Reflux is a bitch, but you're not alone.
James suffered from reflux very early on. He was that NICU baby that need thickened EBM & continuous feeds, who needed their cot elevated, who needed slow gavages (his heart rate and oxygen levels would drop super fast) and who spilled constantly! In hospital, it was managed quite well. But when he came home? Man, that shit almost broke me. James was able to exclusively breastfeed from quite a young gestation, but he struggled with my supply. I had been pumping like crazy to create a good supply for when he came home, but I failed to realise that he wouldn't need anywhere near the 100mls I was pumping from EACH BREAST! My supply was too large and too fast for the little guy to handle. He would choke and splutter and gulp air. He would claw at my chest and arch his back. And then when I finally gave up and removed my nipple from his mouth, I would literally spray him in the face with the force of a fire hydrant - yeah, thanks Mum! As much as I was lucky to have a good supply, it was doing way more harm than good.
I did some serious research - I wasn't ready to give up on our breastfeeding relationship. I resorted to expressing and feeding James bottles while I looked at ways to prevent the reflux (he was MUCH happier on the bottle - he was fed upright, he could control the flow and he wasn't gulping air in frustration). Firstly, I attempted to reduce my supply. I began to express smaller amounts and would hand express in the shower if I felt full and uncomfortable. I tried nursing in different positions. This wasn't really for us, but I did find that placing his feet down in my lap rather than holding him horizontally across my body was easier on him. We burped James frequently during a feed...I mean, a lot! We held him upright for at least 30 minutes after a feed (I used the baby carrier if I needed to get things done). We elevated the head of his bassinet - this was especially helpful for night time feeds when we wanted to put him back down soon after a feed so we could get some sleep!
I then researched conservative ways to ease the discomfort of his reflux. We did some pretty serious tummy massage at each and every nappy change - this has to be quite firm for it to be effective. Our fav NICU nurse show me the most amazing technique and while it looked rough, James absolutely loved it. And then when I tried it, I could seriously feel the air bubbles popping inside his tummy - it brought him huge amounts of relief. Don't be afraid to be firm and try different things - we would lay James on his change table and stand at his side. I would put my thumb on one side of his belly and my four fingers on the other side and squeeze firmly and pull my fingers together and up. Not sure if that makes any sense, but it was super effective for us.
We used wind drops (I'm pretty sure these don't work but it made me feel better that we were trying something!) We also introduced daily baths. I have no idea what it is about baths, but he would release a hell of a lot of gas! Another amazing trick that sounds really weird but works...putting some pressure on bubs bumhole and releasing quickly (this was again shown to us by our favourite NICU nurse). We used a warm, soapy facewasher or gauze to do this, and I swear, each and every time we released the pressure, James would let out ripper farts! He's going to hate me when he's older haha! At one point we even tried reflux medication, and while I wasn't keen on this at all, it did seem to work. We weaned him from this pretty quickly once we felt confident that our own preventative measures were more effective.
And the final measure that worked for us (probably better than all of the above) was a nipple shield. I didn't use one in hospital, in fact I hated them. But my sister-in-law suggested I try one as a last ditch effort. Man these things aren’t glamorous, but James latched on immediately, sucked strongly for 30 minutes and drained a boob. He didn’t fuss, he was comfortable and he didn’t even need a top up. What was the secret? James didn’t have to work so hard, it was similar to a bottle teat, it was easier for him to latch and it slowed the speed of my flow. We didn't look back.
Eventually James was strong enough to feed without the nipple shield, my milk supply slowly decreased to suit his needs, his tummy matured, and he grew out of his reflux. I truly believe that persistence, patience and (a lot of) tummy massage saved our breastfeeding relationship, which ended up lasting a huge 14 months! As difficult and as tiring as it is (during one of the toughest times of your life), try different things with the intention of fixing the root of the problem. I didn’t want to express, I didn’t enjoy using the nipple shield and I really didn’t like the idea of giving James reflux medication. But trial and error is fundamental, and at some point (hopefully before turning grey) you will find something that works.