So confused... how does this breastfeeding thing work? Which breast first, when to swap etc?

[BarrelOfMonkeys]

I'm getting so much conflicting advice on how I'm supposed to be breastfeeding. Can anyone let me know definitively what I am supposed to do?

• Which breast do I start with, the one I finished on last time, or the opposite breast?

• I've been told to offer the same breast twice, and only switch breasts if baby has been on the same breast for an hour, is this right? Or am I supposed to offer both breasts always?

• I've also been told baby isn't getting enough hindmilk - so how do I get more into her?

I'm so confused about what I'm supposed to be doing and I'm sure my midwife has told me different things on different days... anyone have any answers??

I recently phoned Laleche league who said there is conflicting evidence for the hind/fore milk debate as in it's all just milk.
What works for me is letting my ds (baby number 4) feed for at least 20 minutes before swapping. I think the more they feed from a breast the more it replenishes and so swapping too often may inhibit supply (I've no evidence, just an idea). My ds is a efficient feeder and can 'empty' a breast in that time. If you're eating, resting and drinking plenty of water and your dd is putting on weight then you're probably doing fine. I think more important than time is whether your baby is latched on well, mouth wide, close to you you know all the rules!

Barrel - sorry you're confused.

In the early days and weeks it makes sense to start with alternate breasts.

When your baby takes what seems to be a natural break after the first breast (rather than coming off accidentally) you can wait until he perks up a bit (he may doze slightly) and then offer the second one. Time by the clock has very little to do with this - being responsive to the baby is the key and you will get better at this.

How on earth does anyone know your baby isn't getting 'enough hindmilk' - on what basis???
Post again with more details.

Hope this helps.

Divine - sorry, you're not quite right about swapping inhibiting supply. Frequent swapping - deliberately frequently swapping , backwards and forwards several times - is sometimes done to increase supply. I think what you mean is deliberately taking a baby off too soon in order to swap and only doing it once - is that what you mean? This will indeed tend to reduce supply. Some babies will want to swap before 20 mins, some later than this - you've found what works for your baby, and thats good

Eating, resting, drinking water are fine things to do but they do not have any direct impact on breastmilk or breastfeeding.

There's no conflicting evidence about hind/foremilk, really - conflicting 'knowledge' in that some people have it right and some have it wrong yes. The breasts do just make the same milk, it's true. The level of fat in the milk changes according to the volume of milk in the breasts at any time - www.kellymom.com describes how this works.

Thanks both. So, muddling through as I am is not end of the world, phew!

The hindmilk was raised as her pooey nappies are pretty much liquid with little texture. Right colour I think though, sort of orangey like curry. She's 9 days old. She dozes after about half an hour and then I wind or change her to perk her up, and that tends to repeat a couple of times before she's full - hour and a half per feed at mo. (I'm using shields as she refuses the breast otherwise, although can sometimes sneak her on without midway through.)

What is her weight, Barrel?

She was 8lb 11oz at birth, she refused to feed for first day but got her to the breast on day 2. Day 3 she stopped taking breast so days 4-5 were on expressing every 3 hours and feeding every 2. We tried all the skin to skin, feeding in bath, you name it.She's been on shields since day 6. She was weighed on day 7 and had lost 230g I think, midwife said that was fine though. Due another weigh tomorrow...

I should add that although she took breast on day 2 we had real latch probs throughout so was kept in for observation at hospital, she was doing okay for about a day and then gave up.

Tiktok, I am delighted to be corrected. It's only my theory and in my foggy days of sleepless nights I have forgotten about the up to six week mark where sometimes I did just that...swap frequently!

I don't know why they said that about the nappies - a newborns nappies are always just liquid - thats why you need lots of babygros

Are you in touch with your local NCT - they will have breastfeeding supporter people I think.

Just be confident - your body knows what to do and your baby will get it and you are doing great!

Yes, I'd agree - no worries about the weight. Tomorrow you'd be looking for a weight gain (not beyond birth weight but a sign weight is no longer being lost).

Concerns about milk intake are sometimes expressed as 'not getting enough hindmilk' and it's really not the way to say it as we can't measure intake of hindmilk and some babies do very well indeed with nappies that show they are not getting a lot of fat in their feeds at any one time...hard to tell with yours as this colour and texture can be normal. However the history you give shows a baby who has had some setbacks to bf, and the best way to deal with that is just to get her feeding well...not worrying about the constituents of her feeds. If she's feeding well, fore/hindmilk sort themselves out.

Hour and a half per feed is within normal for a new baby. You'll get a better picture of how she's doing when she's weighed, I think, but it all sounds so far as if things are turning out ok.

Brilliant, thanks for the reassurance! I shall keep on doing what I'm doing then and try not to obsess too much!

Btw Lurker, I've spoken to the NCT people a bit, they seen to be quite elusive on the phone round here but hoping to get to a bf clinic on Monday, fingers crossed I can time it between feeds!

Thanks all for the support.

re going out - you can try to time it between feeds but imo (3 breast fed babies) they always want feeding when you're out so just have a think beforehand where you would be comfortable doing so and you won't have to panic if they do.

The going out thing is more that she feeds for 2 hours a go... However midwife has been round and weighed her today and she's still losing weight despite spending 12 of the last 24 hours at the breast.

So, now I'm told to give her the breast for 30 mins only and express 80ml of milk to feed her from a bottle to see if she takes it. If I can't express that much then I have to get formula to top her up. .

BoM - might be worth seeing if there is a Baby Cafe as well near you in case you can't make it to the bfing clinic - they offer a similar service there.
I would tend to resist in putting a time limit on feeds, babies vary enormously. My ds was a very fast feeder, but still could vary in length from 5mins to 20mins. People I know have had babies that fed for upto an hour at a time.
Her nappies seem fine, bfed babies tend to have a mustardy, liquid nappy.
Trouble is there is so much conflicting ideas out there.

Barrel, you don't HAVE to do anything. You need to think it through (hard with a new baby I know) and decide if you agree with the advice. It has to be your decision.

Did the midwife give you more information than what you've written here? Was there a reason why she suggests using a bottle, rather than trying to cup feed EBM or formula?

I'd also question why you need to limit access to the breast, surely if you are feeling ok with frequent feeds then it would be best to ADD the expressed milk or (if needed) the formula to as many breastfeeds as possible to increase the amount of milk your DD is taking, rather than to REPLACE milk from the breast with milk from a cup or bottle.

Do you need to make a decision this evening, or are you able to wait and see what is said at the bf clinic tomorrow?

We've struggled throughout with feeding, she refused the breast for the first 3 days pretty much, so ended up feeding her EBM via syringe for a few days after she'd gone 12 hours with no food accepted - she won't take a cup, we tried. (And we tried all the feeding in the bath, sleeping skin to skin, endless different positions etc even before we got to that point). The syringe made her gums red raw though, we were about to try the bottle when the nipple shields were suggested which had appeared to be the answer. The frequent feeds are exhausting - last night she went on at 8pm and stayed there bar half an hour and two nappy changes til 2am. Then up again feeding from 6am to 8am, 10.30am to 1pm... Midwife theory is she's comfort sucking rather than feeding.

At the moment I am up for trying anything and everything! I keep telling myself to give it a few more days but not sure how many 'few more days' we can carry on especially if she keeps losing the weight. But hanging in there for today and tomorrow at least.

Barrel, you need proper help, I think.

What was the exact weight? How old is she now? Was the baby weighed naked on digital scales?

If you are confident in the weight recorded, then I do agree something needs fixing...the midwife might have put a time limit on feeds, reasonably enough, as she doesnt want a baby who is losing weight to expend too much energy getting not enough milk. Her suggestion to express and give 80 mls may well be based on a sensible calculation, and giving 80 mls in a cup is hard work.

But I do think you are justified in getting more input.

She was weighed on digital scales Day 6 and was 3700g - DH thinks this weighing was done with nappy and vest on, and midwife estimated a weight for this. Not sure what that estimate was. Today's weighing was on the same scales and she was 3580g, and she was weighed in nappy and vest. Midwife weighed the nappy and vest separately and they were 80g, so the 3580g weight reflects that adjustment. Even if DH is right and the estimate may have been wrong from Day 6, she's still losing weight.

Is the clinic the best place to go for proper help? The phoneline people I spoke to have all been a bit vague...

(Phoneline people vague in their advice, as opposed to vague on where best place to go for help is.)

She's 10 days old now, btw.

Ok - not really best practice to weigh the nappy and vest like this, but whatever....it does appear she is continuing to lose weight, and I don't actually disagree with the midwife's suggestions, though I hope she watched you feed too, and checked for tongue tie. You are offering both breasts each time, yes? And it would be worth trying breast compression (see archives).

Hang on in there - it is early days and you have already overcome quite a lot.

I also think it's proper for the phoneline people not to be able to offer you a different strategy - baby losing weight at 10 days and still under midwife care with a midwife who does seem to know what's what is not really their territory apart from offering you support and ecnouragement - but that's good to get too.

She's been checked for tongue tie and is apparently fine. The feeding position is okay, baby roots for the nipple but won't latch without the shields - except sometimes when I sneak them off mid-feed. Offering both breasts at each feed, she seems quite happy on both/either. Will look up breast compression, thanks.

Sorry, no disrespect meant to phoneline people, who have all been lovely but ultimately as they don't have the baby in front of them they (understandably) haven't been able to help much. But yes, very supportive.