Triple feeding - 3 weeks old

[msp2023]

Hi all. Would love some advice / hear your own experiences if similar.

Baby girl is 3 weeks today.
We had to introduce formula top ups at day 5 due to dehydration/lethargy as she wasn't latching well. No tongue tie but we started using nipple shields too as she just couldn't seem to open wide enough.

I'm also pumping to try and get my supply up - I've been advised to pump 10-12 times a day but this just hasn't been possible. I manage six times a day max, I'm going to work harder at this over the next few weeks but I am finding it exhausting.
I'm currently able to get around 250mL in 24h of expressed milk. I've been told I need to get this up to 750mL to cut out formula completely.

What we currently do is offer both breasts, give expressed milk (if any) and then formula until she is satisfied.

Each feed takes around 1-1.5h and she's up every 2-2.5h to feed. Triple feeding doesn't seem sustainable in the long run especially when it's just me home during the days as I won't get anything else done! The nights are exhausting too as I maybe get 45-60 mins between each feed to sleep - I don't have the energy to pump in the nights.

She's still taking 50-60mL of top up at each feed (expressed or formula), after being at the breasts for 30 mins total.
She really does only latch on the teat of the nipple shield too which I imagine isn't helping the flow of milk reach her quickly.

I would love to EBF but I'm not sure if this is going to be feasible without pumping more often to get my milk in.

Does anyone have any similar stories? I'd love to hear the outcomes/any tips you may have :)

Thank you in advance!

Hello @msp2023
I was on a triple feeding plan for the first 6 weeks or so with my baby (now 3 months old).
In her case it was tongue tie (which we had divided) and also the fact she was super sleepy for the first few weeks and kept falling asleep on the breast. Since the tongue tie division her feeding improved significantly I am now almost entirely breastfeeding with occasional bottles.

If you’re not already, ask to be referred to the infant feeding so that you can see a midwife who is a breastfeeding expert. In my experience the midwives on the post natal ward and community midwives gave me a lot of mixed advice and I didn’t get anywhere until I was seen by a specialist.

You have my complete sympathy for the exhaustion you’re going through right now. I was told to BF/express/give formula on a 3 hourly cycle, the idea being that I could get all that done in 1 hour then rest for 2 hours, but in reality it wasn’t possible to get things done the quickly when you factor in the time to pump/sterilise bottles etc. I ended up taking the decision not to pump for a 6 hour slot overnight, so I could get a chunk of sleep while my husband did one of the overnight feeds. I was warned that length of gap between pumps might decrease my supply, but that didn’t happen for me, and it was the right thing to do because I was so sleep deprived.

A few things that helped me:

-If you can afford it, hire a hospital grade electric double breast pump.

-Get a pumping bra so you don’t have to hold the flanges in place.

-Check your flanges are the right size.

-Pumping first thing in the morning generated the most milk in my experience.

-Try the “laid back” breastfeeding position.

-Removing a layer of clothing helps baby to be more awake and alert to feed. Try breast compressions while feeding to help get the milk flowing.

-Ask them to check again for tongue tie. Ours wasn’t confirmed for certain until a few weeks later.

Triple feeding is the worst of all worlds because you’re not only trying to breastfeed but dealing with all the equipment of pumping and formula as well. It’s just not sustainable in the long term. Hopefully with the right support and advice things will improve for you!!

I'm an IBCLC, and I just want you to know, triple feeding should never be a long term plan.

It's a short intervention to buy time to fix whatever is going on, but isn't sustainable long term.
I'd strongly encourage you to ask for a referral to the infant feeding specialist team (there are usually specialist MWs & HVs depending on whether you've been discharged yet).
I see families so often who have been started on a triple feeding plan, with no exit strategy, and the specialist team should be able to go over next steps with you. Alternatively, if funds allow, a private IBCLC can help too.
The charity Maddie's Miracle provide online consultations with IBCLCs if funds are an issue.

I'm sorry you've had this journey so far, it's really hard when feeding isn't going according to plan, and totally valid to be upset, even when we understand that a fed baby is the highest priority.
You've worked so hard, I salute you for every hard earned drop, regardless of where you choose to go next. You breastfed your baby.

Thank you both for your replies.

It likely is nipple confusion and the fact she's now too used to bottle feeding. Hence she just won't open wider now! I try to remove the shields but she just goes for the nipple which is extremely painful and then affects my ability to feed/pump for the next few sessions.

I've spoken to someone from La Leche League - they've seen videos of the tongue and don't suspect a tongue tie.

They did advise to get a private review by an IBCLB but in all honesty I am wondering if this is worth the money considering it's highly unlikely she has a tongue tie?
I'm wondering if they'll advise me to just pump more regularly to get my milk in etc (as everyone else has) and not be able to offer any other advice? I can't see how anybody would be able to help the latch?

I have been advised to rent a hospital grade pump which I will do.

Feeling so confused :(

@msp2023 an IBCLC lactation consultant won’t just assess for tongue tie. They’ll teach you feeding positions, help you get the correct patch (which is crucial for effective transfer of milk from the breast) and, most importantly, help you put together a sustainable plan to stop triple feeding.

As mentioned about, triple feeding should only ever be a short term thing because, as you quite rightly point out, it’s just not sustainable! Also worth attending a peer to peer breastfeeding support group (La Leche League do breastfeeding ‘cafes’ too) as hands on help with latching is invaluable.

Fixing a sub-optimal latch is the bread and butter of any IBCLC, it's at least half of what I do, they should certainly should be able to improve it.

Whether or not there is a tie is really hard to assess visually, as it depends on function issue, not just appearance: again, an IBCLC should be able to perform an oral assessment.

A hospital grade pump like a Spectra S1 or S2 is likely to be much more efficient (and therefore save you time) than a many more expensive but better marketed pumps.

I triple fed my daughter after she lost a lot of weight post birth and we were re-admitted to hospital. I bought a Spectra S2 pump. Like you it was unsustainable to pump for amount of times they recommended - I needed some sleep!

The first month or so I pumped 5-6 times a day (once was around 1am but I would get two chunks of 3/4 hours).
Then around month 2 I dropped to 3 times a day. Then about 4 months I dropped to 2 times a day until 8 months when I stopped pumping. I breastfed until 18 months. 2 times a day worked well as I pumped during first nap and when my daughter went down for the night (she was a decent sleeper).

I had an IBCLC visit around 2 weeks old (a private one) and she advised cranial osteopathy. Maybe that helped... Or my daughter got bigger and the latch was easier, but we never fully got off top ups until she was 8 months (but having some solids do I felt happier to stop pumping).

Good luck

Thank you all so much for your replies.
I've booked an appt with an IBCLC so I'm hoping this will help us a lot! I've become determined to get at least 10 pump sessions in a day with one being a power pump.

At least I'll know I did everything I could to try to EBF :)