don't know where to start, really...

dd is two weeks old today (blimey) and put on her birthweight on wednesday so that's great. however of course she didn't start putting on weight until her formula top-ups, topping up with ebm didn't do the trick.

her weight gain today was only 30g (last few times has been double that or more) and i do put that down to the fact that i've been pumping more and therefore have been giving her more ebm top-ups than formula.

question is... what's the tipping point? she is gaining, i am producing more milk (not heaps, but volume-wise we are on target for the SCBU calculations). we were told to give dd 280mls per day in top-ups as well as bf, but with the formula it's been more like 350ml.

so do i accept the 'slow' weight gain and think of dd's longer-term benefits having protected my supply, or do i want her on formula but with more energy to feed, iyswim?

midwife has suggested one top-up of formula, and at the next topping-up with ebm, this seems like a reasonable compromise to me, but am i missing something.

<double-pumps>

First of all, well done, I know from experience that BF a premature baby is hard. But give her time, and your body, remember that the more she feeds, the more milk you will produce and your body will provide the exact content your baby needs even without the formula. Formula milk actually contains less calories that Breast milk but it just digests less easily so even though she may be full for longer, her body does have to work harder to digest it. Maybe you could speak to a lactation consultant or even a BF councillor as they really know what theyre talking about, and however knowledgable a midwife is about babies, she is not an expert in breastfeeding. Try www.nctpregnancyandbabycare.com (NCT) or www.abm.me.uk (association for Breastfeeding Mothers) or maybe la leche league, sorry I dont know the email address for that. Good Luck, and dont panic youre doing a great job!

cheers, is that right about the bm being less calorific than formula? thing is, the baby is tiring imo before she's getting to the point that the fattier milk is coming through. (not that my milk seems to be that fatty anyway, it never seems to separate in the fridge other than with a little creamy slick on the top).

how did you give up formula top-ups with your situation, if you don't mind me asking?

Aitch, so glad you are out of hospital and both safe.

Am wary of advising wrt to feeding a preemie, but one thing to say is I wouldn't pay too much heed to how your milk separates, I'm sure it isn't proportionally meant to be that much anyway.

When you say "i am producing more milk (not heaps, but volume-wise we are on target for the SCBU calculations)" how are they working this out? What you express is not an indicator of how much milk you are producing.

How regularly are you feeding. If you think she is tiring before getting to the fattier milk I would suggest feeding more often. The shorter space between feeds the less chance your milk has to separate between feeds (in v rudimentary terms!).

I guess the most important thing is to get her fattened up and more energised. Building up your milk supply with a view to trying to get to exclusive bfing can come later when she is stronger.

Sorry if that isn't much help, but I just wanted to give you some kind of answer.

The other option is for the odd feed to express immediately first so she gets some hind milk.
I found that I had to do this with dd as otherwise she seemed to spend most feeds only getting the fore milk.
You're doing well though as shes putting weight on.

of course it helps, you dolt.

funnily enough i've kinda been doing that anyway, re the spacing out less, but then after doing that she's put on 'less' weight so now i don't know... and of course i'm sitting with the pump on a lot, becuase i was figuring that if dd sucks after i've got all my 'foremilk' out then maybe she's getting the fattier stuff but that might not be right.

the scbu calculates a ml requirement daily based on their weight, and because we're bfing (with a limit of 15 mins) they want her to have 7x40ml top-ups as well, in whatever form.

ah but bronze, i think she's only putting on weight cos of the formula, though...

aitch, you have mail. not related to Bf though!
i think ml for ml, breast milk has the edge on formula. i would get specific advice from one of the four helplines... your hospital might well have someone on site who is an infant feeding co-ordinator or some such,

topping up can be a mixed blessing as you know, and i don;t know wnoeugh about preemies to say really

Why with a limit of 15 minutes?

Its up to you with the top ups, you could gradually decrease the amount and increase how often you offer the breast or you could just offer the breast every 2 hours or so and stop the formula completely. Good idea with the expressing first so she can get to the hind milk before she tires, but if shes got plenty of wet nappies etc then im sure shes doing fine. The support and info you can get from a Lactation consultant will be invaluable though they will really be able to help. And also the amount you can express has nothing to do with how much your baby will get as her way of getting it is much more efficient than an expressing machine!!

she has prodigious amounts of poo and pee, so no worries on that front. [costing a fortune in nappies]

the 15 mins thing is that apparently it's been Proven with Proper Research that babies tend to get what they're gonna get in that time, and with dd being prem there is a point at which she's exhausting herself to get calories which isn't practical. don't all jump down my throat... it's what i had to sign to before they'd let me out.

Aitch - not my specialist area (feeding prems) and you need someone with a lot of specialist knowledge and experience....it is a matter of careful individual judgement to decide how much formula a baby needs in order to have the energy to breastfeed well, and also how far you can 'accept' a slow weight gain. The main thing is always to protect the milk supply, whatever is happening hour by hour, day by day, in terms of calories going in and weights. And you are doing that.

Formula and breast are more or less the same calorie-wise, but it's a hard thing to judge, because breastmilk's fat content is dynamic - it changes, as you know, with the amount of milk in the breast. Less milk = fattier milk. However, volume is the crucial thing - a low milk supply does not mean 'oh well, there's not much of it, but it's creamier'. Get a good volume going, and we really don't need to worry about the precise calorie value.

Babies do use up more calories digesting formula, which is why as (non prem) babies grow, they take larger volumes of formula (generally speaking) but do not appear to do this when breastfed (generally speaking) after the first weeks, anyway.

But none of this really translates to prem-care in the SCBU - they like to see the mls going in.

You can boost the calorie content of formula and of ebm with human milk fortifier, which is (despite its name) a cows milk formula. It makes whatever milk the baby is having more calorie dense, which can be a good thing for teeny weeny babies whose tums can't take large volumes. You can also do a bit of lacto-engineering (bronze's idea of expressing immed after a feed).

But if you are protecting your milk supply, then that is, IMO, the main thing. Then it will be there when dd needs it, when she is stronger and bigger

Have you looked at the kellymom pages on bfing a preemie?

It sounds like you are doing the right things, lots of feeding, lots of pumping to maintain supply.

I think that lulu is right, oz for oz bm has higher fat content, so if feeding properly DD should put on more weight with BM than FF. So I guess the crux is why is she getting more FF than BM? E.g. too sleepy, poor latch. Figuring out that will make it easier to figure out how to improve things.

she's not that un-strong, though, tikkers. in fact i'd go so far as to say she's quite feisty. you know she was only in scbu for one night, don't you? she's at home with me now, in her silly hammock. (which i'm soooo glad i have, apart from when dd swings in it.)

The 15-min thing sounds arbitrary to me. The point is not to tire the baby out - fair enough, and very sensible. But this is best judged (surely) by watching the baby...sometimes, 15 mins might be too much, and at other times, 20 mins might be fine. Does this make sense? If the baby is really not feeding effectively or much, and looks like she will zonk out in the next minute and not manage to get the formula/ebm down her...then that's when you stop, yes?

But test these ideas out on someone who is there with you and more expert than me on prems.

Personally I would try and reduce the top ups and offer her the breast as often as possible - sadly this means you do have to feed round the clock but within three days your supply should get there entirely.

BTW your milk has as much fat in as she needs. I think my milk is unusual in being about 50% cream on separation - what can I say, I eat a lot of fat!

You can try expressing twice on the same breast and feeding from the same breast twice too - that will mean that the boob will get emptied properly and fill up entirely and there will still be milk left in the expressing boob which will be creamier the next time you offer it (IYSWIM).

But honestly if she's growing, you are doing the right things already.

If you get really desperate, I'll wizz you a pint of mine in the post and you can feed it to her - that'll fatten her up

Oh, one night???!! Gosh - she must be strong! In that case, the 15 min thing is surely a rough guide, and no more?

Interesting about the 15 mins thing. In normal circumatances the advice would be to feed for as long she wants, but they must have their reasons I guess.

Like tiktok says, preserving milk supply is key, for later when she is stronger.

What are you doing with all the milk that you express?

aitch, please check your inbox when you have two seconds! i think i sent the email to the right address

yes, that's kind of what i've been doing as well, tt. if she's feeding strongly then i'm not unlatching her to a timer. i'm going to give her a feed just now, actually.

re the prems. ime so far the paeds have been teh absolute WORST at supporting bfing, and are much more concerned about her putting weight on at all costs.

lulu, sorry, i got your email and then completely forgot to reply... [twit]

Bump - there is a trade off with prems, though. They are so sleepy and easily tired - we don't need to worry about 7 pound bruisers, who can feed as long as they want and if they get tired they can just sleep a bit longer. The prem baby can get too tired to feed well, and it's a balancing act.

s'alright, had sudden panic it had gone to a totally different random person !
i think you might be a bit busy to answer email immediately.

lol whomoved, i'd gladly accept! [not repulsed]

Can I be really naughty and say ignore what they said in scbu and do what feels right for you.
I had to fight to get them to allow me to take dd home as they weren't convinced me solely breastfeeding wasn't enough for her. I was going to discharge against advice so evetually they agreed on the condition my HV agreed. She did (shes a goodun)
I carried on doing what felt right and dd went from strength to strength being discharged recently having reached the required milestones with ease.

As someone said they (scbu)like to see the mls going in and if they can't they think you're starving the child.

How are you topping up? NGT tube or bottle?

Your body will adjust the milk to suit your dd's needs as it knows that you had a premmie.

I had the human milk fortifier added to my ebm for the first three weeks to increase the calories. Unfortunately through a mixture of diminishing milk, problems latching and pressure to change ds to the high calorie formula, I caved in and gave up. Wish I hadn't.

You're doing really well. Maybe you could talk to the bf co-ordinator that organised the pump or Bliss.

Hi Aitch, well done on feeding your dd, I know it is no picnic. You do not say how prem she was and what weight she was at birth but if she has recovered her birthweight already it sounds like she is on the right path. Do check out the BLISS breastfeeding leaflet which you can access via www.bliss.org.uk and they also have a very good parent messageboard.

I agree that paeds are pants at supporting bf, mainly because they have little or no training. It's also rare to find an infant feeding specialist/lactation consultant who has expertise in prem babies outside a major teaching hospital. You might get on better talking to the nurse manager/matron in SCBU although as neonatal nurses often don't have specilaised training in supporting bfing this can be hit and miss too.

I think also that protocols vary a lot from trust to trust on prem baby feeding. I think that the more enlightened ones encourage bfing and do not recommend special formula or fortifier unless there are serious concerns about weight gain and complicating factors (eg needing respiratory support). By this I mean static or tiny gain over weeks, not a single gain of 30g. I am also puzzled by the 15 minute thing - this sounds very arbitrary to me and something that is not terribly supportive. It makes sense when you are trying to teach a small tube-fed baby to feed- usually they have done all they can in that time and are then topped up down the tube. But dd, who was a sterling feeder from 4 weeks before her due date took at least 30 and often 40 mins to finish a feed until about 8 weeks past her due date. Her weight was static for about a week to ten days while she learned to feed at just below 2kg - and then it just took off and she never looked back.

Sorry if this is very long, as you can tell it's something I feel v strongly about.

Haven't read all of the replies here but just wanted to say that you seem to be doing really well - congrats!

But on the 15 mins thing....I BF my prem DTs and was 'told off' for only feeding them for 15-18mins (which was when they generally tended to fall asleep, etc etc) and was instructed to feed them for at least 20 mins, if not 30 for the first few weeks. Basically, I did whatever it took to keep them awake and feeding...nappy changes (sometimes two in one feed!), tickling feet, blowing gently on their faces, whatever. they were soooooo sleepy that they fed 3 hourly round the clock, mainly with me waking them, until they were about 4 weeks old or so. Then they reached their due date, "woke up" and started demanding it a lot more .

Not saying this is the right way to go about it but I too was struggling with conflicting advice and HVs who kept suggesting top-ups, but we perservered and I am still feeding 13mo on.

Good luck

am very interested in this human milk fortifier, in terms of sheer bulk and effort in feeding that seems to make more sense to me than topping up with formula. where do i find out more?

kat, i was syringe feeding with dd in hosp but there is no way i could have continued with that now that dd is out (have dd1 at 2.5, she's being a monkey...) so am bottle feeding using the preemie teats from hospital. cow and gate. blergh, i'd forgotten how foul it smells.

oh, and dd was 4lb 1oz at 33 plus six, with the complicating factor that she hadn't grown in two weeks. (hence the panic to get her out). i saw my placenta... apparently it wasn't a moment too soon... like a pumice stone it was.

hello! no advice, just saw you were here...

oooooooooooo she was born at the exact same stage as callum.

Sounds like you are doing well aitch

expressing at every available opportunity - before and after feeds sounds like a great idea.

i am indeed, habs. and yes, i will be doing another 'thank you from aitch' email this evening... can't believe the support i've had on here tbh, it's been just unbelievable. and thank you to you for the chocolate. you know i got the print out of the threads from here that you sent just after they told me it was a go-ahead on the cs? nice timing, missus.

before and after, btw? <faints>

Oy, not hinting for email, you - somehow I thought you were probably quite busy. Will send proper hello (non-sugar-based) things for dd2 at some point before her 18th birthday.

i know...

i'm trying to crop a photo of dd down so that i'm not in it, and am considering putting it onto MN. that is racy for me.

nothing to add, just wishing you both the best! have laid low because you have a lot on your plate at the moment, but you're in our thoughts always .

she was supposed to wait till around Struan's birth .

oh - still can't get mms on phone to work, by the way. tried frantically, but gave up. Think it's a common problem with this type of phone <sigh>

oh - still can't get mms on phone to work, by the way. tried frantically, but gave up. Think it's a common problem with this type of phone <sigh>

oh - still can't get mms on phone to work, by the way. tried frantically, but gave up. Think it's a common problem with this type of phone <sigh>

and apparently can't work MN either. Apologies. Expat - you have a name for ds? How lovely.

yes, he is struan. he is 33 weeks and head down and hiccuping for Scotland and wrecking havoc on poor mummy's guts.

just got him this for co-sleeping.

gonna crack this bfing whilst lying on side with saggy norks once and for all!

Not sure that she needed to wait until Struan's birth Expat, but she could have at least waited for Duncan's, as he was due first.

Also nothing useful to add Aitch, but wanted to offer moral support.

I'm sure you'll manage. You're made of stern stuff! Cant wait to see some more photos!

Oh, nice wee bed! Yes, that's one thing I wish I'd managed with dd (but small in grand scheme). Hope all stays well, expat - dd was a champion hiccuper too - I loved it.

some more photos? namechanger...?

you can't be lapin, she's got about fifteen dysons.

My DS was born at 37 wks so not very early compared to your DD but he was very poorly and NICU for 7 nights.

They really didn't want to discharge me because of his weight loss - which got worse when we switched from tube feeding to fully bf.

I also had to sign up to regular HV checks (she phoned and visited me a lot for 4 wks). Luckily she was sympathetic as was a midwife i saw at the local hospital when i dook DS in for weigh in. As long as he was gaining even a little they were happy. It was immensely stressful though and even though i was sure i was doing the right thing as he was poohing and weeing lots it was horrid.

So even though you felt she gained less when she had less formula she still gained!

Not any help i'm afraid but it sounds like you're doing all the right things - am guessing you've tried breast compression - i did that a lot as recommended on kellymom and that was when his weight loss stopped and he began to gain.

she would have been overcooked then, CantSleep!

hmm, now she's here, she might need a Halloween costume .

why is there a pillow on the baby's butt?

and lapin needs to change her name to 'iwanttobuyafuglyjumper'

yep, have been doing breast compression. my tits feel like they've been in a mangle. i'm now thinking that i'm actually getting some pretty piss poor advice from the medical professionals here.

Me? Nah.....

Aitch - I'm that you are surprised re HCP advice....I thought we all knew to take them with a pinch of salt and come on MN to find out the real story...!

Will email you....

Aitch congaratulations on getting your DD out of the scbu so quickly! I also think the 15min limit sounds like bollocks - DS2 was in scbu for 5 weeks and I was encouraged to feed him for as long as it took - somrtimes he'd go 40 mins, sometimes just 5. We were topping up with EBM via a ngt to start with then with a cup for his overnight feeds. He never had a bottle.

DS2 was on fortifier for about a week and given the choice I'd definitely go for that rather than formula. It's a powder made up of hydrolised milk proteins (so in theory ok in trems of allergies) and vitamins that you mix with EBM. Tiktok probably knows more about it than me. I remember reading somewhere that an alternative is to skim the fattiest layer off some ebm and to top up with that - I guess you need a fair amount of ebm to do that.

Sorry for typos, typing with 1 hand while feeding DS2... HTH anyway.

Yeap breast compression was a little uncomfortable!

I was v glad that my poorly DS was my second or am sure i'd have been persuaded into total formula. Although to be fair the Paeds Consultant did a little dance (i kid you not) when i said i was bf.

Not sure what the etiquette is on talking about other forums but ivillage had a pretty helpful bf support board which i used at the time. I got massively engorged with all the pumping and got so much different advice from midwifes about how to handle it.

kellymom forums are useful too.

Hope you are doing ok Aitch. I think you are doing a marvellous job. After struggling so badly with DD1, then to be faced with all this, you are a tenacious little lot you Aitches and little aitches!

My dd was a 35 weeker and was tube fed for a week. My top tip and what got me out of hospital (she had to get back up to birth weight) was to basically put her on the breast all the time - she opened her mouth to vaguely cry and on she went! sometimes she was feeding every 15 mins, sometimes just hanging out at the breast. I understand the concern about tiredness - but it was really in the very first days of breastfeeding, she would breastfeed then the next one be too tired and have to be tube-fed but as she got better at it she built up stamina quickly. I agree with tiktok that the 15 mins thing sounds like a number they have chosen as an average and that sometimes your baby could feed for more. Whilst breastfeeding for a preemie can be tiring, it is also incredibly comforting and I think the best place for a wee one to 'hang out' is at the breast. I don't think they need to be actively sucking but being tucked in next to a nice warm breast skin to skin is the next best thing to being back in the womb. I would most definatively recommend the stuff a breast in mouth at any opportunity method - it worked for me and the little beast is still feeding 2.5 years later. Hang in there, it sounds like you're doing an amazing job.

Speak to the hospital about fortifier because as kasha says it's better than formula, esp if you want to carry on bf. Ds had the same thing as your dd and was under 3lb when born and fortifier seemed to add the weight on.
I found expressing a nightmare, honestly it would take me about an hour if not more - and then I had to feed him. Bf is a totally different thing which we never got the hang of but wish I could. That's life.

have just emailed my obs consultant and head of hosp to complain vividly about not having been offered this fortifier...

aitch, just so you know some hospital will only give in-patients fortifiers, I asked for Callum and was told that the hospital and doctors couldn't give it to me as he had been discharged

ah right. well they certainly never offered it to me when i was in. i asked them about tpn when i was in recovery, annoying paed was just making up reasons to give dd formula. i thought of you...

Would Yorkhill be any more use, Aitch? Would a referral to a paed there help, do you think? Don't know much about their baby care, it's just the specialist paed element I was thinking about.

i'm going to speak to the midwife about it on mon, habs. she's from yorkhill, obv the community care just comes from the nearest hospital. but i want to kick the arse of the prm a bit if they should have given me that option and didn't. i do think they're good, though, but it's been interesting seeing how casual the paeds are with other people's bfing. they're paying lip service, but it's like dealing with the actual physiology is your problem alone and nothing to do with their job caring for your child.

I think that if you get great care from one area of a hosp (e.g. your obs), you kind of expect it from the rest, and it's enormously disappointing if it doesn't happen. The paed reaction seems daft, given that they know that bf is good for the child. Not what you need at all, after everything. Hope mw is good.

The no-fortifier-outside-hospital thing will be - I feel sure - a red herring. You will need to get it on scrip, I expect, and have someone explain how to use it.

www.ich.ucl.ac.uk/clinical_information/clinical_guidelines/cpg_guideline_00040/ is something I found which might help.

It is formula, though, and don't let anyone tell you it isn't! It certainly is not made from human milk (though I have met healthcare professionals who thought it was....)

lol, that's exactly the link i just sent to the divine obs, tiktok.

so did you hear about what happened to me, tiktok, wrt to the 'what is formula made of' question? you will shake your head.

afaic, it seems to me that the only reason they should be advising formula is if they had worries about hydration, but they never have. so i want to up the punch of my ebm, and allowing dd to stimulate supply.

oh tell me that story please!

Aitch, ds3 was born at 32 weeks and I found our SCBU less than helpful when it came to bf. I got a lot of the "We can't see what he's getting" malarkey. I'm in Ireland and the staff were a mix of Irish and Asian. That shouldn't be relevant but Ireland has a very poor bfing record compared to most other countries, only about 41% of mothers initiate bfing.
Well the Irish staff were all about topping up after every feed, even though I could see that ds3 was latched on correctly and he just was not interested in the bottle once he had been on the breast for 15 min. I actually used to tell lies and tell them he had taken a 25ml top up when he had only taken 10ml.
But a filipino nurse and an Indian nurse were that I was topping up after a 15 min feed so I got the impression that it was just an Irish thing.
When it was time to go home, the Pakistani Paediatrician said to go home and breastfeed, the Irish nurse said go home and bf but top up after every feed.
So I went home and bfed! Ds3 gained very well by feeding on demand with no top-ups. Tbh, I was so exhausted anyway that operating the steriliser and the breast pump seemed like an awful faff.
Ds3 did get fortifier in hospital which, had I known what it was I would have refused because ds1 and ds2 had issues with cows milk but I later did some research and found that apparently there is evidence that babies who are given fortifier do better than those just given EBM but didn't go into the research in too much detail as this was months after he was born so no longer relevant to me.

Chipmonkey. Glad I'm not the only one to tell lies.

Aitch I'm glad you're sounding strong enough to stand up and fight.
I can't imagine what its like being a first time mum with all the stress on top trying to do the right thing. Maybe us mums with subsequent babies need to start saying more so that the others don't suffer.
I used to say that SCBU staff had small power trips from being able to dictate.

aitch my dd was induced at 34.5 weeks for pre eclampsia and was 4 pound 2 at birth. I was lucky she didn't need SCBU just a warmed cot and I had a very energetically pro breast feeding midwife with me constantly for the first while (I think it was me they were worried about not dd bp didn't settle and had dural tap).

She encouraged us to take clothes off her, tickle her anything to get her to stay awake to feed. i don't remember a 15 minute limit but I was pretty zonked all i had focus for was holding her and feeding her everything else just went over my head.

Anyway dd latched on from birth but no-one really believed me. They cup fed her aptamil top ups and we were encouraged to do so. I am a bit stubborn and just kept putting her to the breast and filling any old anything in on their stupid forms re top ups.

Literally every time she was awake she was offered boob. She regained birthweight in 2/3 days and has never looked back apart from a spot of jaundice. We were in for ten days my issues not hers!

I think you are doing brilliantly obviously taking on board hcps concerns and considering their advice but also following your instincts!!

chipmonkey your post is v interesting I'm Irish but live in UK. My family were horrified that I BF, couldn't belive that I continued for 7 months (and would have longer) and my aunts are all nurses!!! Ireland has a long way to come on bf

heard back from my obs, he's given me the email of the paed consult... i'm on the case.

Good stuff - hope you get some results now. Did you see the paed consultant when you were in, or more junior staff?

<coughs> i saw him after i put in a complaint about one of his juniors...

at paeds, they should know better. Good luck with the complaint.

Have just been having a look at the medical literature on preterm breastfeeding to see if there're any pointers. On a quick look (have limited time), this one looks promising.

"Transitioning premature infants from gavage to breast."
Neonatal Netw. 2008 Jan-Feb;27(1):7-13.

"Breast milk provides physiologic and neurodevelopmental protection for premature infants. Most hospitals are breast-milk friendly, but the number of premature infants breastfeeding successfully at discharge is relatively small. There are evidence-based techniques to improve the odds of premature infants breastfeeding at discharge and into the first year of life. Measures that help the infant make the transition to the breast include kangaroo care, nonnutritive sucking, avoidance of bottles, and consistent and supportive staff. A guide to management of the transition process is provided in this article."

That's just the abstract - will see if I can get hold of the full article if you like.

So, kangaroo care and non-nutritive sucking - this seems to suggest lots of skin-to-skin contact and time at the breast even when not actively feeding.

Avoidance of bottles - you're doing that as far as is practical.

Consistent and supportive staff - I guess you're working on that one....

mspotatochip, the annoying thing is that in some ways we're ahead. For some time now, we have had protection in law for public breastfeeding, so ahead of England ( Scotland also give the same protection.) But visit a hospital and they're great for lip-service but shockingly bad for practical help. When I had ds2, I was in a ward with 4 other girls. Four of us were bfing. 2 days later, only 2 of us were still bfing. The other 2 had latch trouble and all the MW's did was hand them bottles of dextrose! I was trying to help the girl beside me but then I got moved to a private room. I heard afterwards that she was very upset because I was the only one helping her.

Aitch, my dts were delivered by c/s at 34+4. They were good weights so no scbu, however dt2 was very sleepy and not feeding well. I basically growled (literally ) at the mw in hospital who tried to give me a syringe, then when I went home two days later, the visiting mw threatened to readmit her to hospital after a few days as she had lost 10% of her birth weight - with the support of mn (and Marslady ) I found the confidence to insist on a few days to 'turn it around' - her words. I used breast compression with dramatic effect. I just wish that health professionals didn't undermine women's confidence in bf at every turn as without mn and the confidence of having bf my ds1 for 14 months I am not sure I would not have ended up feeling that I couln't do it.

Good luck and congratulations again, it's a scary time but All Will Be Well. Big love.

Hi Aitch congratulations
DS born at 31 weeks as on a drip for a couple of days and I was told just before my milk came in if it did not come in soon they would formula feed him. I did not want this and had given instructions not to formula feed. I pumped like a (can't think of a pumping analogy) good un and it came in.

DS was tube fed and when I was there for one feed I saw the "fortifier" he had already been given it and asked what it was and was told it was extra vitamins for premmies so I agreed to it. I was then transferred to my local hospital and asked about the "fortifier" for my EBM and was told "it is just formula powder" don't know why they do it we just add ready made formula on a 50/50 basis to your EBM. Now I was a wee bit annoyed about this as that is not what I had been told initially.

They also said in new hospital I don't know why you are adding it anyway - we wouldn't bother. So conflicting advice all round. Basically I then did what you are doing pumped/fed pumped/fed ad infinitum. You will get there and so will your DD congratulations.

MY DS was prescribed multi-vitamins/sytron and folic acid though I was not formula feeding.

Hope you are getting some answers from the paed. Agree with everyone else that SCBU just like to see the mls go in and get very twitchy about direct bfing because you "don't know how much they've had" (ds born at 34+3 due to PET). I was really lucky that my hospital had a milk bank, so I had donated bm to top up my initally woeful attempts at expressing. Thanks to the wonderful women who donated, ds didn't need formula top ups - maybe you should take WMMC up on her offer!

I can only go on what I was told by SCBU, but sounds like the advice you are getting is pretty standard. Ds was "allowed" to be put to the breast every other feed from about 36 weeks (he was poorly and was in SCBU for 7 weeks, despite being a 5lb4 bruiser), ie every 6 hours, was always topped up by NG tube regardless of how well he fed. Because he was in for so long I had plenty of time to build up supply and was fully bfing before he came home, but I would have been terrified bringing him home as early as you have - it sounds like you are both doing amazingly well.

You are probably already doing this, but I managed to up my supply by 1) turning the pump up until it realy hurt (not sure whether to recommend this ), 2) pumping not less than every 2 hours during the day and not less than 4 hours through the night, at least 8-10 times a day. Took about a week of doing this to be able to supply all the feeds myself. Must be bloody hard work with a baby and another child at home though.

Aitch, hope you are doing ok and thanks for filling in some detail on your dd. Fww I believe that the protocol in our hospital was that if babies (both those born under 32 weeks and growth restricted babies) were breastfed then they did not recommend supplements or high calorie formula unless weight gain was consistently poor or there were other challenges (eg needing oxygen or babies with cardiac problems) although they were all prescribed certain vitamin supplements at discharge. I was told by a consultant neonatologist that in the past weight gain to "normal" range was a much bigger focus than it is now - now it's thought that attempting to bulk up low birth weight babies adds to the risk of developing diabetes in later life. DD was on the 9th centile at discharge at 36 weeks gestation, and stayed there until around 4 months past her due date. No one seemed to have a problem as long as she was well in herself and gaining a bit.

I would honestly be surprised if you were prescribed fortifier outside hospital- I suspect due to concerns about correct usage.

Hi Aitch, DS was 6lb 5oz at 35 weeks (huuuge, I know), but wasn't very well at birth and wasn't well enough to be handled for a couple of days, and didn't start going to the breast till 3 days. They didn't say anything about limiting time at the breast, just to feed him as much as possible. Mind, he got no followup care or vitamins, so who knows whether this was a good care example or not

Have you looked into switch nursing ? By swapping breasts several times during a feed they stimulate your breasts more, and take in more as the inital flow is stronger on each swap

i've been switching. dd is feeding much better so have pretty much abandoned the 15 minute rule however... i am fretting that she's looking skinnier about the cheeks. no answer from teh paed but am going to quiz him relentlessly about how quickly dd has to gain weight. i've been switch feeding, as it happens, as much as anything else cos dd often settles better if she has a wee shot on one then a longer, more relaxed on the other. (dd1 thinks that one is hot milk and the other is cold).

Don't fret. She's doing what she wants to be doing! But you know this.

Are you sure one isn't chocolate and the other strawberry?

Aitch, when I was battling to get bf going with dd1 and she wasn't gaining weight, I did quite a lot of reading around to try and find out if there was some sort of minimum acceptable weight gain.

I found absolutely no helpful info in the form of "a baby must gain X amount of weight per week or they're at risk of harm".

I did find a growing concern in editorials and the like, that fattening babies up to conform to centile charts was possibly messing up their natural weight regulation with possible implications for weight control in adult life.

This was all very speculative for the most part, although one reliable-looking study showed that more rapid weight gain in term babies in the first 2 weeks was associated with increased cardiovascular risk factors as teenagers. So more is not necessarily better.

The current thinking seems to be that on balance a slow weight gain is preferable to an artifically quick weight gain.

This gave me the confidence to ditch the top ups with dd1 even though she looked skinny. In retrospect this was the right decision because dd1 is now 4 and still long and skinny - it's her natural body shape. But at the time it was more of a "lesser of 2 evils" thing and I was aware that I could be wrong so it was nerve wracking.

In shoes I would interrogate the paed about what their absolute baseline criteria would be for worrying about dd2, and ask for justification for each one. For example, if they say "a minimum of X oz per week" ask why. Ask how they arrived at that figure. Ask what dd2 is at risk of if she doesn't put on that amount of weight.

I suspect you'll find that a lot of these criteria are pretty arbitrary tbh.

Aargh at "in shoes" - meant to be "in your shoes" - I don't think it's particularly vital to be wearing shoes while talking to a paediatrician.

i'll try to be in heels, all the better to intimidate.

yup and yup, am going to quiz about this, i got very wound up by the weighing with dd last time (which in a weird way led me to BLW etc so it's not all bad, as i SO rejected the 'get x amount in' thesis).

also wellie, so sorry for not answering your email, thanks so much for sending it... and i'd love to see the full paper if you have it. i like the paed guy, but even my mate who's a paed is not that informed or even enthusiastic when it comes to bfing. and my gp, god love her, is positively negative about it because of the fact that she never got the opportunity to do it with her (oxbridge educated) kids. i think getting an untarnished view of such a sensitive, as well as medically and emotionally complex subject, is a big ask. funnily enough, despite the many complaints i read on here about the oppositional nature of the bfing threads, i have accessed more info here over the years than i'd ever have been able to get in RL.

How is it going today Aitch?

Message withdrawn at poster's request.

heard back from the paed.

"Thanks for your Email
Im not against this per se however we normally give this on the unit to babies who are getting enough breast milk but have a greater need for these supplements due to prematurity under 34 weeks. It would also need to be prescribed for you.
We should discuss whether you need this with your midwife as it would be unusual not to have enough breast milk to allow babies to grow but still have enough to fortify, if you see what I mean. As you say, it is not really any different from giving formula in this instance and formula would overall give dd2 more calories, which is really what she needs at present as well as the overall fluid volume which is also important (the extra phosphate and calcium is not the main issue here).
I will have a chat with your midwife this week and contact you before I am due to see you next week in my clinic (wednesday afternoon).
Sounds like you are both doing well however, if she has regained her birth weight and that is good news.
kind regards"

any thoughts? am bricking it about dd being weighed today... hate this feeling.

PS have asked for other to be deleted as left names in, der.

Heels are good.

Sorry, I know all of my post is stuff that you already know perfectly well. I suppose what I was really saying was, don't lose heart. Which I think can happen when you're all upside down from having just had a baby, and other people are trying to scare you into doing something that doesn't feel right to you.

Will see if I can get that paper for you - might take a couple of days though - it doesn't seem to be available online.

On no account are you to reply to emails - dog knows you have enough to do right now.

Agree with you about MN - I've learned a huge amount here and I think the depth of discussion here beats other sites hands down. Not naming names or mentioning ticker tapes....

Cross posted.

If it were completely up to you, what would you do? ie, just looking at dd2, what seems right to you?

Good luck with the weigh-in, boy do I remember that dread.

heard back from the paed.

"Thanks for your Email
Im not against this per se however we normally give this on the unit to babies who are getting enough breast milk but have a greater need for these supplements due to prematurity under 34 weeks. It would also need to be prescribed for you.
We should discuss whether you need this with your midwife as it would be unusual not to