How to juggle expressing for bm top ups with feeds?

[Tier500]

I need to start topping up my 9 week old baby as her weight gain is slowing. Practically, how do I do this? Should I pump after every feed? And then when do I give her the top ups - small amounts after every feed or do I save them up and add in a bottle only feed? And when can I stop the pumping regime? I’m gutted that this is necessary and feel completely overwhelmed by the logistics.

Hi, I had to top up with both of mine due to very low supply. I used the medela symphony pump after each feed, and again halfway to the next feed, and would top baby up with the expressed milk at the next feed. I usually just left the milk in the pump bottle as it is fine left at room temp for up to 6 hours (ideally not longer than four).

My supply was so low that I then ended up having to top up with formula with both babies. My son is 3 months old and when he started sleeping through my supply just tanked, so he’s exclusively formula fed now.

We did try and store breast milk in the fridge to make it up to one full bottle feed, but my milk must have been high lipase, as when I inadvertently tasted it on my finger it was gross, like liquid soap. My son wouldn’t take it. The topping up after feeds with room temp breast milk seemed to work fine for us.

Don’t stress too much about it, just work out what is best for your baby. X

Thanks so much for the reply. I’m not sure what the problem is - she gained well at first but it’s dropped off ☹️. I exclusively breastfed my first daughter and wanted to do the same with this baby but will obviously do what’s best for her.

Bumping for any more thoughts.

@Tier500 have you tried the haakaa? I've managed to build up a milk stash just using that. It's great because I don't have to spend time pumping and I you collect the milk as you're breastfeeding so it doesn't take up any extra time. I was using it just twice overnight and collecting 4 ounces - which equates to a feed. I'd say it's worth getting one (they're fairly cheap) even if you use it in addition to a pump, it will certainly cut down the time it takes you to collect milk.

I've also found breastfeeding teas good for boosting my supply. I have one called Milk's Up that I get on Amazon that's good.

Have you been recommended to top up feeds? I only ask because my lo's weight gains slowed starting at 9 weeks. She'd been just below the 50th percentile from birth to 9 weeks and then at her 14 week weigh in, she had dropped to the 25th percentile. I was told not to worry though and that breastfed babies weight gain can slow and plateau at different points.

I had to top both mine up at first. Always bf first then topped up. First child got formula tops due to supply issues. Second got bm. I used the lansinoh pump on the otherside whilst I was feeding. I found if I wasn’t feeding pumping with electric pump on one side and lansinoh on other after a hot bath worked well.
I only topped up about 4 feeds in 24 hours.
Does she feed a lot in the early hours or can you persuade her to as that’s the best time for ramping up supply? My 5 month old is asleep next to me attached to a nipple from 1am -5am most nights. She has her big blocks of sleep from 10pm-1pm and 11am -3pm.

I second the haakaa, I have managed to build up a good freezer full of milk just by using this.

Third for the haaka, pp have said it all but I found this the least stress!

Thanks so much for this. I have a hakaa but haven’t tried it for some reason! I saw a private lactation consultant because all the bf services are closed in my area. Baby was born on 95th centile and has been steadily dropping. She’s now at 50th. She’s been gaining 22g per day and apparently it should be more like 28-30g. Her tongue tie had reattached (cut in week 1) so that might be why but I also think my supply is likely to be low - I’ve never leaked and never got much when I tried to pump with my first child. I’d so like to keep breastfeeding her and have been feeling pretty miserable today.

The baby usually takes both breasts at a feed - if I use the haakaa while she’s feeding on the other side won’t I just be taking the milk she would have drunk? Should I use it on the first side once I’ve moved to the second?

Maybe give some formula top ups during the day. I had to give about 30 mls after 4 feeds a day. Have you tried doing lots of skin to skin and letting her use you as a dummy.?
Both mine dropped a couple of centiles after birth. With my first he was late, I had the drip and he was a cs which all artificially increase birth weight so I think his rapid weight loss was not an issue. He found his centile and stuck to it, he’s still there now. With my second she just lost weight constantly, it was worrying, the food went in and it was instantly ejected from one end or the other. She has severe cmpa despite being bf.
Your baby is only 6g off the correct weight gain. Have you been referred to the hospital or is it just the hv?

@Tier500 I exclusively pumped with both of my children. Whilst obv I can't comment on how much your baby takes from feeding and therefore what quantity is left to pump, what I can say for certain is that the amount you eat and drink directly affects your breastmilk.

I used to drink 3-4l of water/squash/tea a day. And I had a high dairy and oats intake because I found it made a difference to the amount I expressed by at least 1/3. It was actually quite scary what the difference was.

It takes 2-3 days to get through to the amount you're pumping and equally, takes 2-3 to show if you haven't been drinking and eating enough.

How this is portrayed for you may well be different because obv there's no measure when feeding baby! But I can assure you that it works. The hardest part is remembering to do it.

Thank you @sproutsnbacon. No one has referred me - I haven’t even seen the health visitor in person and the GP wasn’t worried about the drop in centiles. I think probably because he didn’t know much and they’re flat out with covid rather than because he genuinely had no concerns. I paid for a private lactation consultant because I was worried.

Since having her tongue tie recut earlier it’s like she’s forgotten how to feed completely - no suction whatsoever. I’m feeling increasingly panicked.

@tiredqueen I’ll try that - I’m sure I could drink more.

If the gp wasn’t worried don’t panic. When the gp is worried they don’t see you they just ring the children’s ward and book you straight in.
I was just going to say the same as tired queen, eat and drink plenty. As much as you can and then some more.
The first step the nhs advise is feeding them more frequently and waking them up to feed. If necessary stripping them down to the nappy and putting them on your own bare chest.
I was always told to top up after a feed but with such a small lack of weight gain you could just try a couple of times a day so baby doesn’t get used to the bottle. And I know it’s really really hard but relaxing helps milk production. Can you retreat to the sofa or bed for a few days?

So since getting her tongue tie recut yesterday she can’t suck properly at all - seems like she’s not getting proper purchase on the nipple. I’m starting to feel increasingly desperate. I pumped for 20 mins after trying to feed her this morning and only got 1.5oz. She’s sleeping and seems ok but I feel like I’ve broken my baby 😢

Can you try different positions? perhaps laid back nursing would help her to latch.

Pumping is not an indication of supply. So although you may feel you need to be pumping more to top up, try not to worry about it being representative of what your baby is getting.

Can the lactation consultant provide any more help and support?

Definitely try different positions, I found lying down on my side on the bed helped in the early days.

Like this?

Thank you. She’s been asleep for about an hour but will try laid back nursing when she wakes up. I so hope I can fix this.

Hugs @Tier500 Having a newborn is really tough. I just read back through this thread and thought how overwhelmed I would have been with a 9 week old reading all of the replies!

I hope you're ok. Whatever you need to do is what you need to do. It's fine. Don't kill yourself trying.

Would you consider a formula top up after bf for a few days, just to give you a bit of breathing space? It might take the pressure off and give you the mental space to think about what to do next.

Many women do both whilst they're getting into the swing of things. That's not to say that you should or you shouldn't- just a suggestion xx

How are things going @Tier500? Any better?

Thanks for asking @MichelleScarn. there’s been some improvement in the latch but it’s still not right. She’s definitely got milk from the breast though as her nappies have been good. I feel more positive now that things will get better but we aren’t quite there yet. Finding it very difficult to make time for pumping as she’s on me all the time, and wakes up as soon as I put her down.

Good to hear the nappies have been good! The bf support groups in my area are doing facebook virtual support, its via la leche league, don't know if they are active where you are?

My baby was born on 98th centile and I was told for babies born on high centiles it is acceptable for them to drop 3 centiles as long as they are gaining, meeting milestones and having wet/dirty nappies. My DS eventually settled on the 25th centile before we started weaning where he climbed to the 50th. I also ebf

I’m glad things are improving for you. It’s good she’s on the breast so much, it’ll work wonders for your supply, not so much for you having a rest though
remember to put plenty of nipple cream on

Laid back nursing is your best bet. I'm not sure id pump tbh unless a medical professional has actually told you to. Just keep feeding her very often. If you've no other children then stay in bed with her all day skin to skin with her lying on your chest. This will stimulate her to feed often.

Just out of interest can I ask how you even know what weight she is? I have a 5 week old and he hasn't been weighed since he was 14 days old.

@shouldistop the lactation consultant has told me I need to top up. I have a toddler which is why the idea of adding in pumping sessions seems so overwhelming- already feel like I don’t have enough time for her. But I’m desperate to keep feeding the baby.

She was weighed by the HV at 4 weeks and by the GP at her 6 week check and then again by lactation consultant who I paid for privately. Her weight gain for first 4 weeks was good, it just seems to have slowed since then.

Any idea whether that suggests it’s a problem with or or the baby?