Trying to preserve breastfeeding while supplementing with formula

[splendide]

So, I've had a bit of a shit start to feeding. Fed constantly for hours a day for about 7 weeks then finally had a tongue tie diagnosed and cut. I thought things had improved but weight gain still terrible. Added 4 oz formula a day at 8 weeks and he put on 250g the first week of supplementing but only 100g this week. I've been advised to double the supplement to 8 oz a day.

I'm really hoping to maintain some sort of breastfeeding with him, is that realistic? Is there anything particular I should be doing other than feeding often?

splendide, can you give more details of the weight gain? Is he still underweight even after that 350g gain over the past two weeks?

To ensure more breastmilk goes into him, you can try switch nursing, breast compressions and extra feeding inc at night....how often does he feed at the moment?

It is realistic what you want to do, by the way.

Yes he's still right off the bottom of the chart - 3.7kg at 10 weeks.

Doing switch and compressions and the longest he goes at night is 4 hours, very occasionally 5.

Oh and daytime, every 1 to 2 hours normally with one 3 hour gap if he has a long afternoon nap.

I only ever got 2 hours between feeds when BF and evenings were just a constant feed fest. He will need to feed more to stimulate your supply. Has the tongue tie op worked or has it fused again?

I can see why there is concern about his weight - and the fact he put on weight so very readily when the formula was introduced is significant.

To protect your bf, you would need to add the formula - ie it's in addition to bf not instead of.

So four top ups of 2 oz each is better than 2 of four ounces, or one replacement feed of 8 oz.

But it's important to keep up the frequent feeding and the switching and the compressions, too.

You do need to be ensuring he comes to the breast maybe 12-15 times in 24 hours...I can't work out what you are actually doing, sorry!

A three-hour plus a 4-5 hour gap.....this suggests you could maybe feed more often, if you can.

Oh yes should have said the evenings are just constant feeding still. It's definitely as well as not replacing feeds. I feed him before and after each bottle. I guess I need to keep my fingers crossed and continue.

I think the tongue tie op worked. He seemed immediately better afterwards, more content between feeds etc. but the weight gain just not happening.

So I should wake him at night? Every 3 hours? 2?

The paediatricion told me to stretch the feedings out more but I think that was bad advice.

Stretching feeds out in a baby with slow weight gain is completely counter intuitive isn't it?? Did the paed say why you would do this?

He said the baby was in bad habits and would get a better feed if I left it longer between each one.

Can you give us a rough timetable of what you're doing? I don't want to override tiktok because she is the expert (and trained, which I am not) but I was led to believe that it's better to give one consistent bottle feed a day rather than topping up before/after/during feeds.

Has anybody spoken to you about using a Supplemental Nursing System (SNS)? That could be a good way to encourage baby back onto the breast.

Based on your 16:42 post I would say paediatrician knows little to nothing about breastfeeding.

Thank you for the help. Rough timetable is difficult, it's quite chaotic but here's a record of one day last week -

2 am feed both sides
5 am feed both sides
8.15 feed both sides
8.55 feed really quick one side
9.40 feed 3 side
11.05 feed both sides
12.30 feed 4 sides
13.20 2 oz formula
13.40 feed both sides
16.50 feed 3 sides
18.05 feed 1 side
18.35 feed 4 sides
19.20 feed 1 side
20.00 feed 5 sides
21.05 feed 2 sides
21.45 feed 1 side
22.00 formula 2oz
22.20 feed 1 side
23.00 feed both sides

You need to express at the times when he's having formula to keep your supply up. Lots of skin to skin helps too. Can he have expressed breast milk instead of formula if expressing goes well? Are there any peer supporters in your area who can visit? Good luck, you're doing the very best you can.

Could you also try just feeding on just one side per feed to ensure he's getting the richer milk, rather than just snacking?

I'm no expert OP but juts wanted to offer my own experience as an encouragement to you. My first was a terrible feeder (no tounge tie, just a terrible feeder!) and took 8 or 10 weeks to regain her birth weight, can't remember exactly

I was advised by a lovely old-school midwife to give a 2oz top up after every feed and to feed every two hours for two weeks. She put on loads of weight and I gradually reduced her top up and she reduced how often she wanted to feed over several weeks.

I tried to express during that time as well but found it impossible, it was just too much to feed, then top up, then express, it's no life and very depressing. In the end I fed her until she was 9 mths old and from about 4 months replaced one of her bf with a formula feed.

Don't tire yourself out with feeding and worry, try to enjoy your baby, feed as much as you can and top up too, see how it goes over a couple of weeks. There's no pressure to make a choice, it's possible to do both long term.

Not one sided feeding, tranquility. The opposite of what she should be doing. It's a huge misunderstanding and myth, sorry.

Bertie, there is no hard and fast rule. But one full ff a day will mean a big gap between breastfeeds, in addition to the gaps the op already has.

It's sometimes suggested - one ff a day - when there is real concern the baby would just not take in the supplementary formula offered as a top up (sleepy baby, for example, who would just drop off to sleep because of lack of energy, or other vulnerability).

I don't think it would be appropriate here, but op, you do need to check with an hcp who knows what they are talking about and who has seen you and your baby.

Thanks Moon, nice to hear there's light at the end of the tunnel.

I've spoken to a number of HCP's, they all seem to have different ideas so it's tricky.

I am unable to fully breastfeed but managed to breastfeed all five of my children, two of them for over 18mths while supplementing with formula. I supplemented on the late evening and found that getting a fairly long stretch of sleep after that helped. Also I drank fennel tea by the gallon and generally tried to drink significantly more than I would otherwise. When I had my fourth child the midwives really tried everything to increase my supply and but me on medication against indigestion that has the side effect of increasing milk supply. I think it was motilium. Might be worth researching further and discuss with your hv.

Do you remember how much formula you were giving? It does seem to make a big positive difference to my supply if im a bit rested. Also I've been really low so I've lost my appetite a bit. I'm trying hard to eat enough but that can't be helping either.

I don't remember. DS1 is 21 yrs old now. I remember trying for the first months or so to exclusively breastfeed and both of us being really stressed and miserable and my baby not putting on weight. At the time support was limited and I was given very conflicting advice ranging from suggesting to feed constantly to just giving up. I then went to visit family in Germany and saw a doctor there who said the lack of weight gain was quite serious and to supplement immediately. We basically worked out that my supply was worst in the evening and that's when I supplemented as much as I could get into him literally. I would have breastfed first, then bottle and then bed for both of us. Fed until 18mths.With DS2, 15yrs ago I started again trying to fully feed but when I could see I did not have enough milk did not stress but followed the same routine as with DS1. When he was 9 months I was pregnant with DD1. Same routine for around 6 months. With DD2 nine years ago the midwives and local hospital breastfeeding consultant were hellbent on establishing full feeding. We tried everything from double pump, a horrible device called breast milk supplementer, motilium, breast compression etc. Result was that even though motilium seemed to help a bit, I went back to my old routine...she fed until just before she turned two. With DD3 they got me motilium but let me get on with it.
I would try to sleep and to eat properly. Soup is good. You get nutrition and liquid at the same time. Also if you find you cant eat, drink some complan. Its vile but better than nothing.
If your body is genuinely not able to make enough milk and/or to adjust to your baby's increasing need you have to supplement!.
Hope that helps.

That did really help thank you. I'll keep trying!

Oh really tiktok, thete really is so much conflicting advice isn't there. What is the recommendation then if you don't mind me asking?

Tranquility, here's a blogpost that explains it:

thefunnyshapedwoman.blogspot.co.uk/2011/05/foremilk-and-hindmilk-in-quest-of.html

Feeding one sided only can be fine, in situations where a mother is producing plenty of milk and the baby is thriving.

But deliberately feeding one sided only reduces supply and reduces volume of milk..it's what women do if they are troubled by over-supply, because it makes you make less milk.

It would risk a serious situation of reduced supply/undernourished baby, to do it deliberately in the OP's situation.

I suppose you need to find the HCP who knows enough about breastfeeding to be helpful which can be a bit of a holy grail at times. It's easier to tell if you cross reference information they've given with a source you know is good (kellymom, LLL leader, etc).

I think from memory food intake and rest doesn't affect supply, but obviously you'll feel awful if you're not getting enough which might lead to being less willing to wake a sleeping baby to feed, etc. Look after you - do you have a DH who can make you plates of sandwiches to munch on during the day, buy nice treaty foods which tempt you to eat?