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Thread: topping up with formula and wanting to fully breastfeed

  1. #1
    Join Date
    Jul 2006
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    126

    Default topping up with formula and wanting to fully breastfeed

    My baby is 10 days old. From the first day at hospital I was advised to top up feedings with formula, about 30 ml. I was told my milk wasn't coming yet and to offer the breast before the top up every time.
    I later found out how bad this can be to establish breastfeeding and find myself in a vicious cycle. I am always offering the breast first and bb stays for hours if I let. He may fall asleep and then he cries. Sometimes I let him sleep and I'm not sure if he's starving or not. When he doesn't settle then I give the formula and feel depressed about it. I've been giving about 200ml in total a day. I'm not sure how much breast milk he's getting if any but he has lost only 30 grams in the past week which seems to be normal...
    Please help. I'd like to fully breastfeed, how can it be possible.
    Thank you

  2. #2
    Join Date
    Jan 2006
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    18,063

    Default Re: topping up with formula and wanting to fully breastfeed

    sorry you got bad advice at the hospital, that happens to alot of moms!
    heres a good link on how to incease your milk supply.
    http://www.lalecheleague.org/FAQ/increase.html
    your baby is very young.
    Are you pumping between feeds? That might be a 1st step.
    so that the baby can have breastmilk instead of the formula. You can try hand expression if you don't have a pump.
    http://www.lactationinstitute.org/MANUALEX.html
    let us know if you have any other problems, don't be afraid to call your local lll leader, they can help.

  3. #3
    Join Date
    Feb 2006
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    1,168

    Default Re: topping up with formula and wanting to fully breastfeed

    Hi Daniela, and welcome.

    I'm sorry to hear that you got such bad advice at the hospital. That early and regular introduction of formula has probably prevented your baby from stimulating your breasts to make enough milk, and as you note, it's become a vicious cycle.

    There are ways to increase your milk production, and many moms who begin where you are now do go on to fully breastfeed. So take heart!

    The most important thing is to keep feeding your baby, by whatever means necessary. You say that he has lost 30 grams in the past week. You are right that this is not a large weight loss (barely 1 oz. for us Americans!) -- but, we also want to see baby gaining, not just holding steady.

    I'm going to ask a bunch of questions now to try to get a clearer picture of what is going on. Any info you can give will help, so please don't feel overwhelmed or "assaulted" by all these questions.

    What was your son's birth weight? What and when was his lowest weight check? How much does he weigh now (or at his most recent weight check)?

    How many wet diapers has your baby had in the past 24 hours? How many soiled diapers? What color are his stools (still black with meconium, shifting to green, or all the way to brown/yellow?)

    When baby nurses, does he start with short and rapid sucks, then switch to longer sucks with a swallow (may just sound like a breath) after every couple of sucks? Do your breasts feel softer or lighter after he nurses?

    Can you find a lactation consultant or breastfeeding counselor to help you? I'm not sure what system of lactation support is available to you in the UK, but I should think that London (as a major urban center) would be a good place to find expert help. A LLL Leader may be able to connect you with good sources of help as well.

    I suspect you're going to need a good pump -- a hospital-grade, double-electric pump -- to boost your milk supply. Find out if you can lease one, and if that is possible, then try to get it as soon as possible.

    In the meantime, continue nursing as frequently and for as long as you can. Also continue the formula supplements after nursing. To get baby growing and getting stronger (which in the long run will help him to nurse more effectively, which will help increase your supply), you may actually need to increase the amount of formula you are giving him. Don't feel guilty about this! You are feeding your baby the best way you can now, and you are working to get him fully breastfed.

    It's going to take some hard work to nurse, give supplemental feeds, and pump -- but there are many moms on these boards who have done precisely that and come back from a much worse supply situation than you currently have. I hope they will chime in with encouragement as well.

    --Rebecca

  4. #4
    Join Date
    Jul 2006
    Posts
    126

    Default Re: topping up with formula and wanting to fully breastfeed

    Dear Rebecca,

    Thanks for the advice and the questions.
    My baby weighed 2.770 Kg at birth and 2.700 on the last check. My midwife said babies usually loose weight in the first week...
    As for the diapers, I have to keep better track of the wet ones, maybe it's 4 or 5, and about 3 soiled ones, sometimes more.
    From last night, : breast but not latching, very unsettled, 50ml formula, 8:30 to 11:30 am breast, 40ml formula, slept tl 11:45, breast, 10ml formula, slept, still sleeping now at 2:40pm, maybe I should wake him up to feed him.
    Do hospital pumps work better? I've been using a mini electric medela and, as I said, nothing comes out...
    Do you think I should take anything to increase my milk supply?
    I really appreciate your help. I hope one day soon he'll be able to fully breastfeed.
    Take care,
    Daniela

  5. #5
    Join Date
    Feb 2006
    Posts
    1,168

    Default Re: topping up with formula and wanting to fully breastfeed

    A hospital pump -- the kind that one leases -- will do a much better job of increasing your supply. Try today to find one, as the sooner you start pumping with it, the easier it will be to boost your supply.

    Babies do usually lose some weight in the first few days after birth. By 10 days, they may not be back up to birth weight, but they should be gaining from whatever their lowest point was. If British hospitals don't routinely weigh babies at discharge, then please don't let my questions about this cause you distress. Different countries/cultures have different routine procedures with newborns, and I suspect that Americans may have a tendency to use machines and measurements where other people might rely on different indicators of well-being.

    The wet diaper count seems a little low to me. Even with disposable diapers (which are more absorbent and may not feel as wet as cloth), there should be at least 6 wet diapers in every 24 hours. Can you start a written log of his diapers, his times at the breast, his formula bottles, and his sleep periods? This will be valuable information if you work with a lactation consultant.

    With low milk supply and a baby who may not be gaining well or making enough diapers, one thing that will help with all of this is to get him to the breast more frequently. I know -- you spent 3 hours this morning nursing your baby, so you're wondering if I've lost my mind, right!? Try this strategy and see how he does:

    Write down what time it is. Now wake him up and nurse him. When he stops active sucking/swallowing, give your whole breast a gentle but firm and looooong squeeze (called a breast compression) and see if that will prompt some more swallowing and active sucking. Tickle his cheek, muss up his hair (if he has any!), flick the soles of his feet, rub his palms firmly -- we're trying to keep him awake and nursing actively.

    When he won't respond any longer with active sucking/swallowing, then unlatch him, change his diaper to wake him up again, and offer the 2nd breast. Do everything all over again that you did with the first breast (compressions, tickling, rubbing, flicking, mussing). When he again settles into just occasional, light little sucks, then take him off the breast. Offer the formula bottle (let another adult help with that, if you've got anyone around.)

    This is when you pump, with the hospital-grade double-electric pump. Pump both breasts at once for 15 minutes or so. Don't pay any attention to how much milk comes out. It may well be nothing -- baby has already nursed on both breasts. The goal of pumping after nursing is to finish draining the breasts if there's anything in there, and then to provide more nipple stimulation so your breasts will make a bit more milk for the NEXT feeding.

    If you get any expressed breastmilk, consider yourself unusually blessed, and save it for the next post-nursing supplemental bottle. If you get no expressed breastmilk, then give yourself a great big hug for all the work you are doing, and have faith that the pumping will make a difference.

    Next -- feed yourself, catch a quick nap, just focus on taking care of yourself. You won't have long to do any of this, because when the clock says two hours have passed since you wrote down the time and started his last feeding, it's time to start all over again. This time, start with the breast you used last. Otherwise, just repeat everything -- nurse, change diaper, nurse other breast, offer a bottle, pump for 15 minutes.

    It is better to get baby to each breast FREQUENTLY than to nurse for 3 hours and then nothing for 3 hours. If you can get baby to start a feeding every 2-2.5 hours through the day, then it's okay to let him sleep a longer stretch at night if he will (up to 4 hours or so).

    Let us know if you are able to find a hospital pump. Don't hesitate to post again with questions, concerns, vents, joys, updates -- whatever. You may also find some good support in the Increasing Your Milk forum. That will be a good place to ask about fenugreek or other galactogues.

    --Rebecca

  6. #6
    Join Date
    Jul 2006
    Posts
    126

    Default Re: topping up with formula and wanting to fully breastfeed

    Dear Heather,

    I'm really moved by all your support, it made me cry to dream that the breasfeeding may still be possible. I had to give my baby a bottle now, he wasn't latching on for more than half an hour on the breast and hadn't eaten for a long time. I'll start to count his diapers and will check the pump as well.
    I'll let you know how it's going. Thanks again!
    Daniela

  7. #7
    Join Date
    Jul 2006
    Posts
    126

    Default Re: topping up with formula and wanting to fully breastfeed

    Hi,

    today my bb had a bottle at 5am then I managed to just nurse him throughout the day, he would stay on the breast for a while then sleep for about 1:30/2hrs. But at 7:30 he started fighting against the breast ,crying and I gave him 60ml formula. Now he still wants th breast but is agitated and comes off.
    I have two questions:

    - do you think he had some breastmilk during the day?
    - if he's still agitated now, shoul I give him more formula?

    I've been pumping more and get about 10ml each time but it's a bit faster than before.
    thank you for your support
    Daniela

  8. #8
    Join Date
    Jul 2006
    Posts
    126

    Default Re: topping up with formula and wanting to fully breastfeed

    hi

    today my bb had a bottle at 5am then I managed to just nurse him throughout the day, he would stay on the breast for a while then sleep for about 1:30/2hrs. But at 7:30 he started fighting against the breast ,crying and I gave him 60ml formula. Now he still wants th breast but is agitated and comes off.
    I have two questions:

    - do you think he had some breastmilk during the day?
    - if he's still agitated now, shoul I give him more formula?

    I've been pumping more and get about 10ml each time but it's a bit faster than before.
    thank you for your support
    Daniela

    Quote Originally Posted by quakerm0mma
    A hospital pump -- the kind that one leases -- will do a much better job of increasing your supply. Try today to find one, as the sooner you start pumping with it, the easier it will be to boost your supply.

    Babies do usually lose some weight in the first few days after birth. By 10 days, they may not be back up to birth weight, but they should be gaining from whatever their lowest point was. If British hospitals don't routinely weigh babies at discharge, then please don't let my questions about this cause you distress. Different countries/cultures have different routine procedures with newborns, and I suspect that Americans may have a tendency to use machines and measurements where other people might rely on different indicators of well-being.

    The wet diaper count seems a little low to me. Even with disposable diapers (which are more absorbent and may not feel as wet as cloth), there should be at least 6 wet diapers in every 24 hours. Can you start a written log of his diapers, his times at the breast, his formula bottles, and his sleep periods? This will be valuable information if you work with a lactation consultant.

    With low milk supply and a baby who may not be gaining well or making enough diapers, one thing that will help with all of this is to get him to the breast more frequently. I know -- you spent 3 hours this morning nursing your baby, so you're wondering if I've lost my mind, right!? Try this strategy and see how he does:

    Write down what time it is. Now wake him up and nurse him. When he stops active sucking/swallowing, give your whole breast a gentle but firm and looooong squeeze (called a breast compression) and see if that will prompt some more swallowing and active sucking. Tickle his cheek, muss up his hair (if he has any!), flick the soles of his feet, rub his palms firmly -- we're trying to keep him awake and nursing actively.

    When he won't respond any longer with active sucking/swallowing, then unlatch him, change his diaper to wake him up again, and offer the 2nd breast. Do everything all over again that you did with the first breast (compressions, tickling, rubbing, flicking, mussing). When he again settles into just occasional, light little sucks, then take him off the breast. Offer the formula bottle (let another adult help with that, if you've got anyone around.)

    This is when you pump, with the hospital-grade double-electric pump. Pump both breasts at once for 15 minutes or so. Don't pay any attention to how much milk comes out. It may well be nothing -- baby has already nursed on both breasts. The goal of pumping after nursing is to finish draining the breasts if there's anything in there, and then to provide more nipple stimulation so your breasts will make a bit more milk for the NEXT feeding.

    If you get any expressed breastmilk, consider yourself unusually blessed, and save it for the next post-nursing supplemental bottle. If you get no expressed breastmilk, then give yourself a great big hug for all the work you are doing, and have faith that the pumping will make a difference.

    Next -- feed yourself, catch a quick nap, just focus on taking care of yourself. You won't have long to do any of this, because when the clock says two hours have passed since you wrote down the time and started his last feeding, it's time to start all over again. This time, start with the breast you used last. Otherwise, just repeat everything -- nurse, change diaper, nurse other breast, offer a bottle, pump for 15 minutes.

    It is better to get baby to each breast FREQUENTLY than to nurse for 3 hours and then nothing for 3 hours. If you can get baby to start a feeding every 2-2.5 hours through the day, then it's okay to let him sleep a longer stretch at night if he will (up to 4 hours or so).

    Let us know if you are able to find a hospital pump. Don't hesitate to post again with questions, concerns, vents, joys, updates -- whatever. You may also find some good support in the Increasing Your Milk forum. That will be a good place to ask about fenugreek or other galactogues.

    --Rebecca

  9. #9
    Join Date
    Mar 2006
    Posts
    265

    Default Re: topping up with formula and wanting to fully breastfeed

    Daniella,

    Try just nursing, if bb is crying at the breast and you think there is no milk, try to hand express to see if you get some. If you get some, put baby back to breast. Try burping, walking, cuddling, whatever, but as long as you can get milk out, that baby doesn't need formula!

    Your doing a fantastic job! Keep up the great work!

  10. #10
    Join Date
    Feb 2006
    Posts
    1,168

    Default Re: topping up with formula and wanting to fully breastfeed

    Daniela, it sounds like you did a great job today nursing him more frequently throughout the day. If he nursed well and seemed contented afterwards, then chances are he got a good bit of milk at that feeding. But the most reliable way to be certain of his milk intake is to keep track of his diaper output. You should be seeing at least 6 wet diapers and 2-3 dirty diapers in every 24-hour period.

    About the formula -- I'm going to respectfully disagree with Sarah about one thing. Your ability to express milk from your breast does indicate that you are making milk -- but it does not necessarily follow that your baby is nursing effectively. The recent history with a slightly low diaper count and being a bit slow to regain his birth weight suggests, to me, that you need to watch how he's doing and perhaps be ready to supplement with formula if necessary -- just as a stopgap measure until baby gets the hang of nursing well enough and often enough to meet his nutritional needs.

    But I really want to stress here -- in basically one day's time, you went from topping up every feed with formula to more than 12 hours' worth of frequent and exclusive breastfeeding. I think you're definitely on the road to 100% breastfeeding, and you should be VERY proud of your efforts and success.

    Have you had any luck finding a local LLL Leader or lactation consultant? A hospital-grade breast pump? The one thing we worry about with supplemental feeds (be they formula or EBM) is that baby may develop a preference for the bottle, and resist nursing at the breast. I think if you can work closely with someone skilled in lactation support, they might be able to help set you up with an alternate feeding method (using tubing at the breast or taped to a finger, perhaps) instead of an artificial nipple.

    Hang in there -- it sounds like you've made a lot of progress just since yesterday. Keep us posted!

    --Rebecca

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