Please help - back at work, lost breastfeeding and lost perspective

[LifeofByron]

Please can someone give me some advice as I've totally lost perspective here. I'm sorry that this post is long but I want to give you all the facts and I really want your advice.

Ok, the facts are: DD is 28.5 weeks old and I've just returned to full time work. I've been mixed feeding her for the last few months and she is well established on solids.

Even since she was quite small, I've been doing a lot of her breastmilk feeds as EBM. There are a few reasons behind this, including lack of confidence about breastfeeding on my part. I made mistakes in the first 6 weeks or so by allowing formula top ups (she was tiny, HV and others made me worry as she lost 15% of birth weight, I was scared of starving her). Looking back, I introduced bottles too early and it has compromised her interest in feeding from the breast directly. As a result, I have been pumping 4 or 5 times a day pretty much since she was around 6 weeks old.

Anyway, we muddled through and DD was having breastfeeds first thing in the morning and last thing in the evening with EBM and a bit of formula in between.

Without thinking too much about it, I put DD on faster flow teats once she was around 25 weeks old. Within one or two feeds she started rejecting the breast, despite having been happy to take teat or nipple until then. I persevered for a few days but she would be screaming with frustration and we would both become tense and flustered- so I ended up just giving up these morning and evening breastfeeds and doing by bottle instead. I kept regularly pumping and was producing around 15-18 ounces a day.

Last week, knowing I was going back to work this week, I dropped to pumping once a day. I'm doing this at around 10pm, after dinner. I had decided that I was going to keep up this "daily pump" for as long as possible but within a couple of days I find that I've started producing only 1 ounce at this pump. Maybe I'll just dry up totally soon.

So now I'm back at work full time and DD is in childcare for 11 hours a day (I work long hours). She's getting all of her care and attention from someone else. All she's getting from me is a measly 1 ounce of breastmilk a day. I wake her in the morning, give her a bottle, go to work, come home and give her a bottle before she goes to bed. It feels awful. I want to do more for her. I feel it was a mistake to give up on our morning and evening breastfeeds as at least it would give us some special time each day.

My questions are (and thanks for making it this far if you have ): with the breast rejection issue, is it too late to try and get back to at least one breastfeed a day? How could I do this without stressing DD out? Would it be worth trying to reintroduce breastfeeding for DD's sake or is there no difference to her in just having EBM instead? Is it realistic to think I could get my supply up again enough to do one feed a day without pumping during work hours (it's just not possible because of my job)? Most importantly of all, am I just being self-indulgent wanting to hold on to breastfeeding as special time with my daughter and should I just get over it and be glad that she's happy with things as they currently are? With the last question, I don't feel that way at all but I'm sure that a lot of people (e.g. my mother and probably DH) would tell me to just deal with the fact that DD has moved on and I need to as well.

I just feel really lost at the moment. Please help.

haven't got a lot of advice on your breast feeding questions as not great experiences myself but just felt so sad for you seeing so little of your dd, even if you love your job that is quite a hard a week . I did hte same with dd2 the early mixed feeding and then had breast rejection at about 5 montsh as a fast flowing teat was so much quicker and i perservered even when she was screaming blue murder about the breast feeding and amazingly after about 2 months she suddenly went back to enjoying eve and morn feeds and we managed to carry on until she was 2

Oh you poor love - I'm sorry I don't have time to answer much but wanted to send you a most un-Mumsnet hug type thing. It's hard to go back when your DD still seems quite small.

I can't help much because at this stage we had the opposite problem - at 6 months, DD was a bottle-refusnik so was going all day at nursery without milk and just BFing a lot when I got home in the evenings. She lost weight. It was horrid. So I beat myself up at the time - why hadn't I introduced bottles earlier? I was a terrible mother etc etc etc.

So how can I help? I can reassure you that the EBM you give her is not all she's getting from you. She gets love and attention, she's not judging you for that and neither should you.

More later when I get time (working at mo, also trying to sort out our house move!)

But please please stop beating yourself up. Hope someone comes along with more practical tips soon.

Oh LoB - it must be so hard for you
I too am back at work and having issues with supply and can understand your upset.
Am sure someone with proper knowledge will be on soon but you could try:
Oats in your diet - is supposed to increase supply so get out the muesli and flapjacks! Also you can take Fenugreek capsules, 2 caps, 3 x a day.
However, demand is the best increaser of supply and I don't think you have left it too late, no. Pumping more often is definitely important, try and do as often as possible, even if you only get a bit you can put all the bits together for a good feed.
For direct bfing, try when dd is relaxed and not really hungry - in the bath is good. Lots of skin to skin and let her feed more in the evenings.
Does she have nipple confusion now she is taking more bottles? I ended up using nipple shields as dc found it easier to latch on. Not ideal at all as they sometimes affect supply but better than no bfing.
Hope there are some ideas here that work for you

First off it really comes across in your post how much you love and care for your daughter.

I don't think at this stage it seems too late to re-start breastfeeding if that is what you want to do. You could certainly try to pump more often to get your milk supply back up. Also spending some time with your daughter skin to skin and seeing if she tries to feed without the stress of worrying that she HAS to have that feed too.

It seems quite important to you that she is still receiving some breastmilk, so firstly you could try pumping more often so your milk supply goes up and try putting her to the breast as often as you can to see if she is still interested in suckling.

I may just be waffling here sorry, I am sure someone else will be along soon with some better advice.

Please don't beat yourself up, so sound like a lovely caring mother

you sound, not so sound

Also can you try and pump at work? If you speak with your employer, would they be able to supply a room for you to pump in/a fridge to keep it in?

Sorry just reread and you said you can't pump at work

I agree with sherby. Another thing you could try would be to get slow flow newborn type teats for her bottles.

Sorry you have had such rubbish advice You sound like a very caring mum and you have certainly gone to a lot of trouble to give her breast milk.

oh Byron. The thing I read in your post is that you have just gone back to work this week - you are on your second day / third day leaving your baby.

Of course you feel awful. It is a huge adjustment and one that you cannot conceive of. When you last worked you had a bump now you are a mummy and however much your job means to you it has changed

So---- not to underestimate your question but be gentle on yourself and give yourself time. Can you ease into work a little? If not, don't worry. You give your baby many many things. Whether the bf comes back or not, the bottle in the morning and bottle in the evening are times of precious loving contact between you. Of course when you give her the bottle you cuddle her. Can you cuddle on the bed, with lights off, snuggling and having special chats and whispers together? That will mean so much. Having a bath with her is a good idea for more cuddling and snuggling time - regardless of the feeding

I don't mean that I don't really sympathise with your desire to bf and get it going again, but I just want to reassure you that that is not the only way you can show love and special care to your baby

Good luck and take it easy on yourself

thanks everyone so much for taking the time to read this and for your posts. I really appreciate this as I'm tying myself up in knots at the moment and don't really have anyone to talk to about this.

mummydoc - it's very inspiring to hear that you got through the breast rejection phase. I'm seriously impressed that you made it through that and were able to BF for so long. it genuinely is inspiring.

Jackstini's idea about offering the breast when DD is relaxed and not hungry is a fantastic one. I like the idea of trying in the bath as hopefully we will both be relaxed at that point. I can probably try that this evening. The other practical suggestions are really good. I eat loads of oats (I only recently found out that they are good for supply- I just love them anyway!). I haven't tried fenugreek though. Worth a shot.

And I do agree with sherby about pumping more. I know I can pump in the mornings and evenings, it's just during the day that is virtually impossible because of the demands of this job.

Thanks ProvincialLady about the slow flow teats- I hadn't thought of this but could just go back to what we'd been using before. Why not try it.

TheOldestCat - sometimes an un-Mumsnet hug is just the ticket. thank you for that. your situation sounds like it was very challenging. you must have been so anxious. going back to work is not easy, even without feeding issues.

daisy99divine - thank you. your post is very reassuring. I do try to make the two bottles very loving. I cuddle DD close and enjoy whispering to her and kissing the top of her little head. thank you for your reassurance about the other things outside BF that make up the mother-baby relationship

I've got some good tips to try here and I'm really grateful to have had your thoughts

Glad you feel a bit better - let us know how it goes

Oh you sound so upset in your post, I want to give you a non-MN hug too . The advice from oldestcat, jackstini and daisy99divine is spot on - you are everything to your daughter, I promise you.

But I totally understand how important continuing to feed can be to you - it was an enormous part of how I defined, and still do I suppose, my own mothering success. I was desperate to get to at least a year with ds2 and thankfully we've made it but I only went back at that point - so I have every sympathy for you having to go back earlier. It's not 'self indulgence' to want to continue, and it's not fair for people to just say 'just accept it'. I think I really do get how deep a need this can be.

Coming to terms with having to leave your baby is to some extent a little separate from the milk and supply issues, but not totally, and the not being able to pump at work is a big thing though tbh. Does your daughter still feed overnight, or are there any periods where she's relaxed enough to take the nipple (and some milk)? Just practically speaking you have to get in some more breast stimulation if you are to maintain and increase your supply - I'm not sure I see any way round that? There are various posts on here and I think kellymom about 'power pumping' and 'cluster pumping' to quickly increase supply but by definition they depend on being able to pump very frequently throughout the day - sometimes 6 or more times iirc. Do you think there's anything feasible in that that you can take and incorporate into your day?

thanks sparkle12mar08, I really appreciate your lovely post (and your non-MN hug) too. you are right re feeding inevitably being a defining part of mothering and whether or not you see it as a success. I know people debate this all the time but it's hard to avoid that feeling, for me anyway. I think deep down that going back to work is making me confront some of the regrets I have about how feeding worked out for us overall. I know that DD has had a lot of breastmilk but I feel regrets that breastfeeding (via the nipple) didn't work out all that well. When I was with DD 24/7 I was more reconciled to those issues because we were doing so many other things together (even nappy changes) but now I'm apart from her I feel... well, lost and really wanting that connection. DD doesn't feed overnight any more but she might take the nipple for her bedtime feed now she is having some solids at tea time so is less starving. She has a bath after tea so that's probably the time to try. I do have to pump more - I'm going to look on kellymom. During work hours- very difficult. But I need to have a think about what I can do

Oh, forgot to add LoB - I pump during work hours in the car - quite a lot! Needs must and all that laybys, service stations, car parks - you name it. Is that a possibility for you?

I won't give you any advice but wanted to tell you it will get better. I was in your shoes not so long ago - leaving DS for long days, barely seeing him, trying to preserve BFing. It such a very emotional time. You sound like such a loving mum, I am sure with the great support and advice you can get on MN you will feel better soon

What awesome commitment you have shown to your dd and i really mean that.

i am no expert but i have expressed a lot at work.

no, you are not being self indulgent. any closeness your dd has with her mum and any milk she receives when she nurses provides antibodies, reassurance, warmth and comfort which are all just as important as calories, proteins, water, carbs and fat.

can you start off by co-bathing in the evening with your dd to remind her what a lovely thing bfing is? then on the weekend, twice or three times a day? any latching and sucking she does is a step forward so don't feel upset if she pushes you away. just let her take her time to come back.

in addition you can help to relactate by doing 'cluster pumping'. I have written about it on mn before so will go have a look for you and copy and paste it here.

most importantly please call a breastfeeding helpline who can speak to you properly about relactation, going back to work, your emotions and where you may want to go from here. one to one support is excellent and a msg board cannot substitute for that.

this is what i wrote for someone who was considering expressing exclusively. Which i am always in awe that some women have been able to do.

------------
You need to pump at least 8 times a day at roughly 3 hr intervals around the clock.

Fenugreek and domperidone will only have limited effect. What makes you make more milk in the long run is the removal of milk. so setting up a routine is crucial.

No matter how great you are at expressing, your supply will slowly diminish and you will have days when you will have to 'cluster pump' or 'power pump' in order to rebuild your supply. So you will have to have a plan to accomplish that.

You do not need to wash the pump after every expression. I used to wash mine once in the night with hot soapy water. That is it. Between pumps I stored it in a Ziplock bag in the fridge.

If you use breast compressions near the end of the flow, you can get a bit more milk out of each breast. Also, if you go back and pump 10 mins later, you'll get another letdown.

It can be mentally difficult to sustain this routine and having someone to talk it over with in the dark times is helpful.

There is a little book called 'Exclusively Pumping'. I think, available from Expressyourselfmums.co.uk.
It was written by a mum who expressed for a year and it covers the physical and psychological aspects of exclusive expressing.

power pumping: pump every 2 hrs round the clock for 2 days will boost your supply as it is mimicing a natural growth spurt. Enlist friends/family to help look after your baby.

cluster pumping: pump for 5 - 10 mins every 45 mins for a few hrs every few days. (you only need to wash your pump every 4 - 6 hrs)

you may already figured this out but also, when your flow is slowing down, feel your breast for the pea-like structures which are actually milk sinuses. If you hold your breast in a C between your thumb and fore fingers where you can feel the milk, it helps to drain it better when the milk flow is slowing down.

LOB, its not quite the same but I thought I would tell you about my experience. DD wouldn't feed on Saturday, screamed when I put her near my breast. I think it was because she was coming down with a cold but she went about 6 hours not feeding and it terrified me. I called La Leche helpline and they recommended skin to skin contact so DD and I got a bath together and that was were she finally fed.

Good luck, I really hope you get this sorted x

I believe your employer has a duty to do a risk assessment on you as a breastfeeding mother and to provide facilities for you to express in. Have you told them that you need to do this?

You're right NL, I had a risk assessment and was told they had to provide facilities for expressing and a fridge for storing ebm.

sorry have been offline as rushed out of work early to go and see DD and put her to bed.

first of all, just wanted to say thanks so much for all the posts of support. I can't tell you how much it has lifted me today. I was sitting in what is an unabashedly corporate and macho environment feeling at an absolute low ebb of sadness. thank you MNers, you have been fabulous.

I need to have a good hard think about what I want to do. Thanks so much foxytocin for your input on relactating. I need to decide whether I have the stamina and the will to power pump. Tonight I feel so drained and down that I'm having trouble separating out all my feelings and anxieties about leaving my baby and feeding. I'm hoping some sleep will help me get my mind straight.

Northernlurker - you are right re the employer obligations. My problem is just the practicalities. I end up spending most of my days in meetings looking after clients who are a pretty unforgiving bunch. I don't work in a family-friendly environment, or anything like it. It's a pretty sad state of affairs, but it was a big deal for me to take 6 months maternity leave. Most of my colleagues have taken 3 months. Some less.... So I have to pretty much accept that pumping during work hours is out of the question.

I liked Jackstini's post about pumping in the car on the way to work. I've pumped on a few planes and in a couple of airport lounges but I walk to work - not sure how that would go!

anyway, I'm going to sleep on all of this. but thank you, thank you, thank you

ps. Foxytocin - who would I call for breastfeeding support? is there a helpline? you can tell I have not sought support before, when I probably should have....

Association of Breastfeeding Mothers

www.abm.me.uk
Helpline: 08444 122 949
Offers voluntary mother-to-mother support, counselling and information for breastfeeding women. Helpline open from 9.30am to 10.30pm.

National Breastfeeding Helpline

Helpline: 0300 100 0212
Funded by the Department of Health and staffed by trained volunteer mothers from the Breastfeeding Network and the Association of Breastfeeding Mothers. Lines are open 9.30am-9.30pm every day of the year.

NCT Breastfeeding helpline

Breastfeeding Line: 0300 330 0771
The National Childbirth Trust has trained breastfeeding counsellors who can offer individual advice and support.

La Leche League

www.laleche.org.uk
24hr Helpline: 0845 120 2918
Helpline offering advice and information on breastfeeding, plus local group meetings.

Breastfeeding Network

www.breastfeedingnetwork.org.uk
Helpline: 0300 100 0210
Offers free, confidential telephone information on breastfeeding and one-to-one local support.

I haven't had time to read all the responses above, so apols if this has already been said.

Whilst I am all for breastfeeding for as long as possible up to 6 months, and then for as long as mum and baby are happy after that, I now realise that bottle-feeding DD actually gives me more time with her.

I stopped BFing just before her first birthday, three months afer going back to work. Whilst those end of the day breastfeeds were a lovely way to spend time with my daughter, after being away from her all day, BFs with her did take such a long time. A bottle is much quicker... which means I get to spend more 'interactive' time with her before bed. Bfing is a very special thing, but I really enjoy being able to kiss DDs head and snuggle up to her when giving her a bottle.. in a way I wasn't able to when BFing.

I think what I'm trying to say, in a very rambling way, is that bottle feeding is not the end of the world and that there are some positives to take from it. If you can't work a way to get any more time with your LO at either end of the day, I suspect re-establishing direct Bfing will be difficult. If your LO is happy, then you should be too!

HTH

God, just read that back. Sorry for ordering you to be happy! This comes from the most neurotic mother going!

Are you a lawyer? That whole macho environment thing sounds so familiar to me...

sherby thanks very much for the info re phone lines

VeryHungryKatypillar- your post was great, thank you. this is one of the factors I want to take into account i.e. am I just setting myself up for more stress and anxiety if I try to re-establish direct BF and should I just enjoy the time I do spend with DD and relax more about it. I'm not sure what the answer is. I need to have a think about that. and oh dear, yes I might be a lawyer