Breastfeeding/EBM/Formula - all a bit of a mess

[Sugarcoma]

I posted here a few weeks ago about how I was struggling to get my LO to latch after he was born via ELCS with low blood sugar and got some really lovely, encouraging responses.

I decided at the time that there was a chance he might still learn to latch and in the meantime I needed to increase my supply and so am currently using a Medela Symphony 7-8 times a day for thirty minutes each time. I also take Fenugreek and eat tons of oats and I have seen a bit of an increase in the last week meaning I've been able to almost totally wean him off formula (I've certainly significantly reduced the amount of formula) in favour of EBM. And the best bit it my DS has started latching for longer periods of time!

However, the feeding is all a bit of a mess. Last night I tried to feed him just from the breast and he was on for two and a half hours and still needed a bottle top up (EBM) afterwards. That doesn't seem right to me? Could that be a supply issue? It was almost as though one feed had bled into the next.

I'm also finding that pumping every 2-3 hours on top of looking after him is utter hell especially when I also try to BF him before pumping (my DH is helping as much as possible but he still has to work during the day) and I don't know at what stage I can start to reduce this down without compromising my supply?

When I spoke to a lactation consultant right at the beginning she said supply tends to stabilise six weeks after the due date. Does that sound right to anyone else? (I know she's the expert but nothing really came up about it when I googled).

DS is now 6 and a half weeks, but was born 2 and a half weeks early.

Any advice about how best to proceed would be very much appreciated!

Cluster feeding is perfectly normal. If he's latching and feeding successfully he may well be building up your supply.

I might be tempted to give yourself a break to an extent with the expressing and just let him feed whenever he needs to - assuming he is starting to feed well.

I was in a similar situation with a prem baby who found the breast too tiring. It would take a while to get him to latch on and then he'd do a few sips and stop, the hours I spent blowing on his face to wake him up to get him to try and empty a boob. I stopped as I was killing myself trying to express or feed him and it was stressing me out, an hour an a half to feed every four hours and expressing on top. I decided that my mental health was more important that giving him breast milk and that he'd had it for the first few weeks and that was good enough.

Switched to formula, stress levels dropped and I have a happy healthy child.

Do what feels right for you and causes the least stress.

Well done for persevering, it's hard going when breastfeeding doesn't start off brilliantly but it sounds like you're going really well.

The long feeds in the evening is normal at this age. Both mine cluster fed for 4-5 hours in the evening. You're right, it feels like one feed just joins the next but the are increasing your supply and tanking themselves up for a long stretch of sleep. That's the theory anyway!

The thing with topping up is that sucking is a reflux, so most babies will feed if given a bottle but not necessarily need it IYSWIM.

How is the weight gain? If that's ok reduce the the top ups slowly and breastfeed more.

Assuming breastfeeding is ok now, I would stay home for a week or two and put the baby to the breast as much as possible to really get it going. Expressing is a faff and not sustainable IME.

In terms of milk stabilising, it's hormone driven for the first 6-8 weeks, then settles down to suit your babies needs. It's still flexible though and can increase/decrease depending on how often baby feeds.

What is his weight gain doing?

You don't want to reduce tops up if he is struggling to maintain his centile, but if you have no further concerns then look to cut the formula first and then the EBM.

As previous posters have said, cluster feeding is normal, as is constant feeding around growth spurts (you can expect one around 6 weeks).

It's always worth getting another look at the latch to make sure milk transfer is as effective as it could be too.

He lost weight at the beginning then gained it but that was when he was still having lots of formula. He's a big baby and definitely not under weight but if I go cold turkey with him how will I know whether or not he's losing weight? (Do I literally just weigh him on my scales at home?)

Also I've realized that I don't think he's sucking properly - he never does the long slow sucks, it's fast sucks interspersed with flutter sucking the whole way through. Does that mean he's not getting enough milk? And how can I correct that??

Do you have a local la leche group? They'd be able to have a look for you and advise how to move forward however you want too (be that breast/mixed or moving to formula) alternatively they have a 24/7 helpline which is really useful

If you don't think he's feeding properly, then I woouldnt cut back on top ups.

Can you hear him swallowing and how much formula/EBM is he having at the moment? Le leche are great if you can get to a group, they can help you work in getting a really good latch.

Has he been checked for tongue tie?

To get him weighed, you should have a local weekly HV drop in (or sometimes appointment only) weight clinic where you can take him to be weighed.

I've had a similar start with both my children, and did get back to 100% direct breastfeeding. It is a bit of a slog with all the expressing though.

I would definitely get your DS checked for tongue tie by someone who knows what they're looking for and who can do the snipping procedure for you if needed. Do you have any nipple pain, does he make a clicking sound when feeding, or are your nipples shaped like a lipstick after a feed? That might indicate a tongue tie.

In the meantime, I would continue with the top ups after a feed for now, but I might limit the time your DS is on the breast at any one feed. 2.5 hours is a very long time, and might indicate that he's not transferring milk properly. I think I'd give him something like 40 minutes or so, and then give a top up.

If you're not sore, and baby is doing lots of wet and dirty nappies, then don't worry, take his lead and he will be naturally building up your supply. It sounds like you have no supply issues, and with all that pumping you may end up with an oversupply issue (like I did) and that can be quite traumatic for you and baby (think squirting boobs and choking baby!)

Cluster feeding is really normal (my DS had a couple of 12hr sessions in the early days 😮 which I now realise was him building my supply), so 2.5hrs seems quite good in comparison. It seems crazy to add the faff of pumping on top, so I'd reduce the pumping to one bottle a day (if you still want to express) and let baby nurse for as long as he wants (get all set up on the sofa with a large bottle of water and snacks and the remote!)

You'll soon know if baby isn't getting enough milk because he'll let you know! And of course get him weighed every week to make sure 👍🏻