Bottle feeding EBM and formula?

[georg1a]

Hi all,

Some background - After a complicated birth and bad start at breastfeeding my baby lost too much weight. MW insisted that I start bottle feeding expressed breast milk and topping up with formula as baby was dangerously dehydrated and lethargic. Very frightening times as we had to feed him set amounts every 3 hours or go to hospital and saw MW daily for weighing, very stressful. Now he is back at birth weight and feeding well - but from a bottle. On the breast he is unhappy which makes me unhappy, have had help from a breastfeeding consultant who got him to feed a bit with a nipple shield, but only for a few minutes at a time. and we are using Dr Brown bottles.

Now I have a few issues that I wonder if anyone can help with...

I feel huge pressure from successful breastfeeders and from myself to keep trying to get him on the breast, but it is stressful rather than bonding and upsets us both. I am thinking of stopping trying and just enjoy the bottle feeds as these are a lovely time to be together and as we look at each other and cuddle these times are bonding for us. Any advice?

Expressing is exhausting, and my milk supply is increasing more slowly than baby's appetite, so hes getting more formula, now about 60% BM and 40% aptimil, any advice?

Medela mini electric breast pump is driving me mad, using it about 7 times a day. Can anyone suggest a quieter one? or suggest how to increase milk supply realistically whilst also looking after 4 week old baby?

Would be great to hear experiences from others about going through similar stuff, expressing advice seems to assume it is occasional and alongside breastfeeding, I feel left out of breastfeeding and most bottle feeding advice seems to relate to formula....

thanks!

Georg1a - I expressed regularly from about 3 weeks and found the following tips useful (this is for a hand pump, BTW - quieter than an electric but a bit more faff!):

Try expressing during a feed, especially first thing in the morning or after a long period of time between feeds, when you may find you have a lot of milk built up. It is a bit tricky to get the hang of because it requires one hand for the baby and one hand for the pump, but once you've mastered it, expressing is quick and a lot less hassle.

• Pros: It's occasionally possible to get a full feed from one breast like this, and if you only need to give one expressed feed per day this gets it sorted straight off the bat. Because the baby is suckling the other nipple, the breast you're pumping from will probably be letting-down automatically. Flow is usually faster and it means you aren't wasting anything you would normally leak or spray.
• Cons: If your baby is VERY hungry, you run the risk of one breast not being enough for him - and if you've already drained the other one, you might need to top him up in half an hour or so once you've filled up a bit. It can sometimes be difficult to get the pump working properly if your breast is extremely full, but it's worth the effort.

To increase supply, I found feeding really needed to be as frequent as possible. I know it's a pain, but three hourly might not be doing it, especially if baby's not taking much. Letting him have those little amounts every hour, or as often as you can bear it, really can up your quantities. Alternatively, express both sides fully in between feeds (so if you're feeding him every 3 hours, express at the 1.5 hour mark). When it's his feed time, give him the breast first, then top up with whatever you got into the bottle before. Your body should get the message that he's doubled his intake and up the production accordingly.

General tips:

• To get the flow started, use rapid strokes, and then change to a more rhythmic pace once let-down has occurred (1-2 seconds per stroke).
• Once you've taken the bulk of the milk available, waiting for a minute or two and then trying again can give you a bit more, sometimes as much as an ounce.
• If you don't get any let-down after about 5 minutes of trying, wait for a while and try again later. You might be too tense for an effective flow, or there might not be enough milk left if it's immediately after a big feed.
• Don't try to force more than you can comfortably provide. If you keep pumping and you're getting no more than a drop at a time, it can get painful - not to mention frustrating!

FINALLY (sorry about the length of this), do not beat yourself up if the above doesn't work, or if you are really finding it too much pressure on you and little bub. If he's happy bottlefeeding, and you're happy bottlefeeding, then don't feel you have to sacrifice this in the name of meeting some ideal that other people are putting on you. ONLY persist if you want to.

Hope this helps. I'm not trying to teach you to suck eggs if you've already tried all this, just sharing what worked for me.

Hi,

If you're going to be expressing a lot then I would suggest you hire a hospital grade pump or buy one of the more 'heavy use' pumps. Also I would suggest you double pump (twice as fast and more than twice as much yield) and use an expressing bra which holds it in place for you so you can Mumsnet while you express hands free! I expressed exclusively until 6.5 months and then ds got some formula.

I had a lot of help establishing an expressing routine as he was 2 months prem and was being fed through an ng tube at first. I could only get him to latch on with a nipple shield and even then it was tricky. We were sent home but within a few days he was showing signs of dehydration and losing weight so I tried to express and found my supply had taken a dive . So I did the only thing I could think of - started exclusively expressing again and gave him his first bottle (he hadn't had any in special care because I'd refused).

From my experience I'd say you can do one of 3 things.

1. Persevere with the bfing, get even more help, and hopefully crack it - I had a friend that managed this (unfortunately it was because her baby had been admitted to SCBU with dehydration and they gave great bf help in there).

1. Get a better quality pump such as the Ameda Lactaline, Medela Pump in Style, Medela Symphony etc (hire, borrow or buy) and keep expressing 6-8 times a day, every 3 hours including once in the night. Your supply should definitely go up, you should have a happier baby and hopefully be able to get off formula completely if that's what you want. This is a difficult option but it depends how much you want to give breastmilk.

1. You could carry on for as long as you can doing what you're doing and accept that your baby might need more and more formula as your supply drops. The plus side of this is that giving formula will be easier (you don't have to spend half an hour producing each feed but can get it from the shop ) but you might regret not persevering with bf.

I suppose your decision depends on whether you have any other young children/other commitments, how much support you will have, how likely you think that you'll succeed in the long run at bfing, and how much importance you place on your child getting breastmilk. I don't think there's any right or wrong answer.

By the way, I learned about a 'fridge trick' a bit too late but it might be ok for you. The idea is, you rinse your pump parts in boiled water and stick it in a sterile container in the fridge (rather than washing completely). You get it out to use every time and stick it in the dishwasher at the end of the day. Another tip is to find a way to pump directly into the bottles if you can - this involves much less washing up.

I bought the Medela mini electric once when I went to visit family and forgot my pump . I found it terrible compared to my own pump. SO you are doing brilliantly to get this far with it.

Good luck!