Making a feeding plan rather than a birth plan next time round? Or private lactation consultant?

[dodi1978]

I have a 24 week old DS... but my thoughts are already moving on to a possible No2 (which probably won't happen until a few years time).

Anyway, the whole story - DS was born 4 weeks prematurely, but with a good weight (6lb 6oz). However, over the first week he dropped down to 5lb 8oz. Having been told thus far that he was mildly jaundiced the midwife visiting us on day 7 finally saw how poorly he was and sent us back into hospital for jaundice treatment. Went under blue lights, had tongue tie snapped and had formula top us. In that first week, he ha been bf only.

After that, jaundice was knocked on its head and he gained weight quickly (now on the 75th centile). However, we had to go on a strict feeding regime of breast, formula and expressing. And that every three hours. My DH and I had tearful tired fights every night because he wanted me to go on ff only and I wanted to continue bf. In retrospect, I was obviously still quite hormonal, and his opinions were very much driven by the fact the he bonded way more with the little man that he ever thought he would.

Anyway, we continued with that regime for about 1 1/2 weeks, after which we were both at the end of our tether - it was a struggle to get DS to latch properly, so every feeding cycle took 1 1/2 hours, after which I had 1 1/2 rest and then had to repeat everything. This would have been unsustainable once DH went back to work, so I made a decision that was tough at the time, but wise in retrospect: I bf only twice a day and otherwise ff. Funnily enough, it was now much easier to get a good latch -- I guess I was less tired, and we 'didn't have to' any more. We managed to do this until he was ten weeks old, then he 'went of the boob' and we ff only. By that time, I was ok with ff (I guess the hormones had died down a bit).

In retrospect, I really enjoyed the mixed feeding, and quite honestly, this is what I'd like to do again the next time round rather than doing exclusive bf. However, I really want to make sure I am well prepared to establish this feeding regime successfully in order to maybe last a bit longer than 10 weeks and to make it a bit more half / half rather than swinging it more towards the ff.

What would you suggest - try to find a sympathetic midwife who supports you to establish a mixed feeding regime from the start? Or hire a lactation consultant? My DH would like to give a bottle of formula per day from the very first day, but I am worried that would mean that my milk isn't coming in at all...

Any advice highly welcome!

By the way, what I meant by 'rather than a birth plan' is that I am rather relaxed about the birth as such. First time went well so I am hoping it will go rather well again the second time round, and my preferences can be summarized in one sentence (As little pain relief as possible but as much as necessary and a CS when things get sticky). I am much more anxious about what comes afterwards!

I think you will struggle. Not just to find someone who will help you do this (for some reason breastfeeding supporters who are supportive of mixed feeding tend to not have as good BF knowledge - MASSIVE generalisation, and no reason why it should be the case, but in my experience it is true.)

But also, I think that you will struggle to mixed feed that early and maintain BF alongside. Mixed feeding IS totally possible but you need to really and totally understand how BF supply works from the off and work with it rather than against it. It can end up more work than exclusive breastfeeding.

Firstly here are some links to read about how supply works:
kellymom.com/bf/got-milk/basics/milkproduction/
kellymom.com/bf/got-milk/basics/milkproduction-faq/
kellymom.com/bf/pumpingmoms/pumping/pumping_decrease/
www.analyticalarmadillo.co.uk/2010/07/foremilkhindmilk-and-lot-of-confusion.html

I would say to make it work you also need to approach with caution, and strongly consider not starting any bottles until after the 6 week growth spurt. After this point you could slowly introduce one bottle per day per week (e.g. once a day in week 7, twice a day in week 8) and really stick with the routine you have for bottles, breastfeeding on demand the rest of the time and making sure that any growth spurts or fussy periods, you feed extra breastmilk rather than upping the bottles. Basically, you make the breastfeeding the "main" way of feeding and have the bottles as a set extra. In theory, if you go slowly and keep to the same routine with the bottles, your supply should adjust around this and keep your milk going. It would be a good idea to re-read about the different stages of supply and production closer to the time as well as it's easy to panic and forget everything you have read when presented with a hungry baby.

Good luck! I hope that everything works out in the way you want it to.

Thanks for this post. I had similar problems but managed to breastfeed until 10 months. Breastfeed was the main source and then a bottle @ 11pm.

dodi, any HCP who understands about breastfeeding and how it works will be honour-bound to explain to you that mixed feeding from the very start is not a good way to establish breastfeeding....if they don't tell you this, and why, they are not doing their job properly.

The risk of intro'ing formula from the start is that bf never gets going well, and you end up fully formula feeding - which of course is not 'mixed' feeding.

Yes, it can be done, and sometimes mothers continue to breastfeed alongside bottles for as long as they want to. But the evidence is clear that the chances of doing so are low.

There is no reason for your DH to be giving a bottle from the start - why can't he wait a while? Why is he pushing this? You need to talk to him about it - not leave it until it's a subject of arguments.

If it's important to you that your baby has formula (and it would be helpful to know why you feel this way - I'm assuming this baby is likely to be term and without any of the difficulties your DS had at the start - because full bf has a lot going for it :) ) then waiting several weeks is worth exploring.

You can have a feeding plan which incorporates this.

But another option is just to see how things go :)

Interesting qu OP. I would love to be able to hire a breastfeeding professional to just come and sit in my house for a few days after this baby is born to help me. With DD I had huge amounts of conflicting advice, loads of manhandling, rubbish peer counselling and it ended up being a disaster. (DD never latched on.)

But I asked my midwife if such a person existed and she said no

You can hire people who come to your house each day - not sure why your midwife said they didn't exist?

The main choice is between maternity nurses and doulas.

The problem is they will vary in the amount of bf expertise they have.

Google these in your area and guage which of them seems to be up to date with breastfeeding knowledge.

The other option is a breastfeeding counsellor but they work voluntarily, in the main. You could ask if one would visit you often, and keep in touch by phone.

Lactation consultants usually do visits, rather than staying for hours - but you can always ask, and see what they would charge.

tiktok you were the sole voice of reason, info and help for me last time. What would I and others on these boards do without you?

Thanks all! I think my DH is just very anxious - after a blissful first week at home when we thought things are going well DS had to go back to hospital and his jaundice levels were sky high! That evening was really traumatic and initial treatment on the ward didn't work - in the middle of the night he had to be transferred to special care.

From then onwards, things quickly improved, but DH hasn't got much confidence in breastfeeding as a result of this, and he also has issues with what he considers the breastfeeding mafia (midwives, health visitors etc.).

I am willing to give it another try - looking back now, things were probably not going as well from the start as I thought it was. My milk only came in on day 4, DS never asked crazily for the boob as I hear they should be doing in the first couple of days etc. Plus, I was a bit overwhelmed by his early birth, I didn't really know what a good latch was etc. Having a bit of experience, I would know better now. This wasn't helped by the fact that in August, weigh ins were not offered as frequently as in term time - I would have been happy to go to one literally every day to as proof that bf is working and that DS is now gaining weight, but this wasn't an option... in the end, deciding to mixed feed was the best decision. It felt as if a cloud had lifted that day!

So what I'd a imagine a feeding plan to look like would be

• Review every day whether things are working well (weight, latch etc.). Thanks for the advice on a private doula etc., I would be happy to shell out for this.
• Decide beforehand how much weigh loss we'd be comfortable with. I know 10% are normal, but on day 5 DS had lost 12% and the midwife visiting didn't appear concerned - retrospectively, this probably should have been a warning sign.
• Decide in advance when we'd consider 'intervention' necessary.

This being said, I really don't want to bf only - for various reasons. However, I would like to do some bf. This time round, I successfully mixed fed for 10 weeks despite the early introduction of formula. I'd be happy with this again, but I'd be equally happy to do it for a bit longer.

Thanks everybody - first we need to make baby no 2 anyway!

I would be cautious about weighing every day. It's not actually helpful to obsess over weight, better to go on other signs such as the baby's alertness, number of wet and dirty nappies etc. No baby gains weight in a linear fashion and the up and down nature can be worrying. I expect the midwife was less worried about the 12% because with a small birth weight 12% is not that far off 10%. But perhaps it should have been more closely monitored because of his low birth weight.

Interestingly, I read a study about co-sleeping where babies who co-slept immediately from birth and were allowed free access to the breast didn't actually lose any weight at all. DS never lost weight and I had done this - I read the study when he was older but it really interested me.

I would really consider BF only for even a couple of weeks if you want to continue mixed feeding beyond 10 weeks. Then introduce bottle feeds slowly as I said above. This may be helpful to plan in advance as well.

You mention tongue tie in your first post - tongue tie causes real issues with feeding, and may well have contributed to the jaundice.

I'm sorry you had such a difficult start - it must be a lot for you and your DH to come to terms with and it's understandable that you want to do everything possible to avoid the experience.

I really recommend you read as much as you can about breastfeeding - how it works, supply and demand and establishing the early days as well as how to spot and deal with tongue and lip ties.

Whilst it's true that mix feeding is possible and can work for some mums, you do need to be aware that it can disrupt milk supply. Many babies also express a preference for breast or bottle. Some don't care, but by embarking on mix feeding, please be 100% sure that you would be happy to fully formula feed if your baby chooses that as his preference.

One of the most special ways for dads to bond with a new baby is loads of skin to skin. It's a very magical thing for a dad to be able to calm and comfort and bond with a newborn in this way.

Yep - tongue tie was only diagnosed by the 3rd midwife visiting in week 1 - the same midwife who sent us back to hospital. I was then told that the specialized midwife for snapping tongue tie was on leave, which meant that I spent the whole night (which was knackering and emotional anyway) researching private options and other maternity hospitals in the region on my mobile phone!

Next time round I will certainly read more about feeding / breastfeeding - all the reading was supposed to happen in the last four weeks... the four weeks that never happened...

Retrospectively, I also should have had more skin to skin in the first week, and daddy should have, too.

Oh well, lots of things went wrong that time round and I will revisit things when it comes to No 2! Many thanks for all you advice though!

By the way, one of the most random acts of kindness happened in the night when they took DS away from me to take to the special care unit. A teenage mum (17-ish) who had literally just come to the ward from giving birth (a difficult and long one at t hat) gave me a big hug when she heard me crying. Just what I needed, seasoned professional double her age!

And also bear in mind that some babies show a preference for the breast and reject bottles! But either of these scenarios are fairly rare enough to not worry too much about.

We learn so much after the event, that would be so useful to know when pregnant. Any mum who claims they wouldn't do anything different is a big fibber. Tongue tie is incredibly common, and really badly diagnosed. Our babies sometimes make it hard for us to be the mum we planned to be, but they help shape us into the parents we become.

If your local NCT has a Facebook page, you might find it helpful to ask there for local recommendations nearer the time - I know in my area there are some cranial osteopaths who have really helped local mums by spotting and treating tongue tie early. They also can help with other trauma a baby may have from birth, which can lead to stiffness and discomfort making it difficult to latch on.

You may also find it helpful to go to a local breastfeeding group (NCT, BfN, La Leche League) and to speak to one of their counsellors. They can be a welcome listening ear if you want to offload any feelings about your experience last time. They won't judge or criticise you, and they may give you some practical tips for next time around.

You did the best you could with the information and knowledge available to you. It sounds like you're a brilliant mum with a very supportive and hands on partner.

Good idea to go to speak to a counsellor now rather than at the time - I might investigate that!

Next time round I will ask every midwife, doctor or nurse I see to check for tongue tie! Three times over!

My DH was actually quite supportive and hands on, except for not wanting me to continue exclusive breastfeeding (and sometimes he could have chosen his words differently). He would benefit from talking to a guy about all this (deep distrust of midwives and health visitors, who he tends to see as part of the breastfeeding mafia). Any ideas on who he could speak to?

He is actually one of the reasons I would like to mix-feed ... makes him feel more involved. Plus, some of the girls in my NCT group who bf exclusively have babies that don't take a bottle at all. I really wouldn't like that and would accept if it swung the other way round, i.e. towards formula.

Thanks again for all the advice!

It must be so hard for dads - they suddenly have 2 people they feel an overwhelming urge to protect. They don't always say the right thing, but it's a man thing to try and fix a problem.

Breastfeeding counsellors would be able to speak with him too, if he would be willing to open up. They are trained to support the whole family, to listen and to provide information and evidence based facts.

My DH actually went to a breastfeeding session run by the breastfeeding counsellors DH. I have no idea what they talked about in that room, but whatever it was worked. He was incredibly supportive and when we hit tough times seemed to know what was going to happen before I did and guided me through. DH never felt like he missed out on bonding by not feeding as there are so many ways he can form his own bond. In fact, I often envy DH that DS just loves his dad with no interior motive! That said, DH has always been more pro breastfeeding than me. He's an odd one.

I was "blessed" with a baby who mostly fed beautifully, but did indeed hate the bottle. It was tough at times, but ultimately it's just 6 months, and looking back, I'm glad I didn't miss anything.

Ultimately do your research, and then do what feels right for you and your family, bearing in mind your baby may have ideas of its own too. I don't believe every baby should be breastfed, but I believe every mother who wants to breastfeed should be given everything she needs, physically, emotionally and intellectually to enable her to do so.

You sound like a lovely mum, and your babies will turn out brilliantly, no matter how they are fed.

I'm a maternity nurse and most of my clients want to mix feed from early on. Their aim for mix feeding is usually six months or shorter and they've all achieved their aim. I always explain to them how bfing works especially supply and demand and also say that if bb seems to be making a preference for either breast or bottle then to concentrate on reversing this.

I always check latch. First two weeks demand feed. Some offer a bottle at one time of day usually around 6pmish if older children in house. I if mum is expressing then I get her too after first two feeds of the morning and milk is used later in the day. This is what rhythm of the day most mums fall into.
First feed of day feed one side, express other side, feed from expressed side if needed.
Second feed of the day alternative from first feed
Third feed both sides if needed
Fourth feed both sides if needed
Fifth feed split usually because of older children's meals or bath times
Top uo feed of expressed milk or formula and then mum expresses two -three hours after last feed
Dream feed either bf, express or formula
Middle of night feeds usually bf but can be expressed although usually I say to client its good idea to express during night for at least six weeks.

I've numbered feeds and this is probably what a three month old would be doing. In between feeding is mostly bfing during day and night with expressing and a couple of bottles of usually expressed milk but sometimes formula.

I always support a clients decision on feeding method whether breast, expressing or formula especially as I've worked for some French and American mums who've gone back to work at three months. With mixed feeding some have been able to offer breast milk either from breast or bottle until a year, one even longer. Very dependant on each client.