Help!!!! How do I know she is getting milk?

[CarmenH]

I would be really grateful for anyone's help even if my questions seem really stupid!

I am trying to establish breastfeeding for my dd who is 4weeks old but was born at 32+6 weeks and just came home from SCBU on Sunday. When she was in hospital I expressed milk which she was given via a nasogastric feeding tube as well as formula as I couldn't express as much as she needed. Now that we are home we are on a home tube feeding programme where she has attempts at breastfeeing then I top her up according to how long between feeds and how long she has breast fed for. The community nurse saw her feed on Monday and said that it looked fine. I feel that most of the time she has a good latch (looks like descriptions I have read and pics I've seen) and she can suck really vigourously causing the shape of my nipples to change as if she has managed to draw it up to the roof of her mouth.

My worry is that despite everything that I have said I'm unconvinced that she is actualy managing to get any milk out. I had thought that if she was feeding successfully then her mouth would look milky and milk would clearly be coming from my nipples once she has stopped feeding or I break her suck but this isn't happening. She also looks hungry despite sucking for 20 min this evening.

Sorry if post a bit long but wanted to get all the info in.
Any ideas or advice would be welcomed! Thankyou.

carmen - I dont have any advice but just wanted to wish you and your baby well.I am full of admiration for you for expressing for 4 weeks!!!!. i find expressing a real pain! You will find it so much easier when you get Bf established.

Hopefully some of the MN experts on Bf will be along soon

Carmen,congratulations and great that you managed to feed her your own milk over what must have been a very scary time.

It sounds like you need specialist help form a lactation consultant (is your community nurse qualified,or is she just an enthusiastic amateur?)

As long as she is pooing and weeing,things should be fine.

For what it's worth,I have never seen milk come out of my own boobs (unless I am expressing) and my babies' mouths were never milky.

Have you had contact with the La Leche League or the Association of Breastfeeding Mothers' helpline??

0870 401 7711

I don't recognize your name so you may not know this,but Mears and Tiktok are our resident b/feeding experts and hopefully will see your post and offer more specialised advice.

Ah,have just noticed that you were using formula too.
It may prove to be more of a challenge to get exclusive b/feeding going again (but by no means impossible)

The golden rule is that the more you feed,the more milk you will produce,so obviously using formula reduces demand on the breasts which means less milk which often means more formula and so on.....

I imagine you will need specialist help in reestablishing exclusive b/feeding.

Thanks Kristina and Moonog. It's reassuring that you never saw milky mouth and milk coming from breasts Moondog. Think I will ring La Leche tomorrow. Hope mears or tiktok can give some advice too.

Carmen I don't have experience with bfeeding after tube but just wanted to say that when my babies feed when little there is often no milk in their mouths and never any on my nipples. The only time I leak is a few drops at night from the boob not being 'used' but this is later than 4 weeks.
When she finishes feeding and you squeeze your nipple does milk come out?
To me it sounds like you just need to keep persevering as you will still have to get your supply established. Remember this takes about six weeks usually and that's without expressing at first - your baby will be much better at stimulating supply than any pump.
Your latch sounds good and her suck seems strong - reckon you're doing fine .

Crossed posts but good idea to talk to a counsellor.

hi carmenH it sounds like she is doing just fine. if she wasnt getting enough milk from the breast think she would be more fretful.my dd never had milky mouth but looked almost 'drunk' following a good feed, do bear in mind how young she is yet and at her age 20 mins is a good feed. i remember you saying in an earlier thread that you felt one breast was slower than the other, have you managed to build up supply?
if she seems sleepy and contented following a feed, and you are getting around 8/10 wet nappies a day then everything sounds fine.
BIG PAT ON THE BACK FOR DOING A BRILL JOB.

Thanks Gracesmum. I am now trying to not top her up at all but just keep putting her to the breast. I definitely have milk in both breasts but do get a better let down on one side. Will just keep trying! Hope she has gained weight on Friday,

PS Gracesmum, looked at the time of your post! Middle of the night mumsnetter!

Hi Carmen...you are doing so well. It's hard to stay confident in the whole process of bf when you have had a pre-term birth and a spell in SCBU. For some reason, you are looking for the wrong signs of having milk! Loads of babies don't have a milky mouth and loads of mothers don't spurt milk if the baby isn't sucking. If a baby 'looks hungry' after however many minutes, just feed her again :) There is no rule to say babies must stay on the breast for no more than/no less than a certain time; pre-term babies (which she still is, at 37 weeks) may not feed brilliantly direct at the breast, and if she is happy to continue feeding after 20 mins, then it would normally be ok to do so (I say 'normally' because very new, very tiny pre-terms may be better off being tube fed as they don't expend energy that way, but I am assuming your baby has got beyond that stage and is ok to feed for as long as she wants to).

Her intake of milk will correlate to the amount of formula she has and it can be a delicate balancing act giving her the formula she needs without it impacting on her desire to suck from the breast, and therefore stimulate you to make more milk. It would be a good idea to discuss continued expressing with your carers, just for the present, in fact.

Her weight gain and her poos and wees will give you an indication of how much she is getting, but this won't allow you to work out what she is getting from breastmilk and what she is getting from formula.

Good luck.

Thankyou tiktok. That's really reassuring. I have just given her a tube topup (before I read your post) as I was worried that she hadn't got any breastmilk all morning as she just looked constantly hungry. Will give expressing another go its just difficult to organise myself to do it all! Esp as keep having to go back to hospital to get my c-section wound repacked and dressed as had ajor wound dehisence (sp?)prob. Will just keep putting to the breast as often as possible.

Hi Carmen - well done for keeping going! my ds was tube fed for a week after he lost loads of weight in the first week after birth - I managed to get him back onto the breast. Expressing every 3 hours to top up his formula bottles to start with (sometimes I only got 3ml at a go - which was disheartening). It took 6 weeks for me to get him fully back onto the breast and he still seemed hungry every evening after feeding for hours! Now we both love it! Keep going - you are doing great - you can definately do it!
PS. I also had acupuncture which I am sure helped to stimulate milk production :o

Carmen, I don't know what you mean by 'looking hungry'. If you mean she is still seeking the breast and would still suck/settle on it if offered, then I don't understand why you can't just put her on...have they told you not to feed for longer than a set time? This might be appropriate for a very tiny prem (I say 'might') but maybe this advice can change now she is out of the difficult patch.

I suppose what I mean is that she roots and looks like she wants to suck, then i put her to the breast and she sucks well for 10 min or more, then she stops and is just happy to lie there with my nipple in her mouth, not playing or messing anout but just looking quite content, as if she was satisfied. Then when I take her off the breast within a couple of minutes she starts to root etc again.

The advice that I have is to give make sure she gets fed at least every 4 hours. If she feeds for less than 5min then give her a full tube top up, if 5-10min then half topup, if more than 10min and looks satisfied then no topup. I just worry that even after 10min she doesn't look particularly satisfied IYKWIM.

I think that I'm starting to kind of project all of the stresses of the past few weeks onto this one issue which I'm sure isn't helping me. Thanks again for your advice.

Is there any reason you can't give her 10 minutes at the other breast rather than a tube top up? This whill have the double effect of her getting more breastmilk and you making more. Also, if she "looks hungry" fed her IMO - again, will increase yoursupply and get more milk into her.

Congratulations on getting this far though :)

"looking quite content, as if she was satisfied" aaahhhh.

If she roots again in a couple of minutes, feed her again. You can't over breastfeed her.

I have to say, Carmen, that the advice you have been given is absolutely bizarre...very, very few babies of this age 'look satisfied' after 10 minutes. This is really not long enough for most young babies to get their act together - they may very well stop and start several times within a feed, too.

I agree with Soup - can you simply breastfeed her on the other breast?

Just to clarify - can you ask the people you're in touch with re. the feeding again for a clearer explanation of what they are telling you and why? There may be reasons that aren't apparent, and after all, they're the ones who are seeing you and treating you. You can ask them if it would be ok simply to continue the breastfeed after 10 mins - I can't think why it would not be now. A tiny, weeny baby might need to be timed in this way, to conserve energy, but your baby is beyond that stage, from what you say. Maybe they are just not updating their advice to match the needs of a 37-weeker....

i am a night worker darling, this is how i spend my break time!
you are doing a brilliant job,i hope you believe us all when we say that, all mums that have breastfed, particularly a first child can apprciate how mindblowing it all is.

carmen - I should say straight off that I have NO experience of prem babies, just of feeding two normal ( big) birth weight boys.

My youngest is nearly 6 months old and a good weight ( guesstimate 8kg) and he woudl never be full after 10 mins!! Unless he just wanted a wee drink or some comfort, not a proper feed. But he is a bit of a snacker. Also he rarely goes more than 4 hours between feeds. When he was newborn he woudl feed for MUCH longer and MUCH more often than your baby.In the early weeks I swear i did nothing all day but BF

Tiktok - I am confused. I understand that a really small sick baby might be too weak to Bf for long. But why does a bigger healthy baby need tube top ups rather than BF more???

Kristina - the baby is still only 37 weeks, so still technically prem. There may well be a case for Carmen to ask about taking the baby off the tube feeds and the top ups, as I say, but it should only be done with the appro. of the medical people.

I can't really see why she should only feed for 10min TBH as she is nearly 2kg now (BW1.43kg).

I've been trying to just let her feed as often as she wants although last night after 2 and half hours of constant feeding I did resort to giving her a tube topup as I just felt my confidence in what was happening go completely. So far today (since about 8am) she has fed about 5 or 6 times, just finished a 20 min feed 15 min ago. I think that no one prepared me for it being normal for her to feed really frequently/almost constantly.

Her community nurse is coming out to visit tomorrow so will chat to her then about feeding plan. Think that til then I will just try to let her feed as she wants and try to only give tubes if she only feeds for a few min. Hope that she has gained weight!

Thanks again for your help and concern. It's really good to be able to "chat" about these worries to people who have been there and know what I'm going on about. I'm a first time mum and despite being nearly 28 none of my close friends have babies yet (though one due in 2weeks) so can't help me on these issues.

Just another question, when I take her off the breast my nipples are changed in shape but they are really white in the middle and dark at the edges and I have just noticed tiny tiny little dark red specks at the edges, like miniscule blood drops under the surface and they are starting to get a bit sore. Areolae look normal, ths is just the nipple I'm on about. Surely this can't be right even though her latch looks ok? Sorry if TMI

Well community nurse has visited and dd hasn't gained any weight since Monday . I last used the tube to top her her overnight on Wednesday night and have just let her demand breastfeed since then. The nasogastric tube fell out anyway last night. The plan now is to let her demand breastfeed til Monday without the tube, so long as she feeds at least 3hourly, and then weigh her again. Let's hope she has gained by then.

Well she hasn't lost any!!
Keep at it carmen.
Have faith in yourself and your body.