Giving top up- best before or after the breastfeed?

[Thandeka]

Traumatic birth baby in nicu for 5 days and fed ebm through nasogastric tube for first 7days meaning bfeedibg establishment delayed. She is now 2 weeks old and as she lost 14% body weight we now have to top up 40ml every feed (I express about 20ml on average after each feed, then we make up difference with formula - originally diarolyte on hospital advice but she was still hungry). Hospital and mw advise feed at breast first then offer top up ( and not to feed for longer than 30mins at a time in case it wears her out) she usually feeds at boob for 30mins every 2-3 hours. Anyhow my " making more milk book" (borrowed from a mnetter-cheers you!) suggests giving top up first not second. There are adavanrages and disadavantages to both I guess. If top up second then she has to work at her feeding before easy desert but then she doesn't settle well to sleep as she isn't getting boob comfort. Top up first- she falls asleep after good 30min feed disadvantage being she has easy starter and may get lazy on boob. Am not worried bout nipple confusion as at the breast she feeds with shields as I have flat nipples and can't always get a good latch without em. Her top ups are with bottle- originally cup fed or syringe but found she took in too much air and was very windy and bottle bit easier. We do have an at breast supplementer too but can't use it all the time as regime of boob, ebm and formula top up pumping and sterilsing in one feedcycle is enough without adding inat breast supplemtr but will try for some of daytime feeds. Anyhow any advicefor me?

Congratulations

I'd go with the advivce you've been given, not the book, especially if you want to build up your supply and continue with breastfeeding.

Please get in touch with your the la leche league, NCT, or BFN. You are doing so well but their support can be so helpful in continuing breastfeeding

My instinct (but this may be wrong as i am no professional) is not to think of "feeds". She is so small and her tummy is so tiny that she is probably best off grazing with loads of skin to skin and cuddles on the sofa. Give her top ups every 2-3 hours but make sure she has something from you a good deal more often than that. My dd was 8 1/2 pounds at birth but still feed every half an hour or so for the first few weeks.

hope all goes well
w
x

I misread book suggested give small amount top up before putting to breast to give energy for the breastfeed and finish with rest of top up. Am in touch with nct lactation consultant but hospital one also supposed to be in touch, but that is a nightmare. Bub gets boob pretty much on demand but she does only demand it every 2-3 hours but more skin to skin cuddles defo an option!

Could you do a boob-formula-boob sandwich ? Then she would get the comfort element of the BFing to settle her

I had to do topups as my DD lost more than 10% of her birth weight. I was told by hosp BF lady to give small amount of BM to give her energy, then BF, then anything I had expressed after the last feed. Also told to feed at least 3 hourly during the day and 4 hourly at night and to wake to feed if necessary. I found that this worked for us and in a couple of weeks, DD had gained lots of weight and no longer had chicken legs!
Also, re sterilising, that I only needed to sterilise pump equipment, nipple shields etc, once a day, just to wash in hot soapy water and leave to air dry till next use.
HV did not believe me when I told her this and rang up BF coordinator to check!! Hee hee !
My only word of warning would be re nipple shields, my DD didn't latch on til day 8 and then only with nipple shields, and we are still using them at 6 and a half months which is a pain in the ass, I would seek advice in real life to see if there is anything else to help latching on without them.
HTH X

Cheers for all the advice. Since they don't sterilise in nicu but wash in hot soapy water rinse well and air dry, then we are not too worried about sterilising although we do it occaisonally if we can be bothered, but figure if the most special care babies at hospital don't have sterilised stuff as such then we don't need to worry as much at home.

Amazon sell something called a latch assist so getting one to try and get her of nipple shield - my nips are slowly changing shape and about 1 in 7 feeds I can get her to latch without it (and that's if I try as sometimes I don't bother as priority is getting her on boob)

Currently dh is in spare room as he goes back to work tommorrow and am finding this feeding routine intense without him to do winding as I pump and all the nappy changes. Not least becuase we settled to bed at 10pm feed but madam refused to settle til 2am. Am soooooooooo tired!

I was given a latch assist by a midwife friend which is going spare if you haven't already ordered, all the bits are sterilisable, its a Lansinoh one, you're more than welcome to it if you would like.

Awww I love mumsnet- thankyou but amazon have sent it out already apparently. Did it work for you?

I was advised to BF first for 15-20mins on each breast and then then offer one/two ounces (feed/age guidelines) every three hours (I set an alarm!). This worked for us really well. Initially I was concerned that after 20/30 minutes on the breast my DS was still taking the equivalent of a full formula feed - made me realise that he possibly wasn't getting what he needed from me...

He's now 9wks old and thriving on a combination of breast and bottle - some of his feeds are now bottle feeds and others (particularly during the night)are breast. He feeds well both ways and he doesn't seem to mind both.

good luck

am bumping this for you in hopes that tiktok can give you some more advice

aww thanks guys.

She was weighed yesterday and has put on 70g (in 2 days- yay!) so in meantime was advised to carry on with top ups but also to develop our own patterns- ie. not worry too much about the half hour at a time stuff. As a result she has been feeding on the boob for anything between 20-50 mins at a time, pretty much has an hour or so rest and then start again! I figure this means she is getting much more than top ups but am still pumping and giving the occasional top up (especially if she still seems hungry after sucking me dry!) she is 2weeks and 3days so growth spurt time? I only give the top up after the feed now (unless I am bursting for the loo/some food etc. and she is screaming her head off -then DH or my mum will give her a small amount of top up to calm her down while i get myself sorted.

We record all her feeds, wees and poos so we have paperwork for the blimming hospital if it is necessary again but records show she is feeding, weeing and pooing like a champion!

She is getting weighed again friday so hopefully her weight will have gone up again and we can be left alone by HCP's a bit more to get on with it.

Must admit to having a bit of a panic last night as I fell asleep at 10 last night expecting DH to wake me at 11 for her next feed, cept I woke at 3 because of swollen boobs and bub was fast asleep! I woke her up for a feed as was worried it had been 5 hours and she fed for half an hour but fell fast asleep again before i could pump a top up (didnt have any spare), I set alarm for three hours to wake her to feed again but it didnt bloody go off and 3 and 3/4 hours later I woke again and she was still asleep- but on waking she fed for a time and then all day has been feeding really really well. DH has apparently fed her a formula bottle plus my EBM top up at 11 and so she had gone 4 hours between feeds in the night which isnt ideal (but awesome for my sleep!) but I guess since today her longest gap is 2.5 hours and mostly hourly intervals and some really big feeds then am not too worried.

Hi Thandeka, you sound like you're doing well and keeping spirits up which is good as it's a knackering schedule to adhere to, I remember it well!!
I personally didn't use the latch assist, was just given it by a midwife friend with other bf things like milk storage containers for freezer etc, but hope it works for you.

Hi littlemefi, can I change my mind on your very kind offer of a latch assist? Now I have mine I keep finding it often isn't in same room as one I want to feed in so I wanted one spare so I can have one in pocket of "my breast friend pillow- best breastfeeding pillow ever btw!) and one for pocket of change bag, will hopefully make me more likely to use it before a feed along with the other pre feed rituals of infacol, lasinohing the nips, maybe boob massage, finding nipple shield and sticking it on, and occasionally going topless for skin to skin. Nobody tells you it isn't always a case of bunging em straight on the boob!

Anyhow littlemefi my email addy is thandekatotango at hotmail dot com. Have never managed to work out CAT. I can pay you p&p or whatever?

Thandeka - hello - we were hand-holding in the early and final days of pregnancy. This is the first thread I've seen you on as I suddenly found time to cruise my new favourite topic.

Congratulations on the birth of your DD- sorry to read it was traumatic. I hope you are all recovering. I have a DD too who is now 16 days old.

Good luck with it all - you sound like you are doing really well in what must be difficult circs.

Hi Thandeka, no worries, will send latch assist off ASAP, glad to be of help and don't worry re p&p!
Too right nobody tells you it isn't always a case of bung em on a boob; I look back at my bf journey and at times think " how did I ever cope with that schedule?", but somehow you just do, and then you turn a corner, and little one is putting weight on and you know you're doing ok!!
Good luck, and well done for persevering !!

Hi littlemefi, my hotmail is playing up grrr. Have you emailed me for my adress yet? You could also try thandeka_Thomas at yahoo dot co dot uk or post your email and I can email you.

Waves at flyingcloud- so good to be the "other side" now isn't it!

Have emailed hotmail but will try other one now

Got it, and replied. Thankyou so much again!