An update to my breastfeeding woes - opinions on the 'plan' please

[mangofizz]

I posted a couple of weeks ago about the struggles I am having with my hardly weight gaining, non pooing newborn. Since then we have been bumbling along, another small gain of 80g last week, still 75g to get back to birth weight. As we are so close now it seems like everyone has taken the pressure off and the fact he isn't back to birth weight duffel doesn't seem to be an issue anymore. It's still an issue for me though as it means something is wrong somewhere, and being told 'just keep doing what you are doing' isn't cutting it for me.

I asked the infant feeding coordinator to refer me back to the lactation team. I spoke to someone yesterday and she thinks I may have a supply problem. (I'm surprised by this as I thought it was very rare) I think she is going down this road on the basis of:
Breasts never ever feel full, even first thing in the morning
No increase in cup size from pre pregnancy to now
Constant feeding that turns into frustrated chewing
Slow weight gain

She has recommended that until tues we do an alternate feeding plan where I do every other feed as formula in order to get baby gaining properly and I assume to give my boobs a chance to actually produce some milk in between feeds. I'm also going to be using a double pump from the hospital to see if that helps. I'm speaking to them again on tues with a view to increasing to 2 breastfeeds then one formula etc until we get back to exclusive feeding.

Has anyone heard of this approach before? Have I got the right end of the stick about what it's trying to achieve? It goes against everything I have learned about feeding before although if I'm right about the logic behind it it sounds sensible. Am interested to know what people think!

I'm not an expert but giving formula feeds is not how you deal with a supply issue. It will reduce supply. Your boobs do not need time to fill up between feeds, and the best way to increase supply is to feed lots.

Has someone observed a feed? Is baby definitely latching properly? Plenty of wet nappies? I would be asking someone to observe a feed to check everything looks ok for efficient milk transfer and also to check baby for tongue tie.

The fuller your boobs are, it signals to them to stop producing so much milk. The more you empty them, the more they supply

I am far from an expert - my DD is just 8 weeks. But I've spent long enough reading stuff here and elsewhere to know that introducing formula absolutely will not increase your supply or allow your boobs to fill up. If there's a need to put baby on formula because of the weight gain then that's another matter and it's not the end of the world. (I had to in the early days but she's been EBF now since 3 weeks.) But can't see how it would do anything for your supply.

Yes snoggle we are a long way down that road of having people observing feeds and the latch etc. a tongue tie didn't help initially but that been sorted now and we are still only getting small gains.

I understood the same as you re supply but I suppose it's balance between thd supply and getting baby to gain weight. I'm determined to succeed with breastfeeding but not at the expense of my baby, who needs to gain weight, and that has to be my priority for the short term. Breast is only best if they are getting enough of it!

I'm not enough of am expert to comment on the plan. But here's a question for you. Are you eating, drinking and resting enough? Especially the first two as the third is hard to come by with a new born.

What I was eating nearly doubled at the start: big breakfast/ large peice of cake/ substantial lunch with protein/ more afternoon cake / protein snack / dinner with carbs, veg and protein / milk and biscuits before bed. Is also have a snack of toast, fruit and drink full fat milk through the night. I'd dress veg and salad with good quality oils, and carried on the pregnancy multi vitimamins.

I was also drinking loads. More than the recommended 2-3 litres water a day. Nothing dehydrating (no caffeine or fizzy drinks). I had those rehydration sachets you usually have for stomach upset, I still drink one of those if I'd like to boost my supply.

Lots of my NCT stopped feeding early as ' they didn't have much milk' (v international group, none but me that committed to breast feeding) but when we met up I was shocked by how little they ate or drank. Lots went on diets early. Whereas I've lost weight (baby now 11 months, still breast feeding) despite shifting loads of food (if not quite the quantities above) and drinking plenty each day.

IMO the importance of eating and drinking plenty and well is not for good milk supply emphasised enough,,,, if I went a few hours without eating it drinking I really noticed the difference and so did my baby.

Good luck.

Probably not to be honest Dougal, I think I'm in a downward spiral of doom about it all and was actually quite relieved to be told to give formula rather than 'break' and do it myself. Will try and step up the eating and drinking today and see if I notice any difference.

Also I suppose the logic of more stimulation more production is right, but only if everything is in proper working order in the first place. Thinking about it I'm not sure whether this plan is actually designed to give me a bit of a break (had a bath and half an hour on my own yesterday for first time in ages) without really interfering with supply as baby gains weight and feeds increase again after only a few days. I don't know!

Introducing formula is likely to damage supply.

Glad to hear you've had help with latch. Has anyone looked at it since the tongue tie division? Has anyone talked to you about signs of a good latch? (E.g. Nipple shape at the end)

What else has been tried? Switch feeding? Breast compression? Domperidone?

Oh, and Dougal, sorry, but as long as a mum is eating when hungry and drinking when thirsty, what she eats and drinks is unlikely to affect supply. Women successfully breastfeed in v difficult circumstances, but as long as they are not (literally) starving or dehydrated, the baby will be fine.

Yes Notquitecockney, I am literally the thorn in the side of the infant feeding team, I have them out all the time and have been to the breastfeeding clinic this week too. Got another infant feeding person coming this morning.

Domperidone is the next step if this doesnt work.

mango what a battle :(

I think the plan can only be to give you a break. It can only have a negative effect on supply. Can you ask her the reasoning? I don't think it will be disastrous for supply as you are not doing it long term.

The eating, drinking and resting thing really does not have any effect on bf or breastmilk. We know this from research and from what we know of the physiology of bf. Dougal , if it has an effect, it is on the mother's well-being. It honestly does not impact directly on milk production.

It sounds like LC suspects breast hypolplasia. Have a read if this and see if it rings true.

[http://www.llli.org/llleaderweb/lv/lviss2-3-2009p4.html]

Did you have IVF or difficulty falling pregnant?

The first rule is feed the baby so although formula won't help with supply issues there does sound like a need for supplementing a baby not back at birth weight by now. That is what formula is for.

Supply can be further stimulated by pumping as well as feeding. Lots of small pumping sessions have been shown to have greater impact on milk supply than a few long pumps

Can you give top up by SNS? Find your local LLL leader and they'll be able to help either you source one or put you in touch with another mum. Lovely Canadian paediatrician Jack Newman is worth a Google

Good luck and be kind to yourself. It's a long journey. Get as much support as you need. {Hugs}

I can't see how that would work. Breast feeding works on supply and demand. If every other feed is formula then your supply will go down not up. If you want the baby to gain weight then introducing formula might help but it won't help your supply. I'm sure so done with more qualifications will come along soon to talk it through though.

Ignore my post I must have left your op open last night and only replied this morning. I'm very tired.

I agree that formula will not help your supply. If you do use formula, you either need to express at the same time or use a sns system in order to maintain supply.
I'm sure you know that Your breasts produce milk in response to stimuli such as your babies cry and their touch. Anxiety is probably working against you at the moment. Are you giving regular feeds with as much skin to skin contact as possible? Touch your baby as you feed and chat to her, you want to work at getting those love hormones flowing as they will help your supply.
Have you looked at the Kellymom website? It has loads of useful advice. Also check the tongue tie, they can reattach.

Have the LC team investigated reasons why you might not be making enough milk? Hypothroyid? which can turn up during or just after pregnancy. PCOS?
If there is an underlying issues with you that might require treatment and medication to increase supply. Maybe ask them to help you investigate those possible causes also.
It sounds like you are working really really hard. Hope you have lots of loving support around you.

Sorry you are having so much trouble op. Could you pay for a privately for a lactation consultant to help you? you can find your nearest one here I agree you need to get to the cause of the supply issue and they would probably be able to help identify what's going on.

I had lots of problems BFing and saw multiple HCP. DS had a TT which needed dividing three times in the end it I had to pay privately to get it sorted.

I'm wondering whether a supplemental nursing system with donor milk might help, as the baby would be latched on and stimulating your breast while getting a top-up at the same time. My friend used one - this is her blog www.maybediaries.com/ and she's a real advocate of them, so I'm sure she wouldn't mind if you got in touch to ask her to point you to some good info on them (tell her Ann sent you!)

Oh Mango you poor thing. I can't remember if you posted on my thread last week, but I have a similar situation a few weeks down the line. The feeding team is utterly perplexed by me too, as genuine low supply is actually not very common!

I seem to be having a surprising amount of success with fenugreek - managed a whopping 130g weight gain last week, which is more than we have in any week yet (DD is 5 weeks old). I am holding off formula for one more week to see what next week's weight gain, as the 130g was just enough to keep us out of slipping-through-two-percentile-lines territory.

We used a supplemental nursing system to get from top-ups at every feed to two a day (before we started on solids a few months ago). It made all the difference.

Just to update this as I really appreciate all of your responses. I spoke to the LC again and she said it is partly to give me a bit of a break and make the feeds I do do potentially more successful, partly so the pumping can really give me a fighting chance to produce more and as chocolate says, to feed the baby (which is my main concern).

Whoever it was who suggested the LC might suspect low supply I think you are right, although from that list on the link posted I only have the no changes to breasts at all during pregnancy and since birth and absolutely enormous areola, an adult couldnt get a full mouthful of them!

So I started on Thurs night (after having given one formula top up of 50mls per day from Tues) and weighed him yesterday morn and he had gained 9oz since Tues which takes him about 200g over his birthweight. So im really pleased on that front but at the same time im also really upset that I had to resort to formula to get that to happen. I feel a bit like its artificial weight gain if that makes sense?!

Its been going ok so far, im pumping about 6 times a day with the hospital double pump but still only getting a total of about 2-3oz per day which to be honest is totally soul destroying, although its more than I was getting on the single one.

Yesterday my boobs were feeling fuller (I felt) but today they are feeling the same and both breastfeeds Ive done so far today have been unsatisfying for baby, they've been long, chewy and resulted in a formula top up. Hoping bedtime one goes better, am concentrating on making sure we are both committed to having good feeds when he is on the breast, i know its imperative to make sure the latch is always as good as it can be rather than 'good enough'. He isnt always satisfied by formula either, he wants comfort from me which is so sad as im a bit frightened to let him on after having a full formula feed in case it results in a breast feed. The plan has taken what little joy there was in feeding away, which is sad, although im focusing on it being short term.

Im speaking to the LC again on Tues where hopefully we will change from alternate formula to 2 breast and one formula. Im not sure its going to help that much though really but im still willing to try whatever they want at this point.

Thanks again for all of your support, it does mean a lot, its a dark time not being able to breastfeed properly!

Can understand your mixed feelings mango.

But don't understand why you feel worried to let him have the comfort of the breast after a formula feed??

Hey I'm in similar situation. My 'feeding plan' for baby is now feed from me then give 3oz formula top up and is having this 6-8 times a day as feeding on demand. She is 8weeks now so getting most of her food from the formula however I did stop bf as health visitor wanted to know how much she took in in 24 hours and I never manage to express much so she just had formula and she was instantly constipated and uncomfortable so I know the breast milk is helping. Had all the same feelings of failure etc but looking at it now that she is gaining weight and still getting the goodness of breast milk even if it isn't all she is having.

Also I seem to find my let down response is much less for about 48 hours after having any alcohol (even just using it in cooking!) ... This may be me over analysing however I am going to stop alcohol totally and see if that helps.Also the aim is to reduce the formula to 2oz top ups the end of this week as long as she still gaining well and continue like that until she is off formula. Although realistically I am not expecting to reach that point and will just be happy if she continues to gain weight... Altho not having the hassle of the bottles would be good.

Hi,
I am mixed feeding too for different reasons. It is a pain to have to do both but as Helen says, at least you feel like they are getting some breast milk and are satisfied babies. Mine is 5 weeks and I have a 23 month old so it's a struggle and you will see that from the threads I have posted. But, I do feel proud I have managed to get this far. I had to stop fenugreek as it made her really unsettled and windy but it really worked for me although you might want to read up about it before taking it as there are some people for and against. I don't think it is medically proven so all evidence is anecdotal.

Hi mango. 9oz is 9oz and I can understand your feelings but the weight gain is good and not at all artificial! I don't really understand why you can't bf to comfort your baby?? I get the focus on having good bf but I was told over and over that the only way to really increase supply was to increase demand by having my baby at the breast. I always offer both boobs before a top up and then boob after a few oz of f??
Disclaimer- it is entirely possible I'm doing it wrong- I've never fully dropped top ups! Good Luck!

I am giving him the breast for comfort too when he wants it but I just feel like I should be following the plan exactly as they suggested so that little bit of a feed that should be pure enjoyment for both of us is ruined as im frightened of derailing the plan. I know im getting ridiculous but I cant see the wood for the trees anymore!