Breastfeeding query - dd 4 weeks

[Aprilshowers]

I am a Mumsnet Virgin and am hoping that you can offer me advice/support with breastfeeding. My DD is 4 weeks old and whilst we were in hospital (10 days) I exclusively breastfed. The birth was very traumatic as I was induced at 36 weeks as I developed pre eclampsia on top of already being an insulin dependant diabetic and therefore it was all very medical with lots of intervention. On top of those problems I also had a significant post partum haemorrhage and ended up on the High Dependency Unit requiring a blood transfusion.

By the time we were discharged form hospital I was exhausted and we gave DD formula to allow me some sleep/rest - over the following two weeks we have become 'formula junkies' and DD has been having more and more formula and less breast resulting in a rather pathetic milk supply.

I am not happy about this but accept that at the time it was the right decision but I do now want to resume exclusively breastfeeding. On advice from the NCT and midwife I am ensuring that DD goes to the breast each feed (2 1/2 - 4 hourly) and feeds for as long as she likes until she spits the nipple out. I am also offering the other breast most times. After each feed from me I am afraid that I can't help but feel inadequate when she then guzzles down 3oz of formula. This is despite her feeding from me for up to 1 hour.

We are only on day 3 of trying to exclusively breastfeed so appreciate it is early days but what sort of timescale am I looking at before a) I see some improvement and b) I can realistically drop the formula 'top up' feeds.

Is there anything else I can do to stimulate the supply and speed up the process?

Finally and perhaps more naively, when my milk supply increases do I presume that she will just be more satisfied after her feed as she is getting more out as opposed to her having to feed for longer?

Thank you in advance.

previous thread might help

She will guzzle the formula even if she isn't hungry - it's just something babies do. Offer the other breast at all feeds and don't top up, but be prepared to feed more regularly for a few days. She is still young and your breasts will make the changes very quickly. If watching her drink formula upsets you then don't give her any.

Hi April

Not been in exactly this situation, but two of mine were given formula via a tube as newborns.

Agree with Bob that babies will drink some formula after a breastfeed even if they're not actually hungry, just cos they like to suck and the formula slips out without any effort apart from swallowing.

My feeling is that there will never be a clear signal to drop the top up feeds -- you've done three days of mixed, so personally I would try to go cold turkey by dropping the formula and putting her to the breast every time she shows signs of hunger. You'll probably have to feed quite frequently for a few days, but like Bob says, it won't take very long for your body to adjust.

Make sure you've got backup, though -- think lying in bed with the tv remote and a stack of glossy mags, with dh bringing you cups of tea NOT rushing round doing the laundry and washing the kitchen floor.

Let us know how you get on!

Nothing to add to previous thread and other good advice posted here, just wanted to offer you some support after the awful time you've had. I really hope it works out for you and your dd. I found the most worrying thing about b/f was never 'knowing' whether ds was getting enough... but as everyone says, if they are putting on weight and feeding when hungry then they are doing OK. I hope you get to that stage soon.

Hi aprilshowers, just a quick note as I am doing the same thing (see other thread). I feel it's going well (will do a proper update in a few weeks) but i'm doing it really slowlly - only 1 oz out of feeds each week. DS has gone from each feed being 2 breasts and 7 oz formula to each feed being 2 breasts and 5 oz formula so far (2.5 weeks later). so I think you're doing brilliantly with only 3 oz formula!! I'm not putting a timescale on this but expect to keep going for several more weeks - sorry. Good news is that he is speeding up his feeding - feeds down to 30 mins now, occasionally less.

What has helped for me was going to the local bf clinic here and getting my technique checked - we are lucky having this clinic here. But I only felt really OK doing this now (3 months) - at 4 weeks I'm afraid I was totally allergic to bf advice having had 13 different people advising me! So you may want to be left alone a bit, especially after such a traumatic birth. It sounds a bit new agey but I found I was thinking of a feed involving only one breast, or not involving formula, as a 'failed feed' - ridiculous - I now think of it as a hugely successful one. That helped. It also helps me to say a few things to ds like 'you're getting loads of milk, it's really flooding out' - it helps to build the confidence up IMO. Weird but true!

Best wishes and it does feel great each time if/when you manage to drop a bit of formula. NB I was told at the bf clinic there's no reason why my ds should lose any weight while I'm doing this. HTH.

Thank you so much to everyone for your messages. We had a bad night last night where I couldn't get DD to latch on at all so she had formula through the night. Woke up this morning feeling very despondent and ready to throw in the towel but reading the messages of support and advice has made me feel more optimistic. Will spend the day in bed feeding on demand as suggested by Frogs. I will also try to go cold turkey with the formula. There is a local B/F clinic this Thursday that I will attend to check positioning.

Acnebride, know exactly what you mean about feeling that a feed with formula is a 'failed feed'. No one prepares you for how emotional breasfeeding (and especially problems with B/F makes you feel). Looking forward to hearing how you are progressing with your feeds and keep up the good work.

Thank you again and I will keep you posted.

Aprilshowers (lovely name) do do believe in yourself. I do so understand what you and Acnebride mean by a 'failed feed'...but no feed is a failure. Whether you have an exclusively breast feed, or a combined feed, or one boob or two, any feed that starts with the boob is a good feed when you're trying to relactate.

Go on, take the plunge and drop the first feed of the day! When I started relactating (ds was 6w) I cold-turkeyed on the morning bottle - instead I drank plenty of water myself. I saw results within a week or two, with ds settling into a 3h gap between feeds until about lunchtime. He slept through the night (7-7, being woken for a feed at 10-11pmish) from 10w, which I'm sure he wouldn't have done if he had been hungry.

BTW, Acnebride, it's really great that you're feeling good about all this! You've dropped 1/2pint of formula per day!

Can I back up toddlerbob. DS and I had similar issues at the same age, but the problem was nipple confusion and he preferred the bottle. I offered him the boob and when he stopped I gave him a bottle but only with water in it and he soon worked out that boob was best. HTH.

Toddlerbob's advice is brilliant. Try to stay confident. Babies can't help but suck.

When dd was first born we were topping up at each feed - because she was losing weight - but in retrospect i think it was bad advice. I tried in vain to get an answer out of my otherwise very good HV's about how to stop using the formula...then I just decided to stop (like the previous advice, I think its the only way). For the first week I used to express from the second boob while she was feeding from the first, and top her up with the expressed milk, then I just got fed up with expressing and so just fed her for as long as she wanted (1 hour plus each time, every two hours or so during the day but not so much at night). TBH we only had a few weeks totally free of formula, she was a very hungry baby and it was just getting me down spending so much time feeding. In the end I was giving bottle some feeds and breast on others (about 50:50) and this suited us and I carried on longer than I thought i would initially. Hope it goes well for you.

sorry you had such a horrid time. please don't feel under pressure to feed one way or the other. If you really wish to breast feed then keep going and good luck. But there is nothing wrong with mix feeding. I breast fed during the day and gave formula at night for several weeks and that suited me. It did mean that at the weekend, my husband took over the night feeds to give me some rest as was not able to express. You have to look after youself too, so don't worry if you can't breast feed exclusively and don't feel guilty about it, so long as your baby is satisfied and happy that is the most important thing. Good luck!

Can I just say that you are doing really well to breastfeed at all after the awful time you've had!! I'm a peer support bf counsellor and all mums find it hard. It might be worth getting someone just to check DD's position just to check she is latched on well and so she is stimulating the milk supply well, otherwise just putting her to the breast more often will help. It's also worth waking her at night for an extra feed which can help you produce more milk as levels of prolactin are higher then!
Keep going, it's tough but worth it!!!

Sorry to hear that you had such a difficult time. I also had a post partum haemorrhage so can imagine how awful you must have felt.

It can be testing when a baby drinks formula after feeding - but they can just do that. I would agree with just stopping the formula if you want to. To know if your dd is getting enough breastmilk I've read that it's important to count the number of wet nappies per 24hrs - I think it's around 6 disposable or 4-5 cloth (would have to check on this). If she's drinking enough her output will reflect this!

To help with cutting out the formula what about a 'baby-moon' - when you stay in bed just feeding and being with your baby for a day or more - to help your baby to get used to exclusive breastfeeding and to help your breasts get the stimulation necessary to up milk supply. Your breasts will make milk on a supply and demand basis.

Some babies will take ages to feed and some will feed quickly - but both will be satisfied with their milk. It's hard to know if your little one will feed quicker or will take her time. If she takes time to feed then feeding whilst moving around helps to get your daily tasks done. I often feed dd and type (with one hand) on the pc, or put out washing, tidy up, look after other children...that way I'm not tied to sitting down waiting for dd to finish her feed.

hope all is going well for you - best wishes

fairyprincess brilliant name- brilliant advice, wish you had been around both times I was feeding!
Aprilshowers - my bf problems were different to yours but support and love to you - it is a difficult time especially the first 6 weeks but you are doing a wonderful thing. Your baby will take less time to feed in the weeks to come as she becomes more efficient. It does become the beautiful experience that you imagine when you are pg in time!

Just to update you - DD and I spent a cosy two days in bed last week devoted to B/F with DD feeding approx every 1 hour. It seemed to be going well until my nipples started bleeding making it too painful to feed. I hand expressed for a few days and fed her the ebm with formula top ups. The result now being that we are back in 'no mans land' as far as the B/F and formula are concened. I am fairly certain that positioning is ok and have had it checked by the midwives and Health Visitor many times. However, B/f is not always a comfortable activity - but most of the discomfort comes at the start unless DD tries to move her head with my nipple still firmly in her precious mouth!

Not certain where we go from here - DD is thriving on formula but I do want her to have breast milk. When I try and rationally tell myself that she will be fine on formula I end up racked with guilt that I am failing her in some way - not helped by a well meaning Midwife saying that we should do whatever is right for us, happy mum = happy baby etc but then adding as an aftherthought that the research on B/F shows that B/F will offer DD protection against developing diabetes - not a good thing to say to a diabetic Mum!

I am still expressing but have never been able to get more than 1 - 2 oz whether I hand express or use the pump so it takes a few collections to get a full feed for DD but I guess that anything is better than nothing.

Thanks again for all the advice and support will keep you posted.

Aprilshowers, if your nipples are bleeding there are only two explanations - positioning and attachment is not right, or you have thrush (both can occur at the same time). Overwhelmingly, it's gonna be P&A....and any bfc will tell you of the mothers who have had this checked many times, told it's ok....and it isn't. Bleeding nipples means the skin has been grazed/cracked, and this cannot happen when the baby is on 'right'. What is the shape of the nipple when it comes out the baby's mouth? If it is in anyway distorted (for example, like a new lipstick shape) then that is further proof your baby needs to go on to the breast differently.

I think you need to see someone who really knows what they are looking for when checking positioning and attachment. Do you live near a bf support group, or could a bfc see you?

You sound as if you've done brilliantly to get this far! Nipple pain is agony, and the books can be very dismissive of it, as if with the proper positioning all pain can be avoided. You are doing the best you can for your baby, which is all anyone can be expected to do.

I've had very sore nipples with each of mine, but it was worst with dd1 who was a very hungry baby and sucked like crazy in the few days before the milk came in. By day 5 I took her off the breast after her feed and she had a little blood-stained mouth, and then sicked up pink milk. Horrors -- baby vampire! Not to mention the nipple agony...

Once past this point, however, I found the nipples do toughen up quite quickly. One thing that can minimise the pain or prevent it getting too appalling is to feed in as many different positions as you can, so that it isn't the same part of the nipple getting hammered each time. I know this is hard the first time, when it's all so new you that getting to grips with just one position is bad enough, but if you can vary your position it can prevent the same part being scoured between the baby's tongue and hard palate.

Lying down on your side with the baby on its side facing you is quite a comfortable position, and saves you having to support the baby's weight yourself. There are more suggestions and illustrations here and here if you can face experimenting.

You're doing heroically well, so DON'T beat yourself up about it -- you're doing the very best for your baby.

Hi Aprilshowers, have just read through your thread and you've had some excellent advice. My pennies-worth is just to say that it wasn't until about 10-12wks in that both my ds and I got the hang of bf. 6wks was a turning point, but 12wks was even more so. My ds has a tongue-tie which meant he couldn't latch properly and it wasn't until he was older himself before he got the hang of it. Very, very painful few weeks and it took about 25mins each boob each feed. In the first 4wks my supply also dwindled and so did ds' weight, but we perservered with feeds every 1.5-2hrs (any sooner and his tummy wouldn't have had a chance to empty and he just kept posseting). He also had nipple confusion after we offered three bottles of EBM and a dummy which made his latch even worse.

I found eating properly and drinking LOTS of water helped stimulate my supply, plus I expressed in between ds's feeds to help boost supply. I must admit I found hand expressing and the manual pumps a nightmare and moved quickly onto an Ameda electric pump (a good thread on this is here . Plus around 8wks my boobs started to go soft and I thought my supply was dwindling but boobs just do that once feeding has settled. HTH.

Good luck, you're doing great!

try urtica, a herbal remedy available from health shops. it increases milk supply. i used when wanted extra milk to express.

Aprilshowers - agree with Tiktok - feeing correctly should not cause bleeding nipples. Best to get breastfeeding counsellor advice. Could your baby have a tongue-tie where the skin below the tongue reaches right to the end to make a heart shape of the tongue when baby cries?

Aprilshowers you really are trying your best to do the best for your baby. I offer all my support to you in this.

Sore nipples are really awful - had this with dd - just thinking about this makes me wince. I found just letting fresh air onto the nipples solved the problem in a few days. Everytime I was at home I just went about with breasts out! I think that the main reasons for sore nipples can be either how you are positioning the baby, how the baby latches onto the breast or a possible thrush infection. You mention that you are diabetic - can diabetic mothers be more prone to thrush infections? Sometimes thrush infections can cause pain on feeding that doesn't stop even when postioning and baby latch on are fine. Nipples can sometimes feel itchy/painful. There are treatments for thrush that a medic could prescribe (if it is the case). Both you and baby would be treated. When this happened to me with dd (after dd had needed to take antibiotics and this caused thrush) I used a cream on the nipple and in dds mouth for 10 days (I forget the name but the doctor gave it).

For the pain at the start of the feed this could be due to the sore nipples causing you to anticipate pain and this then effecting letdown of the milk. I remember bracing myself for a feed. Hopefully once the sore nipples have healed this will resolve itself. Some babys can be moving feeders or just curious not to miss out on what's happening around!

You've had the positioning checked but it could be worth having another go. If it hurts then something generally needs to be sorted - is there a La Leche League group in your area? Website \linkwww.lalecheleague.org{}

Often with breastfeeding one aspect can impact on the whole experience. It can be difficult sometimes to track down what this is but once you know the origin of the problem the whole thing can be sorted.

Lots of best wishes to you and your dd

Agree wholeheartedly with tiktok - positioning will be linked with cracked/sore nipples. It's such an emotive thing, breast-feeding. You are torn with what is good for the baby against what is right for you. With my first child, I breast fed for 6 and a half months (any mum who breast fed will now how important that half is!) and I almost gave up on a weekly basis but my saviour was a b/f counsellor who sorted out my positioning. (I had been using a pillow to lay DD on and she was too high after a certain time). Second child, cocky me thought b/f would be a doddle, but had cracked nipple after three days and the start of mastitis and started mixing bottle with breast. I got so down over feeling a failure for not being able to feed him but realised me getting down was not good for me, him and the rest of the family. By 2/3 months he was on formula and my last b/f was at 3 mths. I compensated (told myself) by using Hipp organic from day one (DD had been on SMA after b/f finished) and after all the emotional up/down I don't feel any different now for having given up the b/f. The fact that the anti-bodies were well and truly delivered to your child is the most important start for them. Don't beat yourself up over this. You have tried, are trying and doing all you can. Do what feels best for you, the new baby and the rest of the family. Good luck!

Thanks for all the helpful advice and tips. I have arranged to see the breasfeeding counsellor this week to check the positioning as that seems to be the most likely culprit for the pain.

However I will also explore whether it is caused by thrush as I have been suffering with a urinary tract infection since the birth (5 1/2 weeks ago) and am on my 3rd dose of antibiotics.

Hopefully will see some improvement after I explored these two issues.

Thanks

Thrush is extremely likely with your history of antibiotics. Treating baby and you will hopefully cure it. See your GP who will precribe Datarin gel or something similar.

When I had extremely sore/cracked nipples with both my babies, I found nipple protectors really useful when the the pain was at it's worst. I can't remember the name for them but I think they came from Boots. They're just clear plastic that you put over the nipple while the baby feeds. They really did help. I also found that it took up to a couple of months for breastfeeding to become painfree so do keep at it. Good luck.