Low supply, struggling to breastfeed often enough

[Terramirabilis]

DS2 is nearly 2 weeks. Rocky start due to excruciating pain and rapid damage to nipples. (DS1 wasn't breastfed after first 24 hours for similar reasons.). I've had better support this time so have been able to persevere.

I'm seeing a lactation consultant twice a week and she's been very helpful. But I'm being told to bf 8 times daily to try to improve my low supply. However DS seems to want to feed less often but take in more than the recommended amount when he does feed. We're probably managing 5-6 feeds per 24 hours plus drinking lots of formula. He's back to birthweight already.

How do I get him to feed more often and therefore feed from me more regularly with fewer large formula feeds?

It’s not clear why you’re using formula but the obvious solution to me would be to reduce the formula so he’s more hungry for the breast. Other things you can do are waking him by changing his nappy, tickling feet etc to keep him feeding longer and expressing while he’s having formula because otherwise your supply won’t meet his demand. I hope the LC can help and advise you, it’s such hard work!

We started on formula on day 3 until I could get to the lactation consultant because the pain was unbearable and obviously he had to eat. Then I was put on "breast rest" to allow me to recover for 3 days so I only pumped then and didn't bf. Now we're back to bfing but my baby doesn't seem to want to eat 8 times a day as the LC suggests. So I'm concerned he's not getting enough chances to feed from me.

A feed goes: 10-20 minutes feeding from each breast (ie 20-40 minutes total). Then I pump for 10 minutes while DH gives him formula. If DH is not around, I do formula then pump. DS has formula until satisfied.

Is there a way to get him to take less formula so he'll be hungrier sooner so I get more chances to bf without him being hysterical because he's not feeling satisfied?

I also have low supply. When I saw the LC last, at 9 days postpartum, DS only got 22mls in a feed although it was more than 4 hours since I had last fed or pumped.

Breastfeeding is so bloody hard isn’t it.

What happens if you don’t give DS formula after each feed? Also, are you removing him after 10-20 minutes or waiting until he unlatches or falls asleep? I’d go for the latter if that’s not what you’re doing already. I’m curious as to how you could gauge that he had only 22ml, as I’ve no idea how much my DD takes in!

I’m fairly sure that the only way to boost supply is to feed and pump more often. So longer on the boob, stop giving a formula top up automatically at each feed, and if necessary spend hours allowing him to cluster feed on demand until supply has improved.

Firstly you are doing great and don't lose heart! I BF my first until he was 2 and my DS2 is 14weeks and currently feeding now so a few little tips that helped me... I found I needed to drink lots initially, I'm talking about 3 litres daily and plenty to eat too. I would also always offer your milk first as the more the baby sucks and 'requests' milk, this signals the body to produce more milk. I was informed the important times to feed to help with your supply are between midnight and 6am so although it is very unsociable try to ensure your baby is feeding regularly at these times ie 3hrly overnight.
Fenugreek is a natural herb (you can get it in H&B in capsules) which also really helped with my supply with first DS. For something that is supposed to be so easy and natural it isn't always that simple but once you get that milk supply going things will become much easier! I find chocolate always helps with everything too x

Thank you all for the tips. I am taking a supplement of fenugreek since a few days ago. I know how much he took in when I saw the LC because she has special scales that can measure accurately enough to detect the increase in weight after a feed and translate it into a volume of milk ingested. I also get very little when pumping- around 5-8 mls - which is disheartening although I'm pumping straight after feeding and I'm told it's getting the stimulation of pumping that matters and not the volume produced. It's just depressing to be putting up with the pain and the hassle for so little reward.

Also the problem with not offering formula is that DS starts giving hunger cues soon after, becomes increasingly agitated and eventually hysterical.

You need to get him properly assessed for tongue tie. It can’t be a very good lactation consultant if he hasn’t done or suggested that already.

Pain and nipple damage is a classic sign of tongue tie. It might not be that but you must rule it out. And by someone trained to assess it properly, not a midwife for example.

www.tongue-tie.org.uk/Mobile/m-tongue-tie-important-information-for-parents.html

PS You have low supply because a. Your baby isn’t feeding properly and is therefore not draining the breast and b. You are topping up with formula

I've seen a couple of different LCs at the same place and both they and DSs paediatrician are agreed there's no tie.

I'm not a lactating consultabt and therefore no expert. It I have breastfed 3 babies for a year each.
Latch is key to successful breastfeeding. It is sore for a while first time around (subsequent babies less so). Pumping is bitorious for producing less milk than a baby produces when nursing, especially AFTER a feed.

So

1. do you feel a strong let down reflex when your baby nurses?
2. how long have you been topping up with formula?

If tipping up was/is crucial to ensure baby gains weight then of course you must do that but the only way to increase supply effectively (IMO) and purely based on my own experience - is to allow baby to nurse. If your baby isn't hungry s/he won't nurse. Can you drop a formula feed after one bf and see what the knock on effects are? It's a tricky situation because you're now caught in a loop with the FF.

At the end of the day as long as your baby is thriving, it doesn't matter how they are fed. And massive congratulations on your new arrival. Sounds like you're doing the best you can. That's all any of us can do.

Sounds like you are doing great, but the more formula you use, the more your baby will rely upon it. Also what type of pump are you using? It might not be low milk supply that is causing smaller quantities!

What is your baby like after 20minutes on each breast?
do your breasts feel different before and after a feed? I'm what way?
2weeks breastfeeding is amazing but still early days, so take it one feed at a time x

I don't feel anything happen during the feed although I don't know what the letdown is supposed to feel like. DS is definitely swallowing though.

I'm using a hospital grade pump, the Medela Symphony.

My breasts don't really feel much different after a feed. Maybe slightly softer although they're not hard really. No feeling of fullness or needing to empty them at any time.

Congrats op. Your current situation sounds time consuming. What happens when you offer an extra feed - will dc just not latch? Or come off really soon? I am no expect but could you bf. then offer a fixed amount of formula then pop back on breast if dc is still not satisfied. This gives dc 2 goes per feed at the breast. I would stop pumping in this scenario - your baby is / will be more efficient than a pump and that must be absorbing a lot of time and energy for the reward.

What kind of gaps are you expecting between feeds? Are you trying to schedule them?

I’ve always had to work to build supply, which with DD meant feeding her literally on demand- she could have periods of the day feeding every hour or even every 30 mins. It was brutal at times, but it worked and after about eight weeks settled. She’s a very big baby and always followed her centile.

I never managed to build supply with DD1 as I was put on a feeding schedule by the midwife (every three hours) and obviously DD needed to feed more regularly. We ended up supplementing with formula as various family members totally undermined my confidence in needing to feed more often (saying BM wasn’t satisfying, etc.)

If you want to increase breastfeeding you do need to drop (or at least greatly reduce) the formula.

Also expressing really is no indication. I’m still BFing a giant baby at 18 months. She’s never had a drop of formula, but I’ve never been able to express more than about 20ml. Expressing doesn’t work the same as a baby feeding.

Two weeks is very early days so you have time to teach your body to match the supply to your baby, but you’ll only do that if you stop the formula and increase the breastfeeds.

Good luck! The early days of BF suck but it can and will get better

Oh and I never felt let down, some people don’t, so don’t let that worry you x

I think you should always be offering the breast first, whether you have someone else with you or not. That's the main thing that jumps out at me from what you've said.

How do the LCs and paediatrician explain the excruciating pain and nipple damage? If it’s not tongue tie there must be another reason for it. Clearly baby’s latch wasn’t good - has it improved significantly? Are you no longer in pain? Are you using nipple shields? They can sometimes interfere with supply.

When my daughter was 2 weeks old she spent most of the day on the breast. I did pump for a while to 'top up' but realised that it was easier just to put her back to the breast. I didn't feel a let down but just went by wet and dirty nappies to know that she was getting milk. I would reduce formula and put her to the breast every time she's hungry. It's relentless at first but does soon calm down.

After my husband returned to work I spent a lot of time at toddler groups and coffee shops (and watching box sets) because if I was going to be breastfeeding all day at least I was doing it in different surroundings.

Sorry, just seen he's a he and not a she!

namechange30 yes agree nipple sheilds are the devils work when it comes to supply, and simply mask a latch problem.

It took me several weeks of going back to the BF consultant to finally fix the latch. It was something as simple as ensuring I pushed her further over when latching. I watched lots of videos of good latch and took lots of advice from the BF clinic. It wasn’t a quick fix, but we did fix it.

You've had such a hard start, nipple damage can be caused by just bad latch. If feeding is now pain free then a tounge tie is probably not a issue. If not then you need to seek more help with this.

The only way to increase supply is to have baby feed directly from the breast effectively. Not all women respond to a pump I never did hand pumping is an alternative you could try, Google it for videos on how to.

You need a plan to reduce the formula your baby is having and feed more often. I'd even say 8 times a day was to little in this case we would say 10-12 time minimum This is normal for newborns espicaly when try to establish supply. Get support from somewhere like the national breastfeeding helpline or online now at breastfeeding Network. Your lactation consultant should be giving you more support in making this happen.

Remember this you can never feed to often, you can feed to little though.

Don't worry about the let down not everyone feels it either so it's not an indication off anything.

I'm slightly worried your lactation consultant is a bit old school though. I thought they didn't use scales anymore and she not recommending you feed often enough.