Cutting down the 'top ups'

[pinkpip100]

Apologies in advance, this may be long and rambling. dd (dc4) is 4 weeks old. She was born at 36+4 weeks weighing a teeny 4.5lbs and has downs syndrome. She was in scbu and had bottles from the start. I expressed regularly from the start and by day 3 she was on just ebm. I carried on putting her to the breast before each feed even though she was very sleepy and rarely latched on or sucked For more than a few minutes. Since we've been home I've been expressing 6 times a day and she's been having 50-60 ml ebm every 3 hrs (4 hourly at night). The milk I express each day is at least double her intake at the moment but as my aim has been to eventually breastfeed her I've been really focused on keeping my supply up. Anyway, over the last few days she seems to have got the hang of breastfeeding (with the help of nipple shields) and this morning I decided to try cutting down the ebm top ups and the expressing to maybe 2-3 times a day and the rest of the time feed her on demand. I can hear her swallowing when she feeds and she'll stay on and awake for 40 mins or so (every 2-3 hrs). but, by 5pm today my breasts felt like they were going to explode and when I expressed after an hour long feed I got 100ml from each breast, which is more than usual. Does this mean she is actually getting very little from me, despite such long feeds? I really want to breastfeed her and feel like I need to take a leap of faith, but am worried that she won't get enough milk if we cut out the bottles.

Sorry again for such a lengthy post (and any mistakes in it). Any advice greatly appreciated!

Well done for persevering with the bf and it sounds as though your hard work is starting to pay off. Have you spoken with a bf consultant? It's worth going along to a local support group as they can help make sure you are doing everything possible to ensure efficient feeding - some do home visits as well if that's easier for you.

I would start by taking cues from your baby: does she seem satisfied when she comes off the breast, or is she crying out for more food? Try waiting a bit before giving the bottle and, if she does take it, watch carefully for signs of fullness rather than finishing the bottle. Keep track of wet nappies and if the number is the same as before then she's obviously getting enough. You may be able to reduce the amount of bottle over time until she doesn't need it at all. It could be that you just have an oversupply at the moment, especially if you've been pumping more than she needs, which could explain why you have milk left at the end of a feed. Good luck!

"The milk I express each day is at least double her intake at the moment but as my aim has been to eventually breastfeed her I've been really focused on keeping my supply up".
It does not mean that your baby is taking very little from you.
As you say you have been producing at least double the intake for your baby, so your breasts have been producing more than your baby needs. The more you stimulate your breasts the more you produce. It is important to let your baby feed as she wants. Before you put the baby to the breast you will need to hand express to soften the breast so that you can latch the baby on.
What is your baby's latch like? Baby have a wide gape, chin touching the breast, full cheeks and rhymnic sucking with pauses? It is harder to achieve a good latch with nipple shields, but it is crucial that you have a good latch so ensure efficient milk transfer.
Your baby having 6-8 wet nappies a day and at least two dirty nappies a day?

Thanks so much for your replies and really helpful advice. We are under HV care and dd is going to be weighed on Monday to see if increasing bf / reducing top ups over the weekend has affected her weight gain. The HV also glanced at her feeding today and felt happy that she was getting milk, though didn't really check her latch, so maybe I do need more advice from a bf consultant. I"ll be keeping a close eye on nappies too and watching for any signs of dehydration.
I know nipple shields aren't ideal but they really seem to make a difference to dd's ability to latch and suck. It does make it harder for me to recognise whether she is latched properly though and I do worry that she is not getting a big enough mouthful of breast as she still has a very little mouth and doesn't always open it wide enough. The other signs nattynoodle mentions are all there though, which is why I get the feeling that her feeding is turning a corner. Its so hard not to second guess myself though. Maybe dropping one bottle at a time is the best approach in these early days...