I Almost Got Caught in the Top-Up Trap
Bennie was a big baby, just over 4.4kgs when she was born (Around 9lb 12 oz in the “old money”) and 58 cm long- I made the midwife triple check because it seemed ludicrous that someone so tiny could be so apparently large.
As soon as she was born, I put her to the breast, but she wasn’t terribly keen on feeding. She had a few drops of colostrum and that was it. It was the middle of the night and we were both pretty exhausted and eventually went back to the maternity ward to sleep. We had a couple more attempts at feeding but she was just so sleepy! The next day, a midwife said that she thought Bennie had probably had swallowed a lot of amniotic fluid and just wasn’t hungry yet. It took a couple of days for her latch to get sorted, then we were home free. The latch pain continued to be an issue for some time, though.
The Top-Up Trap
When she was a week old, we had a home visit from a midwife who weighed her. I’d noticed her nappies weren’t always saturated- she was probably getting 3-4 wet ones per day. A turn on the scales showed her weight had dropped to 3.8 kg so we were instructed to top up with formula and visit the local lactation consultant clinic. Two or three lactation consultants checked and one mentioned a slight tongue tie- but made no mention of revision, so we plodded on, not realising until much later this may well have been a factor in her ability to feed adequately.
There was no mention of donor milk or milk banks, no one talked to me about expressing techniques (to this day it’s not my strong point!) and the information on using formula to comp feed was varied depending on who you spoke to. No one spoke to me about a supplemental nursing system except a friend I had made online- someone who gave me more advice and encouragement than any health professional I had seen.
The thing the Lactation Consultant clinic helped with was the latch- they showed a few positions and one in particular sat with me until we got it right. This was far more helpful than the hospital approach where they jammed my boob and her head together and hoped for the best (well, this is what it seemed like they were doing!)
My GP had given me motilium (aka domperidone) at my request, to help increase my milk supply, but my other doctor within the same medical practice refused to issue a second script, telling me to switch to formula because “It’s the same as breast milk these days!” and while formula is a fine alternative- it is just NOT the same as breast milk. (Incidentally, the first doctor also told me not to breastfeed my daughter when she had her first and only bout gastro to date as “she shouldn’t have any dairy”- good thing I’m not a cow, then, right?)
The LCs at my local clinic wouldn’t tell me exactly how much formula to offer when trying to comp feed and not one of them actually explained to me that using formula was going to reduce my supply further- the “top-up trap” that many mums fall into. Things like nipple confusion were not discussed either. No one answered me when I asked how to reduce top-up feeds and get back to exclusive breast feeding.
Getting out of the Top-Up Trap
I took matters into my own hands and started reducing top ups. We stopped offering the dummy at rest times and consciously began to feed to sleep for every nap. I ate lactation cookies and drank nursing tea. I took herbal supplements and ate foods reputed to boost supply. None of these things have a huge evidence base in terms of studies etc. Instead I read up on what was known to be safe and thought to be effective- it was the best I could do.
Out of the Top-Up Trap
It took until Bennie was about 4 months old until we weren’t topping up at all any more. We’d gone from topping up at most feeds at our worst point (a case of mastitis tanked my supply at one point and I had to work hard to get it back!) down to 1-2 top ups each day when I stopped offering top ups altogether and just kept breastfeeding. We decided to offer 1 bottle of formula at night to give me a break as although my supply was greatly increased, I seemed to have a smallish capacity which meant feeding was very frequent. She also liked to feed for a long time- around an hour per feed until she hit about 5 months. She didn’t have a bottle every single night but it was handy to know it was there if needed and that she would drink it happily.
I won’t lie- I felt my efforts to breastfeed were not well supported by my health care providers. More than one GP was dismissive and unhelpful with issues relating to breastfeeding. The lactation consultants who I saw were very nice and some helped me with latching- but I felt they did not discuss all options with me and didn’t offer much in the way of information. What saved my breastfeeding relationship with Bennie was determination on my part and the support of some very well read, experienced and encouraging friends who were happy to troubleshoot with me. This is very similar to what anyone can access by calling the ABA helpline– a peer to peer breastfeeding counselling service staffed by breastfeeding experienced mums who have completed ABA training and volunteer their time to help other mums out. It has cemented my belief that more women would breastfeed and breastfeed longer with more consistent education and support- something that might come around if more family doctors decide to do a bit of study in the area of breastfeeding. They are often our first point of call with any issues and I know in my case, I was definitely let down.
This is what a breastfeeding toddler looks like…sometimes. Most of the time, it’s more like this:
Bennie is 22 months old now, and still breastfeeding. She will stop when she’s ready to, I guess. I haven’t really set a time frame. I’m grateful I was able to stick it out and grateful for the knowledgeable friends and lactation consultants who helped me through the hardest parts because it’s so beneficial. I don’t just mean nutritionally- though there is that! For this little girl, it’s a big source of comfort and connection and I’m happy I can give her that.