Aunty Lactivist is all of us so please help with any comments, links or ideas if you can help at all. There are many issues in this question, the mum didn’t get much contact with the baby in hospital, she feels the baby is not taking much from the breast but will from the bottle, she also feels she cannot express enough.

This post will feed through to the Lactivist Facebook page so I will cut and paste any advice from there and add it to the comments later.

Dear Aunty Lactivist

I am wondering if you could maybe give some advice for my sister-in-law.  She is currently living overseas and is not getting much help at all from the doctor’s/midwives with regards to breastfeeding.

Her daughter was born on 6 weeks premature and where she lives they do not allow the babies home until they are at what would have been the 38^th week of pregnancy.  However, my sister in law and brother in law brought the baby home after 2 weeks I think it was as the doctor’s said there was nothing medically wrong with her – other than being a premature baby – and kept wanting to do all these tests on her for no reason (they have to pay for each thing done over there).

While in hospital, the mum had to feed the baby by bottle every 3 hours – if the baby wanted more, she couldn’t have more than what was in the small bottle, she wasn’t allowed to be fed apart from every 3 hours.  My sister in law did express (I’m pretty sure) the whole time so it was EBM the baby was getting.  My sister in law also wasn’t allowed near the baby apart from during feeding time.

Anyway the past week she has been trying to breastfeed the baby as she’s been doing nothing but expressing and she’s really worn out.  Here is some info from my Mother in Law.

She finds she is feeding the baby for a couple of hours – 45 mins on each breast , she is not taking much – then takes 90- 100 mls in a bottle. She then has to express 60  mls for the next bottle. Whilst some one is giving the bottle she is expressing the 30 – 40 ml top up. Last  night at 11 p.m. she looked so weary & down – her husband was telling her to keep trying – she was pumping away and nothing was coming. All day and night she is trying to produce sufficient milk – apart from changing nappies and settling the baby. I really am worried about her – there is little joy in this routine. She hasn’t even been out to show the baby to anyone and has put off anyone coming to see her. A new Mum gets tired but should be having a bit of a life. The baby will be  seven weeks on Sunday. I am making sure she is eating and drinking plenty and resting.

 If there is anything at all you could suggest that I can pass onto my SIL I would be ever so grateful.  When we see her on Skype she looks very tired and worn out – black eyes from lack of sleep, etc etc.  I know I was tired after having my baby, but I don’t recall looking the way she did once I was out of hospital.

These are the Facebook page comments:

• gosh this is horrible because the baby has ready gotten used to a bottle by the sounds of things. My daughter was breastfeed from birth then I had my placenta removed and she ran out of what I expressed so her dad bought formula and that was it she would only accept a bottle and after the surgery I just couldn’t express I tried and tried but nothing would come out. I have a medical condition and in the end my consultant told me I needed to go back on my medication which ment I was no longer allowed to breastfeed or express so after less than a month she was a formula baby I now it’s not want anybody would want but if it’s putting her health at risk and there’s no help maybe express during the day so she can use it at night or the next day and use formula in the interime. I no its not the ideal solution because I’m all for breastfeeding but if it’s getting to the point where she’s not going out and her health isnt get nobody can blame her for needing extra help and it doesn’t make you a bad mother something is better than nothing and hopefully if she expresses more constitantly and builds up a store that will be better- I also think stress plays into it as well. If I was stressed or anxious I would find it almost impossible!! I no I would rather give my children milk that was made my me for them it’s seems stupid not to but try having a relaxing bath being calm, meditation even?
• First of all congratulation to the new addition in your family I don’t quite know what to suggest apart from possibly helping the milk come out e.g massaging the breast that is been fed from preemies get tiers quickly so perhaps she is getting tired also a sling so that lo can feed and be cuddles whilst mom can do things or at least have her hands free, also perhaps express after feeding so that lo has plenty, if I was her I would take to my bed topless and snuggle baby for a day or 2 not getting out of bed unless she really has to that way she can concentrate on baby and baby alone no expressing etc and just attempting to establish feeding.
• I got stuck like this when I an operation and had to give ebm to my 3 month old. I panicked I wouldnt have enough stored and enough when I got out. I felt like a cow! However a found eating ALOT more then what seemed right helped boost my supply and hard as it is, trying to relax. The more I stressed the less milk would come, and I have a very very heavy let down and knew this wasn’t like me at all. My partner would tell me to stop and take a breather, eat something high calorie and try gain. It did help. Also something that made the biggest difference was changing pump, it was like night and day. Not sure if it will help but thought I would share as I know how it feels! Fingers crossed for her and hope it improves soon. X
• Hi I feel for your sister in law, I had my 5 th baby in Cyprus and their attitude is the same and had similar breast feedi problems, ..she seems to be doing everything right, I had the more milk capsules shipped over to me and they definitely helped supply. Maybe she could give the expressed milk with a spoon or syringe so the baby doesn’t get confused with sucking. I also had to power pump which does work even though it was exhausting but it took about 2 weeks for my supply to increase…and am still on my breastfeeding journey 3 years later….wishing you lots of luck xxxx
• Prem baby!!! Breast feed only no bottle. Will need feeding every 1 and half hours!!!! When babe is big enough to take more feed it will and time between feeds will increase… Plenty fluid and iron rich foods…
• i can relate – my girls were hungry too – and would happily have 40 minutes on each breast, a break of 30 minutes and then start all over again….and in the evenings they’d happily be permanently latched on for 3 or 4 hours!!!
  i have since learned that this is called cluster feeding & helps stimulate milk production for the next day and it is best to relent & just latch on & let baby get on with it!
  (with nr. 1 i would go on strike & let her scream & it was awful…several hours!!! i don’t even want to describe it (
  but with nr.2 i just latched her on & let her have as much as she wanted & it would be a matter of a couple of hours at most – rather than 3 or 4 or even longer with nr.1)
  i ate almost every meal with baby latched on & hubby cutting up my food so i could just use a fork with one hand….
  our bodies are incredibly clever – a baby will get a lot more milk out than any pump! (you also get more if you’re pumping while baby is latched on on the other side & when looking at baby or even photos / videos of baby!!! the body is reluctant to give it up for a pump, lol)
  i guess your niece is making up for coming early, making up for lost time in fattening up in the last weeks of pregnancy, lol
  i also think she should ditch expressing – they have not really had a chance for breastfeeding to become properly established and meanwhile it’s nearly 2 months & it’s no wonder that mum is worn out!
  so concentrate on establishing the BREASTfeeding – no middlemen/bottles.
  lots of skin to skin – stay in bed, sleep as much as possible, just consider the nipple a replacement for the umbilical cord.
  lots of carbs in the diet – i wonder if anyone here has a recipe for milk boosting cookies?
  oats are good – porridge! and baked potatoes!
  eat LOTS – i went though about 3000 kcals and over 3 litres of water for the whole time i EBFed. and had my pre-pregnancy weight before baby’s first birthday – without ANY dieting whatsoever!
  i can also highly recommend breastfeeding tea – equal parts of fennel seed, cumin seed & aniseed – i also sell it via mail order from the UK, feel free to leave a message on my page Dolyang Herbals (still very much under construction….) – normally about 3 cups per day (i used to make a big pot & kept topping it up…), but as many as you like, especially in the afternoons.
  a few other things to check:
  she’s not supplementing, is she? it reduces supply!!! a definite no-no at this stage in these circumstances….
  she isn’t on any meds that might be reducing her supply? (esp anti-inflammatories, eg diclofenac)
  is the latch good? (difficult to tell for anyone other than a trained LC…) – there is a youtube video for an enhanced latch, but i haven’t got the link to hand…i could try to find it if you’re desperate & can’t find it yourself.
  is baby growing? 6 wet nappies per day? is there undigested milk in the poo (looks like tomato seed or eraser rubbings)? that’s a sign that she’s getting more than enough…btw, EBF babies do not necessarily poo every day – even once a week is within the normal range…
  is baby using mummy as a dummy…? (ie for comfort)
  i know a lot of ppl are against them & there are concerns about nipple confusion, etc – so i’d be maybe a little hesitant to introduce one at this point, but it might be something to be borne in mind….my first didn’t have one (she spat it out at 6 weeks old), but my 2nd loves hers (she is nearly 2 and a half…) & it was a complete nipple saver…
  it might also be worth looking at block feeding – you keep latching on one side for 4 hours, before using the other side for 4 hours. the idea is that the side you are not using gets a chance to really fill up and baby gets lots of the more fatty hindmilk from the side you are using.
  
  your SIL is bound to be knackered and in no fit state to think properly, so it is really good that she has you & her mum to support her & do some of the thinking – so you can look through all these suggestions & have a think about what you think might be best to pass on to her & maybe ask her questions to help her figure out what’s the best way forward…
  speaking of mummy brain – i can also highly recommend some high strength fish oil/omega 3 – i cannot remember what the exact dosage is, but the breastfeeding pregnacare is worth investing in…
  
  keep supporting your SIL- she is doing an amazing job & it will be worth all the energy she puts into this now….stay strong mama!!
  the family around her can take care of ALL other jobs – and she should just concentrate on nothing but feeding for a little while – except food & toilet breaks….she can have a shower when she gets desperate, lol – even with baby latched on
  everything else will fall into place when the feeding goes well
• Suggest to use SNS (supplementary nursing system)
• Great advice there. Please tell your SIL to give it a go and well done to her for trying.
• Sounds horrific-interested to know where this is? My boys were both 6 wks prem and ebf. Takes a while to get going but entirely possible with dedication and support. I had the advantage of a supportive NICU team, a great lactation consultant and NG tube feeding to start out with. It will be hard to get baby off bottle but can be done. Tracy can u advise re bottle to breast? Re prem though,agree as much skin2skin as poss,only allo guests who are understanding and supportive of her aim. Pump every 3hrs round the clock to maintain supply. Perhaps pump a little before each feed til letdown to make it easier for baby til she/he gets used to it,get technique checked too. Although dummies are not normally advised,they can help prem babies to develop their sucking reflex,although if baby is taking a bottle this is prob not an issue and could be counter-productive. Good luck to her and Thank you for seeking advice and supporting this new Mum.x darn-can’t tag from phone,Tracy eventualy got her daughter from bottled ebm to EBF after more than 10wks! hopefuly she will see main post.
• Only dif I would make to  suggestions is no shower-bathing with baby can be a great way to stimulate production and spontaneous latch!
• Has she tried biological nurturing? Try and spend 24 hours just her and baby in bed skin to skin. If she’s got a sling wearing baby as much as possible as i think this closeness will be nice for baby after having to be apart from them in hospital. She could also try nipple shields as baby might take to the nipple shield because its a bit more like the bottle? Good luck mamma you are doing a great job and well done to dad for being there and encouriging her to keep going x
•  As others have said, biological nurturing ( particularly in the bath) lots of skin to skin, and eventually I tried some nipple shields. I started by letting her feed using them so it was similar to bottle, then after a few days I’d remove them during feed, then at 8 weeks old she fed for the first time without them. Hope this helps, good luck and don’t give up as it is possible xxxx
• First thing I’d do is skip the pumping. Put baby skin to skin in a sling, and let her latch when she wants, feed for how long she wants and then rest, rest, rest. Make sure she is eating and drinking lots, and then her supply will match what the baby wants. We had a lot of trouble getting our LO off the bottles that the hospital had him on, but after about 3 miserable days of just not letting him have them, my supply settled to what he needed, and he got used to the idea that milk came from Mummy..
  Good luck!
• I agree to leave pumping if she can and the bath trick tracy-ann mentions still works for me 6m pp. As soon as i get in the bath with or with out baby im leaking! With baby so much more. I also found eating oats and drink, drink, drink ( water) if you think you have had enough then drink more. easier said than done but ass soon as she stops worrying it will flow much easier. Another thing i do if i feel that my supply is dwindling is to have “boobie time” just relaxing in front of the tv and let baby latch on as and when. the more they latch the more you produce. ( she is very lucky to have such a helpful SIL ) good luck x