Long Term Comp Feeding - How do you prepare yourself

[cheekymonkey]

I suffer with insufficient glandular tissue. I had a very difficult BF journey with DS. Stopped BF at 8weeks due to low supply and breast refusal and expressed till 4 mths until he would no longer take the EBM in a bottle, the ultimate rejection. I often wonder if I could have tried harder, saw different LC's used the SNS more, if I could have done better. I do no have an easy going baby, high needs, shocking sleeper, reflex and generally unsettled , so that certainly didn't help our situation. Things seemed to get sooo much worse when he stopped getting breast milk, but this did coincide with the 4 month mark which I know is when a lot of babies become more wakeful, however, he never really seemed to settle. I guess why I am re-visiting all this is I have decided that I will try again with the next bub, even though I know I will have supply problems again. I know that it will again be difficult, this time with a toddler running around. We are certainly not rushing back into it, we are thinking about a 3 yr age gap?? I know I am going to have to dedicate a huge amount of time to trying to make my next BF journey a bit more rewarding, in the hope that I can finally say, I'm proud of myself as a mother, which to date, DS is 10 months, I have never been able to say. I am starting to put a plan in place. I am going to see Dr Amir during pregnancy and see about natural progesterone and Goat's Rue and I also have an LC in mind to see and work with after the birth. I guess I am after any thoughts and advise from anyone who has comp fed long term successfully. How do you cope with Breast refusal? How do i prepare mentally for what I know will be a difficult BF experience, with a toddler in tow?

[Janie]

I just wanted to pop in here to remind me to come back! My son was long-term comp fed (still is really!), so I might be able to give you a few tips. It sounds as though you have excellent plans in place, especially seeing Lisa (I need to go and see her too, while I'm still lactating, as I suspect I may have the same problem as you, maybe even tubular hypoplastic breast/s).

Good on you for seeking help before it's needed I'll try to come back in here later today, or tomorrow.

[cheekymonkey]

Thanks Janie, your advise would be greatly appreciated, I aspire to achieve what you have

[Michelle71]

I too comp fed for most of our breastfeeding relationship until DS self weaned at 15 months when I was roughly in the 3rd trimester of this pregnancy. My right breast was the *issue* mostly so I will be working hard on feeding this time too.

Janie will give you lots of ABA AND personal advice from her experiences and training but for the generic stuff I can let you know what I did from my personal experience.

[cheekymonkey]

Thanks Michelle, what kind of bottle did you use? I used a Medela Haberman as I was told this would help stop breast refusal, obviously didn't work, I am open to trying something else next time. Congratulations on overcoming the hurdles and continuing to BF until 15 months, a great achievement, you must be very proud!

[Kmn]

Did you ever use or consider using a supply line instead of the bottles? That might reduce the breast refusal aspect of things.

[Michelle71]

I used avent bottles and mostly comp fed in the early days / months and then when I went back to work. I was expressing after each feed and once in the late evening we would do a formula bottle while I expressed again. We co-slept and fed frequently overnight. DS was a 2nd hourly feeder for the first 6 months so there was pleanty of breast stimulation but still some need for supplementation.

[cheekymonkey]

I found out about the SNS towards the end, very hard to manage,especially by myself, DS would pull off heaps during feeds with lots of crying, not sure if it was reflux or frustration, so while I understand the idea, it's better in theory than in practice. Apparently they are good for short term use, but not practical in the long run - I wouldn't have even been able to feed in public, and to be honest, I did find it a bit degrading. I will however be using it as soon as I have to start comping, hoping I can get my "maximum supply" in sooner before bubs needs increase, I still had colostrum at day 9-10 this time, so DS learnt very quickly that he wasn't getting a full tum on the boob. I expressed after every day feed and late night feed, there are details in the Feeding difficulties de-brief....

[Kmn]

You might find that if bub gets used to it when he/she is very new it is not as upsetting. I only mentioned it because Laranna, who is doing an incredible job of long term comp feeding (as far as one can tell from posts!) uses one.

[Janie]

Oh gosh, I don't know where to start LOL. I might pop in and out of here as I think of useful (I hope!) things to mention.

Going to see Lisa will be a wonderful first step. She will hopefully be able to give you a realistic idea of what level of breastfeeding will work for you and your baby. I'm sure you know that breastfeeding is so much more than food......but of course your baby needs to be nourished, so there are two aspects to this.

I would say that to get a good start you need to think about how things will go immediately after having your baby. Some lovely skin-to-skin time right after the birth, leaving all measurements etc until you and your baby have had some time to bond. Have a think about baby-led attachment. Have you heard of it? Your local ABA branch may have a video/DVD about it in their library. Not all babies 'take' to it, but for those that do it means a wonderful, stress-free start to breastfeeding, for mum and baby. Studies show that babies who first breastfeed using baby-led attachment often go on to have relatively easy and successful BFing relationships.

It is very hard to predict how things will be on that first day, I know, but if you can plan to be with your baby at all times, to not let other people handle him/her (except DH!) too much, and not to shower using perfumed soap etc for the first couple of days, those sorts of things may make a difference. Lots of skin on skin time, snuggling under a blanket! Babies are often sleepy in the first day or so after birth, but will then 'wake up' and start demanding some food. This is great, because all that sucking helps to bring your milk in. Try not to time feeds, or space them out - your baby will let you know what s/he needs.

Depending on what Lisa says, I would be aiming not to comp unless there are signs that it is absolutely necessary. You can always try to wean off it, but it is much easier to have never started in the first place. Be wary of hospital staff who just want you to give your baby formula - be armed with information so you can stand up for yourself and your baby. Be guided by your LC as to when you need to start comping, not by midwives who may not have the necessary time (or knowledge) to spend with you.

I'm guess what I'm saying is that if you work hard at it, and are prepared (which I'm sure you will be!) you may not need to comp feed at all, or very little. That by far would be the 'easiest' scenario in the long run. However, being prepared for the best way to go about things if you DO need to comp is a great Plan B I'll come to that next........

[cheekymonkey]

Thanks Janie, lots of good advice. DS had a good drug free birth with lots of skin to skin, I was the only one to hold him for a good hour and a half, they did measures as I had some fairly bad tearing that took about an hour (at which time, I then had the gas) to stitch (5 tears) at which time my DH took off his top to hold for some skin time to!! Also didn't use soap of deodorant or perfumes for a good week or so. The only thing we didn't do was baby led attachment which I will be looking into. I hope you don't mind if I ask you some questions about your situation, I can PM if you prefer.....

[Janie]

I don't mind at all, ask away! And I'm happy to share on the forums, you never know who it might help! Feel free to PM me if you prefer though I'll pop back later to go over what I found helpful/unhelpful while comp feeding.

[cheekymonkey]

Thanks Janie, do you have any idea at all how low your supply was?, I would imagine there is varying severity with this condition. I never actually got engorged, except when I stopped feeding, I know expressing is not a correct indication, but at full engorgement I could get out about 90 mls. Did you experience many breast changes during pregnancy? What was your comp method? How often and how much? Did you have to increase the volume of formula as her grew? Was is just a matter of 1 or 2 bottles for the extra calories or was your bub generally unsatisfied after most BF's? I guess I actually didn't find out what was wrong with me until I stopped attaching him every feed as he would just scream and scream and just refused. I was obviously working for a full supply, not trying to manage a supply that was at its best. Was there a point for you when you realised that "this was as good as it's going to get"? How did you know how much to top up, a big problem for me was only offering small top ups every 2nd feed as well as all night feeds, as I wanted him to work at the breast and he was labeled undernourished, anyway, there are details in the Debrief section. I guess lastly, how do you feel? I have had huge issues with self esteem, just feel abnormal and like I'm not "real mother" as well as the shame and embarrassment. This condition seems so rare, it really helps just to hear that I'm not the only one. Thanks for your help, you are an inspiration.

[Janie]

do you have any idea at all how low your supply was?
No, not really. I haven't actually seen an LC since DS was 12 weeks, and we thought at that point my supply was low purely because he was comp fed, if that makes sense. He was 5 weeks prem, so the hospital had him comp fed from birth. I don't feel that my milk really came in until he was 8 weeks old, but that was affected by other factors ie. being prem, being comp fed from birth!!!!! Um, the most I ever expressed was 40ml! 20-30ml was a much more common amount for me. 90ml is actually quite alot! Could you get that on a regular basis? I expressed around the clock for the first couple of months, then during the day, between feeds until 5 months. I was so sick of the pump by then I sent it back! And my supply was better than ever, I think because I was so much more relaxed about it, and had more time to breastfeed, rather than worrying about expressing.

Did you experience many breast changes during pregnancy?
No, not really any at all. I did however noticed that I could express a little colostrum from about 28 weeks.

What was your comp method?
Syringe and bottles in the early days, then bottles only. I didn't know about SNSs until DS was about 4 months, and I decided not to bother with something new at that stage (I was fairly exhausted!). I would ALWAYS, ALWAYS breastfeed first, and then comp. As time went on, and we tried to eliminate the comps, I would try to assess whether or not he needed the comp. That's where we ran into trouble in the early days, as he didn't demand food at all, so I thought he was getting enough, but he wasn't. t 12 weeks we hit breaking point, as the weight gain situation was going downhill. I spent a weekend in bed with DS, as suggested by Barb Glare, and he suddenly started to demand food! Trouble was of course, I didn't have that much to give him. That was the week we saw the LC. She helped me to realise that he did need the comp feeds, which took alot of the guilt away for me. That was when the breast refusal started, rather, bottle preference. That went on for 2 months.

BBL......

[Laranna]

Cheekymonkey - DS & I are also comp feeding and as kmn mentioned we have been using a supply line. Actually mine isn't even a proper supply line like the ones you get from the ABA. It's simply a NGT and a syringe to flush it out to clean. I mix up the formula as normal in a bottle pop one end of the NGT in the bottle and the other end in DS's mouth while he's at the breast.

Anyhow, we had to start comping at 12 weeks as DS started to lose weight. My supply had dropped off - I finally found a good LC who discovered he had a weak suck. In those first 3 months we were feeding 2 hourly round the clock PLUS I was expressing after each and every one of those feeds, just to get enough EBM for one feed! I could only ever express 10-20mls at a time. I think the most I expressed was 55mls and that was after I started taking motilium and it was in the morning.

So, we started at 100ml comps after every feed. It wasn't long before DS didn't need to feed so many times and once he started sleeping through the night (around 4.5 months) we were down to 5 feeds during the day and we've now just started to go to 4 feeds a day.

Like Janie, I packed away the pump about a month ago. I have another post somewhere about my strategy to eliminate the comp feeds. But, as soon as I packed away the pump, I felt relieved and less stressed about it all and I think my supply picked up because of it. With the supply line and expressing and taking motilium and fenugreek, I have been able to reduce the comps from 100mls to 60mls.

We have gotten rid of one comp feed as of last week! DS's first feed of a morning is just breast, no comp. It's taken us 4 months to get there, it's a long slow process but we are getting there. I'm taking it feed by feed. Even when DS finishes a comp and he's still hungry, he will go back and root for the boob He knows where they are.

We've just been going through some breast refusal too, but it seems to be getting better.

I feel like my post is a bit over the place, but if you have any questions just ask!

[Janie]

How often and how much?
This varied depending on what was going on with his weight gains, and later, depending on what he demanded. I always erred on the side of waiting and seeing, rather than just jumping straight in with the comp.

Did you have to increase the volume of formula as her grew?
Yes, but only to a certain point. I think by about 6 months (don't quote me on that) he was having 180ml of formula, maybe four times a day? He never really had more than 180mls. He still has bottles , but now that he's no longer on formula, I can just give him however much it seems he wants/needs, which is usually about 180mls.

Was is just a matter of 1 or 2 bottles for the extra calories or was your bub generally unsatisfied after most BF's?
In the early days, yes it was a matter of 1 or 2 (or 4 or 5!) bottles to help with the weight gain. But as he grew older, and knew how to be hungry, he started demanding bottles after every BF! I was very pleased when at about 9 months he decided that BFs only was okay during the night.

Was there a point for you when you realised that "this was as good as it's going to get"?
Um, yes, but it was probably at about 10 months . I was very stubborn with this BFing caper, and I was also determined to get rid of the comp feeds. I had hopes of doing so once we started solids. The problem was that once he developed the bottle preference it was very hard to get rid of them. By 6 months he LOVED boobie, but he also LOVED his bottles, so even if he didn't need them for food, he was used to them being part of his routine. I took Motilium from 2 months to 10 months (weaning off it SLOWLY from 8 months). Once I finished taking it I was so pleased that we were breastfeeding ON OUR OWN that I just accepted that this was the way things were. By 12 months I was totally cool with it all. It did take me awhile though, it really used to eat me up that he had to be comp fed. I'm glad I got past that

How did you know how much to top up
This changed on a daily basis. There were some feeds where I knew he'd have the same amount every day. But others would change all the time.

how do you feel?
Mmmm. Now, I feel great about the fact that we're still BFing. I recognise that I did all I could with the information I had at the time, so although things weren't perfect, I couldn't have done anymore. I feel pi$$ed off with some of the health care professionals who led us down this path, but I'm slowly forgiving them I do feel proud of myself, because it would have been so easy to just call it quits, but it wasn't what I wanted, I never gave it a thought, as BFing my son was so important to me. A year ago, I felt guilt that maybe I'd starved my son, I felt crappy every time I sterilised the bottles, I hated giving him a bottle in public, cos I was a breastfeeding mummy! Meh, I'm over all of that now. TBH, I'm so busy with my DS I don't have time to think about it anymore. It's such a big focus when they're little, because feeding is such a big part of their lives. But my DS is so busy with his little life now, that although he loves his boobie still, he doesn't spend too much time on it. As for how I feel about me.........I don't like my boobs, I'm very lopsided. We don't bother feeding with the right one anymore, haven't done for aaaaages. But I would have been lopsided anyway, as the right one is my 'dodgy' one. I feel a bit crap that maybe I'll never be good at nourishing my babies, but you can only deal with what life throws at you. So I'll just do my best to give my babies as much breastmilk as possible, and try to leave the guilt out of it. FWIW, this condition may not be as rare as you think. I found a great website once, I'll see if I can find it for you.

Better go to bed now! BB tomorrow.

[cheekymonkey]

Laranna - thanks for the advise, the NGT sounds a lot easier than the SNS, I had to have both boobs out, sticky tape everywhere with a bottle around my neck and he would pull off so often that formula would just go everywhere. Is the only reason for your supply problems bubs sucking technique? Congratulations on your achievement, you must be very proud.

Janie - Thanks for sharing, your honesty means a lot. I too feel a bit "cheated" by the professionals, as well as friends and family. I saw several LC's, GP's and was encouraged to give up by all of them, "you will have milk every where with your next one, some people just don't make much milk". That was not good enough for me, I know there must have been a reason and I needed to know why. I feel quite stupid as I told everyone that I would BF, I was working so hard and it would all pay off, all the drugs, pumping frequent feeding, these things should have worked...... Our breast refusal started very early on, he was so tiny and he would just scream and scream and scream, I felt like I was torturing him. I went to a family unit I went to when he was 6 wks to get some support and I was told by a psychiatrist that I had a session with that I was putting my need to BF him before his needs, god did I feel guilty. I wish I hadn't listened to them, but nobody would support me to keep going.

How did you cope with the breast refusal? I would have done anything to keep going, to give him some Breast milk, but that was the one thing I couldn't find an answer for.....

I had a debrief with a LC (Margaret Callaghan) recently, I wish I had seen her when I was still BF. She was helpful and she was the only LC I had spoken to that had experience with IGT.

Do you know anything about Goats Rue and natural progesterone, apparently they are said to grow glandular tissue...... I think I have seen the website that you mentioned, with all the photos, there does seem to be more "severe" cases than me, I do however have the characteristics.

[Laranna]

The last LC I saw believed my supply problems were due to DS not sucking properly. It took me 10 weeks to find that out! I had seen 2 LC's prior to that (IBCLC too, mind you!) and they both said he was attached perfectly, text-book attachment they said, therefore he must be sucking properly. This last LC I saw tested his suck herself with her own finger and knew he had a weak suck. She also checked his head, neck, shoulders, posture as this can sometimes affect bubs feeding. I wish I had found this woman in the earlier weeks as we probably could have fixed it sooner and not needed the comps.

I hear you on the sticky tape etc, very tricky to manage. TBH, lately we have just been using the bottle for the comps just because we've been out and about a fair bit. DS is still taking both bottle and boob quite happily, it's just sometimes he likes to have the bottle first which I ALWAYS make him wait until he's had a decent time on the BOOB FIRST.