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??

Thanks! I woke her to feed at 5.30 as she'd slept since 1 (last feed started at 11 and finished at 1ish), she wasn't that interested but managed 20 mins on the left breast. Then followed by expressing - could only get 40ml out of both breasts combined. So, may well be a milk supply issue, I'm thinking... although I got 40 ml easily when I was expressing previously (days 3-5 I think, losing track now), and it took me twice as long today, so maybe its a combination of my supply dropping plus the way baby is feeding... I don't know. Very tired and fed up but will see how it goes today and tomorrow... don't want to give up on it just yet...

Don't base your judgement of your supply on how much you can express. My expressing really varied alot from day to day. I think it can be stress related as well - as in when you're thinking "I have to express milk" you can't! You might find it easier to express in the bath or first thing in the morning when there has been a gap between feeds rather than straight after one. I would also recommend the breast expression as she is feeding and wake her to feed during the day as you are doing. It is tiring and you've been through so much already but you will get there in the end and it is really worth it.

oops - breast compression.

As bubbleymummy says, please don't base your milk supply on the amount you can express. I have been bfing dd for 8 months and express everyday (so dp can feed her, I can have a drink every now and then & for her porridge etc.) but the amount I get still varies widely. As time goes on I feed her from one breast for most of the night (she wakes for food a fair bit) and express from the other the next morning.

However, the absolute sure thing which means I will get hardly no milk no matter what I do is being stressed.

Good luck. If you can do it it's, imo, the most special thing in the world.

Good luck.

MM

You mentioned 'shields' - are you using nipple shields? They can help with latch, but they can also cause problems with supply, from what I know. (They don't always - but they can.)

Have you had any experts help you get the baby latched on without shields?

(If tiktok disagrees with anything I say - believe her. (OT: tiktok - I'm going to start training to be a supporter, with the BFN!))

I had about 3-4 days of trying to get her latched with various lactation consultants and midwives trying to get her to take the breast from birth pretty much, they kept me in an extra day in hospital due to probs - she picked it up for 24 hours from midnight day 2 to midnight day 3 and then she gave up again. We tried everything - skin to skin, bath feeding, positions, expressing a bit to get the nipple out, etc etc. We ended up feeding EBM via syringe which was also stressful as she kept lunging for it and hurting her gums so ended up with the shields as the only way she'd latch. I can get her to latch occasionally if I slip the shields off mid-feed, which I have been trying to a couple of times a day. Doesn't always work though.

I've just done another feed with half an hour on the breast followed by feeding her the 40ml EBM which she wolfed down and cried for more. Tried to express both breasts and managed a measly 10ml. Just sent DH out for formula so we can do a proper top-up at the next feed if she wants it. Poor hungry baby.

BOM - if she still seems hungry put her back on your breast! There will be milk there - honestly! She may fuss a little if she's just come from an easy flow from the bottle but you do need this stimulation to up your supply. Try compressing your breast as she is feeding to increase the flow of milk. Also remember that a lot of babies will guzzle a bottle even after a feed because it is so easy - not necessarily because they are hungry.

I've stuck her on the breast again to stop the crying but then we're back into the two-hour plus feed territory which I think is what midwife was suggesting we avoid as she tires herself out, hence the expressing after the feed to use at next feed as a top up. Can't win!

NQC - good to hear you are training ;)

Yes, this is correct about the shields.

bubbley - it's just not sensible to tell the OP not to do what her midwife has told her (30 mins bf plus EBM), sorry. You are not there, you haven't got the full picture, and for what its worth it sounds to me as if the midwife is basing her advice on a judgement about what the baby's energy levels can be 'asked' to do (see my post earlier).

In many cases, we can tell that an HCP is really a bit clueless - this isnt one of those cases. When it comes to a situation where it really seems as if bf is not going well, the baby is losing weight despite long hours on the breast, then limiting time on the breast can sometimes be justified. In addition, while expressing is not an indication of what the baby can get, in this case, the expressing might even do better than the baby.

Barrel - don't feel you can't ever get to full bf. A baby who is lacking energy to feed well may well be worse off just breastfeeding for ages and ages. When the weight and health is not a problem, she will gain the energy to bf better.

Tiktok - I understand what you are saying but the OP said she had sent her DH out for formula because the baby was crying for more after the ebm. It seems logical that in a situation where you don't have anything else to give you would at least offer the baby the breast again while you are waiting rather than let her scream - surely that would tire her out too?

bubbley - this is what the midwife said the OP should do, and the evidence was the midwife was making a sensible judgement. Your suggestion seemed to imply 'and don't give the formula' though and that's what worried me. If you didn;t mean that, sorry! Of course you are right that it would be fine to comfort the baby while waiting...though Barrel was not painting a pic of a baby screaming while the dh was at the supermarket, 'cos the formula was for the next feed.

I can see how my post could have been read that way so sorry if I caused any confusion BOM - I didn't mean to make a stressful situation any worse!

No probs bubbleymummy.

I took her off breast after half an hour anyway and she seemed calmer but still wanted the 10ml expressed. That was 9pm, then I had a sleep. Apparently she was hungry again at 9.45 so DH gave her a formula feed (I had agreed he could if she woke within the hour as a one-off) and she woke hungry again around 12.30. I was just expressing to keep to a three hour-ish routine for my breasts so timing-wise on track, and just swapped her on. She had around 30ml formula top-up after half an hour at the breast and I've kept what I expressed (40ml this time) for next feed's top-up. Last wet nappy smelled quite strongly of ammonia and fontanelles are slightly sunken - not dramatically so, just keeping an eye on it though - so formula top-ups (if she wants it) on top of the 1/2 hour feed + EBM top up seem best way to go for now, at least to keep her hydrated. Hopefully a temporary solution. We'll see what morning brings at the clinic. Thanks tiktok - really appreciate your input, and hope we can get to full bf at some point!

Ok, got to the clinic today which was useful, they've shown me how to tell if she's actually swallowing or just messing about on the breast. They have agreed she needs the formula top-ups, which was a bit disappointing as I was sort of hoping for a 'magic' answer. On the brighter side, she has started accepting the right breast without nipple shield so I'm working on getting her to accept the left breast too. My left wrist is now agony though, from changing the way I support her head in line with what the clinic suggested. May try a wrist support strap or something to help as it is agony! Cumulative effect of breastfeeding to date exacerbated by change of finger position I think. The other thing suggested was 24 hours in bed skin to skin, not sure that is achievable though, she's got to go to the GPs tomorrow and then there's other stuff like registering the birth etc that need to be done...

After another night with barely a gap between feeding cycle, I'm so exhausted - the whole 'feed her breast, feed her bottle, express, store, sterilise' routine is just draining, on top of everything else we've been through - I really believe in the health benefits of bf and have persevered thus far but its starting to get to the point of a trade off between the health benefits for her and my sanity. Both myself and DH are fraying round the edges to put it mildly. DH helping with the bottles etc but it's so draining. Will try and give it another day or two though.

Anyway - one more question - after the bottle top-ups she's tending to be a bit sick. I think this is probably normal but can anyone provide any reassurance? She's never been sick off the breast before - I'm guessing its the speed the milk comes out of the teat? Doesn't make a difference if it is breast milk or formula from the bottle, she's sick regardless. Not loads, but 3ml or so. Should we try and replace the milk? At the mo we're cleaning it up but not trying to feed her more.

Barrel - it all sounds exhausting.

3 ml coming back up???

Do you mean 30 ml?

Either way, babies do this, and it may be that she is overfeeding a tad and this is what she does to cope with it...could you call the clinic tomorrow and ask?

BoM, hang on in there, you are doing great.

Re the sicking, 3mils is less then a teaspoon (5mls).

And being a little sick is very very normal.

Might just mean babe is nice and full

don't replace it.

Oops xpost with Tiktok, well you know who to listen to

Thanks both. It is only a teaspoonful or so but I think we're just hyper-paranoid at the moment. 'Don't be sick baby, we're trying so hard to get it into you, you can't afford to lose it!!'

BoM, I can so imagine that

btw friend of mine had to do the whole bf, express, topup routine for her severely jaundiced baby. it was very very hard, but she ended up exclusively bf a beautifully chubby baby.

Thanks madmouse - good to know it can be done.

Ok, I think I'm going to become one of those mothers that starts with the best of intentions and then falls by the wayside... sorry.

We've been doing the feed breast 30 mins-express 20 mins -feed top-up EBM/formula for about 3 days now. Baby got weighed today and had put on about 250g which is great! But I'm exhausted and the whole routine takes about 2 hours start to finish. And then she wakes up again about an hour later and we start over. Midwife suggested that we coninue the regime but leave her on the breast for 40 mins now, and check her again in a week with a view to ultimately phasing the top-ups out. I can't carry on like this for another week.

Baby is taking 60ml of top-up which is still quite a lot for the breasts to catch up with, in my non-expert opinion. It's pretty much been alternating between 60ml of EBM and formula, as I am only getting 30-40ml expressed each time.

My reason for continuing would be obviously the health benefits to baby. My reason for not continuing is that feeding is something I dread and it's interfering with my relationship with my child.

I feel like an awful mother but when they weighed her this morning my first feeling was relief she wasn't losing any more, and then (whispers in shame) disappointment that she hadn't lost weight as that would have given me a get-out clause to move over to formula. I am a terrible mother to think that, but that's what I thought.

Yes, I have lost confidence in my body's ability to feed my child (although part of the problem is that she is an inefficient feeder) but I am also in danger of resenting my child as every time I look at her, all I see is a ticking clock counting down to the feeding ordeal.

She's got an infected finger at the moment, we had her to the GP yesterday and he suggested antibiotics or antiseptic cream. Antibiotics obv have side effects, one of which could be diarrheoa and with the feeding/weight situation I want to avoid that so we are using the cream. If it doesn't work by Friday we have to go back for the antibiotics. So I have decided to try and struggle through to Friday with the breast-express-top-up routine and hope her finger is better by then. If not and she goes on ABs then I will try and continue to BF until her course is finished to support her immune system a bit longer. But I think I have reached the end of the line as far as BF goes, sorry if this makes me a wuss. Everyone has been very supportive and I do feel like a failure etc but I will properly lose the plot in a few days at this rate, and that scares me.

(Stands back and braces for flaming...)

I've been reading your thread with interest as it struck a chord.
I had big problems breastfeeding DS. We had a rocky start (jaundice, it too ages for my milk to come in, he lost weight etc etc), topped him up for a bit, managed to bf exclusively for a while, ran into more problems at 10 weeks and switched to formula feeding.
Breastfeeding was making me miserable. I tried and tried, went to loads of clinics, phoned LLL but every feed would end up with me and DS in tears, and DP not far behind. It was without doubt the hardest decision I ever made to stop bfing as I was so committed and tried so hard but it just wasn't working for us and either we had to fix bfing, which I just couldn't do, or switch to formula.

I really hope no one flames you as you've tried your hardest. I really hope that Tiktok, or someone else, can help you through this so you can continue to bfeed. But if you don't, and it's completely your decision, then I don't think you've got anything to feel guilty about.

Yes BOM - look at the positives- she has put on weight - well done you! As starlight says - just take it one day at a time - one feed at a time and before you know it you'll be there! Upping her feeding time to 40 mins as the midwife suggests seems really positive and shows that she has faith in your abilities so you should too! You're doing such a great job - I hope you can find the strength to keep it up. xo