What else can I do to eradicate formula top ups?

[emmjayt]

Sorry, this is a bit of an essay.

DD was born at 38+1 by scheduled CS at the end of April. She was latching on really well in recovery and taking colostrum well.

My milk hadn't come in by the time we left hospital and due to jaundice I was sent home with strict instructions to wake her to feed every three hours, then top her up with EBM, give her formula and then express. I'm not sure which of us was more miserable in the week between discharge and our first office visit to the MCHN. It's definitely not a great way to recover from a CS.

My milk didn't really start coming in until she was nearly 2 weeks old, and supply has never been huge. I wake up most mornings with a leak on both sides but I've never really felt full or desperately uncomfortable and needing to feed. I've never felt a let down either. Feedback from 3 MCHN's and Mum (a retired midwife) is that our technique is good. My MCHN suspects I have tubular breasts.

So far:
-We've been consistently switch feeding
-I've been expressing as much as I can, but have never got more than 10 mls from both sides after a feed
-Lots of skin on skin cuddles in bed and in the shower
-Lactation cookies
-I've just started on motillium to see if that helps
-Always offering the breast first
-I've called the ABA hotline and now have the details for my local support group

On a good day, we'll only top up with 200 mls formula through the day. A bad day 500 mls. Bad days tend to be the days she savagely objects to day sleeps.

At 12 weeks, DD had gained 2.1 kgs from birth, and is sitting in the 75th percentile for height and 50th for weight. Now at 14 weeks, she's a mostly happy, switched on girl who is doing 5 - 6 wet nappies a day and pooing every couple of days.

Any suggestions on what else I can do to get rid of the last bits of formula and keep DD happy, satisfied and well nourished?

Thanks

[Kmn]

The first thing I want to say is good on you for getting as much BM as you can into your daughter.
You may be able to continue exactly what you are doing, and in 2 or 3 months her milk needs will actually decrease slightly as she begins to have other food - so in effect you end up replacing formula with food.

Otherwise feeding her more often may be the key - don't top up after every feed any more; instead, feed as often as you possibly can during the day (even if it ends up being hourly) and see if you can condense your top ups into a couple of larger bottle feeds (perhaps late evening and middle of the night).

"The breastfeeding mother's guide to making more milk" has been useful for some people around here too.

I also want to add that around now many Mums find that their babies act as though they are suddenly being starved. Keep doing what you are doing and that phase should pass - please don't assume that it is indicating that the supply you have is disappearing.

[emmjayt]

Thanks for the support and suggestions.

Yesterday ended up with three top ups - after the second, third and last feeds of the day. On the plus side she is taking longer to drink the bottles - she would inhale them in 5 minutes but is now out to about 12 minutes.

She's just finished her first feed of the day - it is generally her fastest feed and I haven't needed to top her up afterwards for about a month. If the last few days are anything to go by, I'll be feeding again in an hour

[Barb Glare]

Hi,

I wonder, how many times is your baby feeding in 24 hours? Both breasts at a time or one? Most babies need at least 8-12 feeds or more in 24 hours, but many mums are advised by friends and family and even health professionals that baby shouldn't be feeding so often. Most babies have an irritable time of the day (often in the evening) where they just want a cluster of feeds. This is completely normal baby behaviour, but some-times it's read as 'she's hungry and I don't have enough milk = top up) Be prepared to feed her frequently. If you can grab a few days where you can just stay at home and feed her whenever she want it will do fabulous things to your milk supply. Kmn's suggestion is a good one too.
Try to keep a lid on the formula - try not to let the amounts go up and up. Whatever way you slice it up you are doing a great job - you have a breastfed baby

[Bloom]

Emmjayt - I too have tubular breasts and have not been able to exclusively feed either of my two boys. I just wanted to say you are doing a fabulous job and that I know it can be really hard.

I found that it was difficult to judge what was just normal newborn unsettledness and cluster feeding vs genuinely hungry. I also found it stressful counting the number of wet and dirty nappies and tracking the weight gain/loss.

To be honest one of the hardest parts was dealing with probreastfeeding advice too (which I think is totally fantastic generally) BUT what will work for 99% of the population who can exclusively breastfeed doesn't mean that you will be able to exclusively breastfeed. I know that is what you are hoping for, but any amount of breastmilk is beneficial for baby.

Many people confuse what is a genuine physical inability to produce enough milk with a low supply that can be corrected with changes to attachment, feeding times etc. You are doing everything that I was told to do to get as much milk as I can into my bubs.

It may be worth while to see a lactation consultant again - you might be able to see one through your child health service or similar. I found that my visit at 3 months was reassuring in that they told me I was doing everything I could. It would be worthwhile to try and see one you saw earlier as they are more likely to believe you.

[Three Graces]

Hi Emmjay,

I had the same issue with DS1, however, he got to the point where he didn't stay on for b/feeds b.c the bottle feeds were 'easier'. For him, not me I never got much from expressing either and having to do combo feeds is exhausting. Motilium increased my milk, but I don't think you're meant to stay on it for long and my issue was that he didn't stay on long enough to create the demand himself. There's also a smelly herb called Fenugreek from the health food store that you can take to increase your milk. You need to take a few/day and they're not the best smelling things. Make sure that you're also eating and drinking lots.

With DS2, he was born a whopping 4.7kg (a chubby face, full of fluid for being in so long!) and I couldn't be bothered doing it all over again, so I just put him on the boob and he dropped down the percentiles. He fed, slept well and did put on weight, just not enough to keep him in the 90%. He's now in the 10-25% and is fine. A paed I saw said that some babies have a catch up and some have a catch down and not all heavy bubs at birth will continue to be big. He never put on the recommended amount/per week and I think being a second child, the MCHN didn't give me as much grief, cos you know, I'd already churned out one kid who turned out normal

I was also going to suggest just putting DD on as many times as needed, which will increase your supply at the same time. We did this when we got home from hospy with DD in May as she had lost too much weight. At the moment, all the kids are sick and DD isn't sleeping that well, We're doing feed,play, feed, sleep routine. She's mega fussy in the late afternoon/early evening and even though I feel empty, she must be getting something from the several boob feeds at that time.

[Kmn]

Just to give an example of how variable babies feeding can be. My son would feed at 7 and then go back to sleep. Then feed at 12,2,4,5,6,7,8,9,10,11 and midnight. I had a monster of a supply - most of those feeds wouldn't even finish one side, but it was how he preferred to "eat". You may find that now your daughter isn't so tiny and vulnerable letting her set the pace helps you work it all out.

[onthefly]

I don't have any advice, but just wanted to say well done on your hard work and congrats on your baby. You're doing really well And I wish you all the best with cutting out the formula

[Cass72]

Most babies have an irritable time of the day (often in the evening) where they just want a cluster of feeds. This is completely normal baby behaviour, but some-times it's read as 'she's hungry and I don't have enough milk = top up) Be prepared to feed her frequently. If you can grab a few days where you can just stay at home and feed her whenever she want it will do fabulous things to your milk supply.

With DS1 I bowed to pressure because I "didn't have enough milk" and gave him formula. With DS2 I was much more informed and had a wonderful MCHN (who was also a lactation consultant) and we successfully breastfed for nearly 14 months - I was aiming to get to 6 months!

During those times when my LO wanted to cluster feed I practically had my boobs out all day so he could just feed, feed, feed. This would go on for about three days at a time then he would slip back into the more regular times of feeding.

BTW, some awesome advice on this thread ..... you ladies should all pitch in and write a book!

Oh and, need I say it? I think you're doing a wonderful job!!

[k4t]

No advice but just wanted to post as your situation sounds similar to mine in some ways. :hugs:

DD is only 2 weeks old but I'm struggling with supply issues. She is not back to birth weight and only gained 5 grams in the last three days after losing weight the first week we were home. She does seem to be generally settled and has plenty of wet/dirty nappies. She was never jaundiced and has always been happy to feed as far as I can tell but we also went home with advice to feed then top up with EBM and formula. I had a day of expressing with no breastfeeding while in hospital due to nipple damage but insisted on putting her back on the breasts before we went home. (Attachment issues are fixed now and nipples healed.) My milk took over a week to come in even with motilium. DH and I stopped the formula top ups within two days of being home as we were never convinced she was really hungry just unsettled in the evening as many newborns are. We also stopped using bottles and syringe feed her EBM if we do top her up. I've tried to pump between most feeds but had a lazy stretch for a couple of days after I thought my milk had come in. The same as you I average 10ml per pumping session. I'm really hoping to avoid formula top ups as I can see it being a really slippery slope to the end of breast feeding.

How do you decide when/how much formula to give? I find it so hard to decide if it's a normal evening grizzly few hours or if she's hungry.

Massive congratulations on what you've achieved so far. All that expressing and topping up is a heap of work and you're doing an incredible job.

[emmjayt]

Thanks everyone, I'll be back later to reply properly to you all.

k4t, that's a really hard one to identify. DH actually worked out that when she was hungry her crying sounded like she was saying A but when she was grizzly it was more like an E. Mothers group and going through the hungry, tired and satisfied signs really helped too

[Kmn]

Emm,
I've been thinking about this, and if I were you I would stop expressing now. It's important early on, if baby isn't sucking strongly enough to stimulate your supply. But now it would be better to use the baby rather than the pump - she will get more out anyway. And I would also use yourself as her "dummy" - lots and lots of babies like to suck on a near-empty breast. It increases milk supply and comforts them, so everyone wins (assuming that her attachment isn't causing you damage or distress).

No one has a supply that varies by 300 ml from one day to another (unless you are pregnant or taking sudafed or there's something very funky going on) - that's over 1/3 of what she needs. So at least some of her "hunger" is just a desire to suck rather than a desire for food.

[HotI]

i like Kmn's idea. my dd was a slow grower, and i would feed her and then 'top up' 30-60 mins later by offering the breast again. much nicer than pumping, and often more efficient.

[emmjayt]

Thanks everyone. We've had a really odd day here today - I was awake and leaking by 6 so ended up pumping to stop the leaks. Just as well cos DD didn't wake up until 8. She'd slept from 1030 last night!! Her breakfast was both sides, 30mls of EBM and then 50mls of formula. A very hungry munchkin.

We don't have to do anything or be anywhere tomorrow, so my plan is just to spend the day with her, feeding and lots of skin on skin. DH has just said there will be leftovers from dinner I can just reheat for lunch so that solves that challenge.

[emmjayt]

So many great ideas - thank you all

[onthefly]

Hope you have a lovely feed-in!

[Barb Glare]

KT4 - you need to see a lactation consultant! Tell me, how many breastfeeds does she have in 24 hours? Both sides? or just one? What have her wet and dirty nappies been like (colour/quantitiy - esp poo) What kind of pump do you have? How was the birth? Do you have any pre-existing medical conditions?
You need a hand there. If you tell me where you live I could suggest some-one - PM me if you like!)

[Ladylove]

I think maybe try stopping the top ups too. See how often she asks for milk without the top ups, and if she feeds more often that's a good thing as it will tell your boobs to make more milk and in a short while (ideally) she will be getting all she needs from your boobs. Alternatively you could still express after feeds, or every other feed, to help boost your supply but don't give it to her- freeze it for a 'rainy day'.

75th percentile is amazing- doesn't that mean she's bigger than 'average'? So it hardly sounds like she's struggling