Am I punishing my dd for my EBF ambitions?

[Hopefully]

I posted last week about my low supply issues. Having seen a BFC it seems inevitable that she will be topped up at some stage, but I had been determined to get her to 6 weeks exclusively, despite v slow weight gain (currently 4.5 weeks).

However, she's only pooing once a week (disclaimer: I know this isn't indicative of low supply all alone, but we are confident I have a genuine low supply issue) and she is having about 48 hours of misery - straining, screaming, lots of wind etc - before each poo, and the poo is v thick when it does come out - far thicker than toothpaste, but not solid. I am wondering whether having more volume going in might help keep everything moving through and make her less uncomfortable, as well as resolving the lack of weight gain more quickly.

I just can't decide if the benefits of EBF for another couple of weeks outweigh the benefits of being able to fill her up, keep her pooing and give her enough calories to grow . Help me with my crisis of confidence!

If you know you are not producing enough and your attempts so far to increase supply haven't worked then in my opinion you need to be supplementing. She needs the extra calories and you will still be breastfeeding alongside so she will still be getting benefits from that.

I don't understand, formula is not inherently harmful per se, so if you are continuing to provide the same amount of breast milk, and merely topping up with formula rather than having her go hungry, surely that can only be a good thing?

are you on medication for low supply? I know it is available.

I'm taking fenugreek in enormous quantities, and have tried regular pumping etc before. The only thing left to try is domperidone, but I am terrified of taking it as the times I have managed to (slightly) increase my supply by pumping I have got mastitis - have had it six times over two previous DCs .

I think I would be quicker to top up if she were really miserable, but aside from the pooing she is quite contented, just feeds ALL THE TIME and still doesn't gain (slipped from just below 50th percentile to below the 2nd in under a month).

Would you prefer to top her up with expressed milk, if that's a possibility? I think some mums just take a bit longer to get their supply fully established than others, and although obviously formula is not going to help your supply, is it possible that giving her the odd bottle would give you a breather and allow you to relax a wee bit, and maybe that would help you both with feeding?

Just out of interest, why is 6 weeks your goal? I remember mine being 12 weeks just because that was Christmas day :o ended up mix feeding for a couple of weeks then going back to exclusive bfing .

Also worth remembering that mix feeding does not need to be a permanent state of affairs - you can use it as a crutch when you need it. Then go back to exclusive feeding once you feel you are able to.

Best of luck :)

Honestly? I have no idea why EBF is valued higher than feeding your child an appropriate amount of milk to keep them healthy.

I would continue to BF, keep pumping but also supplement.

kveta I think I have in my head something I read about a chunk of the benefits of EBF occurring in the first six weeks. No idea which particular benefits they were but it's obviously stuck in my head!

I ended up topping up both DC1 and 2, but from 12 weeks. They were both born at higher weights, so the panic at lack of weight gain didn't start till later!

I can't top up with expressed milk as I can't express enough, and get mastitis more or less every time I pump.

Hi OP. I wanted to offer my experiences and advice .
DO is 7 weeks and has feeding issues so is tube fed. so slightly different but I'm determined to keep her on BM.
In the beginning I had stress related supply issues and worrying just made it worse. I am taking Domperidone, I thought about fenugreek but wanted to go for a more assured result. It's fine. I'm on 2 tablets 3 times a day and I haven't noticed any kind of adverse effects. For the first couple of weeks supply was still quite shaky but there was a definite improvement.
The other thing I've done, is pump, pump, pump. I know it's different for me as did isn't feeding herself so I need to express, but literally hours a day. I've mastered the art of napping in the armchair with the pump attached to avoid the boredom!

I have a Tommee Tippee Closer to Nature pump and it is VERY BAD! I've used it for a short time twice and both time ended up with major blockages in both breasts. its taken serious dedication to clear them without medication.
My advice would be, firstly, BF DD then top her up with formula in a bottle. Once she's done, pump. If you can get an electric one, great, but try any different pump you can lay your hands on. My local hospital has a BT support line who will lend and I've seen several for sale on local FB selling pages.
Then settle down and just keep pumping. Carrying on after the milk stops coming out for a bit will stimulate supply.
At my expressing everything DD needs worst, I was doing it for 8 hours a day in hour or two bursts.
It's payed dividends because where I was topping her feeds up with formula, I'm now down to 3 or 4 times a day, 1/2 to 1 hour at a time, and I can get 150 or so mls from each side 3 or 4 times a day and have enough for her and extra for the freezer.
A month ago I was in tears that I was drying up. Today we're drowning in it!
Once you've got supply going, you can go back to EBF.

Could you try a different pump? I used the Philips avent manual one and had no problems. Could you perhaps give a good squeeze with your hands too, to keep mastitis at bay?

Saggy that is amazing dedication, well done! Epic pumping.

In an ideal world I might be tempted to try pumping after feeds, even after the mastitis hell of last time, but TBH with two older DCs I would have to pump mainly in the night as I physically don't have enough hours in the day to do it in between DDs feeds at the moment (pretty much the only times during the day she isn't latched on are during school runs!), and with DD currently feeding every 90 mins-2 hourly at night, I don't think I have it in me to pump as well.

Have tried a manual pump (no idea which one) and a medela swing, and hand expressing. The only one that is remotely effective for me is hand expressing, and by effective I mean I might get 3/4oz on each side after a full session of expressing.

I saw your post last week and it really struck a chord with me. I am 36+ weeks with DC3 at the moment and have struggled to feed both DD1 and DD2 with similar issues to you- it seems I am another with genuine low supply issues. I am dreading the newborn weighings and am trying to formulate a plan now before DC3 arrives, but there's really no way of knowing what's going to happen, is there?!

With DD1, I was a bit clueless and after lots of weight loss and top ups, ended up mix feeding a bit half-heartedly for a few weeks, then formula feeding. There were various factors that contributed to our issues, but low supply never really crossed my mind at the time.

With DD2, I was determined to get breastfeeding going well and once it became apparent that there were issues again, I so wanted to get to 6 weeks without supplementing. I took domperidone + many other galactagogues, tried pumping (no output) and feeding all the time- and we did make it, but with completely static weight gain. Fortunately, she was massive to start with, so I had little pressure to top up, and was able to mix feed after thatl for a long time.

1.5 weeks isn't long to go if it means a lot to you to reach that 6 week goal (I know it did for me), on the other hand, you probably will supplement at some point, so how do you feel about when that does happen? Do you have a plan for introducing more volume to her?

I hope this helps, you are doing a great job feeding your DD, especially in the light of tough circumstances and the effort and time it is taking. You've gotten her to this point! Well done :)

My daughter wouldn't latch on and I expressed what I could for six weeks feeding her with formula at most feeds by the end. Then I switched fully to formula. I do have some understanding of the desire to give BM when bf isn't working out. And I'm sorry but is all of this really worth it?

The benefits of BM over formula are in many instances marginal. Give yourself a break and mix feed her, especially if she's dropped that many centiles and is in discomfort.

3-4 oz is a good amount. that's one feed for dd. keep at it. If you can't pump more often I would try domperidone.

could you pump whilst dd is feeding. do the other side?

Based on my experience I think she means 3 quarters of an ounce, not 3-4!
I understand op, I'm desperate to succeed at breast feeding but finding if so difficult, we are getting gains, just not big ones and it's taken me 3 days to pump an ounce and a half so topping up with expressed is only an ad hoc option for me.

I've given 60mls of formula tonight and he promptly spent a while being a docile lovely smiley little lamb with DH (all I get is pepperami style rooting for boob) then went to sleep for 4hours, when I haven't managed to get him to stay down for more than 30mins since 8pm last night!

Tough decisions to be made, just wanted to let you know I feel your pain

I understand that you are vulnerable and that this is always a sensitive time after the birth of a baby. But when I was in a similar position it really helped me to separate my different motivations: am I leaning towards this or that alternative approach to feeding for the better benefit of the baby or me?

Only you know how far you are prepared to push things, but it was really helpful for me to go through this list, and allow myself to believe what I always knew deep down (that logically and sensibly, formula is more than fine) but hadn't wanted to allow myself to believe in case I became too ready to 'cave'. For me, it put into stark relief what exactly was being sacrificed for which benefits.

I am no martyr, I turned out to be quite ready to put myself first to a fair degree (meaning, save myself and DH the emotional anguish I would undoubtedly have created by "failing" to EBF) and I ultimately ended up bf-ing for 6 months, on- and off- exclusively. I was and remain happy with the decision I made.

I would top her up with formula starting right now, as she is in pain and failing to gain weight. If this resolves her health issues, then you can continue with FF and just BF as much as you can. I see why pumping at all hours isn't really a solution for you. Perhaps, though, your supply will slowly improve and you can return to EBF in time. But if not, then I think the decision that makes your DD happy & healthy may be formula.

You should also think about what makes you happy & healthy. Your DD is only this small for such a short and amazing time - don't let stress over this issue overshadow all else.

I would top her up as how can she develop normally if starving?

Another vote for topping her up. To be honest the fact your older DC were bigger to start with doesn't really matter - if they were failing to gain any weight that means they couldn't develop appropriately - to me the most worrying thing about that is the rate at which the brain is supposed to develop in the early weeks. Big babies are supposed to stay big, not get proportionally smaller and drop through the centiles because they aren't fed properly.

I personally have no idea why people would rather let their baby be hungry than give formula. Well I do, but I think that hormones and guilt totally override any common sense and reality check. Please see formula for what it is - we are so lucky to have a back up when things go wrong with breastfeeding and be in a developed country where we can safely feed our babies an alternative where necessary. Don't forget that your baby is hungry - that makes giving formula necessary, it is not a choice.

Btw is your baby properly hydrated? Please don't take any risks with that.

Hi - I exclusively expressed for DS (16 months) and currently doing the same for DD (14 weeks)

I'm not an expert but just wanted to pass on some thoughts in case they helped. I'm doing 5 15 minute pumps a day and getting around 1.5 litres. I know I'm very lucky re supply but I honestly believe a large part of it is having a very good double electric pump - ameda lactaline. Plus a double expressing bra. Could you review your pump and see if that helps with supply?

That said, the benefits of breast milk will be outweighed by weight/development issues if DD isn't getting enough milk. I do sympathise though - with DS, I stopped expressing at 22 weeks as I was unexpectedly pregnant with DD and found the expressing and puking too draining! This time round, I want to get to 26 weeks but then I'm thinking I might keep two pumps a day....

It's good to read stories on here of people who mixed fed and then went back to breast feeding exclusively

I think you need to top up. You have already had advice from a Bf counsellor and taken action to increase your supply, and your DD is not getting enough milk to grow normally. You are planning to mix feed in the longer term, so 6 weeks is a completely arbitrary point at which you start topping up. I have my Dad's advice (he's a consultant paed and very pro BF) ringing in my ears "the first rule of infant feeding is you have to ensure the infant is fed"
How about using a tube supplementer so she gets her additional calories at the breast rather than from a bottle, thus sidestepping nipple confusion and meaning she is still stimulating your supply at the same time?
I do appreciate how emotionally charged this decision is, and you are obviously highly motivated to continue breastfeeding. I think littlefoot had it right - you continue to give her the benefits of the breastmilk you are producing, and keep working at improving supply, but in the meantime she also gets enough calories to grow and develop normally.

I really think you have to ensure she's thriving and gaining weight appropriately. Top up her feeds.

Thank you for all the advice and ideas. It's good (although depressing too, as it only reiterates what I suspect) that the vote is an almost unanimous top up, whether that's with pumped milk or formula. Wise words about motivation/having to see formula as evil to stay motivated as BF.

She has plenty of wet nappies, so am not worried about hydration.

Weigh in is tomorrow, so assuming weight gain has not miraculously improved I will start to too her up. I'll see if I can borrow a double pump from somewhere and keep at least the odd top up as BM for a little while to ensure my supply doesn't drop if she feeds a bit less when first topped up - her tummy won't know what's hit it!

If you top her up you may also get more rest and develop more milk that way. I had to top both mine up, one from just 2 weeks.

I went on to BF them for 9 months with a couple of top ups a day. It just wasn't E. We were all much happier.

you don't need to see formula as "evil" to stay motivated . you need to keep a level head and be sensible. Formula is a perfectly good alternative or supplement to bm.
I agree that she needs help now. Definitely top her up.