Moving to one side at a time feeding?

[CAM123]

Was told earlier to present 2nd breast after baby finishes in first - my 11 week old has always seemed to then finish off both (fussed and won't return to breast, waves arms around and hits breast, and it's nit a burp as far as I can tell).

Doc has just told me to switch to single sided feeding, supplementing with formula top ups.

Am a little concerned though - since the supply/demand is based on sucking and I can't get my baby to suckle on an 'empty' breast, dont I risk getting stuck in a rut of half breast and half top up feeds for every feed from here on? (Which incidentally is the no. 1 reason I know of friends falling off breastfeeding, either due to diminished production, being fed up with the faff of it all, or both).

Any advice? Is single sided feeding the way to go? How can I ensure I increase production and don't just increase top up dependence?

Ps. Think I'm being dense here but what's all this DH, DS and DD lingo? Presume the second letter is husband, son and daughter, but what does the first D stand for?

Why has the doctor told you to do this? What else is going on here?

How is your baby's health? How is your health? How is your baby's weight gain? Is your baby awake and alert and happy?

Are you seeing any breastfeeding specialists?

There is no such thing as an 'empty' breast, they are always refilling. You can switch sides and switch again and again, and there will always be something there - and it will make your breasts produce more milk.

(The first D stands for dear or darling.)

Sorry, that came across a bit shouty. I am just at the advice you've been given - I can't tell if it's complete and utter tosh or there's some sensible reason for it ... I can't think of any, though. And doctors are not necessarily breastfeeding specialists.

What notquitecockney said. Why have you been told this OP, its total tosh! I am a BF peer support advisor and unless there is a specific health reason there is no need to top up with formula, your breasts dont "empty" as such, and if you need to increase supply you need your baby to latch on and suck!
So your baby feeds on one side, then you offer the 2nd and they do or dont feed?
I would call your BF community support person, your HV will be able to tell you who that is, and get then to give you a home visit. Stick with the BF

The inconsistent advice is sooo annoying. Most professionals and bf counsellors I've spoken to have said offer the 2nd when the baby has stopped on the 1st, then start that side next feed. Mine have all taken the 2nd side sometimes but not others. They know when to stop.

Then a very stroppy mw gave me the same advice as your GP on DC3's 5 day visit last week. I have ignored and carried on doing what has worked before.

Is your baby's weight OK? Unless there are other things going on I cannot imagine why you have been told to do this.

FWIW I think that, as with many things, the one breast/two breast/length of time etc etc just vary between people and babies, you need to do what works for you and your baby.

If you have been offering both breasts at feeds, and all is well, then carry on doing that. Trust your instincts if you can, I know it's hard though when you have HCPs trotting out conflicting and/or weird information.

One side per feed does make sense in certain circumstances: for example, if the mother is making too much milk, getting mastitis, etc etc. But if that was the problem, why should the OP give formula?

The best plan, generally, is to let the baby have his or her fill of the first side. Ok, if he's just doing weak sucks, you can move him on, but ideally, you wait until the baby spits out the nipple, having had enough, then offer the other side.

CAM, are you absolutely 100 per cent positive the doctor told you this?

It is most odd.....

The usual reason for formula top ups is because the mother (or her HCP) suspects (rightly or wrongly) there is insufficient milk.

So to deliberately restrict the baby's access to more milk (by not offering the second side) would make the baby have less milk and also make the mother make less milk...a problem which is then 'addressed' by topping up with formula????

Why did he give you this advice? Did he tell you why?

Maybe the doctor believes in an outmoded model of foremilk/hindmilk?

tiktok, I would like to pick your brains, will start another thread.

Yes, probably, NQC.

I see on CAM's other thread that there are 'weight gain issues' so this doc is probably thinking that feeding one sided will improve weight gain.

NO IT WILL NOT!!

IT WILL REDUCE MILK PRODUCTION AND MILK INTAKE AND CALORIE INTAKE!

Yes, shouting at CAM's doc, not at CAM

Hmm, the plot thickens - you're all echoing my feelings too but I also feel torn and as if I should try out what the doctor said so I can finally get some continuity of care...

Background - sorry should have included this - is yes, I am having weight gain issues. DS (thanks for the D explanation!) was born at a good weight (3.24kg for 54cms) and regained birth weight pretty much immediately. But, since then, his weight gain has been very shallow and dropping percentile after percentile to the bottom of the charts. Now, 11 weeks later, he's only put on just over a kilo. That said, he's very happy and alert and extremely active - also remarked upon by the HVs I've seen.

Challenge is that I'm with a clinic that has a number of HVs so I tend to see a different person every week - some are very Red Book chart oriented, others less so.

So far, the weekly advice has included all of the following suggestions which I've followed, in the following order - none of which have increased the growth rate (some decreased it!):

• you're not feeding enough so feed more, which led to non stop feeding
• you're feeding too much and not replenishing / you're encouraging snacking so move to routine of 3 hours during the day and 4 hours at night, waking him as required
• it must be colic so try infacol (did help bring up burps but he's never been a lengthy crier - he only cries when hungry, tired or woken and stops when he gets what he wants)
• try 2 formula top ups a day (this led to initial weight gain but then a spate of vomiting - DS gulps down everything he's given so gives impression of hunger? Or just greed? But much of the top ups came back up)
• he must be resistant to / uncomfortable with the formula so move to expressed top ups only
• sounds like reflux or colic so move to denser formula like Comfort or Staydown
• it's not colic or reflux, move to one-breast at a time, topping up with formula - which is where we are now

And yes, the doctor really said this and yes she did mention foremilk/hindmilk so that must be her rationale. She must believe I've been switching too early but I had thought I wasn't - I was going at least 20-30 mins each side and waiting till he really wouldn't take any more and the breast felt really soft - even tested out expressing after and got next to nothing so he must be emptying. Also, poo not green which I'd read was an indication of foremilk overload (was once when I was switching early, pre formula top ups, very early on, so I corrected that).

I'm going a little out of my mind with all the chopping and changes and they can't be good for the little DS nor for my breasts - talk about mixed messages! And I'm concerned this will reduce my producion further rather than increase it, and I'll gradually fall off breastfeeding and onto the bottle alone which is what I've been trying to avoid all along.

That said, I've heard great reviews of this doctor and so think maybe I should give this a go for the 2 weeks she stipulates if only to try to have some proper follow up. Something's clearly not working as, even when I was breastfeeding all the time (by the next 3 hour feed I'd still be on the previous one, all day long and half the night - not fun), the weight gain didn't change. Not sure if this is just his rate but would hate to think I'm holding him back so am happy to supplement with formula provided it's not the beginning of the end of breastfeeding.

In a nutshell - nightmare!

She may be a great doctor, but she knows sod all about breastfeeding.

I have to go, but a few thoughts:

1. Have you seen a BF professional? If you say what town you're in I can have a dig for clinics and drop ins. It's possible your DS's latch is not ideal, and maybe can be improved.

1. Have you tried breast compression?

Your DS sounds like he's fine. In your shoes, I'd be inclined to not go to the clinic so much and ignore the GP, but maybe see a breastfeeding advisor.

Oh yes and to answer Qs above - he always used to happily take the 2nd breast. As for the knowing when to stop - that's the challenge. He stops for burps and when he's emptied the breast - or that's my impression at least as outlined below.

But, when presented with a top up he'll finish that off too. Just greedy? Or perhaps he's bad at reading his own needs. He doesn't wake for feeds either and that was a challenge as he tried to sleep through the night far too early and before weight gain sufficient - ironic that when others trying to train theirs to sleep through I was having to wake him and struggling to get him to feed when he was sleepy and unhappy about being woken. No other health issues at play, and he's not sleepy otherwise - he's very sleepy at night and very hyperactive during the day. Though have just got him on the Baby Whisperer EASY (eat, activity, sleep) routine and suits him to a tee... except where's the weight gain?

This 'greediness' also was a challenge when I first started top ups - first time I tried, he'd fed for 4 hours straight in the evening, then gobbled up 120mls of top up (HV had said to make up 120 and see how much he took..) then 3 hours later he vomited a good portion of it back up - must have overfed him. So his internal regulation isn't that attuned to his own needs, that's for sure!

Sorry, me again, but would also like reassurance - if I do follow doc's advice for these 2 weeks and go single sided, is it irreversible, or could I build back up to 2 side feeds again and wean him off the top ups once his weight is at a healthier level?

Sorry, me yet again - just to pre-empt another Q you may ask - yes latch is apparently fine and I'm differentiating fine between proper sucking and just nuzzling / dummy effect - I had this checked out. Sorry, keep posting before I've got all off my chest - a tad forgetful at the mo!

Thanks NQC, you're echoing my thoughts... breasts are not happy with the move to single side too (am following Baby Whisperer on that and trying to take edge off other side before concentrating on one, but ouch!)

Will have a good ponder before deciding on final course of action as don't want to keep more chopping and changing - not good for little one or my production.

CAM - no wonder you are mixed up and all over the shop....that's some collection of approaches you have acquired. Some of what you have been told is truly rubbish.

I'm gonna be directive

Ditch the Baby Whisperer book. It is very, very poor on bf, and starts from a total lack of understanding of how it works. It cannot help you in any way, honestly

Find an experienced, trained breastfeeding counsellor and go through the whole thing with her.

Nuzzling and the dummy effect - I assume you mean comfort feeding? - is fine and normal and good for babies and mothers and milk.

Your baby was born on the 25th centile. He is now on the 2nd. This is within normal limits - a drop of 2 centiles. If he continues to fall, then it would be a sign for his overall health to be assessed and feeding to be reviewed. Most babies are fine even so, but it makes sense to check.

Sounds like your baby is healthy and growing, and it also sounds like the HCPs around you are trying to somehow fix this drop of a couple of centiles - they may have a reason for doing so or have a clinical judgement that this centile is not optimal for your ds, so they are being pro-active by trying to get more calories into him.

OK - no probs with that. The most effective way of doing this is to ensure more frequent, effective feeding....on both sides (at least, day and night. Do not worry about 'emptying' the breast - do not worry that he takes formula after bf (many babies do - it just means he could stay on the breast happily a bit more, prob after swapping sides (yet) again )

Expressing gives no reliable indication of milk in the breasts - not getting anything out does not mean there is nothing there.

But see someone in real life about all this - decide for yourself if you can trust them not to bamboozle you even more with rubbish.

And get a decent book about bf

To clarify - when I say 'drop 2 centiles' I mean 2 centile lines as printed on the chart ie it goes 25th 9th 2nd.

tiktok knows what she's talking about. If you already have supply issues (and it's not clear you do!) then switching to single breast feeds will make them worse.

Are you happy to say where you live? I can try to find you somewhere you can see a (free! knowledgeable! friendly!) bf supporter who will help you.

(Alternatively, you can try phoning each of the Big Four: NCT, BfN, ABM and LLL - depending on where you live, one of these groups is likely to have lots of people around.)

Thanks NQC, I'm in Richmond. Would love a hand. Phoned La Leche a while back and they just advised more feeding which I did my best on. Had early help from NCT too who checked latch was fine and also just said feed more. No idea why the weight's not coming on, so yes any further recommendations would be gratefully received or I might also retry NCT and LL just in case.

I think everyone who's advised me has clearly had a logical point, but do idea why it's not helping as, to the best of my knowledge, I've followed each suggestion to the letter - maybe though not for long enough as I've often had a different instruction just a week or two later.

How is it we've been doing this since time began and still haven't got a proper consensus?!

Thanks!

Thanks NQC, I'm in Richmond. Would love a hand. Phoned La Leche a while back and they just advised more feeding which I did my best on. Had early help from NCT too who checked latch was fine and also just said feed more. No idea why the weight's not coming on, so yes any further recommendations would be gratefully received or I might also retry NCT and LL just in case.

I think everyone who's advised me has clearly had a logical point, but do idea why it's not helping as, to the best of my knowledge, I've followed each suggestion to the letter - maybe though not for long enough as I've often had a different instruction just a week or two later.

How is it we've been doing this since time began and still haven't got a proper consensus?!

Thanks!

As Starlight says, it makes sense to offer your breasts more, sure, and it might help. Breast compression can help with sleepy babies: here's a link.

It also is possible that maybe your baby is just meant to be thin. There is a 2nd centile line for a reason: some babies belong there. Are you and your husband small or skinny?

Oh, and there is a babycafe in Richmond, on Monday mornings, where they will be happy to check your latch. It's run by the NCT, so will have v qualified BFCs there. Here is a webpage about it.

Am really appreciating all this support - thanks so much.

Quick answer to some of your Qs

• Haven't tried compression (never heard of it) but will look into it

• I'm about average height at 5'5 and used to be a very skinny child - am at my least skinny now understandably! My husband is 6'3 and was also a skinny kid but is pretty broad built. We were both bottle fed so can't compare there - though mother in law does say he never cried for feeds, so maybe there's a genetic link there...? I was much more needy but I was premature

• I did several weeks of constant breastfeeding - probably 4 or 5. I was glued to the sofa night and day. Looking back on it, now that I'm better at reading the signs, I mistook every squeek for hunger and overtired DS by thinking tiredness was need for a feed. But also admit that it wore me out so maybe that diminished my supply?

Which reminds me - doctor warned me against being too active and said even an hour's walk (which I'd just done, on a rare occasion) can dry up the next feed. I'd just been feeling up to getting out of the house more for my sanity and DS's - should I not until I've got my supply sorted? I'm the least active I've ever been and am generally lying around feeding DS and myself, so surely this can't be the issue either.

Just want so much to nail it! It's horrible feeling like you're failing at something that should surely be natural!