lactation aid and domperidone hell - sympathy needed :(

[oncemorewith]

My son is 3.5 weeks and I'm on day 11 of using a supplemental feeding tube and have been taking a mammoth cocktail of fenugreek, tea and domperidone for a week. I'm about an inch away from packing the whole thing in and having a bottle fed baby (it's either that or putting him on e-bay for a dollar reserve...). Does it get better or am I flogging a dead horse?

I think if I was in the same situation I would forget pumping and just feed the baby directly as often as possible. Go to bed skin to skin and just feed constantly, and then use formula to top up with when necessary. I would find all the pumping and equipment too stressful. If the baby has a good latch then I would think he would stimulate your supply better than a pump.

I'm not advising you do this OP, but that's what I'd do.

That's kind of what I was doing before I saw the second LC. Unfortunately for me it resulted in 14 hours a day of crap (lots of nibbling but no swallowing), constant feeding. He could a 20 minute nap during a walk round the block in his pushchair before waking up screaming for food because he was hungry.

I didn't use the supplemental tube, but had the fenugreek, domperidone and expressing. I topped up with a bottle feed after each feed.

The first thing I would say is that here, all they wanted was a weight gain and as long as it was a gain rather than a loss they were not too worried. The feeding specialist sayid that the growth charts included bottle fed babies so an ebf baby may not gain so quickly. In addition DD was bright and alert and producing nappies etc. I know that practically you still need to increase your supply, but hopefully that puts your mind at ease a little and helps you relax which is really important!

Secondly, can you try to reduce the formula gradually? It took me ages, but if you can decrease by 20mls a day you may be getting closer to your own supply picking up some of the slack. 60mls also sounds like quite a bit of formula, though it will depend on the size of your baby. The doctors calculated the exact amount my DD needed for her size (something really specific like 44mls eight times a day). Perhaps they could do that with you?

It is SOOOOO hard. I would feed, settle her then express and have about 40minutes until the cycle had to start all over again. So prioritise. I found that by not expressing for the two feeds kind of early afternoon/ late evening I was able to have some time to meet people. Yes it meant that increasing production went a bit more slowly, but I stayed sane and kept bf. those two feeds had to be topped up for longer than the others, but it was a reasonable compromise. Also my feeding lady said if you have damaged nipples and are having to express then limit each feed to twenty minutes a side in total (though perhaps ten on each side and then repeat). Then express for ten minutes on each side. This is counter intuitive, but in the short term gave my nipples a chance to heal as they were grim. Once they had healed, I was in a better position to improve her latch. It is hard to do when your nipples are so torn up it hurts even to look at them never mind feed. They will heal really quickly especially if you out some lasinoh on them.

Hope some of this helps. You can do it. You are not alone. Have some cake, it will help.

Hi Cookie. It's great to hear that someone else has managed this. I knew I couldn't be the only one in the world that was doing/had done this!

I agree that 60ml top-up every three hours seems like a lot. The only problem is that I'd started to drop this slowly after the first LC visit (she said 50ml each top-up) and then the second LC immediately raised it to 60ml at each top-up. So I'm thoroughly confused about what to do there.

I'd thought that dropping a couple of the pumping sessions might be worth trying but I wasn't sure what the effect would be. However, it sounds like the short term sanity would be worth the (hopefully small) long term effect. As usual I'll discuss it with my midwife and see what she thinks.

I too was told to only breastfeed for 10 mins max each side then possibly repeat. It does seem to be working slowly, there usually seems to be enough milk available at each feed to keep him slurping noisily for a few mins rather than nibbling badly for hours. I'm resigned to never pumping more than 10mls at a time so I don't use that as a measure of success.

The other problem is that he falls asleep whilst feeding, especially when he's only had a 10 minute nap at the end of the last cycle which I had to wake him up from so we could start again. To use the SFT I need him awake and feeding so timing when to put that in to maximise the breast feed but decrease the risk of him falling asleep is fun. Especially when the tube won't play nicely and takes umpteen goes to put in.

The cake advice is possibly the best and most straightforward I've had so far :) Thanks

Grr- I had a similar issue with seeing a different person and getting conflicting advice. It was really annoying. I guess there is more than one way to do things.

I saw the feeding people for weeks and weeks. Before seeing them I would get really nervous about what would have happened with DDs weight. Things felt out of my control. For me, things really turned around when I realised that I am her mother. I stopped seeing the consultants, read loads online, watched youtube videos and relaxed! I am not suggesting you do this yet- you need advice and support, it is very early days. I think what I am trying to say is do not be afraid to trust your own instincts. As long as your child is gaining weight and hitting developmental milestones then it is all going well. So feel free to pick and choose the advice which seems to suit you best. Especially if you have a read of kellymom or LLL websites and gain an understanding of the most important things.

I had a "final push" where I rigidly stuck to the feeding and pumping cycle for a week or two. Apparently for many people this is enough to totally remove the need to supplement with formula. After that, when it became clear that mine was a longer term issue I stopped expressing for those two afternoon feeds for my sanity.

Also, relatively early on, I dropped to seven feeds a day, which somehow made things more manageable. It is important to feed often to increase supply, but like you I thought it was ridiculous to try and keep a baby awake for a feed they did not seem interested in. My midwife was happy with this as DDs weight was still increasing. Feeds between I think midnight and '4am are the most important as that is when your hormones are built for the next day (or something) so I tried to make sure I fed her twice during that period and then we had a longer gap between the four o'clock feed and the next one. It meant both of us got some sleep- I think even babies need a period of sleep longer than the brief respite she was getting in between feeds. Again this also helped me feel more human.

You sound like you are doing well.

Oh and I hardly ever got more than ten mls either. Once when she was quite a bit further in that you are now, I got 50 mls over two pumping sessions and I was so ecstatic I took pictures and still remember it as a notable day!

Hi Cookie, thanks so much for your time. As i said it's great to hear that this could work. I'm trying to distinguish between all the advice, my midwife is great for that and happy to support me whatever I decide as long as it's not too stupid :)

Dropping to 7 feeds a day also sounds sensible. I think I need to wait a few days and see what his biorhythms so I pick the best timing to suit him.

I usually manage a 1am and 4am feed so hopefully I've ticked the night time box. Did you pump during the night? I try to straight after the feed (I refuse to get up again just to pump) but to be honest I'm so knackered I rarely manage even that.

How long did you do all this for? Did there come a time when you were exclusively breastfeeding or have you always done top-ups?

Over the course of the day I sometimes manage to pump enough for one top-up. It's a proud moment too when I manage to do that (though I haven't got the camera out yet) :)

I was hoping you wouldn't ask how long I had to top up. It is different for everyone. The bad news is her last top up was not long before she was six months old! But the good news is by then she was only getting two top ups a day.

It was really gradual for me- most people get there much faster and I am sure you will. She was born mid September. I was expressing at night mostly (not always- sometimes sleep was too pressing). Around christmas I had gotten less obsessed with expressing during the day, but was still doing it at night. She stopped needing a top up for night feeds which was great because I found formula really woke her up and I was able to stop expressing at night. We started co sleeping and this really helped. She fed more frequently at night, but it was less disruptive to both of our sleep. I know co sleeping isn't for everyone and you need to be safe about it, but it worked for us. (Though be warned- she will be one in a few days still co-sleeping and still feeding a few times a night!)

Then gradually I reduced the top up first thing as I always could express more then (not much, but a little) so figured there was more there. Then I dropped her evening top ups gradually again. Those two top up feeds in the afternoon lasted until almost six months, when she suddenly just lost interest over a couple of days.

Something I just remembered being told- when reducing the volume of formula try to drop it from one feed so that eventually you drop a whole top up ( instead of say keeping all the top ups but reducing them all by 5ml). This gives you a feed where the baby gets used to not having the really full formula feeling. Then work on another feed.

Also though DD had top ups for that long, we didn't need to increase the volume of formula in line with a ff baby. We did increase the volume a bit, but as her needs increased I was able to pick up some of the slack.

Hope some of that makes sense. I hope it doesn't put you off either, most people get there faster.

I think as long as I can see things moving forward I don't mind if it takes a while. My biggest gripe with the LCs is that none of them talked about a long term plan. The first just gave me the SFT and presumed everything was fixed. The second gave me a regime for using it but no long term plan for phasing it out.

I like the idea of choosing one top-up to lose at a time. I did think that reducing all the feeds at once was actually quite a big overall drop for him, especially because it's hard to measure anything less than 10ml. I would try a night time one first. Even before I started supplementing he's slept well at night and he (usually!) gets expressed breast milk then so he might cope better losing that one first.

I think I also need to work out a regime that works for me. If nothing else that will make me feel more in control of my life :) rather than having it dictated by LCs. That will probably be becoming more flexible with the pumping so I can leave the house.

Definitely get your baby checked for tongue tie. I ended up producing very little because DS wasn't drinking enough - he couldn't, despite a good latch, because his tongue couldn't make the correct 'rippling' movement. I remember well the endless screaming (he was hungry and was taking in too much wind with each feed). One tongue tie cut, once happy and content baby who gained weight amazingly well having been 'failure to thrive' previously. Google tongue tie and look at the pictures you see. Then look under your baby's tongue. If you see something there, go to a local bf group and get it checked.

Hi Bronya, he did have a slight tongue-tie which was snipped a few days ago. The paediatrician wasn't sure if it was enough to have been causing any problems but hopefully it will have helped a bit.

Keep an eye on it for re-attachment, and if nothing improves, get a second opinion to check for posterior tongue-tie as you can have both. When my DS's was snipped, he instantly got a better feed from me, then I gradually built up my supply until he was ebf. The big difference was the crying - he just went to sleep after each feed instead of wailing for half an hour or so! I remember driving home in the car after the lactation consultant had snipped it and we'd had our first bf afterwards, marveling at the silence!!!

My GP said to me - if the baby is taking milk efficiently, you will make it. It is VERY rare that it's an actual problem with the mother. That seems to match what I've been advised and read elsewhere. It's not you - it's your child's ability to feed effectively.

Pumping twice between feeds seems a lot. I was told that I should pump immediately after feeding but that my boobs then needed time to replenish as it was important that it was easy for him to feed in the early stages so that he didn't burn extra calories with the effort and lose some of the benefit.

Also stress is a massive factor. We got hospitalised at one point and I was doing the 3hour feed, pump start again routine. Never got more than 10mls. Got home and first pump was 80mls just with reduced stress. Should say this was at 4+ months so supply reasonably established.

Also, when you're ready, you could look at feeding more in the day 2-3 hourly and less at night 3-4 hourly - this helped both me and DS get more sleep.

As for long term plans they are hard to predict. My bf counsellor who was fab and gave us routine after routine as he grew eventually admitted to me that she hadn't thought I'd stick with it as it required so much hard work and "she wouldn't have done it" but although we always mixed fed, bf did get easier, in fact it was easy and really rewarding. I fed to 8.5m and would have done longer but he self weaned (I'd been back at work ft for 2.5months and supply was hit but he was weaning well onto solids also). You can find a way through this if you want to.

But if you do decide to move to ff then don't feel guilty. No one is going to say you didn't give it your best shot. And formula isn't poison. Be kind to yourself whatever you do. The hormones are bastards.

Oh and I recommend mainlining tea and cake.

Do think further tt or latch could still be a prob. You mention slurping and there shouldn't really be any... Of course that may just be a turn of phrase in which case ignore me!

Hi WottaMess, I'm hoping the mammoth pumping sessions can be severely curtailed quite quickly. I've been doing them for three days now and I can see my supply increasing (my boobs are rock hard at feed time even though I've only finished pumping 45 mins before) but at the same time my cabin fever increases too. I know tiny babies are meant to make it hard to go out but a schedule that involves doing something every hour is a step too far. I'm hoping to cut out out the second pumping session very soon so I have an hour or two to at least walk to the end of the street and back :)

Someone suggested giving him a snack in the middle of the three hours if he needs it. This will stimulate supply and calm him down if needed without tying me to the sofa and pump. I'm just on a mission not to get back in to the constant but crap feeding circle we were in.

I think when I see my midwife tomorrow I'll discuss all the ways that I can adapt this regime to something that gives me a semblance of normality (e.g. more often in the day but less at night, less pumping, more flexibility etc etc).

The slurping thing is that he is now the noisiest feeder in the world. It's not quite the right word but not far off. He gulps and yelps whenever my milk lets down and has to stop to catch his breath and pant quite often :)

Bronya - thanks for the info on the posterior tongue tie. He was checked by a neo-natal paediatrician who did the snipping so hopefully she would have looked for that too.

I like the theory that if they feed well there will be milk but I think there may be some chicken and egg factor in place. With no milk they will feed inefficiently so there will be no milk - I'm hoping my current regime will break the cycle.

On you poor thing. I have walked in your shoes... No supplemental feeding tube, I was told to do cup feeds for top ups (the mess!!)
My ds1 was re admitted due to excessive weight loss, so I fed/pumped/fed the pumped stuff/supplemented with formula, and tbh it nearly took 3 hours for the cycle, then start again! I used to get bugger all from pumping.
After a month, I was so tearful, tired and despondent... Having been a staunch pro-bf person (it's even strongly related to my job)... Do you know, I realised that my baby was unhappy, I was unhappy, and we were in a vicious cycle of ever increasing formula top ups... So rather than "giving up" I made the positive decision to switch to bottles, and never looked back. And although I felt guilty, to begin with, I realised I was doing my baby a disservice by trying to carry on- all he wanted was to be fed, and sleep! He is a thriving, bright 4 year old now, I have no regrets. When ds2 started to go the same way, at 2 weeks old... I made the decision earlier as the best thing for our family. I am still v pro-breast feeding but the bottom line is, despite everything I tried, I just didn't seem to make enough milk. You have to be happy making the decision though, satisfied you've tried your best. I have absolutely no regrets now regarding how I have fed my two! I hope that helps, reading a slightly different perspective. Good luck, it's so so hard!

Hi Apple, thanks for the alternative perspective. My big sister went through the same thing with both her kids and she gave me similar advice - Do everything you need to feel you've tried but don't see it is as "giving up" if it's time to try something different and consider your own mental health.

Me and her were both brought up on formula and we've done pretty well between us :)

I was on the exact same schedule for similar reasons. In the end I just had to stop with the pumping but carried on with the meds. Baby got better at feeding after lots of visits to feeding groups and cranial osteopathy.

I fed her until she was 2.

It can be done but don't sacrifice your mental health.

The slurping/gulping/noisy feeding really sounds like tongue tie.

The other thing I want to mention is that 10 minutes a breast every 3 hours is very little for a baby of this age, many newborns even those who are feeding well are feeding twice as often as that. Personally I think I would not restrict his time on the breast.

Is your breast tissue 'normal'? Is there any chance you could have breast hypoplasia, even mildly? blog.medelabreastfeedingus.com/2014/04/signs-of-mammary-hypoplasia-what-to-do-if-youre-diagnosed/
There are lots of images online if you think you might have it. I never knew until well after I had failed to breastfeed exclusively and I wish I had.

Hi Boobsofsteel. I'm hoping I can stop/reduce the pumping soon. That's the killer part of this schedule. The rest isn't actually that far away from business as usual! I've also had one osteo appointment so far, the osteo claims she can help so I'll give it a go for a while - every little helps I reckon.

Hi Hollie. I'll talk to my midwife about the amount of time feeding. It usually morphs into 45mins-1 hour in total as the SFT takes a while to use.

Hi Ehric. Judging by the photos I may have that a little my boobs are very widely spaced and kind of that shape but they did grow a reasonable amount in early pregnancy. However, the solution for it seems to be almost exactly what I'm doing but I guess a label often helps. Thanks for the info.

Hi Oncemore, I logged on here to post about my own misery and ask for advice and I'm really grateful you posted this because there are some similarities to my situ - and yes, it feels like climbing a mountain, doesn't it? Really punishing.

My first baby is now 8 wks and he couldn't latch at all from day one, due (I think, in hindsight) to a combination of high jaundice very quickly, sleepiness, undiagnosed tongue tie and a bit of shock to us both after a traumatic birth. After 24 hrs of trying to latch him on, the paed Dr told us to put him on formula bottles urgently as the jaundice was so bad and he had low blood sugar, was sleeping non stop. I felt horrendous, like I had been so focussed on trying to bf that I dropped the ball and actually deprived my DS of food. We had 5 hellish days in hospital while he was treated for jaundice and I bruised my breasts hand expressing colostrum and later pumping milk every 3 hrs round the clock. I spent more time with the pump than I did holding my new baby, and I WISH someone had told me then that what type of milk your baby gets is completely insignificant compared to how many minutes or hours you can hold them close to you and enjoy them. Anyway, after getting home I kept pumping so we could bottle feed him my EBM. The only way he could latch on was with a nipple shield, so we mixed feeding with nipple shield and top up with either EBM or formula. Because f the jaundice he was on a strict 3h feeding plan to get a certain amount of fluid through him.

At 3 wks we saw a private lactation consultant who treated his tongue tie and put me on a regime of 3 capsules of fenugreek three times a day plus 10mg domperidome 3 times day plus pumping every 3 hours. I managed that for 2 weeks but it nearly killed us all, an almost impossible strain and I very nearly gave up and switched to formula. Funnily enough the closer I came to accepting I would have to give up, the more my milk supply increased. Over those 2 weeks my supply went up so much that I could feed him 8 bottles of 110ml EBM each day. At this point the paed Dr said I had enough milk and could switch him to fully bf with the shield, keeping to the same 3hr schedule and getting weighed each week to check he was still gaining. She told me to keep pumping 3 times a day plus 1 pump between 1am to 5am when prolactin is at its highest peak. Amazingly, we switched to exclusively bf in just 24 hours and had 10 days of blissful feeding!

However I then made the mistake of pulling out the supporting props too quickly - I stopped taking the fenugreek, domperidome and stopped all but one pumping session - I stopped everything within the space of about 5 days. Big mistake. Two days later my supply must have dropped because DS took the breast for only 5 mins or so before pulling off, uninterested. (I think as well as supply, he may have got a taste for the fenugreek in my milk - I'm taking so much that my skin stinks of it, so pretty sure my milk must too).

So on the advice of a BF counsellor I quickly put back in all the above, and within a few days he was feeding ok again.

SO ... I would say ... yes, some women can increase their supply and if you want to keep trying then what you're doing now is the best way I think to go about it. I would encourage you to add in a pumping session between 1am and 4am though, but I hate even writing that to you because I know what a killer it is.

But all the above is the technical stuff, and doesn't really address the heart question - should you keep on trying or switch to formula. I wish I knew the answer. I'm currently wrestling with the question again as my DS can still only feed with the shields and they are such a laborious thing to use and I find it almost impossible to feed him in public with them as they are awkward to put on, he knocks them off, they spill milk all over my clothes at the end of the feed ... and at the core of it I feel ashamed for anyone to see me with a piece of latex over my boob, as if my body is defective or something ... bf is such a highly personal and intimate thing. In the past week, since trying at bf groups to teach DS how to latch onto me rather than a shield (no joy yet), there have been screaming fights at the breast and struggles to the stage where I have given up on some feeds and given him a bottle, because I just can't take anymore. I'm still pumping 4 times a day and taking the meds. My question is will he ever learn to latch on without the shields or will I have to keep chained to my house feeding him with the shields and then pumping ... because the prospect of that is miserable.

I'm aware I have poured out my own story at length in response to your post ... sorry, I'm too tired after DS being up all night to go back and edit it for stuff that's pertinent to you, so you've got my whole story in a blurt.

I know in my heart that the most important thing is to give my baby love and cuddles, and food comes second to that. I am still struggling in my heart to accept that bf has not worked for us and that I need to grieve the longing and let it go so we can move on. Day by day, as you make your decision, choose the options in each moment of the day which allow you the most time to be close to your baby. Everything else is secobd to that. Good luck!!

Hi Books

It sounds like you're doing a great job. Pumping sucks. Anything else you do can be fitted into a relatively "normal" life except that.

I had exactly the same feelings of social stigma with the tube as you describe with the nipple shields. I'm starting to get over it slowly. I've found some great breast feeding support groups in my area and they've help no end. I had to try a few groups before I found the good ones but it's worth it. I've now used the tube in "public" (i.e. at the support groups!) twice and it gets easier every time. The support groups are a great first step to getting out and about. My next step is using it at friend's houses and maybe eventually I'll be able to use it in actual public :)

My biggest change in the last few days has been listening to the advice of folks here and elsewhere and working out to make all this fit into the life I want. I'm now back to feeding on demand (which is my preference over strict 3-hour regimes) and giving formula top-ups only when needed. I've also found a superb LC who goes to one of the support groups every week and is just available there to chat and advise as needed. I'm slowly starting to enjoy my son again and not see him as a huge weight that welds me to the sofa. I've made an executive decision to pump at times that suit me. It might take longer to boost my supply this way but frankly I don't care. If I give up breastfeeding because of pumping 24/7 that's pointless.

My advice is get googling to find your local support groups and try them all. The one that is worked for me is the "special" baby one :) But to me he is special and they don't care who turns up. Use them as your halfway house to re-enter the real world and leave the sofa.