How do I feed my newborn?

[DelphiSwimsLate]

I’m a first time mum to a two week old DD born by c section at 38 weeks. We were readmitted to hospital on day 3 as she lost 13% of her birthweight and were put on a triple feeding plan. It has been totally exhausting, since she was born I’ve gotten about two hours of broken sleep at night. Not sleeping during the day. I don’t know if this is normal or not.

She is a sleepy baby and does not wake up for feeds so I have to wake her every three hours whilst on the triple feeding plan. It takes ages to wake her up. I’m not confident yet with BFing so it takes a while to latch her and get going.

Her last weight check looked like she’d be back at birth weight by tomorrows weigh in. Then it’s over to me on how to feed her. I want to BF but terrified she won’t get enough milk and not sure I can keep up the triple feeding at night. I’m constantly worried about my supply and her eventually preferring the bottle and refusing breast. My mental health is poor following the birth and readmission and early BFing challenges, poor latch, milk not in, etc etc. She’s an IVF baby after several rounds and losses so I feel guilty that I’m not better at all of this.

My health visitor says I should stop expressing and use formula for top ups. The breastfeeding team at the hospital say I should just feed responsively and express when I can. I saw a lactation consultant who said I should only keep her at the breast for 10 mins each then get on with pumping 6 times per day to protect supply until she is a bit stronger. I just don’t know how to find the time for expressing, in between waking her for feeds, the feeds themselves, and I’m conscious that I should be spending skin on skin time with her rather than putting her back in the cot or handing her off to DH after a feed to get on the pump.

Sorry if this isn’t making sense I’m just so tired. I am just looking for how everyone else fees their baby. If you BF and express and supplement, how often do you do each of them? What do you do at night, do you have to wake your baby every three hours?

Firstly (and apologies for the clichés)... fed is best and happy mum, happy baby. Choose the best feeding option for you as well as your baby. No one can tell the difference between someone who was formula fed and someone who was bf.

If it helps, here's my experience with mixed feeding. I had similar when I had my first, although we didn't have to go to hospital. I was told to do 20 minutes on each breast, then give a bottle top up and then pump for the next bottle. I was so overwhelmed by that, that I didn't even try, so did the feed on each breast then topped up with formula, which worked well for us. Once she got back to birthweight I think we stopped with the bottle after every feed and just did what worked for us each day. DD happily took both and it meant I was able to continue breastfeeding until she was over 2.

I've got a newborn again now and we're doing the same - offer breast first then top up with formula if he needs it, occasionally skipping the breast feed if I need the break/need to feed quickly for some reason. He doesn't seem to prefer one over the other at the moment, but I am worried that will change.

The newborn stage is brutal, but you're doing great!

Oh that sounds so hard. You're a superwoman keeping going with the triple feeding. We had much the same when baby was born. I switched to formula top ups pretty quickly. One year on, baby is still breastfed, still has one bottle of formula a day, and is healthy and happy and thriving. Combi feeding can work great, especially when baby is too small and weak to get what they need at the breast in the first few weeks

Combie feeding sounds a good idea as at least you know how much they are taking of the top up. I was advised to do this with my prem baby.
Skin on skin time wasn't even a thing when my 4 were born so don't worry about that.

I would also say ditch the pumping at every feed, it's exhausting and you get the worst of both worlds, never actually getting a break from some sort of feeding.

I combine fed both of mine from day one, neither of them ever lost weight so didn't have your exact experience but as a pp mentioned they're doing with their second, we'd bf mostly during the day then ff at night or if I need a longer stretch between feeds to get an errand run or something.
I would pump occasionally if for some reason I was going to miss a couple of feeds just to keep supply up, but it was definitely the exception.

Neither had a preference and we just flitted between the 2 options until I stopped bf when when we introduced solids

It sounds like you are doing great. It's normal to feel like you are struggling, it's only been 2 weeks!

I remember the early worrying with my two. Both had severe jaundice and were too sleepy to eat properly so I spent a lot of time waking them up and recording feed times and expressing to retain supply then immediately use that milk to 'top up' the breast feeding do I could then record that. It was hell.

I would suggest that you try to cluster feeds to the point where you get a 4 hour period at night to try to get a chunk of sleep. Have a 4 hour gap once will make no difference to baby but a big difference to you.

My DH would take baby from 9pm to allow me to sleep. Feed as needed with pumped or formula then return to me at 1-2am and I would return to normal routine.

You’re doing amazing - it’s unbelievably hard work and exhausting.

Personally I’d do combi feeding with some formula feeds to give yourself a break - your partner could do a feed while you have a longer sleep.

if you’d prefer to bf only that’s totally fine too - hang in there, it’s not forever, just keep remembering this hard period is only for a short time x x

@DelphiSwimsLate I could have written this. My boy was born by c section at 38 weeks. At 7 days old the midwife sent us to hospital as he'd lost 13% of his body weight. He was a big boy and could afford to lose the weight, I wasn't overly worried but lots of pressure from the midwife. I was put on a plan for feeding every 2-3 hours, pumping then giving the pumped milk as a top up. It was exhausting, I did it for 24 hours then couldn't cope any more. Infant feeding team/midwife/HV all had different opinions so which one was right?! In the end I told them (with respect) to leave us alone and let me get on with it, I needed to trust my instincts on what he needed (it was my 2nd baby and I'd successfully BF before) I continued to express every day, but not after every feed as it wasn't sustainable. My husband gave the expressed milk to give me a break each evening. My boy soon regained his birth weight and then put on weight at a great rate. Once he was back to his brith weight, I didn't wake him to feed him, he naturally got into his own routine of wanting a feed every 3 hours. We both just needed to find our stride and be given a chance. It is very early days for you and you will get there. Yes people say 'fed is best' but breastfeeding really is best for you and baby and once you get over the first few weeks of awful tiredness, breastfeeding is so easy and convenient. I'm still breastfeeding now almost a year on, best thing I did. We travel a lot and it is so easy. Good luck. It's so difficult but I would say trust yourself, you know what your baby needs and with time you will get there

My daughter (also born by c section) lost 11% of her birth weight in the first few days and we were on a feeding plan, though not readmitted.

Posters above are right that babies can thrive on formula and you shouldn't feel guilty if that's where you end up. HOWEVER I do think there is a lot of silly panicking about dips in weight and a lack of support for breastfeeding. As soon as there is any issue, everyone just starts encouraging formula and this can produce guilt in the other direction -- that if you persevere with breastfeeding you are harming or starving your baby.

Milk often comes in later if you have a c section and if you have been on an IV drip your baby's birth weight can be artificially high because of water retention so the weight dip looks bigger.

If your baby is about back at birth weight at 2 weeks you have done brilliantly and it should be so much easier from there. My daughter reached her birth weight at 2 weeks and from then on she just fed on demand. Shes 3 months now, still exclusively breastfed and huge.

I found the first 6 weeks of breastfeeding almost hopelessly difficult. Panicky health visitors, constant weighing, a horrendously painful nipple fissure. But I just kept on feeding on demand and she was fine. Obviously, there are babies where there is necessary intervention but I think that problems are overreacted to and really over diagnosed which contributes to our incredibly low breastfeeding rates in the UK.

@KatMansfield6 100% agree. My boy was huge at birth, I think a lot of if was water retention. Even when he lost 13%, he was still 8lb 9 so a great weight for a week old baby born at 38 weeks! Once the midwife/HV/feeding team starting giving conflicting advice, I ignored them all and trusted myself.

You are doing so well and what feels so scary and overwhelming that you are spending every minute thinking about it, will soon feel much easier one way or another. If your baby is now back up to birth weight, you have done so well and I would now prioritise you own needs for a bit so baby can have a functioning mum who has had some sleep. My very personal advice - I‘m no expert, but did struggle with breastfeeding early on and went on to breastfeed both my boys 2+ years each - would be to ditch the pumping whatever you decide. Pumping is exhausting and you can provide enough milk for your baby without it. You could prioritise breastfeeding, resting in bed with baby, and lots of skin to skin. Remember that a cluster feeding baby seems to want to feed all the time and you might feel like you have no milk, but that doesn‘t mean they are starving or you aren‘t providing enough. Or your partner could do some (night) feeds with a bottle. Your baby might end up having a preference for the bottle - not a definite outcome at all…. Snuggles with mummy are so appealing!! But if that happens it‘s not the disaster it might feel like now. You have given your baby that breastfed goodness when it was most needed and after that, what works for you all is just great. My son had to use a nipple shield for 3 months and still ended up hating dummies / bottles etc though so bottle preference is not automatically going to happen. The babies have their own minds from day one!!

Thank you all so much for your replies and sharing your experiences. It’s funny how lonely you can feel as a new mum, even if you have lots of people around you. You’ve all made me feel so much better already.

I think combi feeding would be best. All I want is to mainly BF, but have the option to bottle feed at night or if I can’t provide boob for whatever reason. All without my milk suddenly drying up and BF being over forever!

It’s good to know others do the same and some of you don’t do the expressing either. I find the combination of breast and expressing so taxing. I guess another option would be to exclusively pump.

I think I wanted to BF because it’s got everything baby needs, but also because it is cheaper and convenient if we’re out and about! But I can certainly re think that, I need to get some sleep back, a four hour run would be absolute bliss right now. Probably the most upsetting aspect of all of this triple feeding and worrying about if she is getting enough, is that I think it’s affecting my bond with her. I just want to enjoy her, not worry when it comes to feeding time.

As @Nonametonight mentions I’m thinking topping up will be needed until she is strong enough to BF fully. She was so lethargic after birth, and only now is she more alert during feeds. A few people irl have said BF will improve once she gets stronger.

@KatMansfield6 you are so right about the pressure going the other way. It’s all so strange - before you start feeding, the impression put upon you by professionals is that breast is best. Then when it doesn’t work out as planned, they have to convince you formula is fine and bottle feeding is fine. Which of course it always was.

Thank you all again.

Have they investigated why she lost so much weight at birth?

Often it’s not because of milk production but because of the baby not being able to access your milk due to the restrictions caused by Tongue Tie.

Abd however you feed her, this article on feeding sleepy babies should help

Just because no one's mentioned yet, I recommend using a haakaa to catch letdown on the other breast while you're breastfeeding. Little one is just over 4 weeks and we got a manual Medela pump but I really don't enjoy pumping.

I'm using the haakaa and milk collection bags to store bits of breast milk over up to a few days so DH can then give him a decent bottle feed at night so I can get a stretch of sleep. I'm also trying to put him down when he's sleepier in the day to get a longer stretch in the morning or late afternoon/evening when I can.

I made the mistake early on of getting obsessed with only sleeping when the baby slept in the day and it was affecting my mood. It's also important to try and go outside or enjoy a short visit if you're up to it.

We tried giving one Kendamil bottle over two nights but I wasn't really a fan. The first night I did get a longer stretch but not more than when DH has given him a big feed of milk from the haakaa. He had an awful nappy the next day and was more refluxy and gassy. And the second night I didn't get any more sleep - I tried pumping while DH gave him the formula feed and hated it. I decided I'd rather just breastfeed my baby on demand and use the haakaa.

I've heard to keep supply up, have the number of nipple stimulations (from baby breastfeeding or pumping) equal the number of feeds baby has in a day, if that helps.

I've also heard of plenty of people who combi fed at the beginning and then built supply up over time (I think you can do this by pumping as well as letting baby breastfeed as much as they want) to later move to just breastfeeding. I was very stressed early on about not introducing any type of bottle or formula in case of nipple confusion or affecting my supply but I don't think it's as extreme as once you introduce it, there's no going back - it puts a lot of pressure on in the difficult first weeks.

Hope you're okay and whatever you choose you're doing great, feeding your baby is the most important thing

Thanks @BunnyRuddington I will check out the article.

She was checked by a paediatrician before we left the hospital after the readmission, but he did not check her for tongue tie until I asked him to. He said that she doesn’t have it, and if she did, she would not be able to feed at all. However I will ask for it to be checked again.

Now that my milk is in, I can see that she is drawing it out, there’s milk around her mouth when she comes off. But I still don’t think she is draining the breast, I think perhaps she isn’t strong enough just yet. That’s leading to engorgement which makes isn’t harder for her to latch. I am going to a breast feeding clinic today so will mention it. I’ve been doing the reverse pressure move to try and resolve it, and also pumping 😩

My daughter didn't have weight issues but did have to be stripped down to her nappy every feed every 3h day and night to feed for the first few weeks.

I'd see responsive feeding as the goal, however you decide to feed and would step down the intervention as you get confidence that she's alert enough and responsive enough to ask for the feeds she needs to grow and thrive.

My daughter was back at birth weight at 15 days. I stopped waking her at 3h during the day at this point but wouldn't let her go more than 4h for the next week. By which point she was feeding every 90 minutes so irrelevant!
I kept the 3h alarms overnight during this week and 4h alarms the week after. She was waking every 3h by this point quite reliably....it went to hell a few weeks later when silent reflux kicked in.

Keep in touch with your health visitor. I saw mine every 2 weeks even though it was during the pandemic because of my mental health, my daughters reflux and she developed feeding aversions due to reflux and allergies. It was reassuring having her to check her over and weigh her when she essentially stopped feeding during the day.

My HV arranged for me to have a baby massage course with one of their staff members. I ended up on a mother and baby unit and all the nursery staff were trained in baby massage as it's great for bonding and improving maternal mental health. It sounds like you have had a tricky start to motherhood and might be something to look into even if its just giving those gorgeous little feet a rub!

he did not check her for tongue tie until I asked him to. He said that she doesn’t have it, and if she did, she would not be able to feed at all

This is a load of bollocks. Babies can still feed with tongue ties, but they feed less efficiently/have to work harder at it (which is a vicious circle in babies who are low weight and don't have the energy to work harder at feeding, hence early diagnosis of tongue tie being important).

Please do get another check. A paediatrician once told me that my baby didn't have a tongue tie when, in fact, he had a significant tongue tie that needed to be divided (said paediatrician was sent for additional training, but professionals I've spoken to since have said that this is not an uncommon issue). Irritatingly, paediatricians don't seem to be particularly well clued up about infant feeding. If the breastfeeding clinic today isn't any use (although I'm almost certain they will be!), the best person to consult would be a specialist IBCLC midwife. If you ask your midwife, I'm sure she could refer you to the right person/team.

Thanks @ridl14 - I did get a Hakaa on the advice of the HV but I havent used it yet. TBH I just don’t see how it can work, I don’t ever feel the let down reflex and the non feeding breast never leaks or anything during feeds.

I will give it a go though, if it works it’ll make expressing so much easier.

I second getting baby checked properly for tongue tie. I was told by four hospital midwives and a health visitor that my second baby didn't have tongue tie.

I'd successfully breastfed my first baby with no issues whatsoever. On the first feed with baby number two it hurt and I ended up bleeding. I knew how it should feel and it wasn't like this.
I ended up taking my baby to see a cranial osteopath who straight away identified a posterior tongue tie. This was confirmed by an NHS breastfeeding specialist. We had the tongue tie snipped at home by a private midwife. The difference it made to our lives was overwhelming.

My understanding is that training on tongue tie is somewhat lacking. If you are able to, I absolutely would make an appointment see a specialist. Best of luck OP.

Gosh that sounds awful. Expressing and BFing is the worst. If you feel like your latch is good now I would just BF as much as you can, don’t limit her feeds. Carry on waking her up for feeds for now though.
If you feel like she’s still needing top ups then don’t feel bad for using formula, there’s no use you exhausting yourself expressing on top of everything else.

Very weird comments from the Paediatrician about TT but sadly I’m not surprised. Baby may be able to feed with a TT, afterall there various degrees of tie, it just affects how efficient they are at getting the milk.

My first had TT and I honestly couldn’t believe the difference with how DC2 fed.

I would recommend reading this article on TT and let us know if you think it could be affecting feeding

Thanks again for all the advice! Sorry for late reply, been a busy day.

She is now just over her birthweight following the weigh in yesterday which is a huge relief. I also asked the BF specialist there to check for tongue tie, she said she didn’t have it, and that she was latching well. I think I will still book an appt with a specialist though, it won’t do any harm and I think it’s important to deal with it early. Some of the things in the article @Bunnyshared do apply.

Shes still having top ups of breast milk, and I’m pumping when I can. I use the time pumping to catch up on chores which is weirdly good for my mental health as it’s something I can complete and see an end result, if that makes sense. I’m not going to fret about formula though, if I’ve run out of expressed milk.

I’ve got the community breast feeding lady coming tomorrow to check in on us and will ask her to show me some new positions like lying down and laid back to try and make the nights a bit easier/relaxing.

It’s been a crash course in BFing and feeding in general over the last two weeks. I don’t know how this got ahead of me so much, but I’m going to just do the best I can and enjoy my baby. A PP mentioned a baby massage course which could boost mental health, I will look into that. I won’t get this time back and just want to ensure that I do bond with my baby and not spend this time fretting and frazzled!