some questions (expressing)

[NIfirsttimer]

Ive been exclusively expressing for Roo since she was born 2 weeks ago.. so far my supply is great and im able to keep a few feeds ahead of her now.. my questions are ...

1. She had gotten herself into a wee routine of 3-4 hourly feeds, however today she seems to be especially hungry, and has demanded her midnight feed at 10pm, only 2 hrs after a large feed, is this ok & do i just go with her and feed her what she wants when she wants it at this stage?

2. She has gradually increased the amount she takes, and (until this surge today) has been taking aprox 140ml every 4 hrs.. according to what i can find online, this seems to be a huge amount, is this ok? she was tiny at birth, 6lb1oz, but by day 8 was up to 6lb9oz, and is growing fast!

3. burping.. how many times during a 140ml feed of EBM should i stop to burp her.. she would happily take the bottle in one go, and doesnt burp easily, but at the moment im stopping to burp aprox 3 times during the feed, then again at the end. Does this seems like enough?

4. storing EBM.... we are usually 4 full feeds ahead and these are stored made up in bottles in the fridge. She is due a feed at roughly 5am, so we bring that from the fridge to the bedroom when we turn in for the night, around midnight, so its out of the fridge for aprox 5 hrs, gradually reaching room temp. (aprox 20degrees in the bedroom) is this ok?

thanks in advance guys !!!

 

[asacia]

1) If she is hungry, I'd feed her, but make sure bottles are paced (more about that in answer 3) to make sure she isn't overfed.

2) Breastfed babies should take about 30ml an hour, in the range of 580-880ml per day. The amount they eat shouldn't increase based on weight or age - breastmilk composition changes to accomodate babies need. Breastfed babies shouldn't have more than 120ml at a time.

3) A bottle should take the same length of time as a breastfed, so a bottle should last for 20 minutes. Burping every 30ml is a good idea, and if she is a guzzler, you should have lots of breaks for little cuddles and chats, as well as burps.

4) Freshly expressed milk can be stored in an insulated cooler with icepacks for 24 hours. I think the changing of temperature is the problem, so personally I'd put one bottle in a cool box with some iceblocks during the day, and keep that upstairs.

Can I ask why you are expressing? How much are you getting per day, and how much is she taking per day? Was she premature, or have health problems? What is your pumping schedule? What pump are you using? Are you planning on exlusively pumping long-term?

 

[NIfirsttimer]

thanks so much for your reply.
im expressing as at the start she wouldnt feed at all and was quite badly jaundiced so her fluid intake was a concern. She couldnt latch on, despite the best efforts of 3 midwifes, me and the breast feeding coordinater at the hosp! Ruby was getting more and more frustrated and more jaundice, so they decided to formula feed her from a cup. She had this twice before her phototherapy started, and i decided that id rather she have EBM than formula, so started expressing, and its just worked for us all so far so we have stuck with it. i did continue to try for days and days to get her on the breast but she wasnt interested, although we still do skin to skin for at least half of our feeds.
i seem to have a decent supply, i pump aprox every 3-4 hrs including during the night, and get between 150ml and 200ml each session. at the moment she is taking between 90-140ml per feed so im still ahead of her at the moment.
She is indeed a guzzler, although i do try to make her feeds last as long as possible, we burp aprox every 40ml at the min, although she isnt impressed and demands her bottle be returned asap!

last night she seemed to be extra hungry and asked for an additional 50ml feed inbetween 2 larger ones, 4 hrs apart, although she then slept for longer this morning, and has just finished a 90ml feed rather than her usual 120+

im just confused as on our discharge from hosp they said that her fluids were crucial to her jaundice going, and to feed her what she wanted when she wanted it, but how long do i do this for...

she wasnt premature, but was a bit on the little side at 6lb1oz, although she is gained weight perfectly. apart from the jaundice she has no other issues, and the jaundice is almost totally gone now, just a little bit remaining around her nose. I use the medela swing pump, and with regards to our long term plan.. at the moment we are just taking it as it comes, its going ok so far so we will continue as we are until i run out or cant keep up with her i think..

 

[Kitten]

I'm feeding on demand too on the advice of every midwife I've spoken to and have no idea when this is supposed to stop?

 

[asacia]

Your story sounds just like mine - I kept trying DS, but he just couldn't latch. His jaundice was very bad, so I had to start expressing and giving him that in a bottle. I stuck with expressing, and having lots of skin-to-skin with the baby, and ay 8.5 weeks he latched on! He has been directly breastfed since then, without a single bottle!

If you think you'd like to directly breastfeed, I'd definitely limit bottles to 120ml. Larger bottles regularly can stretch the stomach a little, and then the baby gets frustrated with breastfeeding. Make sure you stick with newborn, slow-flow teats too. Pacing a bottle really helps too. The idea is to make bottlefeeding as close to breastfeeding as possible, to make the switch easier.

I stuck to 120ml bottles, but fed as often as DS wanted. He was a guzzler, and in the end would take 1200ml a day! He gained weight very fast, and went from 50th centile, to 91st, so I think he was a really hungry baby, it has settled now though!

Jaundice babies are often very sleepy - LO didn't want to eat at all, and I had to wake him up to get 40ml down him at first. It sounds like LO is getting plenty.

As you have plenty now, you could always freeze some milk. It is often easier to pump before 6 weeks than after, and having a bit of a freezer stash makes things easier when there are growth spurts!

 

[asacia]

I'm feeding on demand too on the advice of every midwife I've spoken to and have no idea when this is supposed to stop?

Babies that are directly breastfed won't overeat, so it is fine to feed them on demand, and for as long as they want.

With bottled breastmilk, it is easier for the baby and possible to overfed them. From what I've read, most people feed them as often as they want, but pace bottles and watch cues carefully to be sure of not giving too much at once.

A lot of HVs and Midwives don't have up-to-date information on feeding breast milk to babies, but if you are concerned give them a call.

 

[Kitten]

Aaah I'd assumed feeding expressed or breastfeeding was the same because of the milk. How interesting!

 

[NIfirsttimer]

my health visitor was here this morning so discussed this with her too. she said the same, that you cant really over feed a breast fed baby, and that the pacing thing is the key, that way the 'im full' signals get time to reach the brain before its too late and they are already overfed. Ruby is now 7lb1oz so shes gained a full pound in 2 weels, and grown 7 cms, so it looks like somethings going right anyway!

on the down side im more confused about milk storage than ever now.. everyone has such different ideas that im totally confused! this health visitor said that she wouldnt store it out of the fridge for any more than an hr! that makes going out and about with a pre packed bottle a little difficult, and means that the times when roo takes 3/4 of her bottle then wants a snooze before the rest, i will have to discard what shes left and crack open a new bottle?
what do you guys do?

 

[asacia]

I follow the Kellymom storage guidelines:
https://www.kellymom.com/bf/pumping/milkstorage.html#storage

It seems the best resource, lots of research done and there are many women in the forums who use the information.

I kept 8 bottles in the fridge, using the oldest first, and freezing any excess. If I went out, I took a bottle out of the fridge, and into a cool bag. If noy used, I;d put it back in the fridge. I would put an unfinished bottle back into the fridge. I didn' heat milk, I used it cold out of the fridge.