Breastfeeding, so confused, ready to lose the plot!

[Ros92123]

Hi everyone, bit of a story so please bear with, I'm desperate for any and all advice as I'm ready to crack up.

Baby was born early 34+6 by emergency section. He was in neonatal for 2 days. We ended up in hospital for a little longer before we got home, due to jaundice and issues with my health.

I was really keen to BF, but had issues with supply for the first little while, so on the advice of midwives I was expressing and feeding via a bottle, they didn't push too much to get him to latch as he was so little. I was worried that baby wasn't getting enough when I put him to the breast (I have one dodgy nipple I need to use a shield for, and baby gets really stressed and tired when trying to latch for anything more than about 10 mins to either the good nipple or the shield). So on the advice of another midwife I had tried putting him to the breast for 20 mins for 2 feeds a day, whilst expressing the rest of the time and supplementing with formula. This seemed to confuse him more.

Baby is gaining weight and doing well, however I'm being driven insane by having to try and express every 3 hours. And since we got home a week ago my pumping output had decreased, I'm pumping for a shorter time and I'm worried that my supply will dwindle if I leave too long between pumping. He is waking around every 3/4 hours to feed so I'm stressing out that I'm missing expressing times, sleeping through the alarms I set for expressing and generally feel like I'm failing my baby. I'm getting no sleep, feel like a zombie and seem to be in tears most of the time.

I spoke to my HV today about it, as I'm really struggling, and she has suggested that I stop pumping altogether, and let baby do his thing at every feed, just try and nurse whenever he wants, even if it's 5 mins every 15 minutes. She said to definitely give up the nighttime express so I can get some sleep.

I'm really confused as to how this will help, baby can't empty a breast before he gets really annoyed and stressed and won't latch, let alone both! I left it for 12 hours without pumping and now I'm in agony, and he's only tried to feed for about 40 mins total since she left at 2pm this afternoon, and has now become angry, fussy and stressed out.

I'm just wondering if anyone else has had similar advice, or if this is even right?

My main questions are:

*Isn't expressing through the night one of the best times for stimulating production? She's told me just to do it when I wake up naturally and not to worry about it being between 1&3am.

*Should I not still be expressing regularly to keep supply up? As I've said my baby is nowhere near at the stage where we're going a full feed off the breast, he's 3 weeks now and still quite little. Realistically I was expressing about 5 times a day and beating myself up for not doing enough...now not expressing at all seems like it will just make things worse?

*Is it okay to express every 4 hours as opposed to 3? Now he's taking bigger feeds, if I try and express at 3 hours I only end up getting about 40ml, which is about half what he is taking at a feed.

• She also recommended getting my OH to do the night feeds so I can get some rest, however she's told him to use formula, which I thought we were supposed to avoid as much as possible?

I've never been so confused. I know that the running myself down expressing wasn't working for us, but now this HV has brought a while new level of confusion to the table, and I've no idea what to do for the best. I want to BF but I'm really lost and not sure what to do for the best, after getting so much different advice.

Any thoughts or help appreciated, before I go totally mad!

Poor you, you’ve had a tough time and you’re still having one! I can relate.
Baby born early, NICU stay and did the waking to pump, teaching to latch etc. We moved to exclusive breastfeeding so we did manage.
What exactly is happening when baby is feeding from you? you say you are worried they aren’t getting enough - what’s causing the worry?
I’m up with my third baby just now and have a killer sore throat so will be going back to sleep- but I will get back to you when I hear from you as I did manage this in similar circumstances (I even have a dodgy nipple too 😂) but wanted to know first what’s behind your lack of confidence when your son has fed from you.

Hi there! Up in the night also BFing my premmie baby - 9 weeks old now but born at 33+4. We've been on a similarly stressful expressing and feeding journey with supply issues. Will PM you but just wanted to let you know you're not alone!

I would disregard what the HV said completely and find a breastfeeding consultant or your neatest LaLecheLeague. HV aren't always the best with breastfeeding issues and seem to contradict the advice of paediatricians and breastfeeding specialists IME. Maybe try going slightly longer between pumping sessions if you are burnt out though, you need to factor in your mental wellbeing as well

I would also disregard HV - most of them aren't experts on BF which is a very specialised area of expertise. Pp has good suggestions for advice.
My instinct would be that little and often is what you should be aiming at with a baby this young, but yes, you need to factor your MH in to the equation.
It sounds like you could do with a structured plan and some on-demand back up from a BF expert.

@Nighttimenope thanks for the reply, the reason I don't think he's getting enough at the boob is he only feeds for a really short time (normally 5 or less minutes per boob) falls asleep then wakes up 10-15 mins later raging and won't try to latch at all. OH has just done the night feed so I could get some rest and he says it's the worst night baby has had, feeding every 2 hours and taking 80ml a time, which there's no way I can keep up with. That was after trying what the HV said and just letting him take the lead on feeding without expressing.

@FraterculaArctica thank you, it's my first baby so I have no idea what to do for the best, and there seems to be contradictory information everywhere.

@Ambrose2 @Babamamananarama I thought what she told me wasn't right either but now I don't know what to do for the best, do I just express after he feeds from the boob and keep my supply up that way? I knew it wasn't going to be easy but I didn't realise there would be so many different opinions on what's right!

Thank you all for your replies, and sympathy, I don't feel like myself anymore with all the regimented pumping and no sleep!

You need some specialist support here. Do you have a breastfeeding group you can go to today? Call the breastfeeding network on 0300 100 0212 they are really helpful and can point you in the right direction.

Putting the baby to the breast frequently will help your milk supply, as will Breast compressions to keep him activity feeding and stop him falling asleep but at the moment it will be a balance of getting enough into him whilst your supply is increasing.

Does he take both breasts at every feed? If no, I would try and express from the other side whilst feeding if possible just to squeeze as much expressing as you can in. Which pump do you have?

Global health media do some amazing videos on breastfeeding you might find helpful but specialist support is key.

https://globalhealthmedia.org/portfolio-items/breastfeeding-the-small-baby/

You definitely need some specialist support- is such a difficult time!

The other thing I'd recommend is a haaka pump- it's a wee silicon one that you put on one breast while you feed from the other and it catches the let down. When I was losing my mind with tiredness and pumping, someone recommended it to me and it saved my breast feeding journey- it's way less work and effort than normal pumping and because you do it while feeding you can still sleep between times. I ended up topping up with what I'd just expressed, so no messing with trying to warm milk up either.

Thanks for that! Possibly baby is windy after falling asleep, hence waking angry and not relatching. People have pointed you in great directions for advice and support should you so wish. I wouldn’t be so dismissive of the health visitor- she isn’t a breastfeeding expert and her advice might show that, but there’s more to this than breastfeeding (your wellbeing and baby’s wellbeing) and she’s clearly trying to take all that into consideration. Also switching from pumping to feeding is pretty niche and the carte blanche feeding advice that’s often given doesn’t apply. For example with formula- your little one is already taking a bottle so it doesn’t matter in terms of establishing breastfeeding if that’s formula or expressed milk. Of course breastmilk is best, but formula is absolutely amazing and current formulations are the result of years of science, testing and heavily regulated.. it’s an amazing tool and your DS is in such an amazing place globally and historically that he’s got the best of the second bests!
It’s widely accepted that how much you pump isn’t an accurate reflection of how much baby would take from the breast directly, and how long you pump isn’t a reflection of how long you would need to feed. So don’t look at his bottle volumes and panic that you can’t keep up, you likely can-similarly he likely won’t keep up with that himself he just had a hungry night 😁 it’s also a really special kind of tired to be breastfeeding and pumping -it’s a form of torture in my eyes actually, and believe it or not but tiredness can affect your supply. It’s essential to be well nourished yourself too.. Are you eating well, 3 good meals a day and snacks? Are you drinking plenty water?
There’s so many conflicting bits of advice and that makes it really hard, but it’s because there’s so many personal experiences of what’s worked for some people and not for others, but each situation is unique and it depends too on your end goals and your health getting there.
When I was trying to switch from expressing to feeding (I couldn’t express enough for the bottles either) I wasn’t shy to use formula and saw it as a way to keep up the routine. I also didn’t express to produce a set amount, I expressed for supply reasons only. What I then did gradually was swap a feed at a time for a pumping session, so instead of bottle and pumping, I would breastfeed, then the next feed I would give a bottle and express. Use whatever you express and top up with formula. I wouldn’t personally express after breastfeeds or top up after breastfeeds- if it doesn’t seem like baby has had enough try winding and calming and then returning them to the breast, but if they’ve fallen asleep and stay asleep take it as a successful feed and next one express/bottle. Baby has to learn to breastfeed and he’s using different muscles for it, it’s more tiring for them and has a different flow to the bottle too, so it takes them a little getting used to but if they’re latching well there’s every reason to hope for success.
It’s pretty bad advice to stop pumping or putting baby to the breast overnight so I would get back to that asap. However, you need sleep too! It’s probably ok to miss the occasional feed or pumping session

Sorry I wasn’t finished!
And in your situation it’s probably advisable to because you need some sleep, but going cold turkey does not seem like a good plan at all. However- as above HV has overall well being in her minds eye and not just breastfeeding so I have sympathy with her suggestions. It’s really very tough and you are doing amazing and when you’re this tired it’s hard to see the wood from the trees. Sounds like you’ve got a great chance of getting a good breastfeeding relationship going but at the same time, you’re starting on the back foot due to circumstances putwith your control and you’ve got to be kind to yourself and keep an open mind methinks. Sorry. This probably wasn’t much help and I didn’t address everything you said but I wanted to offer you a response of some kind. If you would like to ask anything I’d be happy to share, I very much felt alone at that time in my feeding journey and it was exhausting trying to research and piece together some kind of way forward when I was already shattered.