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 also agree if you want to continue bf, maybe initially spend a few days just working on feeding and latch. Don’t do anything else - snacks by your side, tv on, feeding is your only job! It’s great that the latch feels better now and you can physically feel a difference. I am astonished they told you to stop a feed after half an hour - that is absolutely not the correct advice, it is common and normal for babies this age to cluster feed more or less continuously for hours at a time, breaking for sleeps and cuddles, and in turn that continuous feeding boosts your supply. It is all part of the mechanism. Unfortunately formula top ups can have the opposite effect, however mixed feeding does work well for some and I agree if might be better to do a single formula feed if you want to have more certainty about her intake. Pumping after each feed sounds pretty unrealistic to me with a baby this young who is likely to naturally feed very frequently and to no real pattern. She is still very much in the “establishing breastfeeding” stage which basically means just feed as much as possible! Good luck

Just woke up to these replies, so so helpful thanks to everyone! Just what I needed.
Those of you that have suggested focusing on feeding with better latch to improve supply have really restored my confidence- thank you!

She definitely wasn’t latching deep enough and ive really noticed the difference since. Yesterday we just snuggled on the sofa and fed all day. It was lovely!

Some good indicators are lots more poos yesterday definitely. Plus the last 24 hours I haven’t had a blocked duct at all and that’s the first time that’s happened in 2-3 weeks, so I do feel really confident improving the latch and focusing on feeding IS working and will be enough in its own right.

@buddy79 thank you for reminding me about the cluster feeding being normal. I did know that but came away from weds thinking I should be having these shorter distinct/ feeds, which is totally unrealistic.
That being the case I wouldn’t know when to give the top ups anyway!

I am open to giving one bottle, especially in the evening- if I’m honest probably more to give me a break and with the hope that it would extend that sleep slightly. She currently does 1-2 hours in her next to me, it would be great if she did 2-3. So I will try the hands free pump today. If it’s straightforward I’ll look to add that in but if not I’ll leave it.

In the meantime we will have another few days of cuddles and relaxed feeding together. I’m sure that will be enough!

And thanks @addler for the info and link. I’ve taken a look and while it looks great, adding anything like that in just feels like extra faff and I really want to avoid that if possible but I can see how that would be helpful for a lot of others in a similar position.

Sounds like you're both doing amazingly!

Who is this advice from? In general midwives doctors and nurses get breastfeeding advice very wrong. Have you spoken to someone from LLL?
Definitely option 'C. Just let baby feed from you as often as she likes. Supplementing will reduce your chances of successfully bf for as long as you want to. But it's ok to supplement if that's what you want to do!
Do make sure to get her weighed regularly if you are concerned about weight gain.

Thanks @confuseddotcomma it was the l nhs infant feeding team at the local clinic.

They’ve stopped the drop in weighing for babies due to covid. You can request it but it’s at a clinic not local to me in a different part of the district and recovering from a c section I’ve not really been up to making it there until now. They’re also not doing the 6 week postnatal check up - don’t get me started on this and the care I have received in the nhs pregnancy/ birth system, that’s a whole new thread!

You can weigh her yourself at home. Pop a baby bath on some bathroom scales and set to zero. Then add naked baby. Takes some practice but can be done.
I think it's sad that NHS staff are getting such a beating at the moment. Yes a lot of stuff isn't happening. But people seem to have forgotten why that is! Clearly rainbows and clapping are a distant memory now.....

@confuseddotcomma thanks for the tip! Not sure how sensitive my scales are ie. if it will show ounces too but will check!

I wasn’t giving the nhs a beating at all, that language is very extreme. I was
stating the facts and inferring that I didn’t necessarily agree with it- although I’m totally understanding the reasons why, I do believe there are ways for these things to be facilitated without compromising safety.

The care I received in pregnancy and birth is a separate issue (and perhaps one I shouldn’t have conflated) I’m not happy with the care I received not due to covid but because my experience was terrible, that’s maybe why I came across like that.

So while I wasn’t nhs beating, I was certainly intending to highlight that the advice/ care from the nhs isn’t always the best for antenatal and postnatal health (and shouldn’t always be blindly followed) - that is my experience anyway. I do believe care needs to be radically improved for pregnant and postnatal women

Yeah there is no way you spoke to a LC. Honestly, no way because the info yiu have been given is too off from what they would explore in this situation.

The priority would be to sort the latch, to feed more and to review. Have a google of switch nursing and breast compressions. Feed as many times in a day as possible and with your new and better latch you would very reasonably expect all to be ok:)

The model you are following is for a much younger baby and the top ups still would very rarely be after each feed.

Sorry posted too soon - your last post sounds great. It’s going well.

Sadly even at feeding clinics you can get staff with no more than general skills rather than bf specialists. It’s a disaster. Enjoy your cluster feeds and more comfortable boobs!

I was just going to suggest breast compressions and switch feeding, but @TSBelliot beat me to it . Sounds like now the latch is better that this will help with weight gain.

If you do want to express, try mornings or express at the same as feeding. Covering up the bottle can also help increase the amount you express.

There are times where it would be clinically appropriate to limit bf times, but it would usually be for prem babies where they were using too much energy to breastfeed than they gained. Not so in this case!

Just to add a contradicting perspective, I topped up with a formula feed once or twice a day from three days to six weeks and after that mainly breast fed (maybe a few bottles by DH) for the next three months before stepping down again to stop at 6 months. Minbie very useful. I definitely didn’t have under supply after the first couple of weeks and baby grew well, 95th centile chunk.

Do what feels right to you. There isn’t a right answer. The NHS advice is usually based on avoiding a starving baby (which did happen to a NCT friend who refused any formula - baby in hospital at 3 months with malnutrition) but sometimes not quite so nuanced as it would be in a perfect world. I wouldn’t completely disengage as others have suggested but maybe go and get the baby weighed in 2 weeks somewhere just to check there’s some improvement?

Option C, just focus on that. I was in a very similar situation, albeit that baby is 17 now. So so glad I just pushed on through with my instincts.

Didn't read all the good advice above. This was my gut reaction.

Stop pumping. Keep the baby to the breast 24/7 - normal for this age. If breasts seem overfull, express gently by hand to avoid further mastitis. Until there is weight gain, give a little formula by spoon or if it works safely, by cup (as your baby doesn't want a bottle). Don't worry. Doing a little mixed feeding won't be the end of your ebf experience.

Latch: Sit with your back straight. Have enough pillows and cushions on your lap that you can rest your arm in a position where baby can easily reach the nipple without pulling. Gently touch baby's cheek with nipple. They will turn and latch. Watch for ears wiggling.

Six weeks is only the beginning of your breastfeeding experience. It takes a while to get used to each other.

@amidsummernightsdreamni useful advice about top ups but regarding weights- I bought some baby scales from Amazon for around £20. I’m sure there will be second hand ones on fb marketplace or somewhere like that. Worth investing in for peace of mind and to save you unnecessary journeys.

Gosh I wouldn't be restricting her breastfeeding because it works on supply and demand which at 3 weeks is very much still being figured out. It's absolutely normal for your baby to be on your boob a lot.

As she has plenty of wet and dirty nappies (the best sign) I'd be seeing how you get on now you've got a better latch.

When you're more in routine (which for me was definitely after 6 weeks) if you do have a hands free pump or can set up a wired pump easily with baby pump whilst you're doing the morning feed as you'll often get lots then.

NHS is a mixed when it comes to breastfeeding, I had a great old school midwife who gave great advice when DD was loosing 'too much' weight at the beginning, some are clueless though which probably just comes down to lack of training.

I would agree with just feeding your baby on demand and not worrying about top ups.
My baby lost a lot of birth weight, due to being in icu following an operation and taking breast milk and also formula via ng tube.
Hospital would not discharge until he gained weight and I could not sort latch so again combi breast milk and formula via bottle.
He was 6 weeks when I returned home.
Midwives visited daily to assist with relactation and latch.
I follows their advice to ditch bottles and formula and encourage breast feeding as much as poss. Took baby a while to start gaining weight but he got there and I ebf until he was 14 months.
I think if I’d following hospital advice he would have remained on formula.
Trust your body, try to relax and it will come.
Don’t put extra pressure on yourself with expressing and top ups. You are doing amazingly.

Now that you have a better latch, milk transfer should be more efficient and the baby will potentially drink the same in a shorter time (or drink more in the same time).

My concern about top ups or expressing would be that, given you know you're prone to mastitis and blockages, your baby would take less bm if you do formula top ups (blockage and mastitis for you), or you would overstimulate your supply with pumping (blockage and mastitis for you).

Given there hasn't been actual weight loss, and your baby is alert and having plenty of wet nappies, a trial of feeding with a better latch would seem sensible.

I was also told to restrict feeds (to 10 minutes per side ) in hospital when DS2 was newborn, so that I could top up.

My initial reaction was the same as you - this is nuts! Of course newborns breastfeed for 1 hour+ ! If I take him off he'll just not be getting enough milk etc. I was very upset about it.

With hindsight I don't feel I was given enough information/context. Sometimes if a baby is very sleepy, latching poorly or simply for whatever reason there is poor milk transfer, you actually do want to take them off early because the problem is they keep expending energy trying to feed and although they are getting a dribble of milk, it's not enough to sustain these calories they are expending. Feeding at the breast is then resulting in a net calorie defecit. This is not what you want if they are really new/tiny.

So that is why they say to stop the feed after a certain amount of time and offer a formula or EBM top up. Because it is much easier for them to obtain milk through the bottle, it means they are not expending so many calories plus you are getting calories into them. What they did not tell me (but I worked out for myself) was that I could happily put him to the breast again after the top up and let him keep going for as long as he wanted. Which I did at most feeds. I just interrupted the feeding about once every 4 hours to give a top up. I was supposed to be recording what I was giving him and I just stopped writing down how long I was breastfeeding for and just wrote "breastfeed".

I am not sure that this advice is right for you, considering that the problem with the milk transfer was likely the latch, your latch is now deeper and you're seeing signs that the milk is transferring more effectively such as better nappies etc. So I am not sure that you would be wanting to top up at every single feed.

You could also look into paced bottle feeding. I did this for all the top ups and it helped me feel better about it plus it did not feel like I was overfeeding him nor giving so much that I had no hope of keeping up.

Keep pushing them for a plan to get off the top ups if they are not offering this. As they should be but they rarely do.

Plenty of poos is great. Just a note from me not to panic of DC starts going longer between them though. All 3 of mine had turned into fortnightly pooers (no constipation- and within the normal range for ebf babies) by 4m. It was a gradual change over 4-6 weeks though.

I would try and maximise the amount baby is getting directly from the breast by doing breast compressions while she is feeding (lots of good videos on youtube), and increasing feeds if possible. Lots of skin to skin will also help and working on the latch so she is feeding effectively is crucial. Lucy Webber IBCLC has a lot of good videos on this.