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!

could you be expressing less because he is taking more from the breast himself?

berolina - why are you still expressing? If he has fed at the breast then you do not need to express after every feed and definately not for that length of time. When are you having any relaxing time to yourself? You only need to express at the times he has not gone to the breast.

Are you always wakening him? Is it worth trying a feed where is left to waken himself now and see what happens? You might find that you are wakening him say after 3 hours for a feed where he would normally wake on his own after 4. Since he has regained his birthweight I think you could afford to give it a try. He may well feed better if he looks for a feed himself.

I expressed milk to donate to a SCBU and I never expressed after a feed because I got nothing at all! At the times you do express remember to switch breasts when the milk slows.

My third DS was 5 weeks early and weighed 2.78kg. Sometimes he fed well and other times he would not go on. He was in SCBU and I have to say that I always lied and wrote down that he fed well to keep the midwives of my back. He fed so much better when he wanted to. If he refused a feed I put him back down and tried again later. He may not go on sometimes because quite frankly he isn't hungry. Try letting him dictate the pace tomorrow.

Agree with Mears. It's mad to express after a feed! I would definitely have got nothing then. And my ds was fat lad who gained plenty!
Stop expressing and stop panicking. Your ds is doing really well. Back to birthweight in two weeks is textbook stuff. Trust yourself! You can do this!

Morning!
Thanks mears and aloha. The problem is when he goes on the breast I'm really not sure how much he's getting. I'll see his little muscle (thanks popsycal for the tip) and his ears waggling a tiny bit, there'll be milk crust on his lips but none running from corner of mouth. But I think you (all of you) may be right about the milk flow because we had a string of 'breast refusals' last night and this morning and the amounts expressed are getting bigger again .
mears, we usually tend to leave it up to him when he wants to feed. I'm lucky in that I wake up from his rooting alone and it never gets to the screaming stage (although it does soon enough when I then put him to the boob!) I'm also VERY VERY lucky in that dh is home with me and is for the foreseeable future (he's doing his doctorate), so we share the load - I try and get ds on the breast and dh sterilises... We both get up each time at night though which we might not be able to sustain for ever - we might have to take it in turns.
Anyway, we took him to the doctor for his slightly weepy eye this morning and she's really pleased with how he's doing (he's heading for 3kg fast! ). Am having an 'up' day again today (so far) and trying not to beat myself up about the formula (so much easier said than done).

You are doing fine! Of course you don't know precisely how many ounces he is getting - that's the nature of breastfeeding. But you see it in his weight gain and chubby knees! He's doing fine. Please do stop all this expressing. It must be driving you spare, not to mention being boring and tiring.
he's gaining weight and that is all that matters.
Have faith!

Morning Berolina.

You are definately making milk so the trick here is just to try and give him breastfeeds only and give him unrestricted access to the breast. If he refuses then just cuddle him skin-to-skin and try him again later. Try not to default to a bottle each time he does not have a feed at the breast.

Watch what he does when he feeds. He should initially suck quite quickly when he first latches on. Once the milk 'lets down' he will take longer, deeper sucks. You should be able to hear him swallowing as he sucks. He will not necessarilty dribble milk from his mouth - my babies never did

As the milk lets down in spurts he will pause every so often as he waits for the flow again. If he forgets to strt sucking again gently blow on his cheek or rub his cheek. As he comes to the end of the feed he will 'flutter suck'. These are rapid little sucks where baby usually finishing feed. He should let the niple go of his own accord. If he doesn't you could take him off here if you have other things to do. If not, let him stay there. These sucks still stimulate further milk production.
Change his nappy (do not do that before first breast) then offer him second breast. He should go through the same process again.
I used to always do a 3 boob feed. really. They got both breasts then back on again if they didn't settle.
Try to avoid topping him up because he is then not dictating his amounts himself. He will always such a teat when it is put in his mouth. You could actually cup feed him even now if you really think he needs topped up. He would be best avoiding the teat till he really has got a handle on breastfeeding.

Is he having formula after every breastfeed? If so, you could start reducing the amount each time.

As he establishes breastfeeding, he may well want to feed pretty frequently. As you have DH there, let him do that. Have you heard of a feeding fest? That is where you just take him to bed all day and let him feed as ofetn as he wants. Being close to your skin will encourage him to look for the breast. You could do that and keep the bottles away and see what happens.

Have confinece in your abilities Berolina. He is a bit bigger now and his jaundice should be fading. You should be able to move on from expressing and top-ups.

Watch and listen to him as you are feeding and you will hear the milk going in.

By the way, is he refuses the second breast that is fine. You could always express from that one if you are concerned about having EBM available.

Thanks.
He actually never finishes a bottle if he doesn't want it - we quite often end up throwing formula away - so I'm wondering whether he is regulating his amounts to some degree?
The problem with keeping him exclusively on the breast is that he will often work himself up into a real state - screaming and sobbing - he might calm down if I cuddle and rock him, but when I try to put him on again it'll start again. This can go on for quite a long time .

He may be crying because he actually does not want a feed at that time. You said earlier that you feed him at signs of rooting. By that do you mean you lift him when his mouth is moving or is he awake looking?

Have you tried hand expressing some milk so he can taste it? If you resort to the bottle each time he is like that he will develop a preference. That is why I am suggesting a feeding fest where yo stay cuddled up with him all day. It is a day of breast access and he may then not get in a state.

Have you tried feeding in the bath?

How many feeds is he like that with? Is it all of them or just some?

rooting = moving mouth and arms, eyes open (with slightly 'glazed' look), quite fast breathing
he cries most feedings - will have 'good' phases where he will go on for a longer or shorter time several feeds in a row, then refuse several feeds in a row
(am cuddling him, sorry no caps)

havent tried bath (you mean with me & him in, dont you?) - still have lochia

He has proved he can do it Berolina and it is just trying to keep feed times calm (easier said than done)

As Tiktok said at the beginning you really would benefit from the support of a breastfeeding counsellor. Have you been given any support group numbers local to you in Germany?

It would be better to avoid teats and formula but you need support to do that.

Yes I do mean in the bath and lochia does not matter. It will be very dilute and is not an infection risk. Babies are often calmer in the bath and we encourage it where I work.

That's good. Do give them a call. IME women often don't like to call numbers because they will not know the person and don't want to be a burden either. However, the personal support (which may actually be over the phone) can make such a difference to confidence levels. Well worth a try and best not left till problem becomes greater. The earlier it is tackled the better it is to get sorted out.

Berolina 0 you are doing really well!! Now, like mears says, it is time to have faith in your body....this took ne ages to achieve with ds2 after what we went through with ds1 (just search breast feeding threads from mid march to see!!!)

your ds is piling on weight and it is all down to you

also, the screaming after a feed - does it stop if you sit him upright? i ask as ds2 has mild reflux which i mistook for hunger crying.
get him upright with his head over your shoulder - rub in an upwards direction on the left side of his body (this is where his tummy is) so since he is facing you, you will need your right hand) this really helped ds2 to bring up wind and to ease he reflux pain

also, i have found baby massage to be really helpful. i am in the middle of a course right now based on a book by Vimala McClure and cant recommend it highly enough

Morning. After minor meltdown yesterday eve (cf. Parenting section) am back uneasily perching sort of on top of things today. Samuel has been on the boob again a couple of times and been feeding quite frequently this morning. He's just had some formula because he was refusing again but clearly hungry and I'd run out of EBM. One thing I forgt to mention was at the doctor's yesterday she said he still has a touch of jaundice, and seeing as he ended up having phototherapy before I'm reluctant to risk going all out for the breast right now, just in case he doesn't take anything and the bilirubin levels start going up again. The doctor (paediatrician) has also recommended not letting him get too exhausted at the breast and is also confident that he'll get the hang of it once he gets comfortale past the 3kg mark. Otherwise, this weekend will be based on lots of snuggles and bfing attempts - and a hopefully calm mummy

BTW he was pretty grizzly in the night, but out for the count now. I'm going to ask MW about reflux when she comes on Monday. Anyone got and good links on it?

have you thought about cranial osteopath? Thight might help since he had ventouse delivery.

Have posted you links on your other threasd that may help - some of the m are vidoe which is so much easier to understand

Result! He's just had a Proper Feed . 15 min on one boob, 20 min on the other. I don't know how much he got out, though - he fell asleep in my arms, but a bit later he woke up, was crying, getting worked up and wouldn't go back on the boob, so dh insisted on giving him some formula. This is becoming a bit of a problem - my and dh's very different ideas as to what should be happening now. We have been given advice by our MW and paediatrician that we should of course persevere with bf, but shouldn't let him exhaust himself at the breast, as he's probably still too little and dozy to have got the hang of it properly. I give him EBM whenever I can, and overall he is getting more EBM than formula, but am not expressing enough to give him that exclusively. dh is very pro bf but wants to give ds formula (whenever necessary) until he's either got the hang of bf properly or I'm producing enough EBM. I absolutely hate it though and always leave the formula bottles to dh. I can see where he's coming from, as ds is currently doing very well weightwise (he's gaining at an astonishing rate) and also it's important that he gets rid of his last bit of jaundice, but I so so dislike the fact that he's getting formula! The only things I can do really are keep at the bf and try and increase my milk supply. I don't feel I can go completely against dh, because he is just as involved in the childcare as I am and from Oct will be at home with ds for the hours I have to teach. Also, ds's digestion seems to be more unsettled the last couple of days - he'll wake up and grizzle. We put him on Aptamil on Thurs as MW said we should be using a 'pre' and not a '1' formula. Might it be that? I read an another site today that Angela Cannings' babies died of a cow's milk allergy and that's another thing I'm now worrying about.
Thanks mears for links. Off to other thread now.

Difficult with your dh, berolina, and maybe the way you are doing it is the best compromise....but if he is gaining weight so well, he really doesn't need the formula. It would be better simply to calm him when he grizzles and offer the breast again when he calms down....not to see the formula as a solution, and not to interpret every grizzle as hunger needing formula to resolve. But only you can decide which is the better option with dh so keen to help out.

PS - good news about that good feed! And great you have stopped weighing him. Next job is to stop timing him

Thanks mears SO MUCH for the links! Just had a practice session with ds after looking at them - he latched on no probs and there was definitely milk flowing! I reckon my latch-on is/was part of the problem (whether it's the whole problem or not remains to be seen). Thanks again!

Hurrah Did DH look at links too?