In need of help

[Mummato2]

My little one is 4 weeks old and I've exclusively breastfed all but 3 feeds.

My issues are:

1) My let down seems to have gotten a lot faster in each breast and the first few sucks are fruitless but after that my daughter gets flooded coughs, chokes, takes air then cries. When I pump, it takes a good 10 minutes of solid pumping before the flow is manageable

2) She is only feeding from one breast each 2-3 hours during the day and is only on for 10 minutes. This can't be enough since I pump only 60mls in 10 minutes. She just isn't interested in taking the other side, so each breast gets stimulated every 6 or so hours, however my supply is abundant and I'm pumping 120mls once or twice per day

3) My daughter has gotten to a point where she cries and throws up after each breastfeed, so I've tried her on Nan HA1 3 times in the last 2 weeks and she's been perfect and took 90 mls. I then tried her on the EBM via bottle, throws up (not as much as when on the breast) so I'm comfortable it's not my milk

4) I really want to give her 1 bottle only of formula per day, but am really concerned about her bowel movements. She hasn't had once since Sunday and while I understand breastfed bubs might not go everyday, 4 weeks seems young to stop having them plus considering she's had 1 bottle of formula on Monday, I would have thought we'd see something. I don't think it's the formula since it's designed for babies who have allergy and digestive issues - it's partially broken down

My questions are:

1) In terms of the speed of my let down, I changed positions and the only thing that achieved was bub sucking in air, what is the BEST position to minimize air ingestion and slow that flow? Also, since it's sped up, will it slow down in time?

2) Do I need to keep pumping with her frequency of feeding? I've only done it in these last weeks to ensure her time between feeds doesn't affect my supply, she is feeding approx. 6-8 times per day and sleeping approx 8 hours overnight

3) I suspect the reflux my daughter has is because of the fast letdown and the choking. I can't see how else it is there for BF's but not bottle feeds. It's so bad the poor bugger will still throw up 2 hours after the feed....will a nipple shield help slow the flow?

4) Is the fact she hasn't had a bowel movement in 5 days a concern? Bare in mind she has had 1 bottle of formula in those 5 days, so if she is no longer going to go once a day because she's breastfed, shouldn't she at least be doing something with occasional formula? I should say that in the days leading up to Sunday she was only doing small bits while passing wind - so not sure if her movements were slowing down naturally anyway - I guess I'm concerned because since the one bottle she hasn't gone and I would have thought she should have with that (remembering it's NAN HA - highly unlikely to cause constipation - or that's according to my Dr would love to know if anyone has had constipation as an issue with this formula)

5) I drink a lot of water and vitamins when I remember, but my diet is shocking. I never really eat throughout the day - only dinner so I am concerned that the quality of my milk is not the best (hence why I would like bub to have the 1 bottle of formula per day so she's at least getting something stable)

A huge THANK YOU in advance for any help with the above, I really wanted to BF long term with Cary - but I never anticipated it would be this hard

[OceanPrincess]

Hello! I'm going to attempt to help with a few of your questions and hope that someone much more qualified and knowledgable than me will come thru soon with a comprehensive response

First of all - well done in getting thru the first four weeks! I remember it took me probably 6-8wks to really get into the swing of BF with my DD and we are still going strong 13mths later. It is so good to hear you wanting to continue and looking for help!

I had a similar issue with abundant supply and bubs choking - a MW recommended I partially recline for feeding, so that bubs is working against gravity and has to suck harder to get the milk out. It won't flow so freely and they shouldn't get such an influx of milk.

I'm not too sure about continuing to pump - perhaps I'd only be pumping if you had need to build up EBM, otherwise having her on the breast whenever she wants to feed is the best way to establish a good, regular supply. Remember that pumps are not an accurate assessment of how much your DD will be taking for each feed as they are much more efficient than a pump is.

I'm not too sure about nipple shields either - but my understanding is that they are for use when you are having nipple problems, not to do with supply? Perhaps someone will correct me there...

Now that I think back to when I saw the MW, it was shen DD was about 4wks, so almost the exact same time. She asked me how the feeding was going and I mentioned she was quite gassy and chucky and didn't seem to be feeding well and that's when she got me to feed in a reclining position. Still the cradle hold, but semi-lying down.

It fixed all our issues. Give it a try!

I don't think the lack of bowel movement is a huge issue - it can be up to 10 days for some BF babies. DD had a few Nan HA top ups and she still had long periods between dirty nappies. If it is worrying you, ask your GP or MCHN.

With regards to your diet affecting her, while yes it is important to eat a well-balanced diet, I still believe that breast milk is best for her - I'm sure you're not eating cake and lollies for your one meal a day! So whatever you are eating and whenever you are eating it, your body is taking all the prime nutrients, vitamins and minerals and directing them into your milk. And the milk you're making is exactly what bubs needs right now, as opposed to formula, which is a generic "most babies around this age need most of this stuff".

I don't know how much help I have been, I hope a little bit!

Don't forget you can also call the Australian Breastfeeding Association - their number is 1800 MUM 2 MUM (1800 686 2 686), they are free to call and you will probably find answers to all your questions above. They are a wealth of knowledge and so helpful.

Good luck! Stick with it!!!

[Kmn]

Hang in there - in another few weeks bub will be able to cope with the fast flow much, much better.
In the meantime - have you tried feeding lying on your side and with bub lying on her side?? That way the excess can just splurt out the side of her mouth (put her on a towel!) rather than choking.

Your supply doesn't seem to be an issue. I think that you need to pump if you give her a formula bottle, but otherwise just hand expressing until you are comfy should do the trick - the idea is to ensure that you make what she wants, and the best way to do that (in theory) is no formula and no pumping. As for your diet - you will feel like crap if you are eating really poorly, but your milk will still be fine. What bub needs will be taken from you.....

And throwing up is sometimes part of being a tiny baby - that should improve over the next month or two as well. As long as she is otherwise happy then it's not a problem.

[lindsaymaree]

I'd second what the ladies have said above me, especially in regards to calling the ABA.

I also have one (yep just the one lol) fast flowing boob. To the point were DS pulls off and by boob continues to squirt milk in a continuous stream all over his face As the girls have said above reclining and feeding laying down have really helped.

During the first few weeks I also frequently burped DS during feeds. Almost every 5 minutes or so. I found this stopped him from getting really irritated with the flow, and he would generally go down more settled after this. As we slowly got the hang of managing my flow, we were able to cut down the number of burps.

Hope it all works out for you guys! and good work on making the 4 week mark, I know it can be a real struggle sometimes xx