My son was born two and a half weeks early in a birth pool at home. Although the birth went well and he latched on straight away, he seemed too sleepy to feed. As he still hadn’t fed six hours after birth, the midwife said we would need to give him formula, which went against everything I had read, as well as my own instincts. A few days later, my son also developed jaundice, although that was not severe enough to require treatment. It took five weeks for him to regain his birth weight and, during this time, we had to increase his formula top ups, which meant introducing a bottle.
After a few weeks, he got lazier at the breast, as he was trying to feed off me as if he was having a bottle, and I got mastitis. My husband and I decided to stop using the bottle, so he would learn to breastfeed properly. Although our decision did seem to work, the midwife was not happy with our son’s weight gain when she discharged us at five weeks, so she referred us to our GP, who then referred us to a paediatrician.
The paediatrician told us to top up our son with 30 ml of formula milk after each feed, and by the end of the weekend, he had become really lazy at the breast again. With the health visitor’s permission, we decided to give him the same volume of formula in three bulk feeds, so that he would be feeding off me most of the time. However, I found that it would take most of the day for him to get to grips with nursing properly and the bottles at night would set him back again.
I contacted my local La Leche League Leader to get some support and she suggested I attend a meeting. I was really nervous and anxious, thinking that if things didn’t resolve themselves soon, I would be forced to stop breastfeeding due to my son’s poor weight gain. That first meeting was so amazing and empowering that I wish I had been able to go sooner. It was so reassuring to meet women who had been in my shoes and whose babies and toddlers were thriving.
My local LLL Leader mentioned I might like to try using a nursing supplementer to get my son back on the breast, whilst giving him the extra milk he needed. A nursing supplementer works by filling a bottle with either formula or expressed/donor milk and hanging it around your neck. The cap on the bottle has two tubes which you attach to each breast using micropore tape, delivering small amounts of milk into the baby’s mouth while he breastfeeds. The tubes can be closed off by slotting them through the slits in the cap. I was initially a bit hesitant about ordering one, as many reviews said it was fiddly to use and prone to leaking, but I went for it and I noticed a difference in my son’s breastfeeding straight away. Instead of his shorter comfort sucks, he immediately started having longer, deeper sucks.
I started off using the nursing supplementer in a rugby hold position, so that my baby wouldn’t get in the way of the bottle, and released the tubes straight away so he would get the supplement. I then closed off the tubes intermittently, so that he wouldn’t get a continuous supply of supplement and so that I could check if he would continue to suck properly on his own.
Once I got more confident with the system, I tried using it in cradle hold, but more milk was spilt that way, as my son likes to wriggle around whilst he is feeding and he often opened up the tube of the breast he wasn’t feeding on without me noticing. To prevent that from happening, I taped the tubes higher up my chest as well, so that they were not loose near his hands. To get the bottle out of his way as I drew him in closer to latch on, I lifted it over his body so he could still be very close to me.
When I next attended a breastfeeding clinic and told the midwife that I was using a nursing supplementer, she sounded very surprised as she thought it was only recommended to mothers of babies with Down’s syndrome. When I told her I had been in charge of how much formula he was getting by opening and closing the tubes, she said she hadn’t realised that was possible, as she thought it would just be a continuous flow once the tubes had been released. She then advised me to use the nursing supplementer on alternate feeds, and to only release the supplement once he started to tire and slow down his sucking. This meant that during some feeds he would only get five to ten minutes of supplement if he was feeding well off me.
After two weeks, he had good weight gain, so we dropped one or two of the supplement feeds each day and, by the end of the second week, we ended up giving him a maximum of 60 ml of extra milk per day. When the same midwife weighed my son again at the next breastfeeding clinic, she was pleased with his weight gain and suggested we go down to supplementing once a day with as much top up as he would take. Given his continued weight gain, the following week we stopped top ups altogether.
Before I started using the nursing supplementer, I was beginning to despair that it might have been the end of our breastfeeding journey and that was heartbreaking for me, as I had always wanted to breastfeed. I was so impressed and relieved when my son started feeding properly straight away with the supplementer.
Although I did experience some leaks, they only happened a handful of times and it only took a few drops for me to notice. Leaks were either due to a tube being released by my son without me noticing, or due to the cap not being screwed on tightly enough, or being on too tight. Sometimes the system also leaked if the silicone base that the tubes are attached to was not quite dry, so I started hanging the supplementer upside down over the sink and giving the bottle a little squeeze before hanging it around my neck to check for any leaks first.
After about a month of using it, my son was gaining five oz a week, and although he was still following the bottom percentile line in the growth chart, the health visitor told me that there was no need to continue supplementing.
My son is now 17 months old and since we started baby-led weaning at six months, he has jumped from the bottom weight percentile to the 25th. If I hadn’t attended La Leche League meetings and tried a nursing supplementer, our breastfeeding journey could have been very different. I’m so glad I trusted my motherly instincts and kept believing that he could get what he needed off me!
Sarah Chate Taylor, LLL Vale of Glamorgan
Written by Sarah Chate Taylor, LLL Vale of Glamorgan, and first published in Breastfeeding Matters issue 228 (November/December 2018)