Changing from formula feeding to breastfeeding

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BokkieNYC's picture
Joined: 08/15/11
Posts: 1106
Changing from formula feeding to breastfeeding

Has anyone ever changed from formula feeding to breastfeeding? What was your experience like? What were your challenges? Were you successful?

My DD is 18 days old and has been formula fed since birth. We chose to formula feed because I was taking lamictal (lamotrigine) for my bipolar disorder. I have been on the medication since 2011 And was taking it throughout the pregnancy. I counteracted the potential birth defects by taking an extra high dose of folic acid.

I tried to wean off the medication throughout the pregnancy so that is could breastfeed but around 34 weeks I had an episode and had to increase the dose slightly. That was when we decided to formula feed.

Since DD has been born we've been rethinking that decision. Particularly since I ended up having a c-section and she already seems to have sinus issues. We really want to give her the best start possible.

To prepare over the last week and a hald I have been trying to hand pump my breasts but I find it difficult to make time because DD is very fussy and hates to be put down in her crib. I manage once or twice a day for about 15 min on each breast but I still seem to only be getting drops out. DD is drinking 2+ oz of formula per feed, sometimes 4oz. How do i know if I'm doing it correctly? Will I be able to produce enough for her? When will the real milk come in?

CamelNoodle's picture
Joined: 07/28/04
Posts: 908

Has your doctor okay'd breastfeeding with your med?

I think since it's been 18 days, you'll have to work extra hard to start producing milk. I would recommend an electric pump and a consultation with a lactation consultant. The hospital/center you delivered at should have one, or at least a referral. Your OB/MW can also refer you.

If a LC is not possible, try La Leche League. You need someone who can see if your daughter is latching correctly, something hard to tell over the internet. Smile

It is highly probably you will produce enough milk for her. You have some work ahead of you, but it's worth it!

Spacers's picture
Joined: 12/29/03
Posts: 4100

Have you discussed this with your pediatrician? I checked Dr. Thomas Hale's Infant Risk website and he advises that lower doses of Lamotrigine (200mg/day) are safe while breastfeeding, and higher doses (850mg/day) are generally OK as long as the infant is monitored closely. This drug does get into breastmilk and does get into baby's system at about 1/3 to 1/2 maternal levels, which is a pretty high transfer rate, but the most common side effects are sleepiness and poor sucking. Some babies develop a widespread rash which is an immune system reaction; if that happens, you'll need to stop breastfeeding.

Assuming that you & your ped are comfortable with your dose, or have agreed on a schedule of blood work to monitor baby, then you absolutely can do this! You should get an electric pump ASAP. Pump every three hours, hopefully around the clock, for at least a week to help get your supply built back up. When you are nursing baby on one side, pump the other. (On a bed with lots of pillows is the easist way to accomplish this!) There are also some herbal things you can take to help boost your supply -- fenugreek is awesome. Keep upping the fenugreek until your skin starts to smell like maple syrup and then keep at that dose. As long as baby is allowed to nurse as much as possible, and she is wetting enough diapers every day and gaining weight properly, she's probably getting enough milk. The best way to monitor how much breastmilk baby is getting is to weigh her immediately before & after a feed. You can buy a baby scale at most well-stocked baby supply places, or you might be able to borrow or rent one from the hospital or your ped's office.

You said you're unable to pump much because she hates being put down. That's very normal behavior for a newborn! I call it the fourth trimester. She's on the outside but she's not really ready to be, she wants to be snuggled up against you for a few more weeks. You might want to try wearing her in a sling or wrap carrier, which will allow you to be able to do things while she still feels like she's being held. You can also nurse while she's in it! I never managed to perfect it, I still had to keep one hand under my breast, but my breasts are freakin' huge so you might find it easier to do. Babies also love movement so she might prefer a swing or bouncy seat to being put down in a crib. Good luck to you!!!

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

Oh, sorry ladies. Meant to include in the opening post that I have weaned off the meds. It was a very rapid taper from 100 mg over one week, but it was with my psychiatrist's approval. Had my last dose last Thursday.

Spacers's picture
Joined: 12/29/03
Posts: 4100

Like Janel said, it's going to be harder than if you'd started at birth, but it's not too late; I know a woman IRL who started nursing when her baby was a month old because she had complications that kept her in the hospital and on meds that weren't safe for baby. Lots of pumping, lots of skin-to-skin time, make sure you have a good latch (there are videos online, and have your DH check since you can't really see for yourself), and keep her awake long enough to get a good feed (strip her down to her diaper so she's not too warm, tickle her foot, talk to her & keep eye contact, etc.) Once you get going, it should get easier and you'll be able to drop the pumping if you want, or at least taper down to once or twice a day to have some backup. And if baby gets hungry, offer a bit of formula *after* she's nursed as much as she can.

Oh, and also be sure to use the "newborn" bottle nipples whenever you supplement. If turned upside down, you don't want it to drip out; you want baby to have to suck to get anything. It takes work for baby to nurse and this will keep her from starting to prefer a bottle out of laziness. Blum 3

Danifo's picture
Joined: 09/07/10
Posts: 1377

I had a somewhat different situation because DD2 got breast milk since birth but didn't start nursing until 6 weeks.

I pumped both sides 8x a day for 10 minutes or until I stopped seeing milk. I would say you need an electric pump and a bra that holds the pump in place so you can still hold your baby during that time. The first couple days I got less than 10 mLs total and then each day it started to increase. By the end of my pumping time (around 12 weeks) I was producing double my needs. I went with the assumption that I needed to pump both sides my baby had a bottle. If I had a successful nursing session (10+ minutes) I didn't pump.

I found a nipple shield helped. I would pre-load it with some milk so she would get milk as soon as she started nursing.

Good luck. Try to find a LC who knows about this.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

Thanks for the advice and encouragement, ladies!

I ordered an electric pump thru insurance - just waiting to hear if it was approved. In the mean time I just received my actual hand pump today and managed to express half an ounce (which is more than I expected and is encouraging).

I will def try carrying her in the wrap whole pumping. Going to try ramp it up this week.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

I also now have an appt with a LC for Friday.

CamelNoodle's picture
Joined: 07/28/04
Posts: 908

Great! I also second the pumping bra. Something like this Amazon.com: Simple Wishes Hands-Free Breastpump Bra, Pink, XS-L: Baby

I had this one, Sears.com which requires you to remove your shirt first to put this one, but it worked better for a larger bust (I had the bustier too and it worked, but was droopy)

Spacers's picture
Joined: 12/29/03
Posts: 4100

You can also do a makeshift hands free pumping setup with hair elastics! http://kellymom.com/bf/pumpingmoms/pumping/hands-free-pumping/

I did that a couple of times when I needed a free hand. I generally focused on my baby while pumping but occassionally had a looming deadline that necessitated either not pumping (which is not really an option at the beginning!) or finding a way to manage hands free.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

I got a promo code for the simple wishes bra from another member of pg.org and have ordered 2

Smile

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

I'm concerned: since getting my Medela hand pump on monday night I've been able to pump 4-5 times a day. On Monday night I managed to express a half ounce in total from both breasts but since then I'm barely getting a tablespoon Sad

Is this normal?

How often should I take the fenugreek extract?

(I will be talking to the LC about this on Friday, just want another perspective)

CamelNoodle's picture
Joined: 07/28/04
Posts: 908

I think it's normal to vary, especially if your DD is nursing more, there is less to pump out. I found that if I kept pumping through while no milk was coming out, I'd get a second let-down. The more you nurse/pump, the more milk your body will produce.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

No, DD isn't nursing yet.

I'm still pump-and-dumping to get rid of as much of the medication-tainted milk as possible, and also to get my milk production going because I didn't start immediately after birth.

Spacers's picture
Joined: 12/29/03
Posts: 4100

There's no need to dump your milk. The half life of Lamotrigine is only 29 hours, and you haven't had any for over a week. It's been out of your system for days. Smile

For the fenugreek, start with three capsules three times a day, and then keep adding another capsule or two each day until your skin starts to smell like maple syrup, then stay at that level. Once your supply is well-established, you can slowly start dropping the dose down and see how your body adjusts. Some women only take it for a couple weeks, others stay on it for months, and dosage varies from woman to woman. Also try massaging your breasts as you are pumping. You will probably find a few "trigger points" that help squirt more milk out!

One thing that I forgot to mention earlier, don't take fenugreek if you are diabetic or if you have a peanut or chickpea allergy.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

Huh, my psychiatrist said it would be at least 5 days for the amount in my system to be "negligible" and two weeks to be totally clean!

Thanks again for all your advice, ladies.
Thanks for the warning. Thankfully I'm neither allergic nor diabetic so I will be starting to take the fenugreek tomorrow.

Danifo's picture
Joined: 09/07/10
Posts: 1377

My LC told me to keep track of when I pumped/nursed and how much I got. Part of it was so I could see progress but part of it was incase I had problems, she could see what volumes I was getting and what effect her suggestions had.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

I've got an app that I use to track DD's feeds and diaper changes, and it just so happens to have a function for tracking pumping Smile

So I've been logging my production. It has been much better since I upped my water intake, I got 15 ml at one session! And my breasts feel bigger, and they get a tingly feeling every now and then that makes me want to express them, so I think things are working!

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

I had my appointment with the lactation consultant today and it went really well. DD immediately turned to my breast when I brought her near and kind of latched without our help!!

She said I have milk already and that she is confident that my supply will pick up quickly. She has 2 concerns tho: making sure I get enough rest to maintain a stable mental and emotional state while off the medication; and she suspects that DD has reflux. But she gave me a list of exercises to get DD to latch better and she has nursed 3 times this afternoon/evening so far. I dont know how much she is getting put of me but it feels good Smile

Have a follow up appointment on Monday.

MJDttc's picture
Joined: 08/12/12
Posts: 1118

You are doing great! She will let you know if she is still hungry so don't worry over if she is getting enough.

BokkieNYC's picture
Joined: 08/15/11
Posts: 1106

"MJDttc" wrote:

You are doing great! She will let you know if she is still hungry so don't worry over if she is getting enough.

:-). I'm just popping her on the breast every time she grizzles so I'm sure with the pumped milk & formula top-up she will be getting enough Smile