She has been told to feed the baby on the shields, but she will only take about 10 minutes on each side, but the baby is constantly coming off and on and not happy about it. Apparently she suck for a bit and then just come of and then she has to put her on again. Etc. how can she encourage the baby to stay sucking?
The LC has also told her to express each feed as well, plus top up with formula. Apparently the baby needs to get 90ml with each feed. I mentioned to her that if she was solely breastfeeding that she wouldn't have a clue how much the baby was taking. When she expresses she is getting 50ml, so they completely discount the amount the baby may have gotten from the Breast and then get her to top up 40ml of formula. My friend is only offering her the formula, if the baby rejects it she lets it go.
the baby put on 90g in a day yesterday and she has lots of wet nappies (about 8) and about 6 poo nappies.
I suggested to her last night to maybe try and drop the formula today and just increase the frequency of breastfeeding to maybe every 2 hours during the day to see if that helps her. At the moment she is only feeding 4 hourly, but obviously the baby is getting a decent quantity of differing milks. Do you think that's a good idea or should she stick with the process she was doing?
The main problem is the baby not continuing to suck. I never had this problem so I am at a loss. Suggestions please.
The not sucking I'm not sure what to do, just wanted to say my DD2 did this. We don't know if there was an underlying cause (very possible with breathing issues that were picked up later) or if that was just her thing but every feed until about 8 months was on off on off on off. In the early days she was just too tired and would run out of puff (IUGR baby) but then my supply came in with full force and after awhile I knew she wasn't too tired any more, but she continued with the on off thing. So I guess I'm saying that the continual stopping might just be how it is at the moment and maybe for the time being work on other issues and see how this one pans out once baby is a bit older and stronger?
As for the formula top ups, I had to do them as a result of the IUGR and it really is the hardest thing to judge how much and when because as you say you have no idea how much they get from the breast to know how much to top up!?! So what I was doing on leaving hospital (as directed by my LC) was every feed went BF, EBM or formula top up on demand - as in I always offered the EBM/formula and she either took it or didn't, and she dictated how much she took - then expressing (in that order). Feeds were every 3 hours around the clock when still it hospital but I went back to demand feeding pretty soon after getting home and she just stuck with 2-3 hours from then on. I found after a few days at home she didn't want any top ups so I gradually stopped offering and stopped expressing.
When you say she is feeding every 4 hours is that a routine thing or baby is demanding every 4 hours? If it is a routine think I would maybe try cutting it down to 3 hours and see if that makes any difference to the top ups the baby requires.
If the baby is demanding every 4 hours I'm sitting on the fence as to what to do. When they got me to routinely wake and feed DD2 every 3 hours it felt so unnatural and her and I were both against it (!) but in hindsight it did help us through our crappy feeding start so that tells me the idea has merit (especially with a tired IUGR baby), but on the other hand I am always going to have reservations about interfering with the supply demand thing that works so well. I guess she could always give it a try (waking and feeding every 3 hours) for a few days and if it doesn't change anything go back to demand feeding with top ups?
90mL!!! That's loads!!! So the LC is assuming baby gets *nothing* at the breast?
How does your friend feel about all this? Is she wanting some other ideas? I'd suggest giving the ABA a call and/or getting a private LC in to have a chat about what's going on. She really needs one-on-one advice, because there's clearly a lot of stuff going on here.
Feeding more frequently during the day may be a great idea. Four hourly is pretty unusual, but if baby isn't asking more frequently it might be because of the formula. Whereas, if that is removed (and 40mL is quite a lot, really) then baby might simply feed more frequently to make up the difference. UNLESS, baby isn't feeding effectively at the breast. Which is something that needs to be assessed by LC and help given to mum and baby.
Skin to skin and laid back nursing may help with the sucking issue. has baby been assessed for ties? Also, she may need little extra help after traumatic birth, separation from mum and bottles early on. She probably just needs some more time. Laid-back nursing is good for this, also. And, an LC
It's a bit hard to offer useful info at this remove. Suggest your friend seeks more professional help. Just because an LC has said this doesn't mean another LC mightn't also have good suggestions for her.
Oh how hard for her! And baby Offering a breastfeed less often than 2-3 hours at this early age and considering the need for top ups seems odd to me, even 3 hours is a long time between refs if she is wanting to build supply and get a good BF relationship going. But she and babe have had such a rough trot, any number of issues or combination of issues could be causing this. Maybe another LC. Is the current one an IBCLC I wonder?
So she is visiting the LC again today. Just spoke to her, apparently the baby is taking about 2 hours on the Breast now and still coming off screaming and wanting more. She then gives it ebm about 30ml and its happy. She said she's feeing about every 3-4 hours.
I have suggested she feed it every 2 hours at least but don't keep it on so long otherwise she will get more sore.
The poor thing has had more problems. She has been trying to exclusively bf the baby, but the damage was taking a while on one side so she was pumping that side and bottle feeding it every day or so to let it recover.
Then last week she ended up with mastitis on the side the baby was feeding properly on. She had a course of antibiotics, but the lump didnt go down. it actually increased.
Yesterday she had a follow up at the gp and the gp sent her to the wch. They have diagnosed her with an abscess 10cm by 12cm! (i did point out thats the size of a normal person breast haha...poor thing) so now she was in overnight while they try and get her in for it to be surgically drained.
the poor thing. she says she hates breastfeeding. She is just trying to continue because she knows its best.
They think the abscess may have been from when she was damaged by the nursing staff hand expressing. Im guessing a bug from their hands may have gotten into the damaged nipple and found its way up.
this thread brought up a few thoughts when i read it all again, but probably not all relevant to her right now. I'm really sorry she has had such a rough time, and it looks like some of it was unneccesary.
Anecdotally, my 3rd child often fed for very short times (3 minutes, 5 minutes..), and i was so confused because the older kids fed for an hour or 30 mins in the first few months. i kept wondering what was wrong, but she was getting enough in that time and was happy and healthy.
Breast compressions while bub is feeding can help increase transfer of milk, and help baby if they forget to keep sucking. Nicer for mum too, to keep baby at the breast rather than putting baby down and then expressing with a pump.
It is harder for breasts to regulate if you add in expressing, and your poor friend seems to have copped that now too. When she is home, you could gently suggest nice things for mum and bub to do to reconnect. A big bath and cuddles can be lovely for mum and bub. Lots of skin and skin and checking each other out. with no pressure to breastfeed, but it might happen. Best if you have Dad or someone who can help set them up and take baby out when mum wants a solo soak or wants to get out. There are herbal bath mixes that you can buy.that are good for this.
A day or two in bed, with no visitors except close people/partner who bring food and love with plenty of skin to skin and eye gazing for mum and bub can be another way to just help her feel good with baby.
Oh that's rough! she's doing a wonderful job under extremely difficult circumstances.
It sounds like maybe baby is not feeding very effectively :/
I hope she's got lots of help and support at home.
That's exactly it otf. The baby isn't attaching well, but they don't seem to be able to improve attachment because of he size of her breast. She has literally fun out of bra sizes now, and she is only a small girl, like a size 8.
They are syringing out the pus ever day. So far she has has 100 ml on the first day and 50 ml each of the 3 times after that. They say that there appears to be a thicker type of pus in there and that's harder to remove. Also because there is no blood flow there it's harder for the antibiotics to work.
The Breast specialist has said they'll keep doing this for about 3 weeks. This is meant to be the more Breast feeding friendly option, apparently if they do the surgery like they initially wanted to its a 10c opening and they tell her it would be nearly Impossible to continue feeing because of how much would be coming out the hole.
I've been dropping off meals for her as has her mum, but the poor thing is struggling.
Yep, that is a really, really tough situation. It is incredibly difficult to continue feeding through a abscess.
She is doing a really, really great job. I hope you guys are telling her that. This is a baby who is having lots of trouble feeding and, unfortunately, the people who've been helping her haven't been able to figure out what's going on and how to fix it. And so she's come to this point. It's not her fault. It's not the baby's fault. (if anyone suggests her boobs are too big or her baby is too lazy or she's not tried hard enough, they are really just saying: I don't know why this isn't working.)
She just needs to get better now. Glad she has you guys looking out for her.
Re: What's going wrong?
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Offering a breastfeed less often than 2-3 hours at this early age and considering the need for top ups seems odd to me, even 3 hours is a long time between refs if she is wanting to build supply and get a good BF relationship going. But she and babe have had such a rough trot, any number of issues or combination of issues could be causing this. Maybe another LC. Is the current one an IBCLC I wonder?
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