BFing and formula supplementation - need a plan

[violagal]

Hi all,
Hope this is posted in the right place...apologies for long post but wanted to explain the background. I've had quite a lot of conflicting advice from various midwives and HVs that I'm a bit lost as to what to do next.

DS2 is 3 weeks old. He was 8lbs3 at birth. I had a planned c section and afterwards was helped with bfing and he took to it straight away. For the first 24hours I was advised to let him nurse as often as he wanted which I did. It was quite painful but I was assured by the midwives his latch was fine - I think mainly because he would just grab the nipple as soon as it came within range! By the evening of the second night in hospital he was vomiting blood which the mw told me was my blood as by then my nipples were cracked and bleeding - ouch! He was also hungry all the time - my milk didn't come in odour 6 days so she advised me to feed on both sides for 20mins max and then offer formula to give my nipples a chance to heal and tide him over until his milk came in. He would do this and then take between 60-90ml of formula.

I continued this at home and was visited by a community midwife on day 5. She checked my latch and said it actually wasn't good (first person to give it a proper check) so helped me a lot with positioning etc which was really useful. She then suggested feeding on one side for up to 30mins (as after that he would just be sucking) then offer the second side and he would probably take 5-10mins. But also to keep waking him as he would keep falling asleep after 5-10mins and not taking a full feed. Then after that offer topup if needed. His weight at day 5 was just over his birth weight so no issues there. I carried on with her plan but I would let him take as much as he wanted on the second side and he would take up to half hour on both sides plus topup!

Day 12 I had final midwife check. His weight was 8lbs 6 so happy with weight. Her feeding suggestion was a) stop the topups as he didn't need it. B) let him feed on one side until he falls asleep or pulls off. Burp him and then let him feed on the second side until he falls asleep or pulls off.
I gave this a go for 24hours and it was untenable - he would feed for 5/10mins, fall asleep or pull off then nap for 10-20mins. Then feed again. Then nap again. This would go on for 4hours and he would complain bitterly if I so much as got up to go to the loo or took a break to eat! In the end I caved in and resorted to keeping him awake at the next feed and then topping up which got him back to his 2-3 gap.

Yesterday was first HV check. He now weighs 10lbs so following the 75th percentile. Her suggestion was different again - a) reduce formula top ups after each feed gradually. B) don't wake him up whilst feeding. She talked about something called 'responsive breast feeding' so that baby feeds and sleeps when he wants and that keeping him awake disrupts that. I said i had tried that but he was on the breast for hours and she said that was normal for the first 12weeks and that a routine of 3hour feedings was unrealistic until 12weeks.

So - as of today I am offering both sides for up to 30mins and doing all I can to keep him awake. Sometimes it is only 15mins as he lets me know when to switch as he tugs at my breast, pounds it with his fist and grizzles! Then after the second side if he's still rooting I offer topup. Other times he naps for half hour then wakes up looking for the topup. However this is not sustainable I feel as it can take 1.5hours to feed and wind and we both only get a break of 30-60mins before the cycle starts again. It is fine when DS1 (21months) is at nursery 3 days a week but when I have them both I simply can't carry this elaborate feeding regime. Also overnight it is an issue as he's far too sleep so I have resorted to giving him just a bottle the last couple of nights as then the whole feed is done and dusted in about half an hour.

Can anyone recommend a way forward? My goal ultimately is to have a shorter feeding time in general, whether this means I end up doing some feeds just bf and some just formula I don't really mind, I'm just not sure I can continue bf and topups every feed for much longer!

[*Ali*]

Huge hugs. It is really tough in the first few weeks especially when you have a toddler to entertain as well. My two have the same age gap and I remember those early days well. Luckily I had a lot of support. Do you have any IRL support from your partner or parents for example?

How is his latch now? Is it sorted do you think? And your nipples have healed up ok or are they still split and bleeding etc.? If that is still a problem have you considered nipple shields to help them heal? I think some people have concerns over supply issues caused by shields but they were a lifesaver to me when I could t bear to feed due to the pain in the early weeks. We easily weaned them after a week or two.

How do you feel about pumping and feeding him expressed milk? Or is that just too much work with everything else?

I personally would try to keep him awake to take a big feed from the breast before letting him sleep for a while. That sounds like it was working better for you I think. Would you agree? Here are some tips for keeping a sleepy newborn awake. Tips for Sleepy Newborns
I'd also really limit the top ups to an ounce or so until you can drop them eventually.

I do agree 3hr feedings are probably unrealistic at this age for a breastfed baby. It's the main thing we hope Tracy would have changed her advice on in light of more recent BFing research. Breastfeeding and EASY in the first few weeks
At 3 weeks he is still so little and things will be very different at 6wo and again at 8wo. Hang in there.

[kayra]

Big hugs! I've been bf and supplementing too and it is very tiring, it does take long to finish tge feed when they're so young. We too eventually decided to limit bf time to 30min (constantly waking them when they fell asleep) and then supplemented in which case the feed time came down to an hour, and then like you decided to do the night feeds with bottle only. The feed being long is exhausting but it also meant the babies were awake too long so overtired and hard to settle. I've been pumping so if you have time for that as Ali suggested it would mean he was getting more bm but also keeping your breasts stimulated for the times you arent nursing- if you're not in pain of course,15min each side or so. If you think he's pretty much draining the breast each feed maybe its not a big deal, with mine i was pretty sure they werent.
Sorry not much advice but just wanted to say i understand how you're feeling, hugs!!

[violagal]

Thank you both for your hugs!
Ali for the 3 days DS1 is in nursery then it's great - DH gets him up, does his breakfast and takes him to nursery and also picks him up so I don't even have to get out of bed until I am desperate for tea and toast! However the two days I have both obviously it's more fraught and I barely have time to think about when to feed etc and then at the weekend I really want to spend time with DS1 rather than have to spend all my time feeding him - it's just seemed everytime he's wanted a cuddle or me to read a book the baby is hungry and I can see him getting resentful That is mainly why I haven't taken to pumping as well as I figured only being able to really do it 3 days a week probably won't make a difference?
I think his latch is better - no more bleeding. I have flat nipples so I have to really make sure he gets a good grip and sometimes have to adjust 3 or 4 times at the start but even a couple of sucks with a shallow latch can reopen a crack or cause pain for a while.
Regarding the topups he does sometimes only take 1.5oz but he has been known to take 4! If I limited them to 1oz what would I do if he was still crying for food after that? He just sometimes seems so ravenous and sucks away voraciously both from me and the bottle that I daren't stop until he seems satisfied! I've tried a dummy and he will chomp away for a minute or so then spit it out and cry some more...no fooling him.
Interesting about the 3hours - so 2 hours is probably more normal at this age do we think?

Kayra wow do I see you're doing this with twins?? You've hit on another point there that because the feed takes so long we are always past when he should have gone to sleep so he is getting used to either falling asleep on the bottle or during winding - I'm sure neither of those are good sleep associations!

I'm pretty sure he's draining the breast - they really do feel flat after he's done and I always try to squeeze a bit out afterwards to rub on the cracks and there's barely any there. I guess if he's getting his fill from both breasts and I'm feeding every 2-2.5 hours then hopefully my supply will increase slowly and he'll take less from the bottle? And can I hope that he will take less and less time to drain each side as he gets bigger? Sooner rather than later?!?

[kayra]

I guess if he's getting his fill from both breasts and I'm feeding every 2-2.5 hours then hopefully my supply will increase slowly and he'll take less from the bottle? And can I hope that he will take less and less time to drain each side as he gets bigger?

I would have thought so, he sounds like a good sucker. Maybe if you bring the feeds forward to 2-2.5hrs he wont be so hungry and wont need so much supplement. Mine were and still are having quite a bit supplement so the feeds are stretched out more as formula takes longer to digest. If he's still hungry after bf i think he should have formula but maybe if he's feeding more frequently breast will be enough.
If its going to be a stress dont pump, your ds1 is very young still, you dont want anything extra to take you away from him.
Dont worry about sleep associations at this stage but at this age the ideal a time is around 1hr, mine settled a lot better once we'd shortened the whole feed time.

Hugs, you're doing great and it will get easier even if it doesnt feel like that now! Xx

[*Ali*]

If he is still crying from hunger then yes you must feed him a bit more. Sometimes breastfed babies will take a bottle just because it is there and easy so maybe offer a little and then more only if he seems to be looking for it? I agree with Kayra though, I'd BF more often. That will increase your supply and he should need less formula.