a meeting or they have a helpline.

Finally, if your LO has to keep having some formula top up its not the end of the world. He's still getting your antibodies, the comfort of breastfeeding and plenty of benefits as long as you continue to give him something.

Congratulations on your LO! I too had a c section - at 36 weeks & my dd was in IC for 10 days where she was fed a mixture of my EBM & formula. I've BF her exclusively for. 5 weeks now. Firstly, when you're BF yours, you do not need to keep topping up with expressed BM or formula - doing so will decrease your supply anyway. All you need to do is keep offering your boob, side by side. For example, if she starts with the left, offer the right when she comes off & when she comes off the right, offer the left again & so on. Doing this will build up your supply to ensure you have enough milk. There will be times when it feels like you are constantly BF - that is completely normal & will pass! I wouldn't recommend expressing milk until BC is completely established which usually takes & weeks.

Good luck! X

Hi,
Thanks for taking the time to reply. I guess I have been following what the hospital recommend - 3/4 hourly feeds of no more than an hour, rather than continuing at the breast until done. I leave tomorrow, so will try other approaches. It seems that the consensus is a more relaxed approach (which will take a lot longer each time and take a little while to be effective). in the meantime, I guess I continue with the formula (and cut out pumping?)

I've had a number of midwives check the latch and they seem to think its okay, but tbh, they often also give slightly different advice whch erodes my confidence in what they say. It often feels a bit shallow / insecure and I only occasionally hear the loud gulping that seems normal, but I have nothing to compare it with, iyswim. I have my first home visit on Tuesday, so will ask her to check again. I'll also call the helplines and look up a lactation consultant (am not in the uk, which makes things a bit more difficult,but am sure I will be able to find someone)

JJJ - I'll make sure they check for tongue tie - thanks for the reminder. And for the useful links.

Osterleymama & Applecrumple- thanks for sharing your experiences - it is reassuring to know that I am not alone, and that your LOs are feeding well. How did you give the formula whilst you were using it - in a bottle or cup? I'm concerned about him struggling to suck well...

Thanks again - I'm really grateful!

I had a few issues when DD was first born, and the BFC advised syringes, cup or spoon were much better for baby than bottle. Really its up to you which you use, whatever baby finds easier, but bottles can interfere with the latch, so its best to avoid them.

Anita, that's what I thought, and I am a bit concerned about the latch as well as the fact that he easily falls asleep. I'll avoid the bottles - thanks for the advice!

My best advice is switch feeding as pp said. DD2 used to be crying hungry and it terrible but I just fed until she came off then switched then switched and on and on. Even if she had only been on a minute!

Took days of constant feeding (the 3 hourly schedule is bollocks until they are older!) but my milk supply did catch up.

Have faith yours will too.

Think you are right to ignore the 3/4 hour schedule. That just sounds like a recipe for a hungry baby and disastrous bfing. Just feed when he is hungry, even if he fed just 10 mins before. He is still so little and bfing is about the warmth and comfort of you as we'll as the BM.

How are you getting on today?

Softly, thanks for the advice. I think I am going to give up the pumping for the time being - it's really dispiriting anyway, and try switching with formula to top up. Trying to stay positive, but it is hard at times! On the plus side, I feel so much more relaxed since getting home, which I guess must be a good thing.

NanoNinja, I was in a similar situation. DS was an emergency c-section and my milk took waaay over a week (probably closer to two weeks) to come in properly. I was also supplementing with formula, but it was given from a little cup as opposed to a surenge, after each feed.

However, while formula was given every three hours, I did not time the breastfeeds or follow any particular schedule. DS was on the boob whenever he squeaked and for however long he wanted. I have to say that it was hard as DS was on the boob A LOT. He practically lived there, for hours and hours and hours during the day, in the early weeks. I also tried pumping at first, but it was all too much faff. And my HV was saying that a baby sucking is more efficient for stimulating the breast than the pump, so instead of pumping I should just feed DS more. I think they were right, particularly because I am a terrible expresser and was never able to get more than 2 oz out of both of my boobs together. About two weeks after birth, DS started refusing the formula cups and within the space of about three days we stopped them.

DS is 21m now and is still breastfed.

Ditto!!

I had EMCS at 39 weeks. DS ended up in SCBU with low blood sugar and suspected GBS. They topped up with formula (aptamil) but all the while he was having difficulties latching to my right side. Sometimes it took 20 minutes to latch him on and between 5pm and 4am, he was on/off every 10 minutes!

My mental health deteriorated and at 4 weeks gave up and went onto FF.

For meand him, it was the best decision. Next time, I would like to try again as am hoping that being bed bound and in an awkward position for three days won't happen!

Hi again, thank you so much for sharing your experiences, and sorry fit being late in responding g - it's been a busy couple of days.

I saw my home MW I responding - it's

Sorry - iPhone problems... The MW was unconcerned about his weight and basically said that the hospital was being a bit over the top. She also said that this was nowhere near the worst case that she has seen, which was reassuring. No problems with the latch, but I'll ask her to check again when I see her tomorrow as my nipples are getting a bit sore.

She was, however, keen on continuing the pumping to stimulate the breast (is this reasonable?), so have been continuing to do this, albeit for shorter periods of time. She was more keen that we have lots of time with him on my chest, which is fine by me! So For the past couple of days i have been feeding him expressed milk and no formula. I've also been trying to feed more on demand - which means not much in the morning and afternoon, but constantly in the evening with a couple of night feeds. He's still at the stage of falling asleep within a couple of minutes when I put him on the breast, but I have been reassured that this passes.

Milk seems to be improving, although not at full strength - is this meant to be at ten days? I'm not convinced he's getting enough at the moment.

So in all, a mixed bag. I certainly feel better, but have a range of niggling worries, which will only be addressed (or otherwise) with time. I guess that's true of any parent?!

Lots of skin to skin is a great idea and frequent feeds- probably roughly every 2 hours if you can will really help to get your milk supply going.

In terms of whether he's getting enough.... what makes you think he might not be? You say the mw is happy with his weight (one way to tell if he's getting enough). You can also tell if he's getting enough by keeping track of his wees and poos- 5-6 wet disposable nappies and about 3 yellow poos a day at this stage. As long as his feeds are effective (you mentioned the latch was fine) and you are feeding to his cues then all should be fine.

You're right that it's completely normal to worry, and then just as you get your head around one pattern, things generally change and there's something else to think about. You may find that you can get some good support at a local breastfeeding group. They're not just for feeding problems, but are good places to chat through these little niggles that you are talking about.

Crikey - my concern around not getting enough milk probably is a result of a) milk being late in coming in b) not being happy at the end of each feed c) weighing tests in hospital before and after each feed showing he was only taking on twenty ml or so with each feed. But yes, the nappies are fine, weight seems to beckon the up, although not yet back at birthweight ( after 10 days). So I guess I just need to continue with feeding on cue and getting skin on skin time. I'm still feeding expressed milk at the moment, but no formula, which makes me feel a bit better.

Yes you're right, your tough start has probably affected your confidence, hence your concerns. If he's not happy after a feed, you can just pop him back on the breast.

I'm suprised they've done test weighing in hospital because, as far as I knew, it wasn't very accurate and is rarely used these days.

How far do you have to go to get back to birthweight now?

I'm in Switzerland and they tend to be quite old fashioned here, at least on the French speaking side - I think it's much more progressive on the German side. So that would explain the weighing test. Interesting that its not widely used in the UK.

And you're definitely right that my confidence has taken a bit of a bashing, which leaves me struggling to have faith that I am giving him enough and reduce the pumped milk.

In terms of birth weight - obviously with different sets of scales, but on Thursday (day 10) he was 35g below birth weight (3 kg 35g). And I guess he may have been affected by the IV fluids as well?

35g below bw at 10 days would not bother me at all in itself, and I'm a community midwife. You sound like you're doing very well in that baby is only having your milk, so you are making enough milk for him. I'm not a bf specialist midwife or lactation consultant but ime switch feeding and lots and lots of skin to skin works wonders.

Well done.

Unexpected - thank you for the reassurance and encouragement. I'm glad that you think weight per se is not a problem. I've been trying to switch feed, but am slightly disconcerted by two or three green plops over the course of the weekends hitch make me wonder ifvivshould focus on one or the other?

We've also been battling with gas - although we wind him during and after each feed, he won't be put down in his crib due to gas. He's been awake for the entire evenin - I b feed, give milk in a syringe and wind, put him down and ten minutes later he wakes himself up with burps and what seems to be stomach ache.

I guess things have improved overall , but with him bring awake for do long, I struggle to see where he will get the energy for growth.

Sorry to keep coming back with more problems...!

tiktok who knows all there is to know about breastfeeding put a link to a really interesting article on here recently that talked about the whole foremilk/hindmilk thing and (i hope I'm remembering this right) it basically said not to worry too much because however babies feed, if they are demand fed they get about the same amount of calories and fat over the day, whether it's in lots of little feeds or a few huge ones. If that's bollocks I'm sure someone will be along to correct me.

Wakeful evenings are very common indeed and pretty normal newborn behaviour. Are you sure it's wind? Often babies just want lots (and lots, and lots) of feeds in the evening, and then make up for it by having a lovely loooong sleep at another time of day. I remember not putting my baby down for 7 hours one evening. Try and put the 3-4 hourly feeds out of your mind, it's not how babies behave usually.

Remember that we are mammals and mammalian newborns want to be on or right beside their mothers at all times. It's a social construct that we put them to sleep apart from us, and they fight it a lot of the time. Sometimes what happens is we put a baby down who just wants a cuddle, they become anxious and wake up, then look for food again, so we feed them, then put them down and the whole cycle begins again.

If your baby is having nothing but your milk then you are obviously making plenty for him. Have the confidence to cut out the expressed, and remind yourself that a baby is much more efficient than anything else at getting milk from you, so cut out the middle man syringe, and get the milk straight from you into the baby. Much less faffing around that way.

Bonjour Suisse, by the way. I spent 5 happy years as a child in Vaud .

Hi unexpected - thanks for replying. The info re fore milk / hind milk is interesting and something less to worry about!
I'm no longer giving him the expressed milk and we seem to be doing okay. He's peeing and pooping lots, sleeping well during the day, cluster feeding from about 6 pm onwards. He didn't settle until about 4 am last night, but I suppose that's normal for a newborn?

All sounds good Nano- well done!

that sounds just fine to me, nano, well done! the poo and pee is just the thing you want to see.

sleepless nights par for the course at the mo I think. I think having something to do while you're up all night is good - I had 30Rock series linked and watched it when she was up all night, drinking tea and eating flapjacks while my baby nursed. It was lovely, in a crazy, exhausted sort of way, and much better to accept I was going to be up for hours rather than desperately scrabbling for sleep. She grew out of it. they all do, trust me.

I still can't hear the 30Rock theme music without feeling suddenly very tired and craving a flapjack. I'm like one of pavlov's dogs [hwink] .

Hi, thanks everyone for your help. It does feel as though we are getting there, albeit on a rocky road. Valuable lesson in trusting my baby and body!