i can't carry on like this...but i don't know what to do

[feb]

sorry this is long, pls bear with me...
DS2 born at 36wks and very sleepy and reluctant to feed. was syringe fed for 1st couple of days but couldn't get him interested in breastfeeding (wouldn't even open his mouth) so left hospital bottlefeeding. we had to wake him for feeds and force the teat into his mouth but he drank well once we switched to a slightly faster flow.
I kept expressing every 3 hrs and trying him at the breast and he gradually became more interested and started waking himself for feeds, until he finally latched on at 10 days old.
he is now 3 wks old and since day 10 i have been putting him to the breast when he looks hungry (he will generally spend 30-60 minutes at the breast but spends very little of this actually sucking) then i top him up with formula as he invariably keeps rooting (takes about 2oz normally). I'm then expressing to make sure my breasts are empty (they normally are).
If i express i normally only get 1oz off, and if ds is given a bottle without being offered the breast he takes 3-4oz so i know he is getting some BM, but i obviously don't have enough.
i really want to exclusively BF as this is all so time consuming but i have a very clingy 23mo so no option of staying in bed for a couple of days and feeding constantly to get my supply up.
something has to give as I'm exhausted and DS1 needs my attention too. I can't keep spending 1 1/2 hrs feeding, washing bottles, sterilising and expressing. i know it would be so much easier to just switch to fully FF, but i'll feel so guilty if i just give up...

Phone one of the helplines to get yourself some qualified help and support. National bf helpline: 0844 20 909 20.

just a few quick things:
if he is still rooting after a feed, offer breast again. your bosdy is constantly producing milk, your breasts are never empty, so as long as he is sucking he is getting milk

babies will nearly ALWAYS take a bottle. even after a really, really good big feed. they just do, it is no indication of how hungry he is, or how much milk you have.

expressing is also no indication of your milk supply. ds could be getting loads, and how much you can express afterwards doesn't mean that much, iyswim??

i think, that if you want to exc BF then this is what I would do:
ditch the bottles and demand feed.
you shouldn't need to top up- just keep offering breast if he asks for food

if you do feel that you need to keep giving the formula for a while then you could just gradually reduce the amount you are giving at each feed.
so, if it's 2oz then drop to 1.5, then in a few days drop to 1, and so on.

it is hard sometimes, but you need to regain confidence in yourself and the fact that you can and are producing food for your baby. the more you feed him the more you will make. the more formula you are giving the less he is stimulating yourt supply. it's a vicious circle really.

well done for getting this far though, I had a breast refuser first time round (interesting also only latched on at 10 days old) and it's soul destroying. but you';ve done well, and if you want to exc breastfeed then you can!
have you spoken to a BFC at all?

The more formula you give,the less breastmilk you will have.It's a vicious circle that is frighteningly easy to get into. You need proper help if you want to commit to exclusive breastfeeding.All breastfeeding organisations listed on thsi super blog (right hand side)

How breastfeeding works

sorry i should have said i saw a BFC last week and she suggested using a supplementer (to both give formula and stimulate breast at same time) which i tried but just can't get the hang of as it takes 2 hands to feed him (he loses latch otherwise) and you need 1 hand to work the suplementer. she said he was just lazy as used to the fast flow of bottle and my breasts just need stimulation. she seemed certain that once my supply is built up we'd be fine) she is now on holiday till jan 5th though...so i may try a helpline. thanks

My DD(s) were exactly the same - in order to increase supply i woke them to feed every 3 hrs and expressed every 3 hrs (1.5hrs after feed not straight after) and then used this to top up after the feed. I did this for 3 days (not at night, just BF) and my supply shot up.

Other tricks are to strip them off to wake them up to take a good feed and with DD1 i had to mop her brow with a cold flannel during her feed to keep her awake

Will post more if i can remember what else i did

feb, did she check him for tongue tie?

just wondering as you say he loses latch easily, which both my boys did too, and both were tongue tied whcih meant that they just couldn't stay latched on properly.

may also explain why he doesn't seem to feed effectively or takes a long time if he is struggling a bit to transfer milk

You can actually make a supplementer from a bottle of milk and a simple ng tube. They can be a bit fiddly, the easiest way is usually to poke the tube into the corner of baby's mouth after they're well attached.

video clip of inserting a lactation aid (scroll down til you find the right one)

What was the qualification of the counsellor? Labelling your baby as 'lazy' seems unhelpful...

Has anyone checked to see if he has a tongue tie? If he's slipping off very easily it's worth looking at.

If you're not using a supplementer then generally it's better to offer supplements once (or if necessary) twice a day rather than after every feed, as they can come to expect it.

i think if i didn't offer the bottle he would just stay latched on permanently!

Has anyone shown you how to do breast compressions? these can be really helpful for keeping babies feeding actively. At the breast does not always equate to actively feeding. Check out the videos on the link in my previous post for how to recognise active drinking. Swapping breasts back and ofrth when he stops feeding actively could be helpful too at times when he feels permanently attached.

wow thanks for all the replies.
sazzle - i have been expressing for the last 3 weeks, surely i should have more milk by now?

he has been checked by a number of people (including my BFC who is a lactation consultant) for tongue tie and all say he is fine

Grendle - my DD's were apparently 'reluctant' feeders - guess that is the polite way of saying 'lazy'

Feb - can you express from one side whilst feeding on the other as your let down will always be better with babe latched on?

Expressing doesn't tell you anything about how much milk you have. some women exclusively breastfeed babies for months without ever being able to express.

Breasts are never more than half to 2/3 empty, even when you can't express anything. You won't ever be able to guage how much your baby has taken directly from the breast. It could simply be that as your supply increases your baby takes more at each feed.

Sorry, this is probably O/T, but what do "reluctant" and "lazy" actually mean? And how do they help a mum improve things ?

thanks for the links grendle. i am doing breast compressions and the first couple prompt him to swallow and suck but after that they have no effect. i am switching breasts at least once duing a feed. normally at the point he gets fussy and starts pulling at the breast - just like the jiggling and pulling baby in the jack newman video.

grendle I think what the BFC is saying is that baby has got used to the faster/instant flow of the bottle, and so is "lazy" on the breast as a result of that.
not that the baby is actually being lazy on purpose.

the reason for saying it is to point out that bottles maybe aren't the answer. hence her suggestion of a supplemental feeder instead.

feb - i use an Avent Isis electric pump. i tried a manual and a medela and got very little. could you borrow a different one from the NCT/hospital/friend to see if this helps?

I was SO determined to BF with DD1 (and militant with DD2) that i HAD to make it work so i know where you are coming from. If you can just get through about the first 3-4 weeks when he would actually be full term i think you will find a big difference. DD1 (36 weeker) took this long and then was fine as she 'woke up' and got on with it. DD2 (39 weeks) only took about 2 weeks but lost over 10% of her weight before she picked up. It is difficult with a demanding toddler so do you have any help with her so you can focus on the feeding for a couple more weeks after which i'm sure he'll pick up?

Is there anyone you can rope in to help you with your toddler? It must be very hard for you and any help might take the pressure off just a little.

I do know where you're coming from, as I did breastfeeding, expressing and topping u with my first for several weeks, and that was exhausting even without a toddler. You sound like to are doing a great job in very difficult circumstances.

Are you spending time skin-to-skin with your baby, perhaps in the evening once your older child is asleep? Baths can be nice, or just on the sofa with the TV.

Thisisyesterday -I see the point you are making , but in that case the BFC should say what they mean. They should know to mind their langauge better than that. The words people use have a big impact... if your baby is 'lazy', what are you supposed to be able to change? If your baby has become used to the fater flow from a bottle... ah, well then that gives you something to work on.

Grendle - with mine the reluctance was just falling asleep at the boob resulting in weight loss, in part due to the jaundice i think. Unfortunately this then makes them tell you that you need to top up with formula. I refused to do this, but they can be very insistent & it's wrong . I know some people don't like advocating expressing but i can honestly say it is the only thing that enabled me to 100% BF so i think it is worth a shot. However, if this is not working then i agree that alternatives such as continual breast offering/baby moon are also worth trying. Unfortunately there is no one 'cure' which fits all. Sorry feb, not terribly helpful

sazzle, i am using the electric pump my BFC has lent me.
thanks for your support ladies. i know i need to persevere and just take the plunge in cutting down his formula.