Will bf work out? Any help appreciated (long)

[berolina]

Hi everyone. As some of you know I had my first baby (a ds) last Weds . We were on the maternity ward until Monday and then he was transferred to the neonatal ward because of his jaundice (needed phototherapy), but we were allowed home today. I was and am determined to bf and put him on the breast from the beginning - latching on and sucking didn't seem a problem. My milk started coming in on the Sat. We started weighing him before and after feeding on that day - he wasn't getting much from me at all and the nurses said I needed to give him pre-formula to stop him losing weight (he weighed 2820g at birth). On the Sun I started expressing to try and get the milk flowing. Things were looking up, but after he was transferred because of the jaundice and was also losing some weight he began to get very sleepy when feeding and would also often refuse to latch on - he'd suck briefly, find no milk immediately forthcoming and scream . Often it would work, but he was taking an hour to get 30-45g out of me. Anyway, the doctors/midwives/nurses said he wasn't getting enough to help with the jaundice and the weight loss, so I've been (reluctantly) giving formula - I always put him on the breast first, and I've been expressing like mad, although it takes me an hour to get to 60-100ml and I then can't express after the next feeding because my breasts are too empty. In other words, he's getting a mixture of (very small amounts of) direct breast milk, EBM and formula, and seems to be doing OK on it, but I'm worried he might give up on the breast because if he refuses it, he gets the bottle (of course). I've started expressing briefly before putting him on the breast and sometimes that seems to work, because he doesn't have to make the effort to get the milk flowing, but it doesn't always. Other times he just goes on the breast with no fuss, other times he refuses it completely. There doesn't seem to be a pattern. This evening he refused the breast (with frustrated screaming and a brief perod asleep) for quite a while, but then suddenly went onto the one I hadn't expressed from! I think I don't yet have a huge amount of milk and that's not helping, and everyone at the hospital said it was medically necessary to feed him up a bit (it's not that they aren't supportive of bf either), but I'm absolutely paranoid now that he won't bf and I'll be stuck expressing for months (or even having to continue to mix EBM with formula). I can't help feeling a bit of a failure and worried/guilty about giving him any formula at all, although I know that the stress I have been and am under won't be helping my milk supply either. Any hints, ideas, similar experiences? TIA!

Berolina, I have bf 3 children, the first 2 for a year each and my supply was always slightly down in the evenings when I used a pump. You should have more in the mornings. Good luck!

berolina, the amounts ytou are expressing are fine!

i find that even after expressing i can hand express a little mroe... and plenty of people have told me that how much you express is not an indication of how much you are actually producing.

so it's really just a matter of weaning him back onto the boob.
I find with ds that if he is VERY hungry he refuses the boob, but when tired or when he has had a bit of formula already he will take it.

B - thanks for the hugs - and the card!!! CAT on its way...
Well, just when I was despairing of ever getting him on the breast again, in his night feeds - and this morning - so 5 feeds in total - he went on every time - with no fuss - and drank . He still isn't getting much out of it (either too tired in this heat, or not much in there due to proximity of expressing, I suppose) so I'm still giving EBM and formula, but this is really a change for the better. He even went back on the breast one time after having had his bottle. He's more alert (spent the morning awake, contentedly and amazedly registering what was going on around him ) and has gained weight - is heading for his birth weight fast . MW has said I shouldn't try the nipple shields yet, only in an 'absolute emergency' - but I've got them here in case that emergency comes up. Am giving my boobs a break from expressing before the next feed to see if he then manages to get more out. Thank you all for your encouragement, but please stay around - I'm sure this is only the beginning of a long road, but it's a good beginning

Message withdrawn

wow that's fab news berolina!
would definitely start just offering breast exclusively. If he doesn't get enough, he'll just ask for more sooner... trust me, it's the best way to get your supply up (alythough i think you're probably ok anyway)

Update: I spoke a little too soon - have had a couple of 'refusals' this afternoon/evening. Especially the last one, though,it struck me that he was really not 'refusing', but rather desperate to feed but just not finding his way - he had his arms round my breast and was trying to get on the nipple, poor little mite, but it somehow didn't quite work . Maybe he's just not quite mature enough to do it when there's something else bothering him (e.g. the VERY hot weather today)? If that is the case, then I reckon I can hope for it to pass! The bottle doesn't seem to have put him off the breast either, which is good news too, I think.

berolina - has tongue-tie been ruled out?

I received this top tip for a good latch. Tickle the top lip with your nipple. When your baby's mouth opens really wide, roll your nipple back towards you then roll the bottom of the areola into the baby's mouth first, followed by the nipple which should run along the roof of your baby's mouth. It's the rolling of the nipple along the roof which stimulates a good strong sucking reflex (apparently).

Good luck!

PS My DS would fuss like mad at night - refuse boob, latch on and suck, roll off, cry etc etc etc

Thanks highlander! Will try it.
Your ds sounds like he behaved a lot like mine - mine has tended to be quite good at nights though, worse (both in terms of amount taken and 'refusals'/frustration) in the day. (But not always though, just to make it a bit more complicated!)
general bit/plea for help for everyone: I am so stressing about giving formula - I worry that it'll cancel out the benefits of the bm he is getting. I have asthma so am worried about that; I'm paranoid he'll get infections (I read a statistic on another thread about deaths from respiratory infections in bottle-fed babies that really shocked me). I was worried about all sorts of things during my pregnancy but NEVER about bf. I just sort of assumed it would 'happen naturally'. Now, as well as being pretty taken aback that it hasn't, I'm a nervous wreck about ds's health . I don't 'regret' my decision to allow formula, because I was told it was medically necessary for ds in his condition to be supplemented and my very very pro-bf dh agreed, and I think my milk supply has been slow to come in/get going (no wonder with the stress I had in the hospital, in a cramped room with a second-time mother who knew everything better ). I also don't think ds's problems are due to any kind of nipple/teat confusion, because he has shown he can use both, is still looking for the breast at feeds, and often drinks just as slowly from the bottle as from the breast. Anyway, ds is healthy and home with us, which is great, but now I'm tormenting myself with all the stuff I read about breast vs bottle. I don't really feel a 'failure', just horribly guilty and worried. At its extreme, I worry that we will lose ds to an infection caught through use of formula or by a mistake in bottle sterilisation Can anyone offer any helpful thoughts/comfort?

Berolina, I had very similar troubles. In my case it turned out to be the shape and size of my breasts. It clicked when I was at a bf clinic and the mw was giving me the "nose to nipple" advice and I had to ask what if my nipple sort of stuck out to the side. Then I sort of pinched it to face forwards and dd latched on really well. After a couple of days I didn't have to pinch it anymore. good luck

Message withdrawn

Thank you Pruni and tomkitty. Yes, this new baby thing is overwhelming - so much resonsibility and not only the baby is vulnerable, you, as parents, are per se too - the worry!!!
Have to report what just happened. Settled down to try bfing - ds (who'd just woken up and started to cry a bit) was difficult to latch on for a few minutes but then suddenly went on and drank away. No problems at the other breast either. I could hear/see he was getting milk. Then he came off once and couldn't get on again, but not for want of trying - he was actually quite frantic, clutching at the breast with his hands and arms, trying to get on but then moving away again and so thwarting all of my efforts to get him on - it seemed like he was too frantic to bf properly. It was like his usual frustrated behaviour but so much more intense. As there was no calming him and no getting him on to the breas we finished the feed with a bottle, which I hated doing more than usual, but at the same time tonight is proof that the bottles haven't made him lose interest in the breast! I think what I saw tonight might be the key - how to get him to approach bf (more) calmly! and deal with it if for some reason he can't get a hold immediately. Any advice???

berolina, please don't stress about giving formula.
there are so, so many formula fed babies out there who are perfectly healthy and have no respiratory infections etc etc....
your DS is benefitting from all the breastmilk he has had, and is still getting, the formula won't cancel that out.

Berolina, can you pick him up, sing gently to him, then try again, he might latch on well again? DS used to get very frustrated when he couldn't latch on in the early days - I would try and try and try again until it was approaching right, then curl my toes because it hurt!

As he grew, his mouth got bigger and we both got better at breastfeeding - I definitely think that feeding a baby whose mouth has grown just that little bit makes a huge difference to their latch - and you've seen he can do it, so he will do it again, I promise you.

hm, I had a go at calming him - also got dh to pick him up as I thought getting him out of the frustrating situation might make him calm down - didn't work. maybe I need to try for a bit longer - but it's so hard to bear the screams of your hungry 10-day-old baby .
The mouth thing is exactly what my MW said. ds is on the small side generally and maybe it's just too exhausting for him to sustain feeding position for long.

Definitely difficult - not suggesting that you should leave him to cry with hunger!

What position do you feed him in? Do you use a nursing pillow?

I'm sure that as he grows and gets stronger, he'll feed better - you're doing a brilliant job and it is hard in the early days, I nearly fell apart big time before feeding all suddenly clicked, which I'm sure was to do with him getting that bit bigger (wish I'd had MN then!) xxxxxxxxxx

my dh was great- he used to sit in front of me each time i fed to help me get the angle to latch on- i could never quite see and go t frustrated... that was agreat help, he did that for the first couple of days at least until i was happy- but ds did cry on breast often.. i used to calm him to near sleep then get him to latch on then...keep trying... BUT DONT FEEL GUILTY if you use formula and find it difficult.. i am totally pro bf BUT hate it if women are made to feel guilty ( even inadverdently) if it doesnt happen 'naturally ( what does!!!) good luck xxxxx

berolina....hope things go better today. Read my post of a couple of days ago - all the suggestions in it still stand.

Update from the bf front while ds angelically sleeps...
Last night he was repeatedly hungry and didn't settle. At 4am I picked him up and gave him a little massage first as I wasn't convinced he could be hungry again, but it didn't settle him, so I sat myself on the edge of the bed, just holding him, offered him the breast - and BINGO! he sucked away, could hear him getting lots of milk, and went on the other breast with equal enthusiasm - I couldn't believe it . he then came off but stll wanted more but wouldn't go back on, so he got EBM. Today, however, was less successful - this lunchtime, for example, he did go on both breasts and sucked away but came off the first when we tried to shift his position to support him better and the second when a fly made us jump - cry, wail, EBM. Oh well, at least he went on at all...
Spoke to a LLL counsellor this morning (thank you B ) who has advised me to express more regularly. Now I express maybe 5-6 times a day but am usually on the pump for up to an hour to make sure I have as much as possible for ds's next feed. I can see how doing it more frequently could help but don't want to have to throw away the EBM as I want him to have as much of it/as little formula as possible. Can I collect it in one bottle in the fridge, i.e. every time I've expressed some, open the bottle and add it, or is that not recommended re. hygiene? I'm completely paranoid about hygiene, about contaminating my EBM or the formula somehow and making ds seriously ill - this makes the whole expressing/formula malarkey a bit harder still for me. How easy is it to make that kind of mistake? (Must add that dh (doctoral student, hence at home ) is the bottle and sterilisation master in our house and I trust him implicitly, but there are so many points at wich something could get in - aren't there?) I'm not really aiming at building up a huge supply of EBM, not least because we haven't got a freezer, but just enough for a cople of feeds in advance would be ideal. (Not sure how we're going to manage going out/travelling etc. if the expressing becomes a permanent fixture).
I'm also making sure I'm there to give ds skin-to-skin when he starts waking, so he basically wakes up at the breast and I can respond when he starts rooting. It does sometimes make him drop off again though, at which point a nappy change or similar activitx becomes necessary
hm, I usually have him in a kind of 'cradle' position, which works fine when it works. I also have a nursing pillow, but it can be rather floppy if it isn't plumped up just right and ds can sort of slip between it and me - which doesn't disturb him as such but makes it difficult to latch on.
Thank you all for your suggestions. Keep the thoughts/advice coming!

well done don't know about adding to breastmilk .. you could try looking for advice online, THE NCT site \link{http://www.nct.org.uk} is good and \link{www.babycentre.co.uk} is good too

keep going x

I think you can add to the same pot for 12 if not 24 hours. Well done with your persistence and it sounds as if things are getting more together. It can feel really awkward to get the position comfortable with a newborn any way let alone one who has a variable interest in feeding. I had pillows on standby in both the bedroom and the chair I decide to feed ds in during the day, with other stuff such as muslins and drink on hand

berolina - sounds like things are going well but they may go up and down in the next few weeks. I found week 3 really hard but once I got over that it seemed like the top of the mountain. Sounds like you are doing better than I did though (there was no Mumsnet then so I didn't have all this good advice).

Do not worry about hygiene. If you are steralising then everything will be fine. I used to use breastshells kept in a sterile solution, quickly rinsed and then popped onto the other breast while I fed. I used to leak quite a bit and sometimes got 1/2 oz of precious b/milk from the other breast. I added these into a bottle which I kept in the fridge and mixed them together. Breastmilk contains all sorts of good antibacterial properties and doesn't 'go off' the way formula does so no worries there. As for the formula itself - its basically just the sensible precautions such as don't reheat the milk etc which I am sure you are taking. I found I was using so little formula that I bought those ready made small cartons (about 8oz I think). They are a bit more expensive obviously but worth it for the small quantities. I would just pour in maybe a couple of ounces and leave the rest in the fridge and it would last a day or two. I think also using the small quantities gave me an incentive not to overfeed ds with formula too.

Also no worries about the research reports. They are based on long-term use of formula. A little bit won't hurt your baby and the formula doesn't negate the effects of breast milk. It doesn't work like that. The breast milk you are giving him is doing him good so don't worry

Keep us posted on developments.