Breastfeeding disaster. Is this salvageable?

[Waggamamma]

My ds is 18days old. He was 9lb 6oz. Due to a low temperature and suspected sepsis he was in neonatal from five days from birth. Whilst there he stopped having wet nappies, my milk wasn't in yet and I was given no choice but to 'top up' each feed with formula. The advice from the peadadtrician was to wake ds every 3 hours to bf ten mins on each side and then give 70ml formula. Feeds were about 90mins at the breast before this.

Now we're home and feeding on demand, he breastfeeds constantly, after about an hour he gets really frustrated pulls my Nipple and cries. and routes so I then give formula. He's taking about 15oz per day. I have tried to reduce this but he just cries and routes until I give him a bottle. I'm exhausted with it. as I feel . I'm doing double the work ff and bf. yesterday I spent 14 hours with him on the boob!! If he sleeps longer than two hours I wake him to feed.

I've tried expressing but I never get more than 20mls. I'm taking Fenugreek but thinking maybe I just don't have enough milk? I know supplementing with formula was the start of the downward spiral but I didn't have another option with a sick dehydrated baby .

Any advice or suggestions? I'd love to get down to just a one or two formula feeds a day.

Firstly it sounds like you are doing all the right things offering him breast milk regularly. What you can express is not necessarily how much milk he is getting when he breastfeeds. Some women find it hard to express much milk but babies are very good at sucking it out! You can try massaging your breast whilst you express to try to get more milk out.

It's normal for young babies to spend most of their time on the boob. It can be pretty frustrating for you as you can't get anything else done but just try to enjoy it. It is the best way to increase your milk supply.

Your situation sounds v similar to the start I had with my DS. He was 9lb 13 and had a raging group b strep infection when he was born. He spent 5 days in SCBU although he was not dehydrated. He was on a drip for a day, then a NG tube for 4 days. He was given formula plus whatever I could express.

I did get back to 100% breastfeeding, but it took a while. Don't be disheartened by how much you can express - it's not a reliable indicator of how much milk you have. Some women can feed successfully but never express a drop.

I would suggest (if you aren't already) that you use one of the teats that mimic breastfeeding (we used the Medela Calma ones but there are other similar ones). If your baby is used to a fast and easy flow of milk from a bottle then it can be hard to get them to persist with breastfeeding.

I would look to maybe try and reduce the amount of formula by a small amount each week. He may well want to be on the breast a lot as a result but your supply should eventually catch up.

Also have a look on the Kellymom website for lots of useful info. It might also be worth finding a lactation consultant that you can speak to as well.

Gosh, what a tough start you've had, it sounds like you are doing brilliantly! Have you had a lactation consultant or breastfeeding counsellor check your latch? It might just need to be tweaked so that he can breastfeed more efficiently.

Otherwise would second what Future says about massaging your breast as you feed (google 'breast compressions) you could also try feeding skin to skin and switch feeding where you swap sides each time he pulls off/pauses/stops actively sucking. You can do this several times a feed and it can boost supply and increase milk transfer.

Really hope things get better for you soon. Don't despair, sounds like you are getting on really well.

Thanks . I'm really keen to keep going but it's disheartening that no matter how long I feed him he still wants formula too.

If I try to limit it and put him back to the breast he just goes mad and cries and scratches me. This is how im finding it difficult to reduce the formula even a little amount.

good to hear some positive stories.

You might find letting him sleep longer helps :) More rest for you, and he'll wake up properly hungry and take a good feed.

If I woke mine to feed (had similar problems) they really struggled. They weren't really hungry enough to bother with more than a snack, but then they weren't full enough to go back to sleep. So they cried and got upset until they worked up a proper appetite. Soon gave that up as a bad job!

They did feed pretty constantly in those first months though, but letting them have a good sleep helped.

Its unlikely you don't have enough milk :). More likely getting milk from a bottle is just easier for him so when he gets tired he cba with the breast any more and wants his quick fix :).

It sounds like he is not able to transfer milk effectively from the breast. Either he isn't latched on right or perhaps he has a tongue tie. Expressing some of the top ups could boost your supply but is time consuming. I'd say you need real life help from someone with the knowledge to say why he is still hungry after spending so long breastfeeding.

Why were you told to only feed for 10 minutes on each side when he was in neonatal? That seems like odd advice unless it was due to the amount of time he could be out of the incubator? I understand the need to top up when he was dehydrated - I think you're going to need real life (and knowledgeable) support to cut out the formula, but it's almost certainly possible :)

20ml is a normal amount to get out when expressing and doesn't mean you have a poor supply - pumps are nowhere near as efficient as a baby, and 70ml is a large volume of milk for a breastfed newborn.

There's also a rather disheartening fact in that babies will almost always take more milk from a bottle regardless of how full they are, and then have the audacity to look totally satisfied and settled as well

Hopefully tiktok will be along soon - in the meantime, how much formula are you giving per top up, and how many "sides" (boobs) does he have per feed, usually?

Have you tried skin to skin in bed or in the bath? And also breast compressions might help.

I found this too:
kellymom.com/bf/pumpingmoms/pumping/pumping_decrease/

This is good on breast compressions/bottle preference:
kellymom.com/bf/concerns/child/fussy-while-nursing/#flowpreference

God, I wish doctors would fucking realise they're not qualified to give out breastfeeding advice, or at least get some training to make sure they are

Timing feeds to '10 minutes each side' went out with the dinosaurs. If only you'd had better BFing advice earlier. You could try cup feeding the formula rather than giving it in a bottle? This way he might have less interest in the bottle as he doesn't get the comfort of sucking. I also second the switch feeding a PP mentioned. Just because he's finished on the second side doesn't mean you can't put him back on the first. A couple of days skin to skin in bed doing nothing but switch feeding and avoiding the bottle if at all possible may help.

Also, it's very common and normal for a baby to rage at the breast even if they've never had any problems. It's all part of the process of building supply and aiding the release of oxytocin to trigger let-down. Try different positions such as rugby ball or upright to see if this makes him happier about taking the breast. Whenever DS2 has a falling out with my boobs, rugby ball seems to do the trick as the latch is nice and deep, meaning he doesn't have to work as hard.

X-post with BertieBotts

YY to real-life advice above anything else. Do you have BFN Peer Supporters where you are or support groups?

Thanks again. I had lots if help with latch in hospital so I don't think it's that but no harm in getting it checked again. I do have quite big nipples so maybe thats causing a problem?

I did go to the local breastfeeding group this week but none of the women I spoke to had used formula so they couldn't advise and the health visitor wasn't there . I'll go back next week and see if there's anyone to talk to.

I can't remember who asked but he's taking 3oz formula around 5-6times per day.

The 3am feed went well last night and he didn't look for formula (just sleepy maybe?) but he woke an hour later absolutely ravenous and didn't go back to sleep until lunchtime. I have a three year old too, it's tough on him not getting much of my time.

Sorry to say, but a peer support group with a health visitor is unlikely to be able to offer you the specialised help you need although it might be better than nothing - you would be advised to contact your local LLL group (they have a helpline too - 0845 120 2918) or the NCT sometimes have breastfeeding counsellors, or you could look for an IBCLC - best bet for that is probably google.

It's crap that mothers in your position have to go looking for the proper help, but it's the way it is at the moment. HVs often have no training at all and if they do don't have in depth knowledge. Same with GPs, and they see less of BF so may be even less familiar. Midwives usually have bf training but it might have been years ago and they don't have to update it. Occasionally PCTs will pay for a course for every midwife in the area. Again this is usually a one day course and won't be anything specialised. For an issue like this you need a breastfeeding counsellor or IBCLC. Possibly a LLL leader but I don't know actually what training they have.

Round here one of the LLL leaders is a lactation consultant too. I'd say their helpline is a good place to start. I rate them highly as an organisation.

I think they are definitely very knowledgeable.