This was 6.5 years ago so a bit patchy.
DS was born by EMCS, had infection markers, suspected Group B Strep. Was put on 5 day IV antibiotics. By day 5 infection markers were still too high so it was extended to 7 days, then 10. So we spent the first 10 days in Transitional Care.
We had two bouts of feeding problems, one during those first 10 days so we were at hospital already, and the second one causing us to go to A&E on day 20.
First of all, they took DS away from me very soon after the CS in order to get a cannula fitted, which they failed to achieve but only admitted after a long time trying. So a few hours later they took him again, this time successful. When he was away, a MW told me to express colostrum manually. She made me feel embarrassed that I did not already know how to do that. And she made me feel anxious about being able to express enough ('if you don't manage to express 3ml by x time, we will have to top him up with formula'). That was within a couple of hours of birth, with him being away from me, me super scared as there was a problem and they'd whisked him away, and unable to move any part of my lower body so unable to get into any kind of comfortable position. Luckily my mum was there (DP had gone with DS) and she helped me syringe colostrum off my nipples. We managed 2ml which was grudgingly deemed 'ok'.
After that wobbly start we managed to establish feeding, though it was filled with anxiety and I was asked to keep notes of how long he was on the breast and at what time.
When my milk came in on day 3 I became engorged, and DS was no longer able to latch. He became weaker and dehydrated, which caused a lot of concern, also he went down from 3300g to 2950g so just over 10% loss. They were worried there was something else going on, had to do urine samples which is tough with a dehydrated baby... he became weaker und less responsive, couldn't feed anymore, dehydration became a real worry so a NG tube was fitted. So from day 5 I think, I attempted breast feeding, then he was fed by tube while I expressed, in a three-hourly schedule as described by PPs. Utterly exhausting. Formula was not suggested at that point, I was supported in expressing (as in, provided with equipment, shown how to do it, and how to sterilise, provided a fridge for storage), but the nights were really bad.
Day 8 or 9 the infection seemed to have been beaten, but no discharge possible as long as NG tube still fitted. Most MWs/nurses were just letting me keep doing what I was doing (that mad 3 hour schedule) but one fantastic one supported me in getting him off the tube and re-establishing BF. She suggested a 'sink or swim' approach but also promised that she would stay with me and support me through the first 24 hours and then we would re-evaluate, which she did, she even supported me in gradually reducing the amount I was pumping without becoming to engorged.
So on day 10 we were discharged with 5 days worth of oral antibiotics and feeding established, weight just below birth weight. Took a small stash of EBM home with us, which was put in the freezer.
Things seemed to be going well. We fed on demand, roughly every 3-4 hours. We had no MW follow up at home as 10 days since birth were already over. HV dropped by but was wholly ineffective. But on day 17 DS was noticeably becoming weaker. He was too tired to feed properly, cried for the breast, went on and immediately fell asleep. On day 18 he slept 8h through the night - hugely restful for us, but in hindsight a massive red flag. By day 20 he was so lethargic and feeding so little that we took him to A&E. We were also worried as he started getting worse 12 hours after we completed the course of antibiotics, we thought perhaps the bug had not been completely defeated and was now re-surging.
The visit to A&E was quite traumatic in itself. We were seen really quickly. We knew some of the people we saw from our lengthy stay in Transitional Care. But then we were basically told to get a urine sample off him (the previous time it had taken us over 12 hours to achieve that) and to feed him, because he was being starved. So for 4 hours or so I was trying desperately to BF him while at the same time holding his bare bottom over a vial to catch any eventual wee. That was simply never going to work - the feeding, I mean. We were set up to fail. Rather than supported to BF.
After four hours we caught a wee, it was analysed and seen to be fine, the consultant then saw us and stated that DS needed to be fed and if he was not feeding from the breast he needed formula. She said we could not leave before he had fed, had someone bring a bottle of formula, and left us to it.
DS guzzled most of the bottle, then threw up most of what he had drunk. After that the consultant said, there was nothing wrong with him, he just needed to be fed, and sent us home.
We stopped by the shops on the way home and got formula. But as we still had a stash of EBM, we fed that at first (by bottle), and started expressing again, and by the time the stash was used up my expressed supply was good enough to avoid the formula. But we were back on that crazy 3h schedule.
A week later we went to see a lactation consultant, at the same hospital where we'd been both for birth and A&E. She was superb. She gave us the emotional support and practical advice to gradually come off the mad schedule onto something more sustainable. Slowly gradually we moved from feeding expressed milk by bottle to BF. At 12 weeks he had his last bottle, ever. When we tried him on a bottle of expressed milk at 4 months, in order for me to go out, he point blank refused, he refused bottles ever since. I BF him until 21 months.
There are two things that make me cross:
- The superb lactation consultant was there, in the same building, both times we were having feeding problems. No-one ever mentioned her or suggested she could pop round or we could go see her. We didn't know she existed; all the MWs, nurses, consultants were keen to give us advice but clearly thought they knew better or just as well as the specialist.
- The way the consultant in A&E insisted we were to feed him formula and made it a condition of us leaving. We had expressed milk at home. DP could have popped home and fetched it. But no, it had to be formula.
Looking back, what I think may be learned from our experience:
- I was really scared of introducing formula. I had read that even a single top-up of formula puts you on a slippery slope, your supply will go down, you will need more and more formula and will end up exclusively formula feeding. I wish I had understood that sometimes a bottle of formula can be just the thing needed to give the baby strength enough to continue with BF. I was also overly worried about nipple confusion, and thought it was a given that if DS had a bottle or two, he would no longer want the breast. I know this is a risk but I think it is often overstated.
- When 'starving' babies are put onto the 3h 'attempt BF, feed expressed milk (by bottle or cup or NG tube), express, sterilise equipment, sleep for 20 minutes, start again' schedule, the mothers need support; or else you are setting them up to 'fail'. This schedule is unsustainable for more than a few days. You can't just let them get on with it; or you might just as well say to them 'you can try, it won't work, why not just give the baby formula anyway'. So in the short term, they need support, and in the mid-term, the need a supported plan to move away from this schedule. This can be back to BF, it can be to exclusively feeding expressed milk (saving the time of attempting to BF), to mixed feeding, or whatever - but as the mum in that situation you need a way to move away from the mad schedule, and because you are utterly exhausted you need someone to help you/show you that way.