Here we go again: C-section, low milk supply, nipple confusion and the list goes on

We welcomed our beautiful little girl into the world last Friday (she is 6 days old) and she is just perfect :D

I am having breastfeeding issues again, after an awful experience with DS - I was really hoping that I could make it work this time, but now I really don't know if it will.

I had very little colostrum and a very big and hungry baby. On day two she was permanently on my breast and just screamed and screamed and screamed. Knowing the issues that I had with supply with DS, we were pretty much expecting to comp feed to some degree in a hope that eventually my milk would come in given that she had pretty good attachment. So we gave her some formula. She settled immediately and feel asleep.

Since then, I have been following the standard routine of BF, give EBM, top up with formula and then express. I have been doing this night and day and I am seeing a marginal increase in my supply, but still nowhere near the volume that she is demanding.

Since yesterday she has been doing some major fussing and screaming at the breast - all she seems to want it the bottle and, in particular the formula (as opposed to the EBM). How she knows the difference between the two is anyone's guess! So now we seem to have nipple confusion joining the mix :( Last night she just screamed and kept pulling off the breast and I just gave her the bottle(s) and did a 120 minute express. I only got about 40ml from both breasts - no wonder the poor chook is getting annoyed...

Last time with DS, I threw the towel in after no further increase beyond 50ml after 2 weeks of expressing, feeding etc. It was doing my head in. After 14 days, my milk had still not come in. We plan on doing it again this time given that she has such good attachment and I am in a way better head-space than I was with DS. The only thing is that I just have a feeling that my milk will never come in...it is so soul destroying.

A further consideration is that my little DS is hardly seeing me, let alone spending any quality time with me. If I am not feeding then I am pumping or sterilising or washing bottles or settling DD. Fortunately my folks are here and DH is taking him out and entertaining him. I still just still feel so guilty :(

I really want to make this work, but wonder how long I can (and should) continue doing this before accepting the reality that maybe I am not able to BF her adequately.

I have a personal lactation consultant and she has helped a heap, but she also suggested not comp-feeding and I am afraid that I just don't have it in me to starve my child even if it is for the "greater good" - so please don't suggest this. I would rather not breastfeed that make her suffer just to increase my supply.

I suppose I am just asking for some success stories - stories where people's milk did just come in overnight after expressing really low amounts for a couple of weeks.

Also, for those of you who had c-sections, how late did your milk come in?

As for the nipple confusion, would this improve if my supply did?

Any other tips or feedback would be wonderful too :)

Thanks for reading this.

I feel your frustration! As terrible as it sounds going cold turkey is a good way to build your supply more demand equal more supply. You have to be prepared for a couple of days with a pretty unhappy baby that wants to feed ALL the time. I know it is disheartening when you are only getting such a small amount from expressing but do not take that as an indicator that you have a poor milk supply. Some women have very little success expressing all the way through breast feeding. It is also common to have poor milk supply by the end of the day hence the screaming cluster feeding bub! I had enough milk for two but by the end of the day my ds3 still cluster feed as my supply would drop late afternoon.

On the other hand it is ok to give formula if you want to. Do not beat yourself up you sound like a wonderful caring mother no matter which way you chose to feed your baby.

Has your LC suggested motillium yet? Can work in cases like this. If you do not want to stop comp feeding then don't. I wouldn't be able to do it either. Lots of hugs and good luck.

Oh hun it sounds like you have been put through the wringer!
My advice is less bf related and more personal, I don't want to offend so please don't take it that way.
Firstly give yourself a break. You are doing EVERYTHING humanly possible to feed your little girl. It's just not happening easily for you, not cos you're not putting your heart and soul into it.
Secondly don't worry about DS he will be fine. NO child has suffered any damage from mum having another bub to focus on and in the long run a sibling is an awesome gift to give to your son.
Lastly and I say this really from the heart - it is OK to bottle feed. I know you don't want to "give up" and I truly understand your pain but sometimes the emotional and physical costs just outweigh the benefits. That is an incredibly personal choice that only you can make.

So have you tried motulum? Could you try just soley bf just for a day? I know C sect does take a while for milk but I would have thought it would be in by now. Also maybe consider some counselling or chat with a trusted friend. This is not an easy thing to go through and you sound like you need some support.

That's all I can say hun. Big Big hugs to you and I hope you gain some peace soon.

I'm not sure you want to comp every feed - you may have better success putting her to the breast at least every two hours in the day and three hours over night, and only comping every second or third feed. And try giving her "three sides" (5 minutes on boob 1, 20 on boob 2 and then back to boob 1) - so she gets more initial letdowns and may get more out.

I think that you might also want to consider a supply line - so that your little one has to "breastfeed" to get her formula too.

Others have recommended "The Breastfeeding Mother's Guide to Making More Milk by Diana West, IBCLC, and Lisa Marasco, MA, IBCLC" - it is worth a look.

Finally, just because she is grumpy and settles when given a bottle doesn't necessarily mean that she is starving - you need to consider wees (lots) and poohs (at least one a day) and growth (some is needed) too.

My milk came on at day 4 after my CS. The more bub is attached to you the more milk you will make - give feeding lying down a go too, because that way you can read a story to your DS while feeding your littlie!

Would a supply line be an option? It cuts out the need to express. You fill it with formula or EBM, hang the bottle around your neck, attach the lines to your nipple and baby sucks on your nipple taking milk from you AND milk from the bottle at the same time. So that should stimulate you the same as expressing. Plus you can see how much she's taking from the bottle.

All sounds very fiddly, I know, but once you get the hang of it, it's good. I'm the most unco person ever and I got pretty good with it!

I'd also get motilium.

I found motillium worked wonders for me with DS2 in conjunction with baby on breast and expressing as well, i still had to comp feed once of twice a day but majority of my day was just bfeeding and i was happy with that.

Really good advice above. Using a supply line (lactaid/SNS) is a really great idea. This would really help with the nipple confusion, but stop the feeling you were making her go hungry.

It's so hard because it's such a slipperly slope. If you think of it that every bit of formula she drinks is a signal your body is not getting to make more milk, so that vicious cycle of low supply starts. Plus every bottle feed she has adds to nipple confusion and her learning bottles are easy so more likely to start refusing the breast.
Supply line feeding would cut both those problems right down, she would stimulate your supply the whole time she was drinking formula, because she could get it while sucking at the nipple still, thus increasing your supply each time, and (hopefully!) lessening the amount of formula day by day.

I'd definitely look at getting onto motilium too. As well as resting heaps, drinking well, get someone to bake you up lactation cookies and eat loads, eat up on porridge and nuts and look into fennugreek and other supplements that help supply.

I wouldn't ever express for 120min either. Won't do as much for your supply as shorter, but more frequent expressing would, and sooo tiring for poor you. Don't be too disheartened by the amount either, it's not neccessarily a reflection of what she gets.

Also - get skin to skin with your bubba! As often as you can. This is great for your supply and getting past any frustration and nipple confusion etc.

All the best!

my milk didnt come in until day 7! so i know what your feeling, i too had a c section, my son ended up on mainly formula as he lost half a kilo in the first week and i was threatened with him having to go to hospital again if he didnt gain any, i did express alot and I too didnt get much supply, I do wish I had pressed on though, please dont give up!

Hi,
It can be such a confusing time around the birth and early breastfeeding of a new baby. And hard when you so badly want to breastfeed, but the fears and difficulties of your previous experience kee[ replaying in your head.
there's quite a nice design going with new babies. Colostrum IS small in quantitiy - about 5-7mls per feed in the first day. But babies come pre-prepared with their own stores of brown fat to get them through the first days until your milk comes in and if she was a big baby she would have had plenty to get her through. But, babies are hardwired to suck. By sucking early and often they ensure their and their mother's survival - the sucking contracts your uterus down and prevents bleeding. They know how to get your milk to come in - feed all the time. she was doing exactly what she was designed to do - feed long and often. Here is a great article on The Second Night with your baby kellymom.com :: Baby's Second Night by Jan Barger RN, MA, IBCLC
Babies feed 813 or more times in 24 hours - that's completely normal. Did you have your baby weighed? You would have expected her to lose about 10% of her birthweight and not regain it necessarily until 2 weeks of age. In the first 4 weeks bvabies need about 150mls per kg of bodyweight per 24 hours, so if she is feeding 8 times a day, then she would get 75mls per feed. Like most of us, she might take more (like me when presented with a bit of chocolate cake) but she won't need more. If you are getting 50 mls out with the pump after breastfeeding - that;s heaps! And btw - what you can get out with the pump - especially when you are on your Lplates, tired and stressed tells you NOTHING about how much milk you are makeing (but possibly a lot about how stressed you are and how good your pump is) You generally getting the biggest quantitiy of milk in the first 10 mins or so after your milk lets down. Expressing for 2 hours is not productive - just stressful, painful and discouraging. You are certainly not starving your baby, and you are probably doing a whle lot better than you know you are doing

Thank you, Barb, and everyone else for sharing your experiences and giving suggestions.

First of all, the 120 minutes express was a typo - I meant 20 minutes! I only did 20 minute expresses when she didn't want to attach. When she does attach and feeds for 20 minutes each side, I only express for 10 minutes on each side just to empty my breasts. In the latter case, I seldom see more than 20-30ml expressed. If I express when she doesn't attach, that is when I get around 50ml.

I have been on 20mg of Motillium 3 x daily since I left recovery because I knew I could have supply issues.

I am using a Medela Symphony double pump which is one of the better ones out there to the best of my knowledge.

Just an update as of today: My supply seems to be increasing bit by bit. The nipple confusion seems to have corrected itself (how, I don't know, but she seems happy on the breast again!) For some feeds, she has just BFed and had expressed milk. This last one, she only had an additional 20ml of expressed milk, so seems to have got a bit from my boobs after all! Afternoons are a slightly different story, though - that is when she definitely doesn't get enough and we still have to give her formula. Having said that, she is having less and less of the formula each day.

I am trying not to get my hopes up too much because things are still really slow, but I am really happy that she is getting *some* milk for the time being. I plan on following this routine until the end of next week and then hopefully I will have a better idea of what exactly my boobs are capable of :)

Again, thank you so much for your support - it really helped me through some very "low" days. x

Just another update:

DD has been breastfeeding exclusively for the past 48 hours - with no EBM and no formula top-ups. I know we are not out of the woods yet, but I am so happy that things are moving in the right direction :)

Thanks again for all your help, support and suggestions x

:happydance:

Awesome.

Thats great :D

That's fabulous news!

That's fantastic!! Well done :D

Great news.