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Breastfeeding worries

  1. #1
    clare76 is offline Registered User
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    Breastfeeding worries

    I'd really appreciate your thoughts and experiences. My baby is 8 weeks old and I was exclusively breastfeeding however he was putting on very little weight. He was always seeming hungry and taking a minimum of an hour to feed. A couple of weeks ago he started feeding ALL morning - not even having a nap. Just feeding on and off for 4 hours. He seems to be quite a funny feeder and comes off the breast a lot. I've had a midwife and doctor watch me feed and both say my technique is fine.

    So, a couple of days ago, my husband and I decided to give him one formula feed at night so I can express and give the extra milk to my baby in the morning. It worked well for a day or so but today he has just fed from 4am to 9am with short naps in between. I'm sure it is hunger as as soon as I put him on the breast he feeds again, but only for a few minutes and then he falls asleep as he's too tired.

    I have been expressing twice a day, once when my baby has the formula feed at night and another time during the day. I can't fit aymore in as he takes so long to feed! I usually get only around 50-60ml when I express using an Avent electric pump.

    When he takes a bottle, either of formula or expressed milk, he guzzles it really quickly so it is so tempting to give him more formula, but I'm determined to continue brestfeeding. The thing that really worries me is that he isn't getting enough milk from me and I am the reason he isn't putting on enough weight. What can I do? Any advice appreciated.

  2. #2
    cyberyoda is offline Registered User
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    I have exactly the same experience as you and my baby boy is now 23 days old. You can see details of my thread "Help!! Not enough breast milk". I have done all I can do to increase my milk supply after meeting with lactation consultant. Now I am using Avent hand pump and can pump 2-2.5oz each time, the morning pumping will have 3-4oz. I normally pump every 2-3 hours.

    My baby is also very sleepy and he kept on losting weight after he was born 10days. I cup feeded him for the first 12 days after he was born and after that I pumped all my milk out and put in bottle to feed him. This is really much better method for my case as he can drink the pumped milk much faster before he falls asleep. So he got enough to keep increasing weight now. On the 14th day when I got back to the doctor to check his weight again, surprisingly, he gained over 9% (he was losing more than 5% of birth weight before). So he even gained 4% more than his original birth weight on the 14th day. Everything goes well. We are all very happy.

    After I offered the bottle breast milk, I also tried to nurse him directly sometimes and he still takes my nipple. There is NO nipple confusion for my baby. It may be because I cup feeded him for nearly 2 weeks and he knows the difference already.

    Although everyone said that it is better to nurse direct, I think we have to be flexible to judge based on individual case. For baby who are too sleepy, we will just nurse him forever if we nurse direct as he gets too little in everytime feed. He got asleep in 5 minutes and then he keeps hungry quick again. Also, before my milk supply is establised, my milk flow is not that much and SLOW. So, this will trigger him to fall into sleep faster too as he cannot get much after trying some time. Provided you still breastrfeed, I dont see a problem offering a bottle. My baby is now eating more than before, faster than before and I got more milk than before. We both have more time to sleep too.

  3. #3
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    carang is offline Registered User
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    my first child was given about 80% breast milk and 20% formula...NO nipple confusion...

    my second has had 100% breast milk since day 2. i do express and give her some in the bottle occasionally. NO nipple confusion....

    i'm starting to wonder if i'm just really lucky or if it actually exists...

    good luck!

    try expressing before the feed and then give him the expressed milk right away. that way, you'll know exactly what he's eaten. as well they are less likely to fall asleep when drinking from a bottle than from a breast, i don't think the bottle is as comforting as the breast.

    good luck!

  4. #4
    LLL_Sarah is offline Registered User
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    If your baby is breastfeeding effectively then he will get more when he breastfeeds than when you pump. Pumping is not the same as breastfeeding. The amount of milk you get from pumping is not the amount you have – it is only the amount you managed to get out by pumping.

    When you breastfeed directly three things are working together to help the milk leave your body and enter the baby’s body.
    • Your hormone levels are raised, especially oxytocin. Oxytocin helps the milk ejection reflex – this is the reflex that squeezes the milk out of the aveoli, the milk producing cells, and pushes it into the ducts which take the milk to your nipple. When you pump or hand express the levels of oxytocin are much lower.
    • The baby uses suction to help the milk come out – the pump tries to duplicate this but hand expression doesn’t.
    • The baby’s mouth milks the breast with its tongue and jaw movements. Hand expression tries to duplicate this but the pump doesn’t.

    On top of this many mothers have difficulty getting the let-down to work well when pumping. It works with no trouble when the baby is breastfeeding directly but doesn't seem to work at all when using the pump. Thus things that don’t matter when breastfeeding directly can affect the quantity when pumping. For example, how tried you feel and how much stress you are under.

    I think it is also important to understand how the breast works. Please see separate thread about this, How the breast works

    When you feed a baby with a bottle it is much easier for the baby to drink large quantities. (You can see this by the speed that a baby drinks from the bottle.) But fast is not always what we want. I often think of breastfeeding like having dinner at home, one plateful is enough. And bottle feeding (whether breast milk or formula) like going to a buffet, after the first plate full I go up for a second plateful or even a third! I only stop when my body is telling me I’m really full – by which time I’m actually overfull. Try to pace the bottle feeding. Stop every few minutes and give the baby a rest of a few minutes. This will slow down the feed and allow the baby to stop when has had enough rather than when he is overfull.

    It is very normal for babies to feed in different patterns. See the thread, Breastfeeding after a C-section, Breastfeed after C-section?
    (6th post on second page)

    This talks about the chocolate cake syndrome and Chinese banquet syndrome. Both these behaviours are very normal and nothing to worry about as long as you baby is growing well.

    You mention that your baby hasn’t put on enough weight. I’m looking for around 170 grams per week taken from the baby’s lowest weight – not the birth weight. If your baby isn’t managing this it is important to assess the baby’s latch on technique to make sure it is as good as possible. It is also important to look at the number and lengths of the baby’s feeds and get help – preferably from someone who knows about breastfeeding management, either a lactation consultant or a LLL Leader.

    I believe that nipple confusion does exist – I’ve seen it too many times to not believe in it. But there are lots of factors that play a part in whether a particular mother/baby pair will suffer from it.

    Imagine coming to Hong Kong and trying to learn both Mandarin and Cantonese at the same time. A few people would be able to do this with no problems, far more however would get the two languages mixed up. If, however, you started learning Mandarin after you were already fluent in Cantonese you would find it much easier. Breast and bottle feeding is like this. Once the baby has mastered breastfeeding introducing the bottle has very little effect on the breastfeeding but if you introduce a bottle before the breastfeeding is going well there is usually a problem.

    The factors I’ve found to influence the outcome when bottles are introduces are,
    • When bottles are introduced, usually after 6 weeks has very few problems but rather than age of the baby it is really how well the baby is feeding that matters.
    • The flatness of the mother’s nipples. The baby breastfeeds not nipples feeds so having flat nipples is not a problem unless the baby is introduced to the very point nipples of the bottle teat.
    • The depth of the baby’s palate and whether there are any physical problems such as tongue tie.
    • The mother’s technique of breastfeeding, if the mother has experience of breastfeeding then later babies often do well earlier with bottles (but I’m still talking at three to four weeks instead of six weeks) I think this is because the second baby is feeding better than the first one because the mother has more skill.

    These factors are just things that I’ve found in helping mothers. I’ve found no research which addresses this issue. (If you find any please let me know.)

    Best wishes,
    SARAH

  5. #5
    JennyB is offline Registered User
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    If you are determined to breastfeed, you WILL succeed. Just make sure you seek help from people who can really help. Not all doctors and midwives are skilled at improving breastfeeding management. I suffered with very sore nipples with my first baby but numerous healthcare professionals said my baby's latch-on was fine. It was not until I saw a La Leche Leader that I got the right help - she said that if it's painful, something is wrong, and even improving the latch by half a millimetre could make a big difference (and did).

    The chance of your baby being nipple-confused increases the more bottles per 24hrs you give (even if it's expressed milk). Those times when you are not breastfeeding directly also reduce your milk supply (since expressing does not stimulate supply as much as breastfeeding). That may lead to your baby getting more frustrated at the breast, unless you get help to reverse the situation! Good luck.

  6. #6
    clare76 is offline Registered User
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    Thanks-you all for your replies. I think it would be good to meet with a La Leche Leader - is it best to call someone or go to a meeting Sarah? Are the meetings in Tung Chung taking place at the moment? Or maybe a lactation consultant - does anyone have any recommendations?
    Thanks again,

    Clare

  7. #7
    LLL_Sarah is offline Registered User
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    With breastfeeding problems it is usually best to get help as soon as possible. The longer a situation continues the harder it becomes to solve.

    To see when the LLL meetings are please look on our web site at http://www.lllhk.org/Meetings.html

    It may help to actually discuss over the telephone with someone. This will help the person helping get the information they need to understand the situation fully. It is very difficult to gather this information on a forum without it sounding like 20 questions.

    Lactation Consultants who do home visits are:

    Yvonne Heavyside - 2530 1905, 9887 3235
    Mrs Chee – 2705 9322
    Annerley Midwives – 2983-1558

    LLL Leader telephone numbers are:

    MAGGIE 2817-7475 (away for Easter)
    ROCHELLE 2947-7147 (away for Easter)
    MARGARITA 2257-6757 (away for Easter)
    余婉玲 9048-1701
    SARAH 2548-7636 – this number is only working as an answer machine at the moment! (Telephone just says “place in charger”.) Please leave your telephone number and I’ll call back on a different line.

    Best wishes,
    SARAH

  8. #8
    instantnoodle is offline Registered User
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    Thumbs up suggestions

    Clare,

    Our baby girl is nearly 2m and we struggled quite a bit with bf in the beginning. The beginning was really difficult and we nearly gave up but we are glad that we didn't! It seems that low supply is the problem because a baby should refuse the breast if s/he is full after feeding for so long.

    Here are a few things which were helpful to us to increase milk supply. Not sure if they work for you.

    1. Massaging - when milk started coming in there were lots of little lumps in the breasts. We massaged them to loosen them and that increased the flow.

    2. A good electric pump helps stimulate the breast. We use Medela swing. In the beginning, use the stimulation phase only.

    3. Lots and lots and lots of soup! We are Chinese and tradition has it that fish soup, papaya soup help. They seem to work for us!

    4. There is this Chinese medicine which is called "tun cho"(literally: thru grass), which increases supply. You can boil it in soup or water and drink the liquid. It does have a good short term effect, and no side effect as far as we know.

    5. Sleep and rest - exhaustion is not conducive to milk supply.

    Our baby did not gain weight well in the beginning, and we gave her two bottles of formula at night so that the mother can get some rest. This seems to us to be better than feeding round the clock. Now that her weight gain is becoming normal, milk supply is also increased, and things are fine. If you do try this method, it might be good to express before you sleep (a) to see how much milk you have, and (b) to stimulate the breast to make more.

    Best of luck and don't give up!

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