Poor Lisa! Things seem to have taken a backwards step again since she reduced the top ups of expressed breast milk. Lisa describes Sophie as being windy, farty, burpy, unsettled and once again having frothy stools!
Mixed in with Sophie being very unsettled and then after a few sucks at the breast falling asleep until she wakes again 20 minutes or so later. The only time Sophie is alert and awake at feeds is when she is drinking from the bottle with expressed breast milk.
Lisa needed some help!
There is a combination of factors going on here…
Firstly Sleepy… Then Unsettled Behaviour – Why?
Sophie is in a vicious cycle here (and so is Lisa!) Sophie is only feeding at the breast for a short period of time and clearly not getting full up. Because this has been going on for several days now and she has no longer been getting top up milk feeds after every feed Sophie has become tired because she is not getting quite enough calories.
So you can see how this cycle just keeps repeating itself, poor breastfeeding = not enough calories filling Sophie up = reduced calories over all makes Sophie tired and sleep on the breast after a few sucks = Sophie wakes up a short time later as she realises that she is still hungry… and, so the cycle continues.
There is also another cycle going on here for Lisa. This one could result in her reducing her milk supply:
So, here we have the mum’s cycle showing how easily it can be lose your milk supply!
To help Lisa and Sophie continue to breastfeed, I need to help them break this cycle. This involves feeding Sophie more expressed breast milk, temporarily, but also getting Sophie to feed better on the breast and not rely on the bottle.
It appears Sophie has found it much easier to take the milk from the bottle and this has not helped how she feeds at the breast. The feeding plan will include increasing Sophie’s top up feeds – so that she will have enough energy to sustain a full breastfeed.
So Why is Sophie So Windy and Having Frothy Poos Again? Is this a Lactose Intolerance?
I explained to Lisa that her milk is not causing the unsettled behaviour. Instead, it’s the lack of milk and the fact that Sophie is probably only drinking the first foremilk which is high in Lactose (sugar).
This high sugar milk is filling to a point. It’s a bit like if you ate a punnet of strawberries for your dinner; you would maybe be full for an hour or two but then you would probably want to eat a meal with protein, carbs and fat in it to fill you up for longer.
Drinking mostly high sugar foremilk can make some babies have really frothy stools and feel quite windy and unsettled.
Once they start drinking all the milk you make, they will get the right balance of sugars, fats and proteins. As a result, their poos will probably go back to normal again.
Lisa and I devised a plan which she could manage and I followed up with an email and texts to see how she was getting on.
Here is an email from Katie to Lisa on this topic…
“Hi Lisa – So lovely to finally see you in person! Keep your chin up, this is only temporary. You are doing so well, mini meltdowns included!
It’s all normal under the circumstances. If you are feeling overwhelmed or very upset, please feel that you can talk to me about anything. I’m only a phone call away and it’s good to get these things out in the open so that help can be there for you when and if you need it.
Here’s the plan we discussed. See how you go with it.
- Feed Sophie up with lots more milk. Switch feed: When offering Sophie a breastfeed (BF) – as soon as she becomes sleepy change to the next side/breast to stimulate her to wake and feed again. Continue breast compressions during feeding.
- If Sophie is still sleepy after you’ve switched her to other breast, then give bottle of Expressed Breast Milk (EBM). Only feed 1/3 – 1/2 of the EBM at this point. We’re only giving her a little bit of EBM to gently “trick” her by giving her extra energy to finish the breastfeed.
- After this partial EBM feed, try to BF again. Sophie should now be more awake and alert and breastfeed better now that we have given her some energy to feed.
- If Sophie is still sleepy or becomes sleepy after some feeding at breast and you think she still hasn’t had a full feed then give Sophie the rest of EBM feed. Or if there is time to spare, give her another 1/3 of the EBM and try back on the breast again.
- Ideally, Sophie will start to drink more calories and become more efficient at the breast. This means that she will stay sucking and swallowing for longer periods and this will stimulate your breasts to make more milk.
- Do not “Burp” Sophie too quickly, let Sophie rest first on her back and digest her food gently before picking her up to change/swaddle, etc. This should mean she is calmer after feeds and reduces the chances of vomiting.
- Express your milk after feeds to boost your milk supply back up to where it needs to be – double pump both breasts at the same time with your Medela Swing Maxi as this can mean you express up to 18% more milk in half the time.
Here’s the plan for the future…
- Get Sophie fully BF – without expecting and relying on the bottle
- If Sophie continues to reduce her breastfeeds and prefer the bottle over the next couple of days we will try using the Medela Supplementary Nursing System (tube feeds at the breast).
- Consider going to the day stay offered at your local maternal child health nurse clinic.
Have a restful weekend. Sleep when you can and as much as you can. You need to recharge too!
I’ll be in touch soon,
What breastfeeding questions do you have? How would you describe your own breastfeeding journey? Please join the conversation here or on our Medela Australia Facebook page.