Advice about expressing

[LotusPalm]

Hello!

My LO (nearly 9 weeks) has an upper lip tie that we have a referral for next Wednesday. Over the last coupe if weeks his latch has got worse and he hasn't been feeding well at all. Sucking is quite hard work and because he's an inefficient feeder he is mainly getting foremilk. I have oversupply and OALD which doesn't help with a good balance if milk, but dies mean that he is at least getting some and still gaining - though he has only put on 10oz since his 6 week check. Weight gain is slowing.

Also, over the last few days he has been increasingly windy Nd divert during feeds. He has very frequent explosive poos which get progressively greener throughout the day until they're mown grass by the 10 o'clock feed. He's really uncomfortable with them as well, and they are disrupting his sleep.

Anyway, to try and cut a long story short, the health visitor suggested that I express and bottle feed until we hopefully get his tie snipped next Wednesday. I disregarded it as I don't want him to get a bottle fixation, and am concerned about increasing the foremilk / hindmilk imbalance as a pump isn't as effective as a baby at getting the fat drawn down. But then M isn't an effective feeder!
So I expressed 3 oz and gave it to him once he had lost interest in feeding from me (took one boob at 5, finished at 6 and had 5 mins in the other side) and he pretty much drained the lot and proptly fell asleep. So, I think it may be better for him if I do express as I think breast feeding is really tiring for him and he's not getting the good stuff.

My questions are:
How do I do it? I have a 2 yr old so I'm not sure that I can express before each feed in order to give it to him. How else could I do it?
How do I ensure that he gets enough fat in each feed?
How do we make sure that he doesn't get nipple confusion, or go on a breast strike once his lip is fixed?
Am I right to express in the first place or should we just persevere?

Thanks on advance and sorry thus is so long!

[becj86]

Also, over the last few days he has been increasingly windy Nd divert during feeds. He has very frequent explosive poos which get progressively greener throughout the day until they're mown grass by the 10 o'clock feed. He's really uncomfortable with them as well, and they are disrupting his sleep.

Anyway, to try and cut a long story short, the health visitor suggested that I express and bottle feed

Honey, in this situation (BTDT with the OS/OAL and the grass poos but no tongue tie) I did express and bottle feed and it made a massive difference.

I massaged my breast near the chest wall before expressing to release the fat and actually found hand expressing better once I had the hang of it. I found if I expressed to dry, the feed was well balanced because the fat was distributed right through all the milk again. http://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/

How do I do it? I have a 2 yr old so I'm not sure that I can express before each feed in order to give it to him. How else could I do it?

Not sure... For me with OS, it was not a problem to pump in the morning, again around lunch (so maybe nap time), again in the afternoon if possible (didn't often happen), after LO's BT and before/after a NF. It didn't drop my supply. Granted, I would get about 200mL in 5-10mins of expressing though

How do we make sure that he doesn't get nipple confusion, or go on a breast strike once his lip is fixed?

DS preferred the bottle as the flow was slower. We used a faster teat and suddenly the breast was preferred again... We also did a lot of baby-led attachment in the bath while weaning from the bottle back to the breast.

Good luck and good on you for persevering with the BF despite the difficulty!

[LotusPalm]

Hi, and thanks for the quick reply!

Did you express both breasts each time? And then just 'divvy' the milk up between feeds?

And what's BTDT??

Thanks again

[becj86]

Did you express both breasts each time? And then just 'divvy' the milk up between feeds?

Yes, exactly that

BTDT = Been there, done that

[LotusPalm]

Thanks again. How long did you do it for? And what did you do to regulate your supply?

Started this morning after the morning feed (we slept in!) And he took 6 oz and went to sleep beautifully. Worried that I've been underfeeding him for the last eek or so now!

[becj86]

I expressed and bottle fed for a week at a time here and there when things got bad (my supply went through the roof every time DS had a growth spurt or I walked past a bag of oats in the supermarket ). When I went back to feeding, I did all bottle feeds and weaned one feed at a time back to the breast, starting with the time when my supply was lowest so the flow wasn't too bad...

To regulate supply, I did block feeding (feed from one breast only for a number of feeds or a set time period).

Don't beat yourself up - there are some not insignificant issues at play here. Getting food into him and keeping your supply up while you've a toddler to look after as well is no mean feat!

[LotusPalm]

Hi, again.

I'm really struggling to express past the first let down. I got 7 oz this morning, after the morning feed, but struggling to get more than 5 oz this lunchtime. Milk is quite pale, and has some fat content, but I'm.not convinced that I'm able to get o the creamy stuff. I wonder if this is the problem M is having?

I've tried pumping and hand expressing. Any tips?

[Fiver]

With the lip tie, he probably has been struggling to get much, even if you have a good supply.  Just because the milk you are pumping is "pale" doesn't mean it doesn't have a reasonable/good fat content.  There isn't a point during the feed that foremilk suddenly becomes hindmilk - it's a gradual transition and lots of overlap, so the fat content increases, rather than the milk changing. Does that make some sense?

[LotusPalm]

Thanks again. Yep, I know the fat content increases gradually, but I'm sure I remember with my 1st that it went really creamy/ yellow in colour, but it was a while ago do I may have forgotten. Ge also had a really string duck and would feed for ages, so he was probably getting much further into the supply.

I have a really string let down and fast flow - he swallows audibly and repetitively throughout feeds. He doesn't even really have to suck! He tends to sort of chew as well - o think because his latch is quite shallow.

 My anatomy and oversupply meant that I've never been sore and he's always gained weight (nearly 2lbs between 4 and 6 weeks) and my concerns about his latch have always been disregarded! Luckily I thought to check his lip as my 1st had a tight frenulum as well, but has a much bigger mouth and lip thing going on so we didn't have any problems.

It's very frustrating as I don't know whether they'll do anything about it, and even if they do, changing his latch after nearly 10 week is going to be really difficult...

Oh well!

He's taken 6oz at every feed so far today, though I'm still planning to Brest feed for the nw as it's a much smaller feed anyway, and he stays on longer as well.

How long until the frequency and colour / explosive nature of his nappies changes?

Thanks again for all your help!

[LotusPalm]

Auto-correct gone mental -
String duck = strong suck!

[Fiver]

If it's any comfort, we got DD's posterior tongue tie divided at 9w and her latch improved immediately (although she still has her moments now with teeth coming through and I suspect she has an upper lip tie also).
As for the nappies, I've never had that problem, so no idea re. the answer.

[becj86]

How long until the frequency and colour / explosive nature of his nappies changes?

It took a week or so to recover to mostly yellow again after we got to the grass-like nappies. Part of the issue is the damage to the gut from the milk going through so fast and with the more balanced milk he's getting, it should slow a little since there's more in it that takes longer to digest. The time it takes is related to the healing and DS 'felt better' a little earlier than the nappies went back to mostly yellow. Its pretty discouraging going through this work and not seeing results for a week but it will come.

On the volume of milk - it will always be highest after you've spent the night in bed resting and your milk production hormones are highest between 3am and 7am or something like that. Oh, as well as the breast massage near the chest wall before feeding, you can try warm cloths on your breasts - helps letdown. I also found more success getting a second letdown by expressing R,L,R,L.

[LotusPalm]

Thanks again both.

I expressed this morning and got 14 oz, 9 of which was from one boob with a clear 4oz before any fat came into the milk. I definitely have uneven boobs!

I'm not sure how to regulate my supply either - he's only ever fed off one side per feed, so I've done blocks of 3 hours since the beginning. I've tried doing 2 feeds per side, I've tried complete removal and block feeding - nothing seems to work. I can't feed little and often. Because he's not interested... Will expressing 3 times a day help?

Any other suggestions I can try? I obviously need to regulate quite apart from feeding issues!

[becj86]

My blocks got up to 12hr long - one side for day, one for BT and night I wouldn't advise doing that for long though - leaves you really open to clogged ducts and mastitis (neither of which I got). I block fed for about 2 weeks I think (after each growth spurt as well).

I drank a touch less water (not none!) which reduced my supply and stayed away from galactogogues like oats, etc. Cabbage leaves in the bra - they help with engorgement and also reduce supply.

Expressing less frequently should reduce your supply - as will expressing to get the milk out but not stimulate more milk - so no pumping til dry and then a bit more... Little and often didn't work for me either. Maybe you could get to the point where you just do bottle feed EBM to him all the time and you just pump twice a day - morning and night and divvy the milk up. There are some people for whom that works. I found if I hand expressed til I got a letdown, then just squeezed my breast (rather than milking the areola), I'd get quite a bit of milk without stimulating the areola as much and that helped too.

[LotusPalm]

Hi,
Expressing seems to be sending my boobs into overdrive and am now getting full / borderline engorgment 3 times a day! I'm only expressing the amount I need, but the 'superboob' remains full and quite hard and lumpy. Anything I should be doing with it? Cabbage leaves don't seem to do anything.


And I have routinely done a 12 hour block overnight on the superboob, but it hasn't made any difference. I've done it for about a fortnigy and no change. It's sore, huge and lumpy, but I've nit git mastitis and its always softened by the end if the day...