Hungry newborn

[ToffeeForEveryone]

DS1 is 13 days old and I'm struggling to know what to do for the best. Getting a different answer from every midwife / hv so seeking the collective wisdom of mumsnet

I've been trying to bf but really struggling and am worried I might be damaging my supply this early on by starting to express.

It's been a horrible fortnight tbh. 2 weeks overdue, 6 days in hospital, ecs. Since home, a close family member gravely ill and not expected to survive this weekend. DS constantly hungry and unable to settle, won't let us put him down, midwives just telling me this is normal and to feed on demand but this resulted in basically trying to feed an increasingly distressed baby for 2+ hr stretches who never seemed to be full. And then wouldn't sleep in crib or anywhere but arms. And one cracked nipple.

Told midwife yesterday that I was really struggling and she said baby was hungry and to express and top up with formula if needed to let me get some rest. (This contradicts what I was told before, I have been asking about expressing since last week and consistently told that until bf is fully established I really shouldn't.)

Last night and today I have been expressing from the cracked nipple and giving this plus other boob at feeds. The amount of milk varies from 40 - 80+ mls which is a lot more than I thought a baby that age would take?

If I give DS the bottle first, he is a lot calmer when bfing. He also seems to be getting full and (finally) sleepy as the feed is a lot faster. When going purely on boob the feed takes forever and he gulps in a lot of air as he gets worked up.

Questions: should I be giving the boob first instead of the bottle or does it not matter?

How long can I leave cracked nipple to heal before offering back for bf?

How often should I express?

Any advice much appreciated!

Sorry it's so tough. I not a bf expert, but I'm sure others will come along soon.
Expressing won't harm your supply though, if anything it will trigger more.
I think I have nipple 24 hours to heal and found breast shields very helpful until it was bearable again. Keep putting on the cream.
I topped mine up with formula too as she was loosing weight, my nipple were agony, I was a mess after c section. But I went onto bf for 13 months so I really don't think it was a problem.

Ps give boob first definitely, then less impact on supply
My midwife advised giving formula from a cup unail bf established, but it was a right pain and it sounds like yours is feeding well.

toffee what a difficult start and what a combination of events and stressors :(

Firstly, let's get the info out the way :)

Expressing per se does not damage supply. The reason why some people think there is a rule about it is that some people are inflexible. Expressing does not damage supply, but on top of normal direct BF, it can increase it beyond what's needed and create discomfort. In addition, if the baby has a bottle of expressed to give the mum a break, done too often , to leave several hours repeatedly between direct breastfeeds, this can lead to less milk. Each situation should be assessed individually, and there are circumstances where expressing early on can help.

I'll have another read of your post and come back to you in a bit about the other stuff. In the meantime any of the breastfeeding lines will help, and nct's is open every day including now, and you will get a response straight away, or a response to your message very quickly. So do call.

I was encouraged to express (similar to you - 12 days overdue, EMCS and 5 days in hospital. My milk didn't come in for almost a week and my DD was starving. The expressing was to stimulate more milk flow!

I would recommend seeing a lactation specialist if you haven't already. They are generally much more knowledgeable than midwives about breastfeeding. I found the gel pads really helpful when DD2 destroyed my nipples. They are quite expensive, but worth it short term. I got some on prescription from the breastfeeding cafe.

I tended to offer breast each time before bottle to ensure baby was hungry enough to fully empty the breast. Both to avoid mastitis/blocked ducts and to try to increase supply.

The early weeks are so, so hard. But it does get easier!

I don't have much advice but really sympathise. Has your child been checked for tongue tie, by a lactation specialist? Do you have a local bf cafe/support group?

I had an EMCS with my first son and my milk took a few days to come in. Combined with his undiagnosed TT, we had a horrendous time bfing for the first two months or so, but got through it (and fed until 19 months) with sheer stubbornness and a shedload of Lansinoh. And crying. And, to be honest, a bit of PND, in retrospect...my point is, IMO exclusive bf is only the best option if it isn't making you depressed and inducing wrecking sobs and a horrible feeling of hopelessness at every feed, as it was with me. TikTok has some good advice - don't be afraid to express, and have a good look on kellymom.com for advice. Do you have a La Leche Lwague group near you?

Definitely no expert but just wanted to offer some support. Sounds like a very difficult time it's been for you. It might be that your ds is having a growth spurt. They have one at 2 weeks then again at 3 weeks. Although I'm on number 3 now, I still worried when my ds was constantly feeding! Then I remembered the growth spurts and cluster feeding.

lansinoh is amazing for sore nipples.

Ds2 is 3 weeks old and has not slept anywhere except on me and dh, if that helps x

toffee I am back again with a few more thoughts :)

At 13 days, you are still at the early stages, and one option to consider is just to do whatever makes life easier at present, without being too concerned about longer term effects. Offer the bottle of ebm before, after or during the breastfeed. It does not really matter. Whatever is easiest for you and your baby is fine.

Leave the cracked nipple at least a day or so - more if necessary, it depends on how fast you are healing. Treat the crack with whatever feels best - proprietary lanolin are fine.

Get help with repositioning so the crack does not open again.

If you can manage to get to a BF support group you will meet other mothers who will assure you that many newborns prefer to be close to their mums for much of the time, on or near the breast. If you have someone around ( eg your partner) your baby may well accept skin to skin contact,moving arms, gentle soothing, from them at times to give you a break.

Some good ideas also from other posters.

If your baby is gaining weight and thriving, then you can be pretty sure there is nothing wrong - though it does make sense to check for tongue tie.

Hope things get better soon for you.

Thank you everyone for the advice and support - had a better night last night, although I had to give formula for one feed (was on my own and needed a bit of sleep so skipped expressing after one feed), baby was a lot happier and slept much better. He's also getting used to lying in the cot which helped massively.

He was treated for tongue tie when 2 days old but the midwife mentioned a couple of days ago that it still looks like it is tied. I have details of a bf support clinic to attend on Wed and I am going to ask there whether that is still a problem - just seems that something is stopping him feeding quickly enough from boob to be satisfied. Either that or just latch / position.

Tried feeding him from boob first then bottle of ebm rather than the other way round, he definitely settles better for the whole feed when he fills up from the bottle quickly first, but I don't want to create a rod for my back having to constantly express if I don't have to.

Going to give the sore boob the rest of today to heal up if poss, using jelonet and vast quantities of lanisoh and seems to be improving.

Persevering!

How much should a 15 day old baby eat at each feed??

He is literally never full just from bf, even spending 20-25m on each side today (cracked nipple improving) he was hungry and I had to top up with formula, he took 40mls.

Also, how can I get him to take the bottle more slowly? He has had pains with trapped wind since he was born and its been keeping him awake, don't want to make it worse by overfilling him and making him sick 🙁 I'm using Avent slow flow bottle or Tommee Tippee 1s.

What do you mean by "never full" exactly? What happens before during and after a feed? It's really hard (impossible probably!) To say how much such a tiny baby should have.

Toffee I think it will really help to speak to one of the bf helplines about all this.

20-25 mins on each side is not out of the ordinary at all for a 15 day old. Giving a 40 ml top up will interfere with production, because your baby needs to put his order in for the breastmilk :)

It is normal for babies to spend a lot of time on or near the breast, especially when still very new.

'Trapped wind' is very difficult to pin down - why do you think he may have this?

Hope you are getting lots of support and TLC from the people around you, while this difficult stage lasts.

Been trying to get through to nct whenever I get a spare few mins but no luck so far, goes to voicemail. I will keep trying.

Last visit to midwife she said that the changing - feeding -burping etc should take around an hour and that anything more than about 40min on feeding is too long. . The issue is not that I want to be stopping dead on 40 mins or an hour, but that after that he is still unsettled and hungry. I expressed some milk this morning which I can use for top ups tonight if needed - I don't want to be giving formula at every feed if I can help it, but really at this point supply drying up in the future seems like the lesser of two Evils compared with the baby crying and hungry now 😞

Saying that, he took just bf at the 430 feed and has gone down to sleep after - result! He fell asleep several times mid feed and I gave up trying to rouse him to feed and put him down after about an hour - he woke up after 15 mins but a quick bf top up settled him. I had to sit with him sleeping on me for about half an hour after but transfer to cot successful after that .... And apart from the start he wasn't really crying for most of that time so it was a bit easier.

Sorry this is all probably very tedious to anyone reading this! I'm just desperate to get him settled into a pattern where he can feed until he's full without being distressed, and then go to sleep somewhere other than lying on me so I can have a break from the relentless physicality of it all.

Re the trapped wind - he's being winded during and after every feed but usually towards the end of his sleep session he is making pained noises, pulling his legs up and farting loads. He's usually distressed when waking - not sure if that's hunger or wind or both. Have given him some infacol today which I'm a bit uncomfortable about as he is so young, but will try it for 24 hours to see if it helps him.

My dh went back to work today but I have my parents / mil around until Thursday so I have another week before I have to deal with baby all on my own. At the moment frankly I don't feel like I'm up to it 🙁

Have they spoken to you about silent reflux? Your story sounds a bit like my ds who also had a tongue tie which was diagnosed at birth pretty much because he went into neonatal. Because we knew he had TT (which wasn't snipped until he was 4 weeks) we didn't associate the windy, uncomfortable, constant feeding, constantly hungry with the fact that he actually had reflux. It was only when his TT was snipped and we saw no improvement that the HV considered he may have reflux,(which has its own set of problems and remedies I'm afraid) and after 6 weeks of gaviscon and the usual, we switched to reflux formula - he was like a different child overnight. We were giving 1 or 2 bottles of reflux formula a day for a while as we were already topping up like you are, and eventually made the switch. I'm not saying you should stop bf ing but its a possibility to consider that you may not have thought of. Good luck.

Toffee I am really sorry but your midwife is wrong and is in need of some training. To say more than 40 mins is too long is unhelpful. It is well within normal for a baby of this age. There may be other things going on, though to be honest your description of what happens with your baby all sounds within normal. Hope you will try Nct again and this time leave a message. You will get a reply back within an hour or so. Very few people get through direct. You more or less have to leave a message.

Mine is four weeks old tomorrow and I'm feeding on demand, she's cluster feeding which means my days are eaten up by trying to get a shower/food/wee/anything in between feeds. She's insatiable but gaining well now. I've expressed when I've had the chance but I've not prioritised it.

If you can get support to check the latch is ok and keep at it you will be fine. I was told to rub breast milk into the cracks and that seemed to help along with the cream I've got.

Also you need to eat and drink everything. I think mine suffered a bit because I was in the ward 4 nights and just didn't get fed enough. Eat and drink all the time. Have people bring you stuff it really helps.

Congratulations !!!! X

Yes to Frizzy's suggestion of people bringing food and drink :)

But it really, really does not matter to breastfeeding if your diet or fluid intake is not great. Drink in response to thirst, natch, and eat to keep yourself comfortable. But beyond that, don't be concerned :)

Everything you've said sounds reasonably normal op. I think you're mw sounds a bit nuts putting a time limit on feeding for a newborn! Feed, snooze, feed, cuddle, nappy change, feed, sleep........All sounds good. It's hard op because in the early days it's all so intense. It's hard to tell from your posts but if you're worried your baby is still hungry because he struggles to settle in his cot, don't be, newborns hate being put down. Two weeks ago he lived inside you so a cot will seem unbelievably unsettling for him. They also make lots of grunting noises which can easily be mistaken for troubling wind when really it's just a baby getting used to having to eat.

To put it into perspective, my dd was a great breast feeder really but at 2 weeks she was feeding every hour-90 minutes. She would not be put down to sleep at all during the day and we Co slept at night. She would just about tolerate a short cuddle from daddy whilst I got a shower or gave ds a bath. She spent a lot of time in the sling. I think this was all pretty normal new born behaviour.

How much f is your baby currently having? Have you managed to get through to nct or lll? They really were helpful when I struggled with ds.

I'm no expert on the technicalities but I am ebf for the third time and ime newborns are almost constantly hungry, and only sleep while held. That's just how nine have been and I've just gone with it and fed them a lot - as often as they want for as long as they want. Mostly for lack of ideas as how else to do it but it's worked out ok. Could you just go with it a bit? Let family do all the other stuff and you just lie around snoozing and feeding?

Ps toffee, you're doing a fab job - take all the practical help that's offered. Rest as much as you can and let anything you can, go. The early days and weeks are gruelling and you're doing really well. You're healing and recovering as well as doing everything for the baby. Don't underestimate how awesome you are

Just re read your post about wind - what you describe sounds utterly normal. Really ! The baby wriggling and squawking and making pained noise and bringing legs up and farting and so on on waking...this is what babies do.

Please don't be in too much of a hurry to diagnose wind or reflux or whatever.

He's probably gulping air if he's trying to feed too fast and fussing at the boob. Hence the wind. Have you done the thing where you lie them face down and bum up on your arm to allow them to fart more easily? That used to work for one of mine.
The first few weeks can easily be a very physically demanding time and one hell of a shock to have a baby attached to you for hours.

Sounds like a really tough few weeks for you. I could have written most of your post six months ago, plus my milk was slow to come in and we ended up back in hospital due to DS losing 17% of his birth weight.

The following is based on my personal experience; I'm not a healthcare professional and tiktok is far more knowledgeable than me - this is just what worked for us.

"Normal" is a broad spectrum at this age. In the first fortnight, my baby could spend half an hour feeding from each breast, and rarely went 2 hours between feeds. It felt as though all I did was feed him!

I expressed from around day 10 to try to increase my supply. I aimed to do it three times a day but didn't always manage it. But I had DP around for the first month so was lucky.

I would offer breast first then, if DS hadn't fed to sleep after half an hour on each side, I would get DP to offer 70 ml of formula (of which DS would take 40-50 ml, I think) while I expressed. I got way less than you at this stage (used a manual pump), maybe just 20-30 ml, and would express for about 10 minutes on each side.

I also found it very difficult to get a straight answer about formula top-ups and expressing, and all my friends who were in the same boat for equally contradictory advice.

On the plus side, doing the above did increase my supply and by 6-7 weeks DS was gaining weight steadily and we were exclusively breastfeeding.

To get some rest, I would feed DS early in the evening, hand him over to DP with a bottle, then sleep for up to 3 hours before taking DS back.

DS was very resistant to being put down (we could sometimes get away with it if we waited until he'd been asleep 20 minutes or so and warmed the crib first with a hot water bottle). I think he spent more of the first month than not in our arms. All very normal! I will say that his sleep improved when his tummy was full.

Good luck and I hope you get to where you want to be, feeding-wise. The first few weeks are exhausting but it does get easier.

We had lots of success using infacol with DD.