Breastfeeding ‘top ups’ views and advice needed

[amidsummernightsdream]

Looking for some advice about my ebf 6 week old baby.
I’ve been advised to top up inbetween feeds and I’m not sure what’s the best way for me to go about it and would like some different view points.
A bit of background...
I phoned a local nhs bf helpline last week as I had mastitis and was struggling to feed. I got through the mastitis but have had blocked ducts every day since. They pop up in a different areas of boob each day and come and go in the same day but there’s always a new one. Very painful but baby usually clears them.
The helpline suggested I go in to the clinic to see someone in person, which I did yesterday . They watched me feed and they advised baby wasn’t latching on deeply enough. Showed me how (I’d never been shown previous just watched videos) I could definitely feel the difference when I tried it - all good.
They then weighed baby and she hasn’t put on any weight in nearly 3 weeks (despite good growth for previous 3weeks)

They suggested I need to top up feeds.LC suggested topping up and expressing after every feed. This honestly sounds really stressful and unsustainable for me. I gave it a go today and I have 2 problems.
1)Baby won’t take expressed milk in the bottle (the bottle that comes with the medala pump) so the 3oz I pumped was wasted anyway.

1. I can’t always pump. Baby is on me constantly either feeding or sleeping. She wakes up if I put her down - I do try and she’s just not ready. I find it really difficult to do it with her on me and if I do I don’t always get anything anyway. It’s so hit and miss.

I have looked at resolving these is issues today by ordering a hands free pump and also some new minibie bottles which I’m hoping she will take to better, so I am trying to do what is advised.

But I don’t feel great about it, it doesn’t feel right for me and I feel like I’m feeling really stressed about feeding, which isn’t right.

Looking at alternatives I go from the 2 extremes of either wanting to forget expressing and topping up with formula instead to doing away with the top up idea altogether and focusing on getting the latch right and increasing my own supply.

The latch hasn’t been right previous and I can definitely feel the difference now and she seems to be feeding better. Although I won’t know if she’s put weight on until next week .

So my dilemma is do I:

A) Stick to advice and express and top up after every feed
B) Top up with formula
C) Focus on putting my energy into feeding her, getting the latch deep enough and increasing my supply?

Would be good to get some different view points as the best way to approach this. I don’t want feeding to become stressful!

I had to top up with 30ml formula after a feed for the first few weeks. As soon as he was feeding better I quickly dropped it (think it was week 8) then EBF from that point.

There are other ways you can top up other than bottle feeding, if that's what you wish. You can supplement her at the breasts with an SNS, or you can do finger feeding or cup feeding. An IBCLC could advise you and offer support. You could also pump at the same time as feeding on the other side if you're able, either with a hands free pump or something like a haakaa if you're able to get anything out with that.

I became ill a week or so after birth, it effected my milk supply. We were hospitalised, told by paeds to dual fuel or give up b feeding as priority was my ill health and baby had already lost well over acceptable weight... At the time I wasn't keen but found one 11pm ish night feed from daddy was accepted by baby.... I went to bed early, got better sleep, woke up almost bursting with milk.
That and fenugreek got me over the line and we settled into me feeding with occasional top ups for first 7 months

Thanks @Nextchapterofmybook doing a formula top up is feeling like a more appealing option to me than expressing. How did you know when you were ready to drop it?

Whoops.. DH gave formula.... Rather than expressed milk.. Just in case not clear

@addler thanks for that. Sorry if I’m really ignorant here, can I ask what SNS is?

@happytoday73 so you just did one full feed with formula a day?
Again this feels more comfortable to me. The LC I spoke to advised after a little bit after every feed and it just seemed a bit much.
I’d rather replace a full feed if I need to

I would go with option c. Your baby isn’t losing weight and is presumably happy and healthy with plenty of wet nappies. They’re being too rigid expecting consistent weight gain. Personally I would just ignore them and carry on.

@LuckyWookie I feel like that’s my gut feeling when it comes down to it. They also said I should only be letting her feed for half an hour and then topping up. Just doesn’t feel right. She wants to be on me all the time at the mo and feeds last way longer than half an hour.
Plenty of nappies too, so that is reassuring

We did top ups for the first 6 weeks or so, despite a decent latch. I think if you've literally just discovered a way to improve the latch then that probably be all baby needs.

I found expressing after every feed to be unsustainable (took forever to pump much of anything, so almost time for feed again!), as you say, but I would avoid replacing a full feed as it will probably affect your supply.

Make it easy on yourself and grab some of those premade bottles, give baby whatever they recommended (we had to do 10 ml per kg of weight so 30 ml when she was 3 kg. Hopefully you can get baby weighed again in a week and hopefully you will see a big difference!

They are mad if they’re telling you to restrict your baby’s breastfeeding. Wtf are they thinking?!

Yep... First couple of days we were in hospital and topped up after each feed.... But think that was due to amount of weight lost.
Once we escaped back home we just did that one feed...much easier... As much as baby needed...sometimes would take all, other times far less... It worked really well for us..

When I decided to stop feeding I just slowly upped the bottles, changed them from expressed milk and b fed less... It was really easy..

I guess one reason why she doesn't want to be put down could be if she's hungry

Maybe offer a bottle of formula for one feed and see if she settles better afterwards...? If the latch improvement help you might find she takes less and less of the bottle

I guess one advantage of expressing would be to clear the blocked ducts but doing it after every feed sounds a lot

Go with your gut in terms of how much milk she’s getting. Especially if she appears happy and the wet nappies are plentiful.

I’d agree with PP that one full formula feed is easier and more sustainable than constant top ups. It’s worth a until you see if there’s any weight gain.

Do you have a silicone pump? Like a Hakka? I found it much easier to collect milk that way while feeding baby from the other breast (it collects letdown).

Has baby been checked for tongue tie?

Mine ended up having a tongue tie which was not spotted til 6 weeks old and corrected at 7 weeks old. They had advised top ups earlier on but I didn’t do any because
A) I’d been there done that with dd and it didn’t solve the actual problem
B) he was growing and developing so well and very content
C) he never lost weight, always gained just not as fast as the magic line on their bloody chart
D) it was a massive faff and would have added enormous stress which is not conducive to happy mum / happy baby.

Completely depends though.... do YOU think baby is doing ok? Are you concerned about their weight gain or milk intake?

So in short unless you have any concerns about your baby I would not do any top ups for now and concentrate on correct latch. As much time at breast as poss. Plus perhaps get an expert to check for tongue tie as it’s so common and often not spotted.

SNS is a supplemental nursing system, so you have a small tube and dip one end in a bottle of expressed milk and tape the other to your nipple so baby gets additional milk while suckling. this has a dual benefit of protecting your supply and ensuring baby gets extra milk.

for the blocked ducts try lecithin. kellymom.com/nutrition/vitamins/lecithin/

also it sounds like you know this but let her feed from you as much as she wants, even when she has fallen asleep and is just flutter sucking, she is still stimulating your milk supply, getting fatty milk and may trigger additional letdowns.

PS for the blocked ducts the only thing that worked for me was using a wide toothed comb, combing where I could feel the blocked duct, towards the nipple. Also lots of feeding obviously.

Also if you do supplement yes SNS is a great option IMO as baby gets more milk but still does stimulate supply.

Thanks everyone, expressing after every feed does seem unsustainable for me.
I’ll try the hands free pump when it comes tomorrow and if it works great, if not I think I will try the formula.
Breastfeeding is tough as it is and adding in expressing as an extra task just doesn’t feel manageable for me.
I’d prefer to do it for the full feed to, rather than every feed, so I’m glad some of you are suggesting that too

@LuckyWookie I agree, they seem to want her to have distinct feeds but she’s not there yet and I don’t think that’s unusual at 6 weeks? Plus sometimes she will want to feed for comfort and I’m happy with that.

Midwives etc often treat breastfed babies like bottle fed babies because they don’t know any better. Breastfed babies don’t have distinct feeds. They just feed whenever they feel like it for as long as they want. Honestly it sounds like they need educating because telling you to restrict breastfeeding is ridiculous.

https://www.amazon.co.uk/Medela-009-0005-Supplementary-Nutrition-System/dp/B00JZF8LHK/ref=mpssa113?dchild=1&keywords=medela+supplemental+nursing+system&qid=1622751671&sprefix=medela+su&sr=8-3

You can buy a premade one like this or make one yourself out of any bottle and a thin feeding tube

The trouble with adding in artificial feeding is that it can reduce milk production because it’s such a sensitive feedback mechanism. More so if your already getting blocked ducts.

Honestly, I’d be tempted to have warm baths to make flow easier and have a ‘feed in’ to boost production and intake, An afternoon curling up on your bed with a good book or a film and just feed constantly or nearly constantly.

Expressing can be challenging if supply is low anyway. Far better to encourage yourself to have a proper let down. Relaxing on your bed and working with your baby to get a latch that works for you both is much easier if you’re both relaxed. It works better than being shown ‘the right way’. It doesn’t undermine your confidence either.

The baby is too young for an established routine of regular full feeds.

I'm currently ebf DS3 - 10 weeks old and the 3rd DC that I've bf.

I recommend avoiding formula unless given at the end of a bf. It takes much longer to digest than breast milk - if you try to replace a "feed" you'll probably find DC goes 4hrs without a feed afterwards and this will affect your supply more.

If it was me I'd do a week of as much skin to skin as possible. Feed at every opportunity - child wakes up = feed, child opens mouth = feed, child sticks out tongue =feed, child blinks = feed. Really focus on getting the latch right, you should find that you get significantly fewer blocked ducts as that improves. AND as it improves your dc will be consuming more milk and upping your supply.

If it's your first ebf child I can't emphasise enough how often you can/should try to feed them. If they refuse the breast that's fine, but from experience at that age they are likely to take it 5mins later.

Good luck whatever you choose

I can’t believe you’ve been given such bad advice 💐

Focus on improving milk transfer with better latch etc and ignore all this other noise. Being asked to add more tasks and fuss to your day is a great way to mess with your supply and or leave you so miserable that you give up!

I hope there are some local peer supporters or a good consultant (Kathryn stagg does online consults I think 👍) who can help you refine the latch and positioning xxx

I did formula top ups after bf with my 2nd dd. We were advised to by midwives in hospital as they were concerned about her fluid output. We continued to do it as it meant I had more flexibility with dh or my mum feeding her. As I already had dd1 it helped to be able to share the feeding out. I did ebf dd1 for 17mths so I've done both. I know my milk supply wasn't as good with dd2 probably due to the top ups but I found it made me less anxious about her feeding and gave me a break too.