Advised by midwife to top up with formula - is this a good idea?

[hazelnutlatte]

Dd is 1 week old and I've found breastfeeding difficult so far due to initially having a poor latch and then getting extremely painful and bleeding nipples. At 3 days old the midwife advised me to feed every 3 hours and up every feed with 30ml formula as she had lost 11% body weight. I did this and at 5 days my milk had come in and she had put on a little weight so the HV said I could stop the top ups. Today she is 7 days old and I thought things were getting better - I have had lots of advice on latching on and my nipples are much less painful now and dd has been feeding frequently (every 2 hrs on average).
However she has been weighed again today and lost weight! Now the midwife wants me to top up every feed with formula again but I'm worried about supply. I've tried expressing but getting very little and I feel like the breastfeeding isn't enough for my dd and she is already starting to prefer the bottle. I worry that by giving formula my supply is going to dwindle to nothing.
On the other hand I don't want to go against medical advice! Is there anything I can do to increase my supply whilst also giving formula?

It'll be tiring, but if you keep feeding her as much as possible your supply should increase, leave the expressing for now, it's tiring and takes a while to get going. You could try taking fenugreek. Both of my children lost just over ten per cent of their body weight in the first week and recovered. Good luck.

Keep drinking lots of water. I topped up, following medical advice, and it was fine - it did not interfere with my supply and I had a happy healthy baby.

It sounds like they have tried to improve the weight gain but not actually helped with the breastfeeding

Can you get some face to face support from someone skilled to help you with positioning and attachment? is there a local group or feeding support workers attached to the maternity team?

I think feed as much as possible but also topping up by a small amount of formula shouldn't affect your supply too much imo.

It is getting the balance right though, my dd had top ups from day 1 due to being in scbu for over a week when she was born. I was able to continue with bfing with the occasional top up for nearly a year!

I know there is conflicting advice on increasing supply but personally what I found helped was drinking lots of water and increasing my calorie intake, plus oats are good so lots of porridge!!

Hazelnuttlatte, sounds like for this you need real life face to face support. Can you find out if you have a baby cafe, Nct BFC, LL leDer or IBCLC locally, your hospital may have an infant feeding specialist.

Until it's certain that your baby can feed effectively at the breast and that your supply is ok top ups could we'll be helpful. Realistically lots of feeding and lots of double pumping with a hospital grade pump could be your best immediate plan. Until someone assesses your feeding no one can give you more specific information.

Good luck with finding good support.

For me, the thing I needed to do in hindsight was relax. Deep breaths at every feed, almost like meditation. The stress of it all stopped my milk flow.

Sorry just realised I didn't finish saying what I meant to which was use the expressed milk first but use the formula as necessary too until you get a better sense of what is going on for you.

There is nothing that will boost your supply as much as removing more milk which is why you are better trying with pumping again if top ups are needed. These can be given by cup, your MW can show you so the bottle issue doesn't become more problematic.

Hazel, so sorry you are facing this.

I agree with previous posters about reassessing. If your baby needs topping up, then first choice can be expressed breastmilk. The advice to top up and feed three hourly on day three was possibly questionable anyway.

However the underlying issue is why your baby has lost weight. Do check there has been no errors in translation from/to metric/imperial. If different scales were used, or different weigher, or other conditions changed (baby dressed, baby undressed, before or after a feed, after or before a wee or poo) then the weight can be affected.

Thanks all for your replies. I have seen a breastfeeding counsellor at a support group last week, she helped me with getting the latch right and I think it's ok now - still painful at times but my nipples are healing and each feed is getting easier - the MW explained that now the damage is done I'm still going to get some pain until they are healed.
I am feeding as much as I can but find the top ups can interfere with that - she is very sleepy so will fall asleep on the breast a lot, when she wakes I could bf her but I need to give formula, this seems to space out the feeds more than is ideal. I am feeding 2 hrly on average which is basically every moment she is awake and not having formula! She will sometimes only feed for 10 mins or so then falls asleep - I do my best to keep her awake a bit longer.
I did try cup feeding but it was impossible! She was either too sleepy or screaming to take milk from a cup so we have been bottle feeding instead.
I will try and drink more water and eat some oats - maybe not porridge in this hot weather - I will send my DH to tesco for some medicinal flapjacks! Is fenugreek something I can buy in tablet form or do I need to get tea or something?

Oh

Oops posted too soon.
I was also wondering about pumping. If I feed for an hour and then pump for half an hour while dd sleeps, if she then wakes up to feed again is there going to be any milk there? Not really sure how this works - do my breasts need time to 'refil' between feeds?

Your breasts continually make milk, and the more that is removed, the more they'll make. So feeding after pumping will be fine, your dd might just have to work a little harder for it but don't worry, she'll be getting milk.

A mw told me that the best way to get milk from the breasts is from your little one herself feeding. Expressing isn't a reflection of how much milk you have so don't worry about that.

I thought all newborns were expected to lose weight initially? If I were OP I would persevere with ebf for a bit longer. Every 2hrs sounds about right.

When DS was born he was a very sleepy baby and not particularly interested in feeding. He struggled to gain weight and the midwives said to feed on demand but not to leave it any longer than 3 hours max - could this be what they meant rather than going 3 hours full stop?

Congratulations on your baby! Another tip would be to make sure you and baby have plenty (hours!) of skin to skin contact which should stimulate your milk supply and baby's natural latch-on reflexes.

Yes the midwife did mean 3 hrs maximum between feeds, sorry that wasn't clear. I'm feeding more often than that and waking dd to feed if she does go 3 hrs

One midwife I saw advised this, but then every other midwife/HV I saw pulled this face when I repeated it! So get a second opinion.

If I were you I would be tempted to carry on exclusive breastfeeding but get her weighed really regularly and log her nappy output so you can keep an eye on it. I know how worry inducing your baby not feeding is though, so it's a personal decision.

My DS was cupfed expressed milk but we did it from birth. It worked best when using one of those little medicine cups, tilting the cup so that the milk just touched his lips to tempt him to start lapping. If your baby thrashes about when crying you could try swaddling to keep her reassured and still.

Also, maybe you could try a different pump? I always got on with my Avent one, but I heard other women say that changing pumps made a real difference for them.

Sabrinna, babies do lose weight initially, but once that weight loss has happened, babies should continue to gain....losing weight after this initial weight loss/gain is unusual and always needs checking out.

Hazel, if there is an issue with your baby's weight (and I would still be wondering if there is a scales or operator problem here instead), the key is simply getting more milk into your baby. All the stuff about taking fenugreek, eating oats and pumping is irrelevant - do all that if you can be bothered, but bear in mind the main thing is for your baby to feed efficiently and often. Nothing you have said about her feeding makes me think you have a problem which cant be address by simply ensuring that :)

Sleeping after 10 mins is normal at this age. They often wake up after a short nap and feed again. This is good :)

I was in a similar situation re. Weight loss and being advised to give top ups which I did. It worked well for a bit but pretty quickly I feel dd started preferring bottles (I think I have a pretty slow let down and slow flow) and there were gradually more feeds where I couldn't get her to latch on. We'd had issues with the latch and hadn't really got it sorted/established so that might have contributed.
I'd had similar with my other two children and so was fine with switching to formula (I initially pumped whenever she couldn't latch on but found this hard to keep up with the other kids to look after once DH back at work) and so at about 3 wks she's now completely ff. I'm ok with this, I don't feel I had a choice as they were 'threatening' readmission if her weight didn't pick up which I really wanted to avoid.
Mix feeding seems to work for some but it is high risk that it will undermine bf so just be aware.
As I say, I'm happy ff and feel pleased dd at least got colostrum and was part bf for a few wks but if you're dead set on ebf then you might want to take a different approach.

I had this problem, baby lost 12% in first five days, was advised to supplement with 30ml per feed to keep weight up. Got advise on latch, which improved feeding, by 2 weeks baby was putting on weight, big relief all round, stopped supplements, baby weight a week later had lost 10% again, huge panic.

I found it so stressful. I was so tired, and so worn out yet determined to continue, and had no end in sight. My heart goes out to you.

My baby is now ten months old, on the 50% for weight and currently battering his toy piano. I am still breast feeding...hang in there!

What worked for me:

1. Attending lots of different breast feeding clinics. I got the latch better after a week or so but I found going to them very supportive and got to know a couple of the MW very well, and THEY GOT TO KNOW MY BABY which was really important, could see his feeds as part of a pattern and give better advice, would ring to see how we were doing and I could ask them questions etc.

1. Had his tongue tie checked. Two GPS and two breastfeeding MW's checked him and said no tongue tie. A third checked and referred him. He had a tiny bit of tissue but it was restricting his tongue so that he could pull it out but not curve it round the nipple which meant he couldn't get a deep suck to reach the hind milk. He was always feeding but never got the rich stuff. The consultant said he counted it as a 75% anterior tongue tie yet everyone missed it, so if you suspect it might be an issue, get checked at every clinic you can go to!

1. One top up of 120ml at 10pm - This was much better for us than lots of 30ml ones throughout the day, again it was not the first MW's advice but one we met later. This meant he felt really 'full' at 10 and fell asleep until 2am and I could get 4 hours sleep once a day- it really helped my supply as when you are exhausted your body just starts shutting down.

1. Having him in bed with me, again suggested by the very experienced mw- make a separate safe little area away from bedding etc. But it meant I would awaken to his snuffling and help him latch on and then drift off with him, repeating every couple of hours. In his moses basket I wouldn't wake till he was crying, bolt awake, try and calm him, by which time I was wide awake, and would take ages to drift off, whereas in bed I would just shuffle down in bed and drift off straight away when he finished. This meant I was so much better rested. This made a massive difference. At the weekend when my DH was around more I'd just stay in bed drifting off and he'd wait on us.

What didn't work:
30ml top up every feed, meant baby wouldn't be hungry as soon to stimulate my supply.
Fenugreek, oats, etc
Expressing- flipping heck I hated that machine. It was so stressful, artificial, I didn't get much out which made me worry I had so little milk etc. It really was awful. But I was much better when I gave it a 48 hour 'rest' on advice from the very experience MW.

She said what I needed was rest, to relax with baby and lots of cuddles. This was key.

Once I snuggled down in bed with baby, relaxed with all the expressing, constant top ups, timing feeds etc things were much better, he was soon back to putting on weight and then I slowly decreased that one supplementary feed a day down to zero over a few weeks.

Sorry for the long post, really wanted to help as I know what its like!

Oh sorry, also meant to say the advantage of one mega- top up per day was also explained to me in terms of the fact that baby would not be habituated to the experience of the bottle, was having breast only at every other feed so less likely to confuse them

just looked at my diary at it was actually one 120ml at 2am and baby would then sleep till 6am, (not 10pm feed and sleep until 2am),

Hi thanks for the detailed reply doggydaycare, I seem to be doing something similar to you now, my dd has put on some weight again and the midwives are happier so I've reduced top ups to one in the evening (as she is frantically cluster feeding and this gets a bit painful so it gives me a rest). She is also sleeping in bed with me for a few hours each morning (after DH has got up with our older dd) so we can feed and doze without too much effort and I get a bit more sleep.
I've also seen a breastfeeding expert from the health visiting team, she has checked really thoroughly for tongue tie and suggested some ways to make feeding more comfortable which has helped. She thinks that dd has a very small mouth which makes a good latch a bit tricky but otherwise no problems.
I feel much better today and am happy to continue with the once a day top ups to give me a break, so continuing to bf seems achievable now which it really didn't a few days ago! I've also given up on expressing for the moment as it was too much faff. I've been reading through everyone's replies on here again and there is loads of helpful stuff so thanks all!