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!

Sounds as if things are getting better, berolina....skin to skin is for all the time though, not just when your baby is waking. Of course literally all the time is not gonna be possible but as much as you can is good!

Forget massaging to see if he is really hungry Just feed - take the opportunity to do it. Feeding is not for when babies are really hungry - esp not for you, when the more relaxed and happy feeds he gets, the better

Am really down this evening. Ds bf himself to sleep after his bath - however the sleep came far too quickly and was far too short - he woke up again, scream, cry, refuse breast, EBM. Started expressing again immediately and as soon as I was finished he was hungry again, refused breast and got himself worked up. Fed him the EBM and a little formula . Will get expressing again in a bit. Have just been on the 'bf v bottle studies' thread and am distraught about the information on SIDS risk and respiratory infections. Feel absolutely awful and am questioning everything that happened feeding-wise since the birth

Sorry Eulalia - just reread your post and your comment on the studies got a wan but relieved out of me. But I'm still pretty crushed. I know, I know, patience... Was never one of my strong points.

Sorry to bang on about skin to skin, berolina...but it really does help. Tonight, for instance, the sleep he fell into after his (happy) bf is not necesarily a sign he should be put elsewhere to sleep.....keeping him with you is often easier, and so when he stirs he doesn't scream to be near you, 'cos he's already there

It's the screaming that makes the feeding difficult because he has to calm down to take the breast efficiently, and he finds it hard to do this, once upset.

Berolina, just read what you posted re your nursing pillow - is it one of the beanbag ones?

I have one of those and it wasn't as good as even a regular pillow for supporting DS - got given a v-shaped pillow (not beanbag) when DS was a couple of months old and immediately was FAR more comfortable. If you are using a beanbag one, I'd suggest you try one or more ordinary pillows or seeing if you can get a v-shaped one (Blooming Marvellous do them, and there are usually second hand ones on eBay). It's SO much easier when they're the right height on your lap.

Also, did you know you can keep EBM in the fridge for up to 8 days (in the main body of the fridge, not the door)?

Hi, have you thought about seeing a cranial osteopath ? Sometimes instrumental births cause pressure points/problems etc etc. Your midwife/health visitor should be able to recommend one to you.

Also have you tried laying down (on your side, with your arm above your head)to feed ? you might find your nipple is in exactly the right place for ds to feed, can also try a soft pillow/cushion behind his back for extra support

Sounds like you're really trying hard, I'm sure it'll come together soon

PS Make sure you're eating regular good meals & snacks, need to keep your strength up !

tiktok, the thing about skin to skin at the moment is I simply don't dare to take him to bed with me because I'm so knackered and would instantly fall asleep. I have to keep up and awake to keep going. Plus there's the all-consuming expressing.
hm, it's a v-shaped pillow but with a beanbag-type filling. We try and plump it up all kinds of ways and sometimes it works and sometimes it doesn't. suppose we will have to see about getting another, not easy on our budget.
I'm completely miserable. Another failed attempt tonight. Then, although I'm knackered, I sat up expressing and only managed 50ml. I gave him to dh to do the second half of the feeding so I could get on with expressing - I'm worried ds is not getting enough of me (dh tends to be doing most of the nappy changes too) and then, when he is with me his experience isn't positive. Am I going to damage him by these bf attempts where he ends up screaming until his bottle arrives? Is/will he be able to trust me to give him what he needs? It breaks my heart. I had a dire relationship with my own mother because of her various problems which she took out on me and I just so, so want to be a good mum and want ds to be enveloped in a world where all his needs are lovingly fulfilled as soon as he expresses them. Surely it's damaging his confidence in me to have to scream at the breast all the time? I just want to do what's best for him. I never anticipated any of this and I never knew I could feel so helpless, scared and miserable. Tonight I had a nightmare that he was dead.

Berolina, you do not have to keep up and awake - you have just had a baby. If you need to go to bed then go.

what about cot death risk though? (bed-sharing not recommended when parent is very tired - and oh, I am!)

Hausfrau - shucks, thanks - nice to get positive feedback.

berolina - I remember being in a kind of mad cycle - expressing, feeding, top-ups and you feel as if you can't just get a grip. I had to eventually try and cut down the time spent on trying to get him to latch on properly as I was wasting so much time doing that.... then I'd get him to sleep and only have 3 hours till he woke again to try and express more and of course do other things like eat and go to the toilet!

I found the night feeds got better first probably because I was more relaxed and had nothing else to worry about. Do try cosleeping. I was scared too as ds was tiny and actually ended up propping lots of pillows around my back and side so that I could doze off while sitting up and keep ds in my arms.

Another mistake I made with ds was always assuming that his crying was hunger - turned out that sometimes it was wind. Trouble is that the crying makes wind and it turns into a viscious circle. At least be thankful that he is still taking the breast and as long as he is doing that and growing bigger he will be able to work out what to do in time.

berolina....what a difficult situation, and no wonder you are tired. I am not going to be available to check in over the next week or so, so what I say here may be a bit directive rather than exploratory:

Get someone in, to really get back to the basics. I can't tell from your story whether this extensive expressing is necessary. You are playing catch-up all the time with your baby's needs, and scared every time i) he won't go on the breast ii) he won't go on for long enough iii) he will wake up too soon iv) you won't be able to express enough...this is exhausting, and I don't know if this is the only option available to you. You need someone experienced and qualified to assess it with you. Someone who is there, on the spot, not on the web, not on mumsnet, not sharing their own experience (which is supportive but not necessarily helpful to you now and which can be confusing. Your head must be spinning )

Skin to skin is so important. If you feel unable to bed-share, then do it when you can in the day. Yes, bed-sharing is one of the points advised against, but discuss your levels of tiredness with someone you trust, and who supports bf, and decide for yourself. You need to be rested to get your head around all the confusing and conflicting pressures on you.

If you do skin to skin, the screaming at the breast will lessen because you will be responding to him more quickly.

You need to talk all this over with someone who knows what's what. There may be a private lactation consultant available to you in Germany, or perhaps the LLL person could see you....I really think she needs to help you rethink your expressing regime....5-6 times a day at an hour each time is not a good use of your time, IMO. You'd be better off just holding your baby.

Thinking of you....

I am just back from a weekend away and have just read through this thread.

You must be exhausted with all this breastfeeding and expressing Berolina. By the sounds of things you do have a good supply of milk - the amounts you get are good. Sometimes you will only get a little which is totally normal. Please do not sit for an hour on the pump. I agree with Tiktok that you would be better using that time for skin-to-skin.

When you are expressing (which I think you should consider reducing now), keep switching the pump from side to side as the flow slows. As you express on one side, the milk lets down on the other. Switching frequently means that you express faster. I expressed regularly to doate milk (hand expressing) and got various amounts. I would store it in the fridge over 2 days then freeze it in batched of 2-4oz. Each amount I got I would put in the fridge and when it was cold I added it to the bottle that I was accumulating milk in.

I think that there is nothing wrong with your supply of milk now, it is your supply of confidence. Some of your babe's behaviours are typical of a newborn and do not mean he is being deprived of milk. Latching on, coming off, crying and apparently fighting at the breast are pretty common behviours of most babies in the early days. Instead of reading that as a sign he needs EBM or formula, just stop the feeding attempt and calm him down. A screaming baby will not breast feed. Cuddle him patting him firmly, massage him, bathe him, rock him in the pram. Anything that you find will calm him. He may even fall asleep. Let him rest then wake him later if need be. As he establishes all breastfeeds he may want to feed frequently. Again do not view that as a lack of milk. Not all breastfeeds that are sought are for milk alone - it is comforting for a baby to be at the breast and that is what they are looking for.

By having him skin-to-skin for the majority of the time you will pick up on his feeding cues. A baby wrapped up s;eeping may well start to show signs of wakening for a feed but if the breast is not close by may not fully wake and just go back to sleep again. That is the purpose of skin-to-skin. It is so important when trying to get a baby established on the breast. It does not mean you will have to do that forever

He sounds as though he has had lots of good feeds so he definately can do it. Have confidence in yourself not to resort immediately to the bottle. Be aware though that he may well want to be fed within an hour of the last feed. That is normal and is much more effective at building up your milk supply that expressing is.

Breastfeeding whilst in the bath often encourages babies to feed well.

I'll stop now as I am bombarding you with info. You are doing really well ensuring he gets breastmilk. I think it is time to take the next step and try reducing the number of times he gets the bottle. A baby will always suck a bottle even if they are full of breastmilk.

Think of when you go out for a meal. You may be stuffed full after the main course but when the pudding comes (which is different), you can always make room for it. A baby taking a bottle after being on the breast does not mean that he did not have enough at the breast. It is just something different.

You will get there, honestly

thanks all of you. no caps sorry as have ds in my arm.
im trying to follow your advice - keeping ds close to me when poss - dont dare to go to bed though, i know im too knackered- and expressing for shorter periods - am still getting 50ml from max hslf an hour, so quite pleased. i no longer think my breasts are empty - had them under the warm shower this am and afterwards i was dripping like a couple of taps!
my very sensible and very pro-bf mw came this am and reckons its a head thing and also partly da being small and having had a difficul start - he will sort himself out eventually, she says. she suggested trying nipple shields, at least for a time, and it does seem to help. mears, i know he is getting very little at the breast ftom weighing - i know, not recommended in uk, but started in the hosdpital due to his smallness and jaundice. he gets less than 2oz a time before stopping and going back to sleep, often for hours. and he has very long pauses between bouts of sucking. can i risk letting him go back to sleep and hopefully waking again when he needs it? hes feeding 8 times a day. at the moment.

i calm him down by rocking or giving him to dh briefly but he starts up again when put back to the breast...
often he wont even get 1oz.

berolina,

2oz feeds in a newborn doesn't sound all that little imho and he may well be taking more than you think as he gets more efficient at it (or are you still weighing before and after, which I wonder may be misleading if, for example, he wees in between). Little and often (at least 8 times a day ie. every 3 hours) with snoozes and breaks during feeds sounds pretty normal too. How are his nappies and is the jaundice clearing ?

Are you getting any sleep - you do need to get some rest to keep yourself well and in control. If you are now feeling very full , could he find the faster let down a bit overwhelming now ?Don't panic, try the nipple shields if it helps him latch on and you feel more confident that he is feeding, and then if he pops off try again direct. ds suddenly got the hang of it one night feed when I couldn't be bothered to get up and fetch the sterilised shields but even after that there were ups and downs.

Good luck, you are doing really well so far.

berolina - you sound like me three yyears ago. jaundiced baby, punishing expressing cycle and low confidence in youtr own ability to provide enough nutrition for your baby
i wish i had had mn then as it wold have helpd me so much.
listen to these ladies and do as tiktok said - get some help from a lactation expert in 'real life'

good luck xxxx

berolina, I didn't even mean that you should take ds to bed, just that you needed to be there yourself.

berolina - I have just sent you a long email - let me know if you don't get it.

A baby's stomach is apparently about the size of a walnut - it really can't take much more than a couple of ounces at that age. Mine usually only took that in expressed milk at that stage.

If he is not waking up to feed then maybe try waking him at 3 hour intervals for a few days.

Keep at it - you are nearly there now.

I personally do not like test weighing because it generates more anxiety than reassurance. It is not an accurate way of measuring input of breast milk. That is why it is no longer done routinely in the UK. When it is done it certainly needs to be done with very accurate electronic scales and it is the total amount that is looked at, not just with individual feeds. You have already described how your breasts are producing milk and I am sure that your midwife is right that it will all improve.
I would try and offer 2 hourly feeds if he is only feeding for short bursts at a time. Also switch feeding - changing sides frequently during a feed may stimulate him to suck more. It will all improve as he gets less sleepy.

switch feeding

berolina - i found this switch feeding really helpful with ds2 (not ds1..the jaundiced one)
ds2 had slight jaundice and was a very sleep feeder....and I fed him every 2 hours and tried switch feeding and it really helped (both his jaundice, the amount he took, and my paranoia!)

Oh gosh Berolina - I remember this well with DD. She was only a titch when born 5lbs 3ozs and the Bf'ing was frustrating cos she was small - should have been an old hand at with after two DS's. But I had a fantastic midwife on my last night in hosp without whom I would have given up. Other midwives had me recording times fed and for how long which increased my frustration. But did the switch feeding and after a couple of days we were both doing really well. Fingers crossed for you - main thing is to persevere if you can - tiring and frustrating but worth in the end.