Determined to bf after breast reduction & 2 c/s

[Gemma]

I had a breast reduction about 15 or so years ago. I also had an emergency c/s with Amy and I am booked in for another c/s with this baby on 27th Sept.

I really wanted to bf Amy but it wasn't to be. I hadn't planned for a low supply and therefore did not do any research to build up my milk. The private hospital who prides themselves on bf success rates were not very supportive and everyone told me that because of the breast reduction, there was a chance I couldn't bf. Anyway, I syringed the colustrum and my milk came in on day 4 but Amy wasn't interested after she was offered formula and a bottle. I expessed when I got home but only got about 20-30ml each time so Amy was on formula.

I have read the posts on BB about building up supply and will try Fenugreek, gatorade, museli and Activite. When should I start taking these and how much? Any advice would be appreciated.

[AnyDream]

Hi Gemma, sorry I can't help as I don't have any experience with this, but I just wanted to pop in and say good on you and good luck! I hope it all goes well.

It might be helpful to make contact at this point with your local ABA counsellor, as she will no doubt have some helpful information for you. Also finding a lactation consultant with experience in this area beforehand so you can make contact just as soon as the need arises may be helpful too.

[BellyBelly]

Gemma, I would be getting an independent lactation consultant to help you establish breastfeeding, you have quite a challenge there with c/s too - so I would start looking for some good LCs (I have some names if you like) and work with one closely... you'll need lots of support, physical and emotional.

I'm sure you have considered a VBAC, this can also help improve your chances.

[Barb Glare]

HI, Gemma,

I'm sorry you got so little support for your decision to breastfeed last time, and really admire your resolve to give things a better go this time. The good news is, there is plenty of information at hand. A good place to start is http://www.bfar.org/. Diana's book "Defining your own success" is available from Mothers Direct http://www.mothersdirect.com.au/prod523.htm.
It is so hard to work out what can be attributed to circumstances around the birth and what can be attributed to the effects of the breast reduction. It's certainly encouraging that your milk came in.
It is important that you feed early and often to maximise your chances, and aquaint yourself with what is normal in newborns. For instance, you will expect your baby to lose up to 10% of her birthweight. This is normal - and not cause for giving formula. You will expect your milk to come in day 3 or 4. It's normal for the baby to have one wet nappy per day of life for the first 4 days.
It would be worth getting hold of Sue Cox's DVD "Mom and Baby I can do that" available from Mothers Direct and her other DVD- video "Mother and baby the first week"
Things must be busy for you at the moment, but I wonder if you would consider visiting a Lactation Consultant before your baby is born to go over what happened last time and identify what could be changed and improved?
It is hard to know whether you will be able to fully breastfeed, but many mothers are able to breastfeed successfully after a reduction

Warm Regards
Barb

[Gemma]

Marydean, Kelly and Barb - thanks for your advice. I am considering joining the ABA so will look into buying some of the things suggested.

Jessica is one week old tomorrow and we are having some challenges. When she was born she fed for about 3 hrs on and off and had good attachment. The paed suggested comp feeding her from day 2 and I questioned if that would affect bf and he said that it was better than having a hungry baby. On day 3 a midwife said that I wasn't doing it correctly as the areola wasn't going in her mouth (I have big nipples) so I was angry that it wasn't working and I gave it up. On day 5, a lovely midwife had a talk with me and said she wasn't there to talk me into it but would provide support. So that night I gave baby a bf which worked and started expressing in hospital. I also had a talk with a lactation consultant which was great. Her suggestion was bf then offer EBM, if hungry BF then offer 30ml formula.

We are now at home and baby has been having some great feeds but they do last over an hour which is fine but the advice was to feed 20mins of good sucking on each side. I am waiting on the lactation consultant to phone me back as I have also contacted her again for advice.
The last few feeds she has been fussing and not wanting to feed so I have resorted to giving her forumula. I know this is counter productive but she is very content. She only feeds about 4-5 hrs when she has had formula. I bought a Medela electric pump yesterday for $300 so I am in this for the long haul but I am only expressing about 10ml each time. When she won't feed on the breast I try for about an hour before giving formula. This morning she had a good feed but that is the only one recently that went well. I am concerned about my supply and am taking Fenugreek - not sure if that has changed the taste of my milk?

Any advice would be appreciated.

[Janie]

Gemma, hugs hun, I can really relate to what you're going through.

From experience, I would say that if you can, hold off on comp feeding her. Unless of course she is not having enough wet and dirty nappies and not gaining enough weight. If she does need to be comp fed, it needn't mean the end of BFing for you. My DS has been comp fed from birth, and we are still going at 5 months! I am so pleased that we're still BFing, but using bottles regularly creates a whole new world of problems. In our case it has ended up being really necessary, but it would have been better to exclusively BF!

4-5 hours is way too long to go between feeds if you are BFing, bub needs to be feeding probably every 2-3 hours, sometimes more often. Try to fit in AT LEAST 8 feeds in 24 hours. Keep up with the expressing, and don't stress about the amount. Really make a concious effort to relax when expressing, do it while watching her sleep, or look at a photo of her. Gently massage your breast at the same time. Make sure you keep up your water intake, as alot of people find this makes a big difference. I take Fenugreek (amongst a million other things!) and I haven't noticed a problem. Has anyone discussed taking Motilium with you? No one did with me until I asked about it, and by then Nicky was 10 weeks old. Apparently it works alot better if you start it within the baby's first four weeks. I would definietly discuss it with your LC or MCHN and see what they think. Your OB, GP or Paed can prescribe it for you. If you want any more info on it let me know

I really have to dash, and can't think of anything else ATM........just remember that we're all here to help and support you. There are a number of girls on BB with supply problems and they have been such wonderful support for me!

Good luck hun.

[~Raven~]

Congratulations on the little pink bundle

Gemma all of mine were b/f 2 hourly around the clock at that age and sometimes it feels like bub is permanantly attached but that is what they need to do to get your supply built up. Expressing doesn't always get as much as what bub can get.

I agree with Sez that if bub is waiting 4 - 5 hourly after a f/f it could affect your supply waiting that long. It is supply and demand afterall. Perhaps if bub is asleep for that time then express 2 hourly even if yu are only getting a little bit. The most I could get out was 20mls and that is logical as bub only has a tiny tummy at one week old.

Keep a good eye on the output. If there is plenty of wet and dirty nappies then plenty is going in. That was my mantra!

I took fenugreek and drank Aktivite also.

Call me if you need

[Gemma]

Thansk Sezjm and Sam.

Water intake, thanks for the reminder. I am drinking Activite and will check out the increasing supply thread on BB again. I have discussed Motilium with the LC (thanks to the posts on BB) and she said that she can write a letter to my GP explaining why I need the script. She isn't too concerned at this stage but I can get it if needed in the next few weeks. I am going to decrease the formula in the hope that she feeds more often and hopefully starts feeding from the breast again. She did have a good feed this morning for 5 mins one side and 10 mins on the other but hasn't been interested in the breasts since. That's why I am a little concerned about positioning.

I just expressed 40 ml so my supply seems to be increasing . The LC phoned me yesterday and again this morning and she has had some good advice also. I was trying to get Jessica on the breast for and hour but she said to only try 5 mins each side and to give her more skin to skin contact so she doesn't just associate the breast with feeding. Jessica's wet and pooey nappies are good. The LC said to express every 3-4 hrs but because she is sleeping so long I will start to express more often. There is a clinic at the hospital on Thurs and I am on the waiting list. It is a day stay so I hope I can attend. I am a little worried about doing BF correctly but I do know the difference if she is not attached properly and my nipples are not really sore.

Thanks again for the advice.

[Barb Glare]

Hi, Gemma,

Congratulations, and good on you. What you are describing is very common in a breastfed baby. Do you know why the dr suggested comp feeding from day 2? At day two your milk wouln't be coming in yet, so she would not really be expecting any quantity from you, and would have reserves of brown fat that she would be using up. Did you feel that your milk came in? Any fullness? Any feelings of letdow? Milk dripping from the other breast? How big was she when she was born? Have you had her weighed since her birth?
It sounds like your LC is giving you good advice, so stick with her! How much formula are you giving your baby now? Many mothers of week old babies are in just the position you are - breast reduction or not! But she won't learn to breastfeed by drinking from a bottle. So try to get her to feed from the breast as much as possible. Have plenty of skin to skin contact. I wouldn't necessarily assume that your milk supply is low.
Looking forward to hearing from you again

Regards
Barb

[Gemma]

Thanks for your advice Barb.

Jessica was 3.69kg when she was born and 3.58kg on discharge. We will be getting her weighed next week. I think the paed said to give her formula because of the breast reduction. Yes I felt my milk come in, well I was expressing colustrum and giving it to her by syringe when she wouldn't feed but it had changed to milk. Letdown, I'm still not really sure what that feels like but from what I have read, I may have felt it once or twice. Milk is not dripping but when I hand express milk squirts out from both breasts.

Yesterday afternoon we were home alone and had a bath together then skin to skin contact and she fed beautifully. She refused the breast the next few feeds and I gave her formula although I have cut it down to encourage her to bf more. I didn't express much overnight and early this morning. Today we were skin to skin again and she fed for about 25 mins in total on the breasts. She was still hungry about an hour later so I gave her EBM then offered the breast again but she refused. She was still hungry so I gave her 30ml forumula then another 30ml. She is settled again now so we will have to see how she goes. At least she goes on the breast sometimes.

I think we will just have to go day to day and hopefully things will get better. Still no sore nipples so that is good. Thanks again for your advice Barb.

[Barb Glare]

Hi,
Good on you. Well done. I think it will be important to stick to your LC and follow her advice. Have you considered using an SNS (supplemental feeding system) at the breast? Your LC would show you how to use it, and it will get your baby feeding at the breast if she is refusing. Usually it works pretty well with a younger baby, though you feel like you need extra hands when you first try it out. Many health professionals might have taken a more "wait and see" approach. Observed the baby and signs of your milk supply. Early formula comps do have a negative impact on breastfeeding.
Warm Regards
Barb

[Janie]

Gemma, it sounds like you're doing a fabulous job, good on you! It sounds like your milk is doing alot of the right things too. Skin to skin sounds like the way to go, it really helps us too when we're having a bad day.

If you can, consider Barb's suggestion of using a supplemental feeding system. I wish we had done it earlier on, it could have made a big difference for us. Maybe have a chat to your LC about it and see what she thinks. Apparently they're a bit of work, but can be quite effective at helping to increase your supply. And helpful in getting bub to the breast.

Keep us updated Gemma

[Gemma]

Thanks Barb and Sezjm.

The maternal health nurse is coming over today and she is also a lactation consultant. She is going to observe Jessica feeding which will be really helpful. I will ask her about the SNS, I haven't heard of it. Fed laying down this morning and she had a good feed. DH suggested nipple shields because she is refusing the breast a lot - maybe a last resort, will speak with the LC.

[Janie]

Gemma, if you go to the ABA website, go to breastfeeding information, then under supply there is some info about breastfeeding supplementers....that will give you some more info