Long Term Comp Feeding - How do you prepare yourself

Margaret is excellent, she was my LC :D I hope she was helpful. Just out of curiosity, how did you hear about Dr Amir? Who recommended her?

No, I haven't heard alot about Goat's Rue, or natural progesterone. Have you heard of Diana West? She's an LC in the states who has particular interest in low milk supply, and BFing after breast surgery. It was at a seminar where she was speaking that I first heard about breast hypoplasia and thought - 'that's me!'. She has a website, from memory, that has some information too. Try googling 'low milk supply'. I will listen out in ABA circles about the goat's rue etc.

As for the breast refusal, well I don't like to think about it much. Pretty much the only way he would feed was lying down, or standing up. It wasn't total breast refusal, but it was pretty bl00dy hard to get him to feed most of the time, he would just scream :(. I just did whatever worked, which wasn't alot. He went from happily sucking for 30 mins per side, to me jumping for joy if he attached for longer than 1 minute per side! Fortunately, it passed, and just in the nick of time I think, I suspect I wouldn't have been able to hold out past 6 months. But by then things had well and truly settled down.

I'm sorry you were so unsupported, it sounds as though you were terribly let down by the unit you went to :hug:. Are you a member of the ABA? I would strongly suggest getting to know your local ABA group before having you next baby, maybe sometime while you're pg. Having that support network already established will make things so much easier for you if you do run into problems next time. Yep, having an LC lined up is fantastic, but having that awesome mum to mum support is really important too. I know I will be relying on it heavily!

I'm assuming you're also in Melbourne, given that we know the same LCs :) Whereabouts are you? Feel free to PM me if you don't want to say on the boards.

cheekymonkey, I thought I would also answer all the questions you asked of Janie as I thought you might get something out of it....


do you have any idea at all how low your supply was
I couldn't really tell, although it was really difficult to get my head around the fact that how much you can express is not indicative of supply. I've only ever been able to express 10-20mls at a time. The most I've expressed was 55mls.

Did you experience many breast changes during pregnancy?
Only an increase in bra size, otherwise they looked the same, felt the same, had no early leakage or anything like that.

What was your comp method?
First fingerline feeding with the NGT. This was our "suck training" to teach DS how to suck properly. I would put him to the breast and as soon as he fell asleep or started to "dummy" suck, I would take him off and put my index finger with the end of the NGT in his mouth. He had to suck properly to draw the milk through the tube.

We were doing that with EBM 2-3 times day, then when my EBM stock ran out and I had to start formula I just decided to keep him at the breast and stick the tube in the corner of his mouth after he'd been at the breast for a good amount of time with a good amount of active sucking. This also stimulated my supply a lot more.

We use bottles when we're out and about.

How often and how much?
How did you know how much to top up?
I had to start with 100mls after every breastfeed. We started this at 12 weeks. DS weighed just 3.47kg at that time and he should have weighed around 5.5kg if he had followed his curve. So, that's how we worked out how much. He was having about 8 feeds a day then, so I used the calculation 150mls x weight / number of feeds per 24 hours.

Did you have to increase the volume of formula as he grew?
No, the paed told me I would have to but we didn't. I expressed like crazy, took fenugreek, motillium and by the time of our next appt, I had reduced the volume of formula down to 80mls :)
We are now down to nothing after the first morning feed and 60mls after the other 3 feeds.

Was is just a matter of 1 or 2 bottles for the extra calories or was your bub generally unsatisfied after most BF's?
This was the confusing part for me because I thought DS was generally satisfied after feeds, he was reaching his milestones and having wet and dirty nappies. He wasn't sucking strongly enough to get the calorie dense milk so for us he really needed the extra calories and needed them quickly.

Was there a point for you when you realised that "this was as good as it's going to get"?
Yep, I have just got to this realisation and am accepting that yeah I am still breastfeeding. At first, I felt like a cheat and a liar to call myself a breastfeeding mother. But a breastfeed is a breastfeed no matter what else they have with it.

Like Janie said, when I had to start comping I was absolutely determined to get rid of the comps. I still am, it's one of my goals but I'm ok if it doesn't happen now because I know I've tried my goddamn hardest to get this far and have done everything in my power to make it work the best way we know how. My main goal is to breastfeed to 12 months. If that means we are still comping as well, then so be it. We'll still be breastfeeding and eating solids and maybe having FF comps.

how do you feel?
I feel a lot better about it now but at first I was determined to exclusively BF until 6 months, we got to 3 months and DS started losing weight. Once we started topping him up, I saw how full and content he was and I felt soooo guilty and worried that I had been starving him and felt like a complete failure. I felt like my body failed me. I birthed a child, I am supposed to be able to nourish him properly but couldn't.

It's taken me until recently to get my head around this and be proud of what we've achieved. Sometimes I still have to remind myself. I have my Breastfeeding Goals stuck up on my fridge which I can see from my feeding chair and I look at each month crossed off so far and it helps me see how far we've come. I feel proud at every CHN or paed checkup to say that we are still breastfeeding as most assume once you start FF, it's the beginning of the end. But it's not, BF and FF can be combined successfully, just look at Janie and myself.

I was the same as Janie and felt embarrassed feeding him bottles in public. I would much rather get my boobs out for the world to see than give him a bottle in public ;) so we would always feed in the parenting rooms at the shops. Now I just do both wherever, whenever and I've never had anyone comment.

I know our causes for low supply and BF'ing issues are different but I hope some of this info will be helpful to you (if not others reading this forum).

Thanks Laranna, even though or supply issues were for different reasons, the all f your information has been great, I think I will be using your comp method next time, I guess the real hurdle is Breast refusal, we can do the feeding, pumping, sterilising, comping, but when it comes down to it, babies aren't stupid, they know it's much easier to get it from a bottle all the while further compromising your supply. I am also embarrassed to feed in public, much easier now he is only on 3 feeds.

Janie - Yep, I have seen Diana West's site, would have been great to hear her speak. Goats Rue is a herb said to grow glandular tissue, obviously the problem being "storage". I have done a bit of research, and you can take it at about 36 weeks gestation. I think natural progesterone does a similar thing, I am hoping to use both when the time comes. I will also be joining the ABA, I won't now as I am not a BF mum :cry: so I would feel like a bit of a fraud......

Ummm, I think I heard about Lisa from the Lactation clinic where I did a day stay at the 4 wk mark, I called them back when I realised I fit the bill for IGT to see if they had seen any cases and how I would go about getting a diagnosis. I tried to get in at the time as I was still expressing, but she was on leave and they were not taking appointments at that time.

I guess you could say that everything went kind of dark at that time, DS would scream and refuse every time I offered him EBM, and the thought of having to "hide" it in formula was just devastating. The realisation that I was unlikely to ever achieve a "successful BF journey" was pretty much rock-bottom for me. So I packed up my pump and stopped taking the motillium and that was that. I still hopped in the bath with him every night and try and attach him when we were both relaxed, but that of course didn't last long, DS is one smart Cookie and he has never been soothed by BF.

Well DS is finally asleep, so I am off to bed.

One thing I forgot to say was that whenever we use a bottle I use the newborn, slowest flow teats. DS is still on the newborn ones. I figure he should work just as hard at the bottle as he does at the breast. Of course it's still easier, but not tooo easy!

I knew I forgot something!

We stuffed around for ages with different bottles.........by far the best one (for us) were the Pigeon, but most importantly with the Pigeon peristaltic teats, either the 'S' (newborn) or the 'Y' (variable flow) teats. Anything else was just too fast and heightened the breast refusal. It was quite amazing to see the direct link - the faster the bottle flowed, the more he preferred it over the breast. So yeah, which bottles/teats we used was a big consideration.

BTW, we never upgraded his teats, he has ALWAYS had the newborn flow :lol: Even though he has a real booby boy for ages now, I never wanted him to think that the bottle was better ;)

Have you guys heard of the Medela Haberman feeder? I always used it on the slowest flow (variable teat) as a LC at the hospital told me that normal bottles even with slow teats are too fast. That said, It didn't stop the breast refusal.....

Laranna - Sounds like your problems have been situational, there's every chance you will not need to comp with your next bub. Yay!

Janie - I guess ultimately our aim would been to hold off on comp feeds as long as possible, do you have a plan of attack? When/If you need to introduce top ups would you use bottles or another method?

I thought that Haberman feeders were for babies who can't suck properly (i.e. have cleft palates or similar problems). If your little one can suck properly I would have expected the newborn teat to be fine.

Yeah, that's what I thought, although I didn't know at the time, I just did what I was advised to by the LC, I guess if it's a suck training kind of thing, ie. they really have to work to get the milk so they don't go off the breast......

I've not heard of the Haberman feeders, maybe it could have been useful for us....we had our own workaround with the NGT and finger feeding to get the suck improving. DS didn't have any physical probs, he was just not strong enough.

CM - I certainly hope we don't go through these probs with the next bub! Give me cracked, sore nipples any day over the troubles we went through!

I know laranna, I wish my problem was cracked nipples, that I could have delt with.

CheekyMonkey~ You may not be reading this anymore but I am in search of answers for my own low milk supply and wanted to know how you were diagnosed with IGT? I noticed in another post that you mentioned you had an ultrasound revealing normal glands, but I noticed you received a diagnosis. How is insufficient glandular tissue diagnosed?

A brief account of my story:
I had my first daughter last year. I experienced some breast changes (i.e. tenderness, nipple changes, some change in shape (breasts more full), but not a huge increase in size during pregnancy. I did not experience engorgement after birth, and struggled to establish a supply. We started supplementing at about 4 weeks because it was apparent my little girl wasn't gaining. There are multiple issues that may have affected breastfeeding, including my little girl's weak suck, though perhaps this was DUE to my low supply rather than the other way around. I worry that IGT might be something I suffer from as well. My breasts don't really look like the pictures I've seen, but maybe that is not something immediately apparent. Where do I go to find out? I really want to have another child, and like you, hope this next BF experience can be less traumatic for both myself and my baby. Thanks for any insights you can provide.

Farella - I made contact with a good LC, she said that the ultrasound showed normal glands for the size of my breasts, but not for normal lactating breasts. A lot of GP's know very little about breastfeeding. When the GP told me the scan was normal I asked if there was enough glandular tissue to feed a baby and he couldn't give me an answer. Someone like Dr Lisa Amir (in Melbourne) is a doctor specialising in Breastfeeding so I will be seeing her before I embark on my next breastfeeding journey. My breasts don't look exactly like the pictures (the severity varies) but the general characteristics are there, small, uneven, widely spaced, kind of cone shaped. Are you still lactating at the moment? It would be a good idea to see a good LC. I believe that if your bub has a weak suck, this is a probable cause for your low supply though, which means it may not be the case ext time around. Hopefully the other girls in this thread will pop in and share their experiences.

HTH

Cheekymonkey~ Thanks so much for your reply. I am not currently lactating, but I'm in the process of trying to find a good lactation specialist so that I can be prepared for possible problems next time around. It is so frustrating to struggle with breastfeeding and not know why, and there are so many factors that cause things to not go as planned! Let's hope we both have much better breastfeeding experiences with future babies!

I wish I had searched for this earlier, but I am still comp feeding at 7 weeks. I am about to see an LC as I have fast let down now, yet I started with what we thought was a low supply, after an emergency caesar.

All the best with the LC em2. Hopefully she can help you guys out.

I spoke to the LC over the phone for free which was really kind of her to do so.

Basically we've done almost everything, at the moment the issues are that I have a fast let down but low supply. Some days he gets up to 500ml of NAN HA 1, but not every day.

So that was reassuring to know that I've done my best. I also got some more tips on comping from an ABA counsellor via email which are useful, and I would paste them here but she's put our names in the email so it would take some editing.

I've decided to keep comping and see what happens. Stress is a big impact on my supply though, it becomes even more watery.