Mix feeding 3 week old due to weight loss issues - am I stuck with this?

[eagleray]

I have nearly 3 wk old DD who had problems feeding from birth (wouldn't latch on in hospital). We were discharged after 48 hours (my choice) with a plan for feeding her formula, although I then had some luck with BF once we were home. However, by day 4, she was found to be 13% below birthweight, and ever since then we have been on mixed feeding. She was also found to have a tongue tie, which was corrected when she was 5 days old.

She has started to gain weight now (although still quite a bit below her birth weight) and the current feeding plan (as advised by MW/paediatricians) is to feed 4 hourly, with 30 mins of BF, then 90ml of formula. I also express when I can, although have never managed to get more than an ounce at a time.

The main priority has been (quite rightly) to get DD to gain weight, but it seems that my milk supply got off to a bad start and has never had a chance to get going properly (birth was forceps and I felt really low in the days afterwards, and also felt bombarded with varying advice re feeding while in hospital, none of which seemed to really help). In addition, no one has been able to reassure me that things will get any better and it seems I will always have to give formula at every feed.

In terms of current BF, my boobs have grown quite a lot, especially week 2 onwards, DD seems to be latching on well, and after feeding is generally a bit drowsy with milk dribbling from her mouth (as if she has fed well??). However, within 30 mins - 1 hour she is happy to take the bottle of formula and often is quite hungry for it.

So here are my questions:

1. I have no idea whatsoever how much BF is contributing to feeding (I know that what I express is not necessarily an indicator, but it isn't encouraging!). DD is very fond of BF, but have no idea now efficiently she is getting milk, or how much is available. My boobs are quite soft (although achey and quite sore after feeds) and have never had any milk squirting or even close to it.

1. Is there any way of improving supply? I realise I am up against it given that formula has to be given - this caused massive distress to me as I felt I'd been written off and seem to have just been told to accept that my milk supply is what it is

1. Is there any way we could move towards at least cutting the amount of formula feeds in half? I keep being reassured by HCPs that there is a point to me continuing BF due to health benefits, but finding mixing really hard, ie BF first and then racing to the kitchen to make up bottles each time. It's certainly not how I thought things would be!

Would be grateful for any advice anyone can give. Just realising these last few days how hugely common feeding issues are, but just can't believe we are stuck with this 4 hourly juggling routine of BF, pump and FF!

Well, first of all congrats on the birth of your DD!
Sounds like you've had a really hard time so well done for getting this far.
The first thing that jumped up to me reading your post was how infrequently you've been told to feed. Four hourly is not very much at all for such a tiny baby who still hasn't regained her birth weight.
The only really effective way to boost supply would be to feed, feed and feed some more by offering both sides at each feed and as frequently as baby will take. Sounds like hard work but it's probably nothing compared to your current bf, pump and ff regime!
Also, if you carry on ff, you're giving your boobs the message that they need to produce less than your DD needs. In the first few months your supply is very fragile and you also run the risk that your DD may just decide that she prefers to ff because she needs less effort to draw milk.
However, if your DD still hasn't regained her birth weight I would be very careful before dropping a ff. I would only do so after having had real life help from a bf counsellor or lactation consultant who can monitor your DD and offer continued advice. So, can you go to a LLL meeting near you or can you get real life help from an expert?
Best of luck

I don't really know much about mixed feeding with formula as I'm ebf now, however I was giving bottles of ebm up until 4 weeks old so I know how hard it is to do the whole feed, pump, sterilize thing. One thing in your post stood out to me though - you said that you bf then 30min to 1 hour later your DD is hungry for a bottle, have you tried bf her then instead?

My DS was feeding between every 30mins to 1.5 hours up until 10 weeks and since then I have noticed he's set up his own routine of feeding every 2 hours (he's 12 weeks now).

Hopefully someone who knows more will be along soon but I think as your DD is so young, her stomach can't take a lot in one go and may well just want another feed (whether bm or formula) 30min to an hour after the last feed. Keep going with the bf if you want to, you're doing great at the moment and it will get easier the older she gets.

We were in a similar position. BFing went much better once I was able to get help regularly from the local BF clinic. They sorted my latch and positioning issues. We were able to stop topping up after about 8 weeks. We were still giving the odd bottle until about 12 weeks when our baby started refusing them! I am still BFing at 17 months. Keep pushing for RL support and feed feed feed as often as you can. Good luvk and congratulations.

Thank you so much to both of you for replying. The one thing I forgot to mention before is that there was concern that DD was expending too much energy at the breast, hence being told to limit BF to 30 mins within each 4 hour period. We have struggled a bit with the 4 hour timeslots as a whole feed can take a while to do so I generally try to look at the 'inputs' over each 24 hour period (thank god for feeding apps on the iphone!)

Now that she seems to be putting on weight, I am slightly less concerned with following the regime set out for us and will try more frequent BF. Here's what's happened since midnight last night, to give you some idea of what she's getting:

21.00 - BF left 10 mins
21.15 - BF right 12 mins
01.50 - BF left 10 mins
02.00 - BF right 10 mins
02.10 - BF left 10 mins
03.00 - FF 50ml
04.00 - FF 30ml
07.00 - BF right 10 mins
07.10 - BF left 10 mins
08.45 - BF right 10 mins
09.00 - BF left 15 mins
10.00 - FF 80ml
12.20 - BF right 15 mins
12.40 - BF left 15 mins
13.45 - FF 60ml
17.25 - BF right 15 mins
17.50 - BF left 20 mins
18.35 - BF right 15 mins
19.45 - FF 90ml
20:40 - BF left 15 mins

Up until yesterday, I had been advised to stick to one breast per feed, but have decided to experiment with switch feeding, to see if that makes any difference. Now that I see the above laid out, it seems that feeds are fairly evenly spread, apart from this afternoon, where for 4 hours she slept like a log! I am not sure if it is possible to interpret anything from the above regarding whether BF is doing much for DD?

In terms of RL help, I have been a bit flumoxed by the amount of sources of help, and while we've had almost daily MW visits I haven't really had the energy to pursue anything (and also had got a bit wary about getting yet more advice), but will make a big effort next week. Have already left a voicemail for the feeding advisor employed by the local council, plus there are LLL meetings in my area so will pursue that as well.

I got the feeling from MWs that the emphasis should possibly be on supporting me emotionally regarding these issues, but I feel like I need technical help - I just want to get this bloody thing fixed!

Thanks also LadyWidmerpool - I probably need to get latch and positioning checked as it may well still be wrong (DD's enthusiasm doesn't necessarily mean we are doing it right!)

And well done to all of you with persevering with BF too - it really is hard and frankly I have no idea how the human race didn't die out ages ago through starvation...

I can see where you're coming from with the concern about your LO expending too much energy but I agree with other posters that four hourly really is very infrequent. 2 hourly is probably more like it to get your supply back up.

I'm also surprised that you've been told to only feed with one breast and this is usually a way to reduce supply, not increase it. It's good that you are trying out switch feeding- you can use both breasts and then go back to the 'third' and 'fourth' side. If DD is looking for more after an hour, then why not offer the breast first?

I can see why you would feel bombarded with varying levels of advice and support, but I would recommend you see that Infant Feeding Specialist at your hospital or, if you can afford it a certified lactation consultant. They will be able to work with you and come up with a plan to reduce the amount of formula gradually.

You say she is gaining weight now- great news, how far off her birthweight is she?

Thanks Crikeybadger - we were on 3 hourly feeds but it was killing us, and so were then advised to do 4 hourly. However, the BF and FF tend to be spread out a bit in that period so I am hoping that helps a bit (it certainly didn't make sense to me to stuff DD with breast and bottle all at once then leave her til the next feed!)

I was a bit at the only one breast thing, but it's only really not that I have the confidence and energy to try to deviate from the plans we've been given and try things that seem more instinctively right. It might be my imagination, but feeds seem to be shorter since trying the switch feeding - I guess there is less opportunity for lazing at the breast/comfort sucking?

Her birthweight was 3950g approx, then around 3460g on day 4, then hovered around the 3600g mark between days 10 and 14, then up to 3700g on day 16. There's a few days til the next weigh-in and not sure how much weight gain is achieveable but hoping it will be back to her birth weight by then.

Strangely, although she is still smaller than when she was born, she is definitely more grown-up and is very bright, alert and strong (holds her head well and is making attempts to smile). The weight loss has been such a major problem that I think we might have gone mad a while back if she hadn't reassured us with all these signs of thriving!

I would doubt that birth weight was accurate OP. 500 gr is over 1 lb and it's an enormous amount of weight to lose for a newborn in 4 days! Perhaps all this worry was unfounded!
I think we need tiktok to come along...

Congrats in your LO :)

Agree with the other posters on getting some RL help.

• definitely switch feed offering both breasts as many times as required
• co-sleep for a few days/nights and let baby just keep suckling to help stimulate supply, gradually reducing FF (if that's what you want)
• from your feeding times above, looks like fairly normal morning and evening cluster feeding to me ie. there are some longer gaps between feeds so you'd expect a bit of guzzling when she wakes. IMO it will be less tiring being in bed feeding than preparing 2 FF
• in the early days some babies take a while to feed so time between feeds seem short. Make sure you try and keep them awake, chin tickling etc. it will get quicker

GL :)

One thing is I read a few times, is that your supply is most affected by feeding in the night and early hours of the morning, so FF between 2am and 7am is the absolute worst time to be doing so.
See if you can find a local LLL, they'll be able to offer you personal advice.

Hi, I had a similar experience to you - forceps, lost weight, poor weight gain etc. i expressed once a day anything from 20-150ml, so unpredictable, but I did it in order to make up for the formula used so my supply wouldn't drop.
...in the end once baby had passed her birthweight and was putting weight on nicely, I mixed fed with one bottle of about 100ml formula once a day every evening and one bottle of expressed milk at another time. I was too nervous not to give some formula.
I also breastfed every 2-3 hours even if it was just a short feed. If the nappies were wet i didn't worry.
About half the time I used pre made formula and the rest Of the time inused powder.
fyi Baby refused bottle at 6 months and now is just breastfed. She started in below the 20th centile and is now in the 50th.
Breastfeeding took me 8 weeks to get right so it does get better.......I would not recommend expressing every day for 6 months like I did , as it was a massive hassle. But this is just my experience. Maybe call la leche league to ask for advice?

Bimba - I wondered about the birth weight too - couldn't believe that there could be so much loss in such a short space of time. Very difficult to challenge it though, and DP was pretty certain they got it right in the delivery room.

Lois - thanks for the advice - we are continuing with switch feeding, and co sleeping for part of the night. Last night there was an absence of cluster feeding in the evening and then she was hungry all night long which was a nightmare! Trying to make sure she takes more milk this evening.

WhichisBest - FF at night is my least favourite thing, as my kitchen is two floors below my bedroom and it's exhausting going down there at night! There is a local LLL and I will be contacting them later this week. Meanwhile, I have managed to speak to a BF counsellor and also a lactation consultant (by phone and email respectively) and they are confident that I should be able to reduce FF gradually.

Kennington - interesting and reassuring that you have had such a similar experience! Baby is being weighed tomorrow and I'm really hoping she will be back around her birthweight, which will then give me some confidence to start making changes to the feeding plan/routine. I'm not finding the expressing too bad - it was a nightmare when I was originally doing it for ages after each feed, but have since been advised just to do short amounts when I can, and today I managed to amass 90ml, which is the same as a single FF! So I will give this to her later. It can be hard to find time to express, but quite like seeing measured progress, ie expressing a bit more than the previous day.

Were you given IV fluids at all during labour? From what I've read this can boost a baby's birthweight artificially.

Gosh - this is like reading my experience x 2. It's horribly stressful and horrendously timeconsuming. I've done this with two DD's who in my experience are a royal PITA. The boys just seem to get on with it if friends children are a good example, but I digress.
First time around my issue was poor supply after a C/S. We were supplementing before we left the hospital after 10% weight loss.
Second time around, smaller preterm baby. I had lots of milk which came in straight after unplanned vbac but she wasn't feeding well enough and we were readmitted after 5 days and 15% weight loss.

Firstly, I know it doesn't feel like this right now but it really isn't the end of the world if you have to use some formula. A year from now you will hopefully be looking at a very healthy robust toddler who will be spitting sweet potato puree back at you and wondering why you were so stressed.

If you have poor supply, switch feeding is the way to go. Tried this with DD2 and it has brought my supply right back up. It also helps to keep them awake and focused on feeding.
If you are having problems expressing anything reasonable in terms of quantity a) your DD will get considerably more out of you and b) it helps to switch feed when expressing too. Keep moving the pump back and forth. Give up after 30 mins though. Take a look at the USA medela website for useful tips.
3 weeks is very early days. My expectations with DD1 did not include being superglued to the sofa day in and day out doing nothing but feeding for weeks on end. Sorry but that's the way it is for lots of people. If you can readjust your expectations it will help you and your DH a lot.
With DD1 I spent a week concentrating on my supply when she was about 3-4 weeks old. Did feck all but sleep, feed and skin to skin. I didn't move to EBF but we were down to one bottle of formula per day in the evening when my supply clearly went through the floor.
You will have lots of milk first thing in the morning and after some rest. You can probably not bother with the top ups then. Rest and food are key to this.
I found it helped to do the occasional full feed of formula and to express instead, then do a full bf +top up at the next feed. You might need to anyway to get anything done and the occasional bottle of milk will give your newborn a nice contented sleep after which they'll be reenergised to attack your boobs.
If you want to ebf then you will need to feed on demand. Forget a schedule and keep feeding. In a few weeks you should start to see a baby getting more milk at each feed.
If it is at all reassuring. With DD2, I had to move entirely to bottle feeding her with EBM / formula as she simply wouldn't feed from me (low energy and liked getting it the easy way via a bottle). At 6 weeks when her weight came up to 9lbs+ she started to get the hang of it and now at 14 weeks is almost entirely ebf (two top ups 150ml per day). However, the little baggage is now refusing to take a bottle almost entirely. As I have now gone back to work part-time, it's creating it's own headache.
So, hope I haven't bored you to death.
Formula is not the end of the world, you can move to EBF but if you don't manage it, trust me when I tell you that your baby will be fine for it, and it is a lifesaver occasionally when they crash in a milk coma around 9pm when your boobs have had it for the day
Best of luck

Ooh - one other thing. I got two breast fittings with my medela swing. A standard size and a larger size, squishier latexy type finish. I have tiny boobs generally but I am getting much better expressing results this time around with the larger attachment. You can buy them from the website along with other parts.

Noblegiraffe - ooh how interesting... originally, I was saying no to your question about fluids, but then I remembered a thing sticking out of my hand... Have just asked DP and he said yes I was given fluids! Have just retrieved an article on it as well. Funnily enough, the HV was here earlier on and she was saying it was as if the baby was never the stated birthweight in the first place... The article states that birthweight should really be measured from 24 hours later when excess fluids have gone. We would have had an entirely different outcome if that were the case, and looks like you might have provided the missing piece of the jigsaw

Oscarwilde - thank you so much for sharing your experiences - very useful information. Baby was weighed this morning and is finally back to her 'original' birthweight, which is great news. It gives me confidence to start making changes to how she's fed as she has put on a great amount of weight in the last few days. I have started using the pump for shorter amounts of time, and switch after a few mins and my 'productivity' seems to be increasing. And you are right about the occasional formula feed being good - I am not sure I could get through the night on BF alone as she is rather persistent at various times in the night! Re the pump - I have a Medela Mini, but may look into getting the Swing as think I will be expressing longer term.

Hello Eagleray.
It sounds as though you are doing tremendously well. As the others have said, these are early days.

It sounds as though there have been a few things going on which have not helped the situation;

1. being told to feed every 4 hrs
2. possibly an inaccurate birthweight?

I agree with the others - just feed, feed, feed and feed some more. Forget the 4-hour thing. Babies love suckling, - for feeding and just as a general hobby I think! I don't think it would be too tiring for your DD?, esp not after 3 weeks of giving it a go. If nothing else, her being near you will be good for all the hormones to kick in to help milk production. I know you said that 3h feeds were tough going, so perhaps being advised to feed ++++ is not what you want to hear? In the long run, it will get your supply really well boosted and you'll be off FF before you know it.

Regarding expressing, I find that my supply is at its very best in the morning. If I need to express, I do it after DS's first "proper" feed of the day (as opposed to night). I wouldn't give FF in the morning at all, or any EBM. If you need to give her a bit, late afternoon/ early evening, just when you are maybe flagging a bit, is perhaps the better time to take the pressure of you, build your supplies.

From my sums, you gave your DD ~300ml of formula? I know it sounds like a heck of a lot of milk for you to just "produce" all of a sudden if you were to cut out the FF. However, I would have confidence in yourself to bridge the gap. Also, I think that the amount that a BF baby will take out a bottle is unreal. My DS is quite a sucky wee boy I think. I went out one night with my husband and his folks looked after him. I had a lot of EBM in the freezer and has fed DS before going out. In the course of 3h, he had been given 380ml. I kid you not. I nearly cried (having anticipated the supplies I had built up lasting a little longer...). I reckon though that he just enjoys sucking, and so every time he sucked a bottle dry, Granny got him another one. [not complaining - got a night out]. My point is....your DD has got good at sucking after 3 weeks and the amount she takes out a bottle might be more than she would be happy with if you were BF her.

The birthweight thing sounds like a lot of pressure on you [pressure and stress not good for supply]. I have some experience of this.

My DS was born at 34weeks, weighing 2.6kg. He was tube fed for about a week (FF and EBM), and I expressed, trying to feed him myself with the tube hanging out his mouth (latch pretty woeful as you'd imagine). Anyhow, he did get to grips with BF with time. However, he did lose probably >10% of his birthweight. When I got him home, by that time he was EBF, and the HV was pretty scary about his weight and that he was on about the 2nd centile("oh no, big boy, that's not good enough", type comments after weighing him). I was genuinely not concerned at all about his rate of growth - at the end of the day, the 2nd centile is still normal. He was happy. He was making wet and dirty nappies. He was feeding away.

HV and MW are well meaning, but alarmist types, sometimes I think. I really had to reassure them that I was very happy with his progress and that I didn't have concerns. I think they backed off because they knew I was a doctor, so didn't pressure me to supplement with FF or question me (too) much. But, I did feel I had to stick up for myself, and my wee boy and the plan for him to be EBF.

Getting up to express in the middle of the night when DS was in hospital was a PITA, sterilising things, freezing milk, etc etc. I can only imagine that making up FF is a massive PITA too, compared to the relative ease of just popping a baby on the boob. Hats off to you for persevering. Getting some personal advice is hopefully going to be helpful, but I would just like to encourage you, and I do really believe that when you have confidence in yourself to BF your baby, this will help you relax, help milk to come in, and stop you from asking yourself the awful is-my-baby-getting-enough question.

(Incidentally, even though I didn't every really have issues with my supply - I had to be expressing >750ml/24h before they'd let me take DS home..., if I wasn't eating well, or trying to do housework, or basically not looking after myself, or too tired, I found my supply wasn't so good. You sometimes really do need to put yourself first!).

Prob far too long and waffly. Hope if helps a bit though.

Hi CremeDeCassis - thanks for posting and sorry to take so long to write - things have been a bit hectic here!

I think feed, feed, feed is definitely the right way to go - have to admit to not being so good at that as we are a bit entrenched in our 4 hour routine, but she was very unsettled yesterday and had a few extra feeds because of that. This week I'm going to make a concerted effort to cut the FF down a bit. Also, we're hoping to go on holiday in a couple of months' time, and can't bear the thought of faffing with bottes at every feed so got some extra motivation now!

That's interesting comparing how much a baby takes from a bottle vs how much they will take from BF - thankfully (I think!) I am in the habit of recording all her feeds, including volume of FF so will probably cut down gradually.

at being able to express 750ml/24h! I am still expressing laughable amounts, but it seems to be increasing gradually, and I find that a few 5 minute stints at the pump throughout the day is enough to amass sufficient milk for one feed.

Well done on sticking up for yourself and your DS, and thanks again for posting!