Encouraging Bottlefed Baby to Breastfeed

Encouraging a Bottlefed Baby to Breastfeed

Babies will be more interested in breastfeeding if there is a great supply present. Coaxing a bottle fed baby to breastfeeding is likely to be more successful if mum is making 75-100% of baby's milk needs. If you currently have low supply, you may find that working to increase you milk supply first is important. The most effective way to increase milk supply is with increased milk removal, either by improved breastfeeding or improved expressing. Herbs and medications can be used to support this process, but will not work well as a stand-alone method.

The information here is written for a generic audience, and all information may not be appropriate for you - please refer to your personalised plan and contact Heidi Hembry IBCLC if further clarification is needed.

Expressing When Baby Isn’t Latching

Aim to express a minimum of 8 times per day. More is better. The more often you drain your breasts, the more they want to make to refill.
Planning to express every 2 hrs from eg 7 am to 11 pm will mean that you get 9 expressings completed, and then you don’t need to do so many at night (aim for every 3-4hrs overnight eg, 2 am, 5 am)
Night expressings are important as most mums have higher levels of prolactin at night. It also means your breasts are not being left unstimulated for a long period. The longer your breasts are left unstimulated, the slower they are to make milk.
Hand expressing is an essential skill for collecting colostrum. It gets easier with practice. You can move to a pump when your more mature milk is made on top of your colostrum, usually on days 3-5.
Massaging your breasts before (and during) pumping can help you to collect up to 50% more milk.
If you have a single pump, express one breast until you notice the flow has slowed to a drip. This may only be a few minutes at first, or 10-20mins. Then switch to the second breast and repeat. As the flow slows again, switch back to the first breast, and again, switch to the second breast a 2nd time. Massage and jiggle your breasts to encourage more milk to flow.
You can continue this for as long as it feels productive, though it’s good to aim for a minimum of 4 breasts.
If you are using a double pump, express both breasts until the flow slows to a drip. Set your pump down for a few minutes. Massage and jiggle, then return for a second pumping session. This might look like 10mins on, 5 off, 5-10mins on, 5 off, 5mins on, or any similar variation
Continue massaging your breasts between exach expressing burst.
Hand expressing can also be effective when pumps struggle to get fatty milk out - a few minutes of hand expressing at the end of a pumping session can add a few extra mls to your stash!
Different expressings can be added together to make a top-up or full feed as needed, freshly expressed milk can be added to milk expressed earlier in the same day.
If using a bottle, aim to use Responsive Bottle-feeding techniques to minimise the risk of bottle preference Infant formula and responsive bottle-feeding
To help minimise work whilst expressing regularly, there is no need to sterilise kit that is only used for breastmilk. You can wash in hot soapy water and rinse in fresh water and leave to dry. Alternatively, many mums expressing very frequently to build supply will keep their expressing kit in a clean Tupperware box in the fridge and only wash or sterilise once a day to reduce time.
If your baby is premature or unwell, sterilising after each use is important in the early weeks. Unfortunately there is no research on when it is safe or appropriate to move to simple cleaning after each use. Be guided by your health visitor or GP.

https://www.breastfeedingnetwork.org.uk/breastfeeding-help/expressing-storing/

VIDEOS- hand expressing

https://youtu.be/K0zVCwdJZw0?si=xoUU6f0s9lbOeoqk

Herbs & Medications to Increase Supply

Fenugreek to Increase Supply

Fenugreek may not be a suitable supplement if you are asthmatic, take insulin or warfarin, have a peanut/chickpea allergy, or if you have a history of thyroid issues.
Fenugreek, when taken in high doses can improve milk production in about 70% of women who take it. A few women report a reduction in supply, particularly if there is a history of hypothyroidism for you or in your maternal family.
If you have 500/600mg capsules, you need to take 9-12 per day, ie 3-4 in the morning, 3-4 in the afternoon and 3-4 in the evening.
If fenugreek is going to work for you, when taken in these doses you will generally notice a difference in 3 days, but give it a week to be sure.
Fenugreek works best when taken in conjunction with additional milk removal, either through increased frequency/efficiency of feeding or expressing.
When you feel your milk supply is raised and stabilised, wean off the capsules gently. Ie drop from 4 x 3 times per day to 3x3 per day. Wait for a few days and drop to 2x3 per day. Wait again, etc etc.
Most mums find that when their supply has stabilised they no longer need to take the capsules, but for a few mums, continuing to take them for several weeks seems necessary.
https://kellymom.com/bf/can-i-breastfeed/herbs/fenugreek/

Goats Rue

https://www.ncbi.nlm.nih.gov/books/NBK501817/

Blessed Thistle

https://www.ncbi.nlm.nih.gov/books/NBK501775/

Helpful Blog on Herbs

https://sarahoakleylactation.co.uk/wp-content/uploads/2021/03/Galactagogues-info-sheet.pdf

https://www.mahmee.com/articles/herbal-supplements-and-milk-production

Domperidone

Domperidone is an anti-sickness drug that is not regulated for milk production, though it is a common side effect of taking the drug. Some GPs are happy to prescribe, others are not, so these information sheets below (particularly the Breastfeeding Network one as it is put together by internationally recognised and respected pharmacist Wendy Jones) can be useful when talking to your GP:

https://ibconline.ca/information-sheets/domperidone/

https://www.breastfeedingnetwork.org.uk/domperidone/

https://gpifn.org.uk/galactagogues/

Encouraging a Bottle-fed Baby to the Breast

Aim to make bottle feeding as close to breastfeeding as possible by tapping the bottle teat to baby’s top lip and encouraging them to do a wide gape. Say "big mouth baby. aaaaaahhhh" at the same time, and open your own mouth wide. This wide gape is not needed for bottle feeding, it will help baby to learn faster and to open wide at the breast.
Skin-to-skin can be a fantastic tool to help babies with their breastfeeding reflexes. It’s also great for calming a frustrated baby. Some mums find that starting a bottlefeed with skin-to-skin is great and can greatly facilitate a smooth transition to breastfeeding at the end of the bottle
Pace bottle feeding. Ideally start with no milk in the teat so that baby has to repeatedly suckle for 20-30s before getting any milk - this better replicates a breastfeeding latch, and stimulation to start breastmilk flow, and will help baby to have more patience at the breast.
Every 10/20ml or so (or every 5-15 swallows) let baby take a break, ideally by tipping the bottle down so that no milk is in the teat. This will help baby not to panic or get frustrated when milk slows down at the breast.
Towards the last portion of the feed, remove the bottle entirely. When you tap it back on baby’s top lip, if s/he keeps their mouth shut or turns their head away, this is a sign that s/he has had enough at this feed.
For babies that are very reluctant to latch, initially give baby about 50% of a usual feed via bottle, then offer your breast. Touch chin to breast so that baby’s bottom lip is about an inch away from your nipple, and make “aaah” noises. Tapping your nipple to her top lip can be helpful. Be fast and firm when baby does open wide.
It may take several attempts at latching before baby stays on to feed. Be gentle but insistent, calming between latching attempts if needed. You can manually express, or drip bottle milk onto your nipple to encourage rooting.
If baby becomes distressed, give a little more by bottle and try again.
For some babies you will need to give the full feed before they begin to latch at then end of the feed, suckling for comfort. As latching at the end of the feed becomes consistent, your can begin to cut the feed short by a few mls and encourage more active suckles and swallows.
Nipple shields can be a great short-term intervention to help bottle-fed babies transition to the breast. This works best with a good supply. If supply is low, baby will remain frustrated with or without a shield in place. The shield is similar in texture to the bottle, and it can be easier to maintain a latch. Once feeding with shields is going well, you can wean off these too. However, they do not work for all families, and avoiding them is best if possible
Regardless of how you encourage baby to latch, when the suck/swallow pattern slows, use breast compressions to help baby take more milk. When compressions are no longer effective, switch to the second breast. Use compressions when needed, and switch back and forth between breasts for as long as it is successful.
As the latches become more consistent you can either reduce the amount given by bottle at the start of the feed or skip the bottle at some feeds altogether, depending on the volume your baby is taking.

Using an SNS

An SNS (Supplemental Nursing System) can be used to encourage a bottle-fed baby to the breast and has the added benefit of increasing mum's milk supply too.
Feeding at the breast should be prioritised where it is effective and the SNS introduced when feeding becomes slow and ineffective, for a few families this may be immediately at the start of a feed.
Baby continuing to take a bottle feed at the breast via the tube means s/he will get some additional milk directly from the breast, as well as stimulating more prolactin (your milk-producing hormone) as s/he feeds, further increasing your supply.
It can reduce the work of “breast - then - bottle”, and in addition greatly change the emotional dynamic of breastfeeding for mum and baby.
One end of the tube needs to be at the bottom of the bottle, covered with milk. The other end needs to be at your nipple, extending about 1cm beyond your nipple. It can be held in place with a little medical tape/plaster on your breast - you may not need this as you and baby get the hang of it. Most babies work well with the tube in the corner of their mouths. Others prefer it under their top lip away from their tongue and a few will be quite happy to have it placed on their tongue - find out which works best for you and your baby.
An SNS is simply a syphon, so you can control the flow well to suit you and your baby. Holding the bottle higher than baby’s mouth height means the milk will flow rapidly. Holding at mouth height will give a neutral flow, and holding lower will mean s/he has to work harder to keep the milk flowing. Initially, you may need to start with a ready flow to encourage good feeding. As baby gets used to this new system you can lower the bottle and encourage more active feeding.
In addition, you can pinch off the tube every few minutes and see if baby will continue to suckle on breast milk alone, releasing the flow if s/he becomes agitated. Pinching the tube occasionally also helps to better mimic the natural ebb and flow of breastmilk and will reduce the risk of breast rejection.
Offering both sides with the SNS at every feed is ideal, but can be fiddly. It's fine to use the SNS on one side per feed and to plan to alternate the side you use it on. IF you have a lower supply on one side, you can prioritise SNS use on this side to stimulate an even better supply.
Purpose bought SNS kits will have cleaning instructions to follow.
NG tubes as part of a home-made SNS, used with expressed milk only, do not need to be sterilised each use if your baby was term and is well. As with the pump kit, they can be kept in the fridge between uses and washed and cleaned once a day: Using a syringe, rinse through with hot soapy water to remove milk residue. Rinse again with clean water to remove soap. Finally push air through the tube using an empty syringe to dry the tube, or swing the tube around in the air to force the water out. If you wish to you can sterilise as per instructions for formula used tubes below.
Cleaning and sterilising after each use is necessary for premature and/or unwell babies, as per formula procedures below.
NG tubes used with formula milk need to be sterilised after each use: Rinse through with hot soapy water to remove formula residue. Rinse through with sterilising fluid and leave for the required time. Rinse again with clean water to remove chemical residue, and flush through with air. Microwave or heat sterilisation can cause rapid degeneration of the tubes.

VIDEOS

https://youtu.be/T1nZmxbEObs

Breastfeeding Support - Supplementing at the Breast