Temporary supplementation during the first few days of baby’s life, before the milk came in.

The Situation

First time mother had a long and difficult birth with substantial blood loss. She had no colostrum after the first day, and no milk for 5 days. The parents wanted to safely feed their baby whilst protecting the breastmilk supply.

I started work with the family on the second day of baby’s life and had reports from the hospital that baby struggled to latch. After each attempted breastfeed she had been given formula in order to maintain healthy blood sugar levels, and to allow baby to be comfortable and content.

On return from the hospital it was obvious that the mother was in severe pain from what later turned out to be a tear in the artery in her neck so there was a balance to be found in taking care of both mother and baby.

The Problem.

After observing a feed it was obvious that baby wanted to latch but very quickly became frustrated when there was no colostrum or milk and refused even to try to latch, just screamed and screamed.

I have come across this many times over the years so we decided to try what I call my ‘Motivation Kit’. This is simply a 1ml syringe and some formula in a little pot (flat based baby bottle caps are great for his) along with a thin cotton swaddle and a pacifier.

Motivating Baby

As the mother prepared herself for the feed I ensured baby was awake, but kept her calm, with a pacifier. The aim was to make sure she was in the best possible frame of mind to start the feed.

In a bid to encourage baby to latch I carefully placed a drop of milk from the syringe on to the nipple so that when baby did try she got an instant reward.

I continued dribbling small amounts of formula down the mothers’s nipple or into the corner of baby’s mouth, constantly rewarding her efforts and encouraging her to stay at the breast.

When baby began to get too wriggly we swaddled her firmly with a muslin cloth folded in to a triangle. This made it much easier for the new mother to manoeuvre her and control flailing arms. We also used the pacifier any time she started to get upset from hunger or frustration to prevent escalation.

Caring For Mother

When the mothers pain became too much we stopped the breastfeed and the father or myself topped the baby up with formula, and allowed her to drink until she was peaceful and content. The mother used the breast pump to stimulate the breasts for another 10 minutes (as much as she could bear at that time).

This gentle approach reduced stress to a minimum enabling the baby to satisfy her hunger quickly and calmly, and allowing the parents to relax and enjoy their baby, getting to know her and bond as a family.

We used a bottle called the Munchkin Latch which has a large teat that is soft and supple. This mimics the mouth position and action of the baby at the breast, and also has a very slow flow rate to help prevent baby getting lazy at the breast.

We repeated this every 3 hours during the day and I then did a bottle feed in the middle of the night so that the mother could rest because she was in so much pain..

I know many people say that it is vital for the mother to breastfeed in the night to stimulate her breasts, but in practical experience I have found this to make no difference to the long term feeding outcome. For an exhausted mum, the best possible boost to recovery is sleep, along with good food, so is always beneficial for the milk supply.

We continued in this pattern for four days, tempting and rewarding baby at the breast, then topping up with formula, and she became increasingly adept at latching and staying on for a few minutes longer each day.

Breastmilk Arrives

On day 5 the mother’s milk started to come in and baby began to feed properly from the breast for the first time. We kept the number of minutes feeding low to begin with, again, because of the mother’s pain levels.

We used the syringe technique to help overcome the initial engorgement when the breasts were hard and tight and difficult for a small mouth to cope with. We continued to use the swaddle to calm baby whenever she got frustrated.

Dealing With The Unexpected

During this time the mother had been under medical supervision but on day 6 was readmitted to hospital where she remained for 5 days.

The decision was made to keep baby at home with me overnight so the mother could rest, and I would take her in during the day for feeds.

Throughout this difficult period the baby was fed a mixture of breast and formula, whichever was available at the time without pressurising or stressing the mother, and we continued with 3 hourly feeds which usually included pumping at some point.

The mother’s breastmilk supply continued increasing slowly but steadily, and baby continued getting better at latching and staying at the breast.

When the mother was discharged and blissfully free from pain for the first time in her baby’s life things improved even more.

Happy Endings

As mother became more relaxed and could focus she became very adept at getting baby on the breast and the need for the syringe disappeared almost overnight. By the end of 2 weeks baby was latching easily and the amount of top up needed was naturally decreasing.

By the end of week 3 baby was being breastfed for all feeds apart from the one night feed at 3am. This was formula or expressed breastmilk, by parental choice, so that I could do the feed and allow parents to sleep, and they were very happy with the result.

All this was achieved with no cracked or bleeding nipples, and no excessive breastfeeding pain for the mother simply by taking our time, building up gradually, and figuring out a solution that suited this particular family.