Have I messed up my milk supply?

[Asiama]

My baby is not putting on enough weight so I'm having to top up with 30ml formula after each feed. Today he wouldn't stop crying, wouldn't latch on and it just go so frustrating, I gave him 60ml formula instead of breastfeeding him. I just felt so helpless seeing how upset he was getting. Now I'm worrying myself that I've just further reduced my milk supply. Is there anything I can do to undo the damage? I really want to breastfeed but the formula top ups and pumping milk is hard.

It is really hard, I’ve been there, it’s shit!
Can you get to a breastfeeding support group (LLL are great) or to see a lactation consultant?
Midwives and health visitors are great, but not always the best people to support you in breastfeeding.
How old is baby, could the fussing be a normal growth spurt/wonder week leap?

Hi, how old is baby? My baby was mixed fed as a newborn then moved to exclusively breastfed at a few months old as she became fussy with a bottle and was gaining weight fine. Advice I can think of off the top of my head, don't beat yourself up,, one bottle feed isn't going to
ruin your supply. find local breastfeeding support group. Express after feeding, or whenever your feeling full and baby is sleeping. Sometimes if your too full baby can struggle to latch. Midwives told me breast, express then formula. Finally excersize like a brisk walk helped me with supply and drink plenty/eat well etc.

Express if you're topping up to 'replace' that feed l. Exclusively breast feeding works best not expressing.

How old is your baby? You won't have messed it up. Have a "breastfeeding moon" tomorrow if you get chance and set yourself up on the sofa with some sacks and the TV on and just feed, feed, feed with lots of skin to skin contact. Offer the breast even when baby isn't showing signs of hunger. Just feed as much as you can.

Don't worry. An extra 30ml will absolutely not have messed anything up. Yes it would be a good idea to pump but don't worry if it was some time ago now - just carry on to the next feed.

How old is your baby? It sounds like he might only be very little? How often is he generally feeding, and what support have you been offered to increase his weight gain apart from the formula advice? Some babies are a little slow to gain weight and it won't be anything you've done or are not doing. It's absolutely possible to get there in the end, but you will need support from somebody who can offer you more solutions than formula. Hopefully we can help you find that and/or suggest some things which might help in the meantime :)

When DS1 wasn't gaining enough weight I was advised to top up initially and also express after every feed to build up my supply. At first the expressing didn't give me anything, but eventually things built up and I could drop the top up. I was loaned an electric pump from the hospital but ended up prefering an Avent manual pump.

How old is your DS? re BF it sounds like he is fussing as he is really hungry. Try and look out for early cues that he is hungry which are things like him striring, opening his mouth and turning his head and routing. Next hungry cues are stretching, moving around a lot and putting their hand to mouth, try and feed him by this point before he gets really hungry and it’s difficult to calm him down.

Really hungry cues are where you need to calm him down first before BF, this is where he’ll be crying, fussing and going red with crying so it sounds like you may just have missed his cue where he was telling you he was hungry, then got upset.

The thing with BF is it’s feed feed feed to establish your milk supply in the first few weeks and in the early days, then it happens again as he has a growth or development spurt (google growth spurts). Re your supply express during the feeds that you miss, but also try and look out for the cues that he’s hungry first then BF offering the second breast then back to the first breast if he’s still hungry. But if you’ve been advised to top up as he hasn’t gained enough weight offer the top up after offering the second breast.

Also get your latch checked to check that he’s feeding properly if you’ve not done so already and keep going, it does get easier.

I doubt one bottle will mess your supply.

Sorry - posted too soon.
What I meant to add was that skipping a feed (or reducing it) is absolutely not going to have affected your supply and you can build it up even if your baby is fussing and needs something else in the short term.
What I've learnt (although it's taken me 3 children to realise this!) is that there's no point trying to second guess the feeding. Your body will do what it needs to do.

Oh love, these early days are so hard. I used to have anxiety attacks about my supply dropping when I had no option but to give formula top ups as DS was so weak with jaundice that he could barely latch. A wee formula top up here and there isn’t going to ruin your supply. DS had formula top ups every day for about 5 months then was EBF. Here we are still breastfeeding at 17 months. For the first 3 months I used to express to cover ‘missed’ feeds but found that was unnecessary eventually. I would also second what other posters say about having a babymoon in bed where you just let her feed all day. You get cozy with Netflix (Dirty John is good, btw) and chocolate Hobnobs (because they say oats help with milk supply and you need treats).

I hope you don't mind OP I had a search and can see that your baby is around 11/12 weeks old based on another thread (just to save people asking) :)

Is it the health visitor/weighing clinic who have told you his weight gain is too slow, or are you worried because of signs in your baby/your breasts? It is very common at about 3 months for your milk supply to regulate which sometimes feels like your milk supply is dropping, as your boobs stop filling up between feeds and many women experience a decrease in leaking. In addition many babies have a fussy or distractable period at this time and night time sleep can go haywire, plus there is a usual lull in weight gain, where weight gain begins to slow down a little, but this is normal, and should not be a concern unless your baby is dropping through the centiles on his chart in his red book. If they continued to gain weight at the rate they do shortly after birth they would be the size of an elephant by three.

My advice to you would be to put the baby to the breast at least once an hour during the day when you're at home, and every time he feeds offer both sides (wind or change in between if he is sleepy or refuses) and then offer the first side again before you top up. If you don't have older children (I think no?) at some point during the day make some time (I found the morning was good) where you strip your baby down to just a nappy, take your top off and just lie in bed together with you both covered with a blanket or sheet, baby on your chest. You can lie flat on your back or prop yourself up on some pillows. The baby may try to latch or may simply be happy just being close to you - you can breastfeed, make faces at each other or simply let baby sleep. If he's crying and won't latch, try again when he is calmer. This is called Kangaroo Care and it is excellent for getting the oxytocin flowing which helps your milk supply. You can also bath together if you have another adult to help you.

There is no problem with giving top ups as well especially as this will be an interim measure. If you've managed to breastfeed this far, I doubt you will need the top ups for long. For now, I would strongly recommend doing paced feeding, which means you hold the baby in a supported upright/sitting position and hold the bottle horizontal or close to, so that he has to actively suck to get the milk and gravity isn't doing the work for him. It doesn't matter what kind of bottle you use, but you should use the slowest flow teat you can find (size 0/newborn is good). You don't need to size up as he gets bigger. I did find that a small, narrow bottle works better than a fatter one. The kind which come with Medela breast pumps are perfect, this kind of thing. This feeding position lets baby take lots of breaks much as they do while breastfeeding and you'll find that it is clear when they have had enough. This way you can offer up to 30ml but it isn't a problem if he doesn't take all of it (it probably means he isn't hungry). If you're offering the breast every hour I wouldn't top up every feed but offer the top ups about as often as he would demand feeding, or once every 3-4 hours, or when he still seems hungry after you've offered both breasts and the first one again. You can skip topping up at night at this age unless you want to (e.g. he won't go back to sleep without it).

As for expressing, if you're putting the baby to the breast once an hour then you shouldn't need to but if your baby is only taking a "big" feed once every few hours then it may be worth expressing at the midpoint between - just do it for about 5/10 minutes each side and don't worry about how much milk you get out, it's for stimulation not production.

This article is a very good guide to common worries about supply plus has advice about the steps which can help increase supply and/or identify problems which may be impacting on supply, so may be useful:
www.emmapickettbreastfeedingsupport.com/twitter-and-blog/low-milk-supply-101

Thank you all, I'm feeling less guilty now. Baby is 12 weeks old but started dropping down the centiles from about 6 weeks onwards, and is now off the chart 😞 I am feeding on demand at least 8 times a day, then expressing about 4 times a day with a double pump (I know I should express after every feed but don't always get to it) then offer formula top up if he takes it.

He tends to wake up very upset from naps and it becomes a battle to latch on and drink. I also feel like giving him bottles is making him want the breast less, as it's harder work. For the past 3 weeks we have stayed at home as much as possible so o can constantly offer him the breast. He falls asleep while feeding, then when I wake him up he cries but won't latch on. It's frustrating for us both.

I'm not doing so well with the pump, I can get barely anything out although I feel like there must be something there as I'm getting lumps in my breasts. We are also co-sleeping so that he can latch on easily at night.

Sounds like doing an amazing job. 4 times a day is great as I only managed once or twice. I remember in the early days baby waking up and being upset but now (8 months) she wakes up happy. It does get easier. It doesn't matter how you feed your baby, go with your instincts. Local groups are great if your feeling frustrated.

OP - I read your update last night and was still pondering it this morning so just wanted to say that it really sounds as though you're working so hard to get through this and make it work, and for that you should feel really proud. But... If it doesn't work out, and you do feel you want/need to move onto formula, then that's OK. You've already done a great job and given your DS a fantastic start. There is so much pressure to breast feed, but it isn't worth sacrificing your wellbeing over, or losing precious time doing other things with your son. I second others suggestions of trying out a breastfeeding support group if you do want to persevere. Good luck!

OK. That sounds like you have an issue which is more than online support can help you with. I am glad you're feeling better :)

If you want to continue with this, I do believe that you can be successful however I would say in your situation, good help and support will be crucial to that success. So your next step if it's what you want will be to seek out a good breastfeeding support person in real life, as he might not be transferring milk well which is leading him to become exhausted by feeding, and you to get milk duct blockages as the breasts sound like they may not be fully draining. (I'm saying might, because it's impossible to tell this ove ran internet forum, you need face to face input here.) You are right that the bottle is easier for him which is important in terms of keeping his blood sugar and weight gain up but can be detrimental to the breastfeeding relationship if he begins to prefer this to the breast. It sounds like it wouldn't be sensible to cut down the top ups until you're confident that he's getting what he needs from the breast.

If on demand is around 8 times a day it might be you need to be a bit more pushy. Try to latch him on once every 1-2 hours during the day and (if you can bear it) set an alarm to wake up every 3-4 hours at night. But you want to seek out a breastfeeding specialist ASAP to observe a feed and check baby for tongue tie. I would say that should be your first priority over anything else.

Here are some places to look:

NCT: www.nct.org.uk/local-activities-and-meet-ups

ABM: abm.me.uk/find-a-local-breastfeeding-support-group/

LLL: www.laleche.org.uk/find-lll-support-group/

Baby Café: www.thebabycafe.org/find-a-cafe/

All of the above are free. You can also try children's centres if you have one locally. There is also the Public Health England breastfeeding helpline: www.nationalbreastfeedinghelpline.org.uk/

If you have no luck you can try an IBCLC. Some run free support groups and some are pay to hire. You can find one here:

www.lcgb.org/find-an-ibclc/

Good luck :)

Thank you all so much for your advice. I should have mentioned that I'm attending a breastfeeding support group, meeting with my health visitor on a weekly basis and also seeing a midwife friend every week. I just got a bit panicky after I gave the additional 30ml formula that I might have undone some of the hard work I have put in to increase my supply.

I saw the HV again today, and also a paediatrician. She confirmed my suspicion that giving him bottle top ups may be making breastfeeding more difficult, as he seems to be developing a preference for the bottle. However, we have to balance this against his nutrition so she has asked me to fully replace two of his feeds with a formula bottle while expressing instead, while continuing to give top ups at other feeds. I just hope this doesn't lead to us having to eventually just use formula.

Are you pace feeding the bottles you are giving? It helps stop baby getting used to fast flow from a bottle.
Totally agree you need to find a balance between calorie needs and breastfeeding.
Someone once said to me catching up centiles is like getting out of a hole - it’s hard to do.
I really would advise a lactation consultant if you can afford to see one. They are so valuable and will give advice about bottle feeding as well as breastfeeding.
Take care, you’re doing great

OK I am glad you are getting real life support. I do appreciate your health visitor's concerns about his nutrition. It seems like a good idea to try and consolidate the formula into single feeds rather than topping up every time - but I'd be tempted to suggest that you offer the breast at these feeds as well, rather than expressing instead of a feed. Perhaps after the bottle feed if she is concerned with getting the calories into him first. Why not both? Although OTOH it can be a great chance to get a guaranteed stretch without needing to feed if you have a partner who can do the bottle feed for you and it's much much easier to have it once/twice a day (try to spread these out so the gap between breastfeeds isn't too long) than have to stress about sterilising, washing bottles and either making up single ounces or portioning out those tiny ready made bottles for every single feed of the day. I must admit I didn't actually express at all once I left hospital. Express/feed/top up was just far too much to deal with every feed and I didn't have a decent pump anyway so I just dropped the expressing and kept putting the baby to the breast as much and as often as possible. I'd usually try to breastfeed about an hour or so before the bottle feed but then I'd quite often use the chance to get some sleep. Usually the point of expressing is to remove excess milk build up (which it doesn't sound like you're needing to do) and provide regular stimulation to your breasts when you're not able to get that from feeding, so it might be that you'd be OK without doing this. But if you feel it's making a difference then keep it in.

I had very slow building supply this time and something which I definitely found helpful was putting baby to the breast once an hour when I was awake and at home. If I was having a slow day that would definitely boost things within 48 hours.

Yes I would definitely recommend paced feeding for the bottle feeds. It makes them take longer but it does help reduce bottle preference.

It sounds like overall he is having very little formula - what, 8oz a day? That's a couple of feeds, with the rest being breastmilk, so it sounds very likely that you can boost your supply to meet his needs - and if you can't - you can continue to supplement for the next 3-4 months and then slowly phase out the formula as you phase in solids instead. I don't think there's any reason that you will need to stop completely even if you don't end up breastfeeding 100%. In the end, this is what we have done, because DH liked giving the bottle in the evening so we kept it going past the point where my supply seemed to have caught up. DS2 started to want the breast straight after the bottle anyway so I didn't really get any break from it and then he started to drink less from his bottle so we stopped it, and that was around the time he started to eat solids regularly.

Has your baby been checked for tongue tie? How are feeds for you - comfortable or still any pain? Does he stay latched or seem to slip off regularly? Any clicking, milk spillage or generally noisy feeding?

Another option you might want to look into - have you heard of an SNS - Supplemental Nursing System?

I hadn't heard of pace feeding before, I've googled it and will be giving that a go. Is a lactation consultant the same as an NHS breastfeeding counsellor? I've been going to see them at our Sure Start Centre once a week, they were the ones who leant me a pump and also observe my feeds.

I'm going to breastfeed and also offer the large amount of formula, instead of replacing with formula and expressing. They still want me to do 30ml top ups at all the other feeds. The expressing does seem to make a difference, I can feel that my breasts are more full but the pump doesn't seem to want to extract much of it. I'd like to continue with it though, I guess a little is better than nothing.

I just had a thought. Could these issues be caused by me sleeping at night with a red light on? The weight gain suddenly stalked at 6 weeks which I think might be around the time that we got the light. I used to use my mobile phone light to help me see at night to latch on, which would switch off automatically after 30 seconds. The red light ends up staying on all night as I fall asleep with it on. We got it because my husband felt it's better for my sleep than the bright light from a phone.

Sorry forgot to add, he doesn't have tongue tie. Feeds are very comfortable and he was staying on, although since introducing the bottle he seems to come on and off more, cry, and sometimes just refuse to take the nipple. We don't tend to have noises like clicking and when we do, if he doesn't rectify his latch himself within a few seconds then I do it for him.

I hadn't heard of SNS but sounds like it might resolve the issue of him preferring the bottle. Thank you!

Has anyone suggested breast compressions while feeding to help milk transfer? If not, have a search for videos demonstrating the correct technique (or ask the real life supporters you have).
You can also use these to more effectively drain milk from your breasts while expressing. It's called "hands on pumping" and there is a good video on the Stanford uni site. (Having a bra you don't mind cutting holes out to put the breast shield through or getting a special pumping bra that holds the bits in place is a massive help for this if you don't already have one.)
The other thing for expressing is to make sure the shields fit you properly. I use medela gear and the standard flange was too big for me, so it wasn't properly stimulating supply etc.

I doubt the red light is making a difference.

A lactation consultant is not the same as a breastfeeding counsellor but the breastfeeding counsellor might be just as good. It depends on their training and experience really. Sure Start tends to be good so I'd tentatively say that sounds fine. IME the one you need to be wary of is "infant feeding specialist" as their training seems to vary a lot. Some are good and knowledgeable but a lot seem to be lacking in their BF knowledge sadly.

Oh - I thought the one big feed was to replace/consolidate the top ups into one shot. I'd ask about the reasoning for this. Of course it's important to prioritise keeping the baby fed and calories up.

I agree with breast compressions, checking breast pump shield size, and that the red light is not likely to be a problem.

I've tried doing breast compressions while feeding, hadn't thought of cutting holes in a bra so I can do it while pumping.

My HV phoned yesterday and offered me a same day appointment with a paediatrician at the hospital. We were there for 3 hours. He confirmed no tongue tie and he is developing well. Baby held his head on his own, colluded stand when held, and was alert. He had bloods and urine taken. The nurse weighed a wer nappy and said he produced loads, but they suspect that the tests will come out clear and the problem is he's not getting enough milk.

New plan is now breastfeed 8 times a day, 10 mins on each side, then give him as much formula as he will take, at least 200ml total per day. I want to continue expressing and giving him that too. Yesterday he took 250ml formula and 50ml expressed milk. I guess that means he is not getting much from the breast.

The reason for 10 mins each side is that he will get most of the milk in that time and he will be exhausted after that...but I wonder if that will impact my milk supply.

Hmm. This is what I was told to do when DS2 was newborn as well. As a breastfeeding supporter, I don't think 10 mins x 8 a day is likely to be enough. I am guessing that is a lot less than he has when he feeds on demand?

You can't really tell how much you're making by how much the baby takes from a bottle, as they will, generally, always take more from a bottle - it's easier for them and because of the suck reflex they tend to drink instinctively from bottles (though he might be losing that around now).

What I did in that situation was I got a bit stubborn and they conceded that I could do weighed feeds - that is accurate but it's a massive pain in the arse to do, and you need medical grade baby scales, so it might not be feasible to do this at home. (If you did want to - my friend did tell me - small dog scales work just as well and are cheaper but it's probably a bit overkill.)

You shouldn't go against medical advice - but I don't think there is any harm in breastfeeding MORE than they have said in addition to the other stuff - I did tend to give the top up after about 10 mins per side but I didn't count this strictly and did tend to let him go over if he was still actively sucking and not falling asleep/seeming exhausted. Do you know what I mean like when it switches from the active feeding to the more fluttery sucking? And in fact, this was usually about 10 minutes, often even less, but sometimes it was a little more so I watched the baby rather than the clock in that instance, but I did give the top up once both boobs had stopped that active sucking. And I did this every 3 hours, with the top up, and called the whole thing (in my head) a "proper feed". In between this, after this, before this, I let him have access to the breast as much as he wanted. A lot of the time he would just feed/sleep/feed as newborns typically do, and I didn't worry that he was "exhausted" or not getting much milk because I knew that he was getting some, and that would help. If I needed to do something which didn't involve holding a baby then I'd put him down and let him sleep for as long as he slept for. But this all seemed to help.

I agree with Bertie about watching for active feeding being more important than watching the clock. Medical staff don’t get much breastfeeding training- I think it’s obviously most important that your DS gets nourished but that doesn’t mean you can’t work on improving your milk supply and milk transfer alongside giving formula. (If you want to of course, it’s absolute ok to not want to).

Take a look at this for some good advice.