Establishing breastfeeding and skin to skin

[Sxp842]

Hi, grateful for some advice as I’ve been getting slightly conflicting messages from various midwives and infant feeding team.

my baby is 2 weeks old and was born at 37 weeks. I breastfed him for the first 2 days but then stopped because he wasn’t feeding well. The hospital put us on a feeding plan and he’s been mainly formula fed since day 2 plus whatever I can express (normally around 20mls per pump session).

I’d like to give breastfeeding a go, or at least increase my milk supply to reduce the amount of formula. I know I need to pump more, but how much? Some midwives have said 4 times a day, others 8 to 12, and others every 2 hours.

I am thinking of trying the following routine for pumping sessions: 1am, 4am, 7am, 9am, 11am, 1pm, 3pm, 5pm, 7pm. Then sleep between 7:30 and 1.

would this work to increase my supply?

also, I know skin to skin is really important for increasing supply but when do you do it? Ideally I would be sleeping when baby sleeps, so when would I do it? My baby isn’t often awake unless he is feeding (which is a bottle feed so can’t do skin to skin then). He still has a bit of jaundice.

I can get my head around pumping every 2 hours. But I don’t understand how you’re meant to do all the other necessary things - make time to eat well, keep hydrated, do skin to skin.

am I missing something?

Will baby latch? It can be useful to get baby to latch to stimulate milk supply, if you are pumping then there is a supply so you could try before or after a feed. Pumping is great, but I always found nursing better.

Have a look at la leche league or the breastfeeding network and if it's affordable for you, you could try a lactation consultant for extra support.

A lactation consultant would be great for you. Do your hospital have an infant feeding team?

Standard advice is a minimum of 8 expressions/feeds a day to establish supply but more frequent expression even if short is even more helpful. There’s also techniques like power pumping that a midwife or LC could discuss with you.

Will your baby latch? That opens up a lot more options, many 37 week babies struggle initially but get better at breastfeeding when they would have been 38/39 weeks gestation.

You can do skin to skin while bottle feeding or take a bath together each day or do skin to skin while burping and settling post feed.

I never got a full supply but am still breastfeeding my 4yo, there are lots of options, I certainly didn’t feel able to do everything that would have increased my supply, it just didn’t work with the rest of my life but I did what I could and achieved a balance I was happy with. Mine were mostly breastfed with formula on the breast using an SNS which was the best compromise for us.

I would echo PP that latching will be better, but you could also pump after each feed too, that will help. Or you could try block feeding? If baby is 2 weeks old then they might be about to go through a growth spurt and start cluster feeding so just keep an eye out for hunger cues and feed feed feed on demand as often as they ask for it! Also speaking to/seeing a lactation consultant could be useful, maybe ask your midwife if there's a local Bambi's group or something. With skin to skin - any naps baby has when you're awake just stick them on your chest! Even a few minutes a few times a day will be really beneficial. Get a box of snacks and sit on the sofa for a few hours letting baby go from boob to chest to boob!

Thanks for the replies. Problem is baby won’t latch, ideally if he would latch I think he would get some milk (although maybe not much) but he just won’t. I’m getting a private assessment done next week to check for tongue tie, just in case. The infant feeding team won’t come out to assess until I’ve started pumping at least 8 times a day as they said there is no point in working on his latch if I’m not pumping that much.

I’d be happy to pay extra for a lactation consultant, but I’m wondering if the infant feeding team is right - do I start pumping 8 times a day first and then work on the latch?

would power pumping be instead of normal pumping?

I think part of the problem with skin to skin is that we’ve had so many medical appointments etc for baby and other things going on that I’ve barely had a chance to sit down and have a cup of tea, let alone find a few hours to sit on the sofa with baby when I haven’t wanted to sleep myself! Maybe I just need to find a way to slow life down a bit

I’m sorry the the infant team are putting onerous obstacles in your way before they’ll support you.

You definitely can do skin to skin while ff; make sure you have any privacy you need. It sounds like you’ve had a full-on on start and I totally get why pumping 8 times a day seems Herculean.

Is your partner back at work? Ideally you need someone or people who cover EVERYTHING, while you sit comfortably, sleep when you can, and focus on cuddling, pumping and feeding. You need plenty of fluids and regular snacks or meals and someone should sort that out for you. In many cultures you’d get this for the first 40 days!

Sometimes mothers of bottle fed babies struggle with everyone else wanting to feed the baby but in these early days, it’s important that you do as much feeding skin to skin as possible so after a cuddle, family should be giving your baby back for feeds unless you need a rest.

Don’t try to do too much. For the next fortnight you have one focus only.

Good luck! I hope it works out. Your baby will be just fine either way but I totally understand why you are so keen to give it a really good go.

Thanks @LightDrizzle, my partner is back at work but works from home so may be able to help with food and snacks a little bit. I think you’re right, I just need to focus on this for the next week or two. We keep seeing family and friends as they want to see the baby, which is lovely but also makes it hard to focus on this.

if I’m going to try and pump 8 times a day, can my partner still look after baby in the evening between 8 and 1 while I sleep?

Contact a lactation consultant, they will help you put a more proactive plan in place than the infant feeding team has offered, and can check your baby for tongue tie at the same time. Even if your baby has a tongue tie a lactation consultant may be able to help you achieve a latch that will be good enough until the tie can be dealt with if it needs to be.

There is a good book by Lucy Ruddle called Relactation which is all tips to increase your milk supply. She has a facebook support group as well which I'd recommend joining.

I wouldn't kill yourself pumping, try to think about pumping as having two separate jobs - one of those is to provide regular stimulation to your breasts so they get the message to keep producing milk, one of them is to get milk for your baby, but this is secondary while you're establishing feeding - so don't get too hung up on amounts, most important is the stimulation part.

I used to do skin to skin for about an hour in the morning with DS2 who was in NICU for 24 hours which messed up my milk supply. You could definitely bottle feed while doing skin to skin - I used to do it after his first morning nappy change. I'd strip him down, put the new nappy on but not the clothes and then take my top off and climb back into bed with him with a blanket over both of us. You don't have to be in any special position, it's literally just skin contact. So you could be sitting up in a feeding position with a blanket around the outside of the baby. I'd do this in bed, so if he falls asleep and you want to sleep, you can gently roll to the side and leave him lying next to you while you do the co-sleeping C curl around him and a blanket over each of you.

Can you afford a lactation consultant? If so just do it, it was one of the best things I did both times I breastfed.

If you can't afford one, get in touch with your local la leche league, many of their leaders will do home visits or other support for free. They have lots of meet ups all over the country.

Very best of luck to you xxx

If you want to get your milk going you need to pump as often as baby would breastfeed. This means at least every 3 hours including through the night.

Best way to get this working though is too put baby back in the breast and breastfeed.

My second was born at 34 weeks and I pumped for 2 weeks then started breastfeeding at 36 weeks.

Pumping and bottle feeding is double the work. That's why you are finding it so hard.

DS was born at 33 weeks and I had to pump till he learned to feed. Yes to 8x pumping per day - and you need support from your partner or other family with all the washing and sterilising, and to bottle feed your baby until he will latch. This is absolutely a full time job, so be prepared to cut back on the visitors unless they are going to HELP.

If if helps I paid £110 for an hour with a lactation consultant in Essex (Little Latchers if you're in that area - all qualified nurses as well as International Board of Lactation Consultants certified). They were very helpful. I agree that your hospital feeding team are being unhelpful - there's not an entry requirement to giving you support. Find your local La Leche League too - the leader will provide free advice by phone or message and may be able to meet up in person.

This sounds like me and DS at that age!

Have you tried nipple shields? They made a big difference to me, still tricky and he was having quite a bit of formula for the first few months but they kept the momentum with breastfeeding til he was able to properly latch at about 3 months. I'd try a breastfeed each time then follow up with bottle.

Just to say, pumping that much can become really stressful so don't beat yourself up if you can't find the time. From a similar start I worked up to mostly breastfed with one bottle a day (from choice, could have been EBF). At no point was I pumping 8 times a day, I think I managed 4 at the most.

I found my health visiting team way more useful than the midwives, they had a weekly breastfeeding group with people in a similar situation which was such a help - would recommend seeing if there's anything similar or an independent breastfeeding group with lactation consultants around to help.

Good luck, I'm sure you'll get there!

Be kind to yourself, it’s still early days and there’s ample time to boost your supply and establish breastfeeding.

When DD was born I was strongly encouraged to combi feed as I was unwell to the point of being readmitted to hospital. By the time she was 5 weeks old I’d stumbled into her being 60% formula fed and was desperately worried I’d damaged my supply so much that I’d never be able to exclusively breastfeed. She’s now 4 months old and has been ebf from about 10 weeks so it is possible to increase milk supply without breaking yourself mentally or physically.

I remember feeling so overwhelmed at the suggestion I needed to pump after every feed/every two hours as some days I barely got a chance to pee let alone had time to pump. Instead I tried to commit to pumping 4 times a day, ideally for 20 mins, but even 10 mins is better than nothing. In the early days I also tried to power pump a couple of days a week to help boost my supply, but this is best done when you have someone who can entertain baby and can feel a bit full on if you’re already in the midst of cluster feeding.

I also found the pump I used mattered. I bought an elvie single pump before DD was born with the romantic notion that I’d pump on one side whilst feeding on the other, how wrong was I! I found it near impossible to pump and feed, and the faff and added time needed to pump on both sides just made things feel even more insurmountable when faced with pumping multiple times a day. I also hadn’t realised that it was the pump that wasn’t good at expressing my milk, rather than an indication of my supply. The best thing I ever did was hire a hospital grade pump (medela symphony) as not only could I double pump which saved me so much time and stress, but I also found I was expressing more than double the amount in half the time.

Other things that worked for me was drinking a protein shake a day, popping socks over the bottles so I didn’t fixate on the amount I was expressing and watching videos of DD on my phone whilst I pumped.

Feel free to PM me if I can be of any further help as I remember all too well how tough it is in those early days x

Thanks for the replies. I think I will be getting a lactation consultant to help.

skin to skin while feeding sounds great but I don’t think it will work for us. It’s difficult enough to feed baby as he is sleepy and jaundiced, skin to skin makes him too comfortable to feed properly. I’ll try and get an hours skin to skin in the morning though. One thing that puts me off skin to skin is that he’ll fall asleep really well, but then I’ll have to go and pump so will need to put his clothes back on him and put him down, and I think he would wake up when putting his clothes on - has anyone else found this?

it really is like a full time job. Everyone says sleep when baby sleeps but I just feel like there isn’t time to do that when pumping so regularly, and also sorting out everything for baby and getting myself fed and watered. My husband is trying to help but he doesn’t feel like he can do much more than he is now given he is working, and what he’s doing now isn’t enough. His parents are around and offering to support but tbh I don’t really want to be relying on his parents when I’m feeling this vulnerable and my family aren’t available. So there’s just limited support.

I’ll keep trying to pump 8 times a day for a week but if my supply hasn’t increased by the end of the week I think I may need to give up, I don’t know if I have it in me to do much more and it’s having a detrimental effect on my mental health and relationship. Weirdly my supply has been decreasing each day since I started regular pumping and my boobs are already starting to get sore

Try putting baby to breast (doing skin to skin) at every feed. Have a bottle ready to give if baby gets frustrated but always go to breast first. Responsively feed, not on a schedule.

Are your flanges for the pump the correct size for you?

Contact a lactation consultant ASAP ideally, the sooner you do the sooner they can help you and protect your supply.

Pumping is TOUGH. My twins had to be born at 34 weeks, so were tube had initially and then had bottles as we wanted to leave SCBU and they still weren't strong enough to latch well and dozed off too quickly when we attempted breastfeeding.

Personally, I find breastfeeding much easier than bottles (I remember the first night at 4 months when we got through the whole night with no bottles and just breast. Bliss!!!!). Many babies cluster feed at approx 8pm-10pm and this is great for boosting your supply. Can you manage this? And then have your block of sleep at a different time? Pumping is not as good at stimulating lactation as a baby, so do as much skin to skin as possible and keep trying to get baby to latch. It's fine if they nod off. Pop them on as often as you can, ideally before their bottle.

Good luck OP. Your baby is still very little, they will.get bigger and stronger in time.

I would not worry about clothes on him. DC was in NICU with no clothes for ages. As long as he is warm enough he is grand, just pop a blanket over him and pump beside him. You will produce more milk in his presence anyway.

I would also encourage his parents to support by supplying food. They could make casseroles/ curries etc and leave them to you. Make sandwiches/salads so you have something to grab.

I also used the contented calf cookbook of lactogenic foods. No idea if it helped but I got both my children to ebf

I would join the Facebook group breastfeeding for yummy mummies, so many people asking similar questions and they have experts who will respond to your questions and assess your latch for you