Baby not feeding, advised to top up with formula and really struggling

[Rosess364]

My little boy was born nearly 5 weeks ago via emergency CS. I had to be put under general anaesthetic too.

After a really strong start to breastfeeding (he lost 7% of birth weight but gained it back in just over 2 weeks) we are faltering.

The main issue is that baby is reluctant to feed for more than a few minutes each side. So a ‘feed’ can take an hour but out of that time 99% of it is just him suckling for comfort.

As a result he is gaining weight very slowly and is tracking along the 0.4 percentile. Lots of wet dirty nappies and is bright and alert when awake. I’m worried sick about his weight gain though.

He was diagnosed with tongue tie and had this snipped at 4 weeks. Ive been advised by HV, midwife and breastfeeding specialist to pump and top up with expressed milk or formula.

I’ve been giving 40-60ml after a feed in a bottle, which he demolishes and eventually seems quiet and content. If I just breastfeed him he is rarely quiet and content, often squirms, cries and generally seems unsettled.

Everything I’ve read on here is that topping up tanks your supply and leads to baby refusing the breast/preferring bottles. Advice always is to just let him feed all day if necessary but what do I do if he’s not actively feeding?! Tried breast compressions, switching sides regularly etc. nothing seems to get him to have a good feed so he’s full.

I’m in bits. I already feel a failure of a mother because I couldn’t give birth naturally or even hold him for hours after he was born. Now I can’t even feed him properly.

Any words of advice?

Give yourself a break. I felt like this and when I look back at all the wasted guilt and torment - time not enjoying my baby, just feeling guilty all the time.

You gave birth to your baby, doesn’t matter if it came out of your vagina or your stomach. You can feed your baby, it doesn’t matter if it’s from your nipple, your milk from a teat, or formula milk from a teat.

You are not a failure what ever you do next. You know your baby best, you need to do what makes you both happy. I wish I had realised that sooner, I definitely won’t be making that mistake again. Don’t waste another second feeling guilty, you are the best mother to your baby however you decide to feed.

If you’re worried about your supply then expressing will help. But I would contact one of the specialist breastfeeding services in your area, I wouldn’t rely on HV.

My DS had quite a stiff jaw and a visit to an osteopath made a big difference in his latch and ability to feed for longer.

How’s your letdown? If it’s very fast it might also upset his stomach and he might need burping partway through the feed.

But don’t beat yourself up and worry about it too much. How you gave birth or how you’re feeding your baby doesn’t determine if you’re a good mum or not.

I would disagree. The best way to increase supply is to feed more- a baby is far more effective at stimulating the hormonal responses to increase supply.

o/p when you say he “feeds for comfort” have you considered that he’s suckling to increase supply? Topping up etc will reduce the need to suckle if it’s filling him up, but that will lead to a decrease in supply.

the best way to establish feeding is to feed. As much as you can. Faffing with expressing, bottles and top ups will add extra work and interferes with supply regulation. Add to that many babies learn to prefer the “instant access” of bottles as bf in comparison is more work. Especially when they’re going through a growth spurt and constantly on the breast to increase supply.

there does come a point if you’re topping up a lot where you’re getting worst of every world. Bf, bottle washing, expressing, bottle feeding. Time consuming and exhausting. You may need to decide whether to give bf one last go or accept that you will need to bottle feed.

Hi there I am a labour ward midwife. I volunteered for 3 years in a breastfeeding support group for 3 hours every week in my previous life. Firstly, don't beat yourself up on having an EMCS. I always say to women - how long a woman's labour is going to last and how baby is going to be born depends on the size and position of the baby and the shape and size of the woman's pelvis.So combinations are endless and a lot of caesareans are purely a straw of bad luck. Please don't beat yourself up on having an EMCS. Give your body a chance to heal and if you are brave enough to have another child you may want to consider a VBAC (vaginal birth after caesarean) - 3 out of 4 women are successful. As for your breastfeeding difficulties.... I have seen it time and again in the breastfeeding support group- topped up babies put on a convincing show on the breast however they lack motivation to suckle effectively. As a result, mums find out their milk supply is going down and babies are fractious if they are only fed at the breast. The solution would be to choose 3 days in a row when you have lots of support at home and pump 8 times a day for 40 minutes at a time for 3 days in a row. It's a big ask with a newborn, please don't feel guilty if you don't manage quite so many expressing sessions. However, at the end of 3 days you should see a noticeable increase in your milk supply. You may never be able to bring up your milk supply to completely discard the formula as you had a really difficult start with an EMCS under GA. However you are doing an amazing job and every drop of breastmilk is precious. Give yourself credit where credit is due

I get what your saying about supply and I’d be more than happy letting him suckle for hours if he wanted to and he was getting what he needed from me. But the slow weight gain indicates he’s not. He manages 1-2 minutes of active sucking before just suckling.

So letting him suck for hours would just end up with an even more underweight baby?

You are not a failure. I know bugger all about BF but have you considered seeing a lactation consultant? There’s nowt wrong with formula that’s what my 2 had but it might be worth exploring that first?

This was almost exactly me and my baby a year ago OP, it was one of the hardest things I ever did. We had two tongue tie corrections, saw several osteos (waste of money) and I tried everything and got all the conflicting advice. My baby seemed to be having these hugely long feeds that were mostly napping and wasn't gaining weight well. The best thing I did was see an excellent lactation consultant who was also a La Leche League leader who helped so much emotionally as well as practically. She helped with the latch, feeding positions, and trusting my instincts and the process. She could see my baby was alert and thriving and she debunked a lot of terrible advice I got from HVs/infant feeding team. We did a weighted feed that was reassuring as I knew she was getting enough. My daughter started to gain more steadily on her low percentile but didn't recover her original curve until she started solids. She has a huge appetite and is now high percentile but I think mostly from food!

Doing it next time I would try switching sides earlier while she was still awake (rather than worrying about her 'draining' each breast to get to the hindmilk which is what I'd been told) but then let her nap and suckle on the second side, that was her absolute happy place and it does stimulate supply. I would also top up with formula like you're doing - which I never did out of fear for my supply - if I felt it was better for my MH. For us it just took time - but much longer than the 12 weeks they always say. We were still having latch issues and pain at 7 months, it got better at 8 really.

Now we're still feeding without issues (except teething related biting!) at 14 months but I feel a lot more rational about it. I can see doing a shorter time BF and stopping when it was so hard would have been absolutely fine. I lost my head about it a bit and wasn't very kind to myself when I should have been focussing on enjoying our time together.

As a PP mentioned, triple feeding (expressing after a feed for minimum 8 feeds per day and then topping up with expressed milk and then formula of needed) can be really effective as a very short term way to increase your supply. I did 3/4 days of this and it greatly increased my supply which was low probably due to an EMCS and PPH.

However it might be wise to do this with the support of your local infant feeding team or an IBCLC. Has it been checked whether the tongue tie snip was successful and has not re-attached?

In regards to trying to avoid bottle preference, are you doing paced bottle feeding when topping up, and also using a slow flow teat? These should be done to avoid baby gulping down milk and reduce the chance of them preferring bottle over breast as it's such a quick flow and low effort to feed.

@Kosenrufugirl I'm interested what you say about VBAC, I thought the first time c section rate was almost 50% so wouldn't that mean the VBAC EMCS rate was lower than all first births, surely that can't be right?

Echoing what other posters have said that your worth as a mother is not determined by how you gave birth or how you feed.

I ''failed' to breastfeed my first. When I had my second I put a huge amount of pressure on myself to make BF work and it's been an incredibly hard journey where he dropped from the 98th to 9th centile. After months of breastfeeding support I've slowly come to peace with combi feeding now and he's just nodded off after a formula bottle and will BF through the night. It doesn't have to be all or nothing and it isn't a failure. I too tied myself up in knots reading how topping up would wreck my supply but there comes a point when fed really is best and you can't just keep watching their weight falter.

That being said, 5 weeks is pretty early days, my baby had barely regained his birth weight by this point and our difficulties persisted. An IBCLC lactation consultant really is the gold standard in supporting breastfeeding and if you can afford a 1:1 consultation they may be able to spot issues others haven't. Sometimes they frequent local baby groups for less in depth but free advice.

Go easy on yourself, you're doing great.

Our hospital total CS rates is over 50%. We do a lot of elective Caesareans (repeat Caesareans, Caesarean for maternal request and primary Caesareans for medical indication). The emergency CS rate for women who attempted a vaginal delivery was 25.5% in 2022 audit, in line with national statistics.

I had a similar situation and was expressing alongside feeding, topping up with bottles of expressed milk and a bit of formula too after the 6 week check showed weight gain was still minimal. I was so stressed and upset - this was my 3rd after successfully feeding the first 2 by the way so don’t beat yourself up. Some babies are hard to feed!

I took advice from a friend who had been through the same thing and she said stop all bottles and spend 3 days in bed with your baby skin to skin and just feed feed feed. All the expressing and formula top ups just reduced the time baby was at the breast and reduced her drive to suck because she could get it more easily from the bottle. For me, this worked. My supply picked up and feeding improved a lot. It took a few days but we got there and I fed for 2 years in the end!

I was a bit gutted it meant I didn’t have the ease of bottles anymore but ditching them was the only way she’d breastfeed effectively. When I tried to introduce them again later she was having none of it!

If you have support then it’s worth a try? Make sure you’re eating and drinking lots. I ate loads of oats to boost supply too. But if it doesn’t work or you can’t do it then don’t beat yourself up, baby will thrive on formula. You could still mix feed and express.

I would try and stop beating yourself up about this. Continue with the combination feeding. Formula is perfectly good and your baby will thrive.

@Kosenrufugirl interesting, thanks for clarifying

Lots of good advice here OP, I triple fed for 5 months and it was so hard (and definitely NOT the right choice for everyone!), I had a lot of support from a local IBCLC throughout and just could not have done it otherwise. I fed until 2 years old in the end and am so happy I did. I strongly advise you talk to an IBCLC as you will need specialist and tailored advice. Best of luck.

Thanks everyone. Rationally I know that as long as she is fed and happy that’s all that matters. But it’s become really important to me that I am able to breastfeed so the idea that topping up with bottles means that she is going off me (or rejecting me as that’s what it feels like) is really hard.

I have another appointment with the feeding team next week so will ask them to double check the tongue tie hasn’t reattached.

I’ve looked up lactation consultants in my area and the top one listed actually works in my local feeding team (and has been brilliant) so I’m confident I’m getting the best advise/support I can.

I appreciate the advice is meant in good faith but please don’t advise me to ‘ just let baby feed’. I’ve seen so much advice to spend days in bed/on the sofa, skin to skin etc. That doesn’t work when the baby won’t feed and just makes me feel worse.

I’m beginning to realise that it’s probably more mental health support for me that I need. I think I’m doing everything I can but I need some help coming to terms with the fact that I may not be able to breastfeed properly.

Oh OP, I can massively relate to your post. I had to triple feed DD1 for months as she was drifting below the 0.4th centile. She had been in NICU - i already had huge guilt feelings from that and not being able to fully bf massively destroyed my MH. It's good to hear you are under the relevant services. I'd had fertility treatment to conceive and i remember saying to the NICU psychologist that i felt like a failure of a woman - i couldn't get pregnant in the first place, I couldn't keep her safe in labour and then I couldn't successfully feed her. It was a horrible time.

I can say that sometimes it takes a while for the tongue tie division to start making a difference, so that might improve in a bit. But what really helped me was to disengage a bit from social media and to some of the baby groups for a while as well. The whole infant feeding topic is so polarised, i decided in the end to figure out who I wanted to trust (whether that's the feeding team, or an LC) and just listen to them without all the external noise. Once I filtered a lot of other stuff out, it became easier to learn what my own instincts were.

Without top ups, I now believe my DD's weight would have continued to drift, her sleep affected, her development affected etc. She was a very sucky baby and would have stayed at the breast for hours, not drinking properly, getting tired and that would not have been good for her. It would not have been for the best to me to try and get to EBF. Not to mention the fact that I think all the extra expressing was a massive factor in my declining MH. But I would never have recognised that at the time when I was in the thick of it and it is only now it is in the past that I have been able to see the wood for the trees.

I also totally understand the feelings of rejection. I have no real advice other than to say from someone who has come out the otherside that it does get better. At the stage you are at, every day feels so hard but day by day, your feelings will change. I used to set myself little goals - BF for one more week, then the end of the month, then 3 months, then 6months etx.

In hindsight, I should have also considered seeking out some PND help to help process all the feelings I was having - maybe some antidepressants or CBT or something.

I've since had DD2, who also has some feeding issues, a 90% tongue tie that wasnt found until she was 8weeks and other issues that means a feed takes 90mins. This time, I accepted the need for top ups with a more positive mindset, which I feel means i haven't had the same MH issues. Kind of because I approached it differently? I also refused to do the 8 x expressing this time, which has hugely helped with MH and sleep!

Both babies have still been having some breastmilk at 6months, which given where we were at 4weeks with them both, I am now very proud of that achievement. And I hope in time you will feel the same. My amazing HV reminds me at our fortnightly weigh ins that every drop of breastmilk helps so not to flog myself if the balance between breastmilk and top ups sways more to the formula. I've decided to stop breastfeeding at the end of the month (DD2 will be 6months then) and this time i feel really at peace with my decision (unlike last time).

Sorry this was an absolute mammoth essay but your post just resonated so much. You are not alone in how you are feeling. You are doing brilliantly and you will get there, even if it ends up looking slightly differently to how you expected when you were pregnant 💪

This was me 20 years ago. I started to trial a little bottle last thing but gave up in the end as I pushed through and things got rapidly easier about 6 weeks. I then solely BF till 16 months. Babe became very efficient and quick, traveling consistently along the same weight line

To reassure, we added formula at 9 weeks old due to static weight. I sobbed my way through the first bottle, despite knowing logically it was absolutely what he needed as my supply had tanked. I found it really hard and emotional to start with and struggled with the guilt you're also feeling xx

I combi fed until 9 months old, when breast feeding tailed off naturally (and a bitey phase!) so adding formula absolutely does not mean that you won't be able to continue breastfeeding.

Oh my, I remember this so well.

You have given birth - doesn't matter the exact way he came out - you delivered him safely and that's what matters.

Feeding - it's an art and it takes time to perfect it. Well done on continuing.

Please, please, give yourself a break.

It's perfectly normal what you're experiencing.

Sending you kindness and support.

Sorry, she!!

I echo the advice to try babymooning and skin to skin, also a lactation consultant was absolutely invaluable because my baby was not latching properly and that stopped let down. He was literally sucking from a straw instead of getting a mouthful and that was the reason feeds took an hour. He was exhausted and the feeds were really unproductive
I gave top ups and it helped get us back on track once the feeding pattern had been corrected. Demand feeding yes definitely but the latch is crucial

Please avoid getting into the pumping express top up trap. Small formula top ups are not the devil's work and combination feeding can make all the difference to continuing to breastfeed. But finding the confidence to realise you might need some extra help is not being a failure, and understanding what demand feeding actually is, loving responsiveness to your baby not some awful gruelling ordeal where he is fighting for milk and you are battling to satisfy him.

I was in exactly your position, down to the tongue tie and everything, and I wish I could tell my younger self that however you feed your baby is just that: you are feeding your baby! I was so sad that the breastfeeding didn't really work out but I tried and that's all you can do. I would love to go back, embrace the bottle feeding and not waste precious baby time worrying about how they fed. They're teenagers now and how they got their milk for the first few months REALLY doesn't feature in my thoughts at all, but remembering cuddling them, reading to them etc does.