Breastfeeding woes

[seeyouinanotherlifewhenwearebothcats]

Hi all. I feel so utterly confused and lost. I’m breastfeeding my 3rd baby. I’ve had gestational diabetes with all pregnancies, no insulin for any thought. With my DS1 he lost a lot of weight, feeding was a nightmare. I was triple feeding up until 4 months when my milk supply stopped and I fed him full formula. DD1 was losing weight so advised formula top ups. So she got two bottles a day and the rest breast milk until a nursing strike at 11 months. Now DD2 lost 8% birth weight and then began to gain. I was thrilled. Thought we had finally cracked this breast feeding. But then HV told me when she only put on 50g one week it wasn’t enough. So we’ve been topping up with an ebm bottle each day ever since. She’s been steadily gaining 150g a week. But again, that’s not enough and she has dropped below 9th centile. I’ll attach pic. I don’t know if it is relevant She has what paeds doc has told us is breast milk jaundice but that is slowly clearing. Bilirubin levels coming down each week. I spoke to lactation consultant (that I saw with all 3 children) no tongue tie. She seems to think I have supply issues. But I just feel so despondent about that. I feed on demand. Cluster feeds most evenings. When she has ebm I pump. If she doesn’t wake up during the night, I pump so I’m stimulating breast at night. I’m drinking loads of water, I eat oats for breakfast everyday, drink fennel tea. What is wrong with me and my supply?!

Just bumping for you op. Hopefully someone will be along with advice.

I advise seeing a lactation consultant you can find one on lcgb website.
just to say it is only a concern if baby CROSSES two centiles. It is not a concern yet.
are you triple feeding?
is the latch comfortable? Any clicking when baby is feeding?
are you making sure you’re feeding at least 8 times in 24 hours
i would strongly advise you see someone highly skilled in lactation (not a health visitor unless they’ve had additional training!) is there a la leche league support group near you?
do you have any thyroid issues? Pcos?
these kinds of things can be explored with a lactation consultant

Also she really should be feeding once overnight ideally x

That should say “at least once” sorry!

I'm no expert I'm afraid but I do know that PCOS can play a part, as PP has mentioned. Wanted to reiterate that it really might not be anything you're doing!

150g a week is perfectly ok for weight gain but depending where they were at birth they might drop down centules a bit. My DS1 only gained 75g a week for a while but then about 4 months started packing it on. Did you have fluids in Labour? That can inflate their birth weight a bit and make a difference too. How is she in all other respects? Happy/settled for short periods? Lots of wet/dirty nappies?

Good on you op, you are doing a great job and it's not easy.
My dd1 lost weight while breastfeeding. This wasn't down to supply issues but due to the amount of visitors coming and going. (I still stress thinking about it )
I was advised by hv to top her up with formula. From then on I combi- fed and I've since had 3 more dcs who were combi. Youngest is now 5 months. Could this be a solution for you? Is your dd hungry? Do you think she has enough wet nappies? If so maybe she is just small sized and she may not have a massive appetite. My last 3 babies have been a lot hungrier than my 1st. Obviously though, if the hv is worried maybe you will need to take this on board.

I can’t see if you’ve said how old your baby is, but my advice would be to wake the baby for a feed overnight.

Night time feeding is essential for optimum milk production in the early months and pumping will not build up your supply anywhere near as much as feeding your baby would. In general, the removal of milk by a pump cannot be compared to the removal of milk by a baby, in terms of both how much milk is removed and how the method of removal stimulates further milk production.

Plus waking and feeding the baby means they will have an increased intake of milk which in turn will lead to more weight gain.

Also look into using breast compressions during the feeds to increase the volume of milk your baby is getting.

If there are any concerns about your supply then you need to have some breast feeds observed by an IBCLC so they can fully assess milk transfer. Poor milk transfer is a big factor in low milk supply and this is a separate issue as to whether the baby has a tongue tie or not. If there are concerns with poor milk transfer which in turn leads to reduced milk supply then expressing after each feeding session may help with this but is obviously quite time consuming.

Is your baby having lots of dirty nappies as this can also be used as a good indicator of milk transfer.

I would also wake in the night for a feed too

Thank you all so so much. I appreciate the replies. So to answer the questions:
sorry I should have said she is 9 weeks coming 10 weeks this Thursday. She was born via c section as were all my babies, not sure if this means more fluids?
Typically she will cluster feed from about 7 til 11 when my husband gives her ebm (she hasn’t had any formula to date) during which time I pump. Then she’ll sleep. It varies, some nights she’ll wake at 2.30, feed, then feed again about 5.30. Some nights she’ll sleep til 5. I always set an alarm so if she hasn’t woken by 4.30 I pump. I have tried waking her before but when she is sleepy she doesn’t feed well? Then I have to pump regardless cos she hasn’t drained the breast? But should I keep doing this anyway?
She has lots of wet nappies, dirty nappies maybe once every two days but very large ones when she does go. She does be settled after feeds, happy on play mat or swing cooing at us and smiling at us. Her daytime sleep is awful though. She only really naps in car or pram but I thought that was just babies generally? You wouldn’t think this was my third baby, I feel like I haven’t got a clue anymore
No PCOS. I do have concerns about positioning and attachment. She occasionally clicks when the let down seems too much for her. After a lot of feeds she has blanched lips or as my husband calls them “salt & vinegar lips”. I said this to lactation consultant but she didn’t really address that. I don’t have pain feeding but there will be a slight compression on nipples after feeds. Husband is keen to introduce a bottle of formula but my concern there is that it will tank my supply (what there is of it) altogether.

Following as I'm also BFing and expressing and my DD was born on the 9th centile but is now on about the 5th. She's 8 weeks old.

We do give a daily formula bottle too as my supply was a bit low at the beginning (I was expressing as DD was unwell and couldn't latch at one point, so I could see I wasn't quite making enough each feed).

I'll be interested to see advice but it looks to me like you're doing all the right things, OP

Btw, I wish my DD only pooed every 2 days. She goes about 10 times a day, generally just as she falls asleep :/

Oh we have the salt and vinegar lips too, usually after a long feed.
She also gets little milk blisters sometimes, but her latch seems perfect and we saw a lactation consultant who was happy with everything.

Just in case you aren't already doing this - Are you switching breasts constantly? It's the number 1 way of increasing supply. Keep massaging towards the nipple while latched on. As soon as the breast is soft, switch sides and repeat. Aim to switch every 5 min. You should notice supply increasing within a few days of doing this

Ps I personally wouldn't keep pumping, just latch on when you would otherwise have pumped.

When the baby latches on, it triggers a milk producing hormone that increases your supply - pumping doesn't do this as effectively

@Alloveragain3 maybe the more frequent poos are a better sign for you 😆I’ve honestly never second guessed myself as much as this time round. Everyone says to me you must feel much more confident this time but no. At her 8 week appointment the GP was all congratulating me on breastfeeding all 3 babies and I felt such a fraud.
Thank you @Mumoftwo1312. She’s cluster fed all night there and now when I went to pump when she’s having ebm it’s like dust. Barely pumping anything. I’m just shattered tbh

And @Mumoftwo1312 sorry yes I am switching sides constantly. She never only feeds from one side, always get both, sometimes multiple times before a feed is “finished”.

This will do the trick I think! But replace the pumping with just doing this. You mentioned she's too sleepy to feed sometimes- try doing a nappy change to wake her up and then try again. Or go into a cold part of the house briefly (eg pop into the kitchen and back) whatever works.

Pumping is really counter productive to supply imo (and miserable!)