Low collustrum - can't hand express

[NotAgain77]

Hi - my baby is 2 days old. I started hand expressing at 36 weeks and got some small amounts of collustrum which stupidly I didn't harevst I then got admitted to hospital and put on a lot of medication for complecations and since then I got nothing from hand expressing.

Fast forward to day 1 of babies life and I am advised when he is 12 hours old that my supply is low so I need to top up with formula. I resisted until 24 hours when I was told it is in the clinical needs of my child to give him a top up. So I did but by cup. I have a feeding plan involving putting him on the boob, trying to get a feed and then if I can't topping him up with a cup and then sitting on a pump for 15 mins to stimulate my supply.

I've just had to give him 15 ms of formula as he hasn't weed for a while. I did this by syringe but was advised this was pointless and I should do it by bottle. The feeding specialists don't see to be able to decide on the best way to give the formula.

Baby still seemed hungry after the formula so I tried to latch him onto the boob, but now he's not interested. Even though he does some to be rooting. My fear is he is only interested in formula now and the easy mode of delivery.

I battled to breastfeed my firsf son for 6 weeks and didn't manage it. Which I still regret.

Any advice?

You're doing really well op I know it's hard, it will get easier.

Yes I am in a UK hospital, London based. They've said It'll take me so long to feed with the cup (the volumes they are talking about) that the feeds will run together and he won't go on the breast at all.

Why on earth is this shitty breastfeeding advice still going on in hospitals in 2021?
This was the exact advice I was given in 2008 and even then it was completely shit - I realised that after hours of research, bf councillors and unfortunately my baby never breastfed well due to shit advice at the start.
The hospital midwives also said I had no supply at 12 hours - got me on what they called their milking machine which only served to terrify me and hurt my breasts. Produced nothing of course.
They tried to squeeze my nipples for colostrum which also produced nothing and hurt a lot.
Got sent home with no checks to latch really or any advice.
MW the next day at home pretty much terrified me into feeding formula from a cup and said I had no milk because the hand pump she told me to use didn’t produce. Never mind the fact that my milk hadn’t come in or that I didn’t even know how to use the pump- just awful. I trusted her and thought I didn’t have milk. The whole thing was undermined and I wasn’t able to breastfeed after a while because the baby only wanted formula and wouldn’t suck as not enough time on Breast. My milk was wasted all over night shirts and clothes and dried up.
I didn’t realise what was happening until too late and it took 2 years to get over the guilt.
The fact this advice is still happening now makes my heart cry.
You will have milk coming if you keep putting baby to breast many many times. You may never see a drop of colostrum and that is fine and normal. Get baby to latch and suck as much as possible. Look at latching on Google. Put lower lip on first wait for the open mouth and quickly put the top lip right over the other side.
Listen for the soft quiet swallowing noises from
Baby.
If they make you top up with formula, you must try to get him to latch first and have a good sucking session. This is critical to your milk coming in.give formula only for the absolute minimum time possible that you have to and try to increase latching, listening for swallowing and checking wees.
Get some proper breastfeeding advice over the phone from NCT helpline or a bf councillor. Doing that May totally save your bf journey.

[quote NotAgain77]@EarringsandLipstick what would you use? I only have a syringe with me. They won't give me a cup.[/quote]
Oh no NotAgain 😞** why won't they give you a cup?

A cup is absolutely what you should use. I used it with both my boys, until milk supply was established.

Can you ask them again?

Because the only thing I'd worry about is if you give him a bottle so soon, it may affect b/f

Your baby is tiny! It does not need volumes of formula!! What are they taking about? At 2 days old baby needs to be sucking every hour to make your milk come in. The colostrum a baby needs at 2 days old is only a few drops every hour!

@NotAgain77

Yes I am in a UK hospital, London based. They've said It'll take me so long to feed with the cup (the volumes they are talking about) that the feeds will run together and he won't go on the breast at all.

I'm really bad at amounts.

But I can say definitely that I used the cup, fed formula that way, then at the next feed (so when he was rested), tried the breast first.

Feeds didn't run in to each other at all.

It honestly sounds like the hospital haven't a clue, depressingly. Can you contact your lactation consultant for further advice? Or is there one in the hospital who might be better than your team?

So disappointing to read this kind of poor care from the hospital, when b/f is important to you.

Do not give a bottle!! A cup is fine and he would only need a few of mils of top up anyway (if needed at all which he probably doesn’t if being put to the breast)
I find some midwives just want what’s easiest which is obviously formula and don’t care about breastfeeding!
Have you stated your desire to breastfeed and how giving these top ups will be negatively affecting your chances of breastfeeding?

@OnTheBrink1

Really sorry you had that experience 😞

I've heard it so much. The amount of times I've heard of midwives wandering into rooms, shoving a boob into a baby's mouth - not allowing baby to latch themselves - insisting on hand expressing or inventing ludicrous rules around feeding is staggering.

All the information is easily available to them. It's madness

When I had my first child in 2007, b/f went like a dream, luckily. I remember asking to put her to the breast after birth, to see confused faces, and asking them to check the latch, and they couldn't have cared less. Despite all the signs up in support of breastfeeding & the principles they followed.

When I had some of the same issues as OP on DCs 2 & 3, I was able to be reasonably authoritative, based on my experience. Still ended up doing stuff like trying to hand express on their instruction, and having to be very clear I wouldn't give a bottle.

Your advice to OP is spot on.

Have you stated your desire to breastfeed and how giving these top ups will be negatively affecting your chances of breastfeeding?

That's a good point from onthebrink.

Say this very clearly to them.

I would agree however that if baby is dehydrated & sleepy, some formula (in a cup) is fine.

He'll fall fast asleep after it. Then next feed, breast first, only top up if needed.

Minimum amount of formula, as said, he's tiny & sucking is the most important thing he can do now.

Hopefully it gets easier for you 💐

I work with breastfeeding mothers and am appalled at the advice you have been given. 30mls is too much for his tiny stomach which is the size of a marble. You continue with lots of skin to skin, putting him to the breast often to try and feed and to suckle for comfort as if all stimulates supply. Colostrum Is produced one tiny amounts and hopefully your milk will come in later today or tomorrow and feeding will improve. Obviously if the midwives are concerned about his health and he’s excessively sleepy then give some formula Too ups but I agree this should be by cup. It’s part of the UNICEF BFI that cup feeding should be supported. Ask to see the trusts infant feeding team as you should not be being pushed to give a bottle.

That's really good to hear @Planningobjection

(I'm in Ireland so I recognise approaches / supports differ. Good to hear from someone with professional expertise in the area).

www.llli.org/cup-feeding/

Yes I have made it extremely clear how important breast feeding is to me. There has been crying, from frustration. I also made clear that I had met the target of 4 15-45 minute breast feeds on day 0. But I was told it was a medical need for baby to have the top up.

I have managed to secure a cup. Trying to get discharged. Have spoken to my lactation consultant. She thinks I've been doing well with breastfeeding. I wish I'd been more assertive earlier on. It's very hard when you're new at something and other people are medical professionals.

OP I'm so sorry. I know those tears. 😞You've literally just given birth, I'm sure you're exhausted & this is not what you need.

It's is hard to be assertive (tho it sounds like you have been!) when faced with medical professionals. I totally get it.

At least you have the cup now. I agree to push for discharge & continue at home & with your lactation consultant. I bet you'll feel much better & in control then.

Keep going. You'll soon be home.

You have done everything right.

Hi OP. I'm sorry you're having a difficult time, but glad to see you're receiving support here. I won't add much to the already great advice that you have had, but hope I can help with the amounts. In the first 24 hours, a newborn baby's stomach can hold no more than about 10 ml and by day 3, this has grown to about 22 - 28 ml per feed. By the end of the first week, a baby can take between about 45 and 60 ml per feed. I hope this helps.

If your baby is latching and sucking, you are right to put them to the breast first at each feed to stimulate your supply and then to deliver the formula top ups via cup or spoon. Babies have to use their tongue to lap it up for this, helping them to practise using their tongue, similarly to breastfeeding. The time at your breast will satisfy their need to suck and it is indeed better not to interfere with this by giving a bottle. Use a syringe if no cup available. View the top ups as medicine in the meantime, to help your baby settle and sleep in order to wake up with the energy to again suckle at the breast at the next feed, without the distress of too much hunger, if you are temporarily not producing enough colostrum.

Best of luck! It can feel overwhelming to begin with, but it improves day by day. You sound like you're doing a wonderful job and you are the perfect person to be the spokesperson for your baby

@Somethingsnappy

What a great, helpful post! 👏

You are doing fantastically well!

I was separated in a different hospital from my last newborn. They were giving him 50ml bottle feeds on day 2 and kept telling me how pleased they were about this 🙄 it took six days for my milk to come in and I didn't have the proper syringes so couldn't express the colostrum properly at all. It was a nightmare! So frustrating and I had to fight to get advice about reducing the top ups too.

But we got through it and I'm still breastfeeding now he's 2.5 years old. You can do it. Keep going

Thank you @EarringsandLipstick, I thought the same about all yours!

And @BertieBotts, you wrote a fantastic reply on a different thread that I read today about frequent feeding at 10 weeks. It takes a bit of courage to go against the grain of what others are saying, but you were right to say what you did.

Sorry to de-rail a bit there.... But I am always glad to read some of the brilliant posts on the infant feeding board. OP, keep posting here... You sound amazing and are doing so well.

@NotAgain77 firstly congratulations on your baby.

I had exactly the same issue. Dd screaming at my nipples for the first 72 hours and dry nappies. I put her on my breast each time before then topping up with formula. I did use a bottle, day 3 when my milk came in it was a game changer. Straight onto my boob and feeding. No more bottles

Also just to add my friend who produced enough milk to feed her son and her friends baby in nicu had to give her baby formula for the first 48 hours until her milk came in

You've got this xxx

I'm sorry to hear that you're not getting the support you need in hospital OP. You sound very sensible and to have a clearer idea of what's needed that the professionals.
I agree that if baby is drowsy and not weeing then some form of supplementary feeding may well be needed but the volumes and frequency that you're being told sound very odd to me. I'm no expert it's true, as I was fortunate enough not to need to give supplements but I would have thought that the aim would be to replicate a newborn baby's natural feeding pattern ie little and often. 30ml is a huge meal for a newborn. It's like eating a massive Sunday lunch for us and then feeling full and not interested in anything else to eat for ages.
I also think you are correct to avoid using a bottle. Whilst some babies will swap easily between breast and bottke, many won't. Getting used to the easier and quicker way of feeding from a bottle can definitely lead to very young babies rejecting the breast so syringe or cup is almost certainly better.
Hopefully you can get home and get a face to face or at least video consultation with your lactation consultant soon. Get plenty of skin to skin contact and offer the breast frequently. Your milk will almost certainly come in in the next day or two and that's often a game changer so hang on in there. You're a great Mum who is doing a brilliant job.

Thanks so much for all of your advice and kind replies. I struggled to read it all yesterday. Part panic, part exhaustion. But both me and my husband read them all late yesterday and born found them incredibly useful.

I managed to get discharged yesterday afternoon and the relief at being home is hard to describe. We are all far more relaxed. I've been putting baby on the breast whenever he 'asks'. And have stopped the pumping. I did do probably 3 cycles in hospital though. I have noticed during the night that my milk has come in my left breast not yet in the right. However both have hard lumpy areas which are hot. I am wondering if this would have been caused by the pumping? And also what to do about it!

Also what actually constitutes a wet nappy. A bit damp or actually fit to burst?

Hard and lumpy can be normal when milk comes in. If you get red streaks or it feels very painful then call your gp incase it's mastitis.

See what your lactation consultant says about your right breast supply. I have less supply in my left breast so have been starting every feed on that side to make sure he continues to drain it. I don't think that's the right advice for a tiny baby though as you need to concentrate on him getting plenty of milk without tiring him out.

Do you have the nappies with the strip that changes colour when it's wet?

If you have a handheld pump you could try using it on the right side.

I remember with my first baby it seemed like her nappies were bone dry in the first week. Someone advised me to weigh them against a new nappy and sure enough, they were actually wet but in small amounts the nappy absorbs so well you can't really tell by sight/touch. A newborn is taking in tiny amounts (and when I expressed colostrum in the hospital they said the 1ml I got out was a brilliant amount!) of concentrated liquid so won't have a huge amount of waste liquid to excrete.
It sounds like you are doing absolutely fine. If you are getting hot areas in your breasts though, keep feeding as much as possible in case of mastitis.

How are you doing now OP?

I'm so glad you are home!

Re hot lumpy breasts, continue to feed, and feed as often from the most affected breast, if there is one. It will most likely settle.

But if it doesn't, and you start to feel unwell, do contact GP promptly & start antibiotics. Previously people used to hold off taking them but I find from observation / friends, that taking them early is usually best.

I hope you've had a better day, now you & baby are home 💐