How long have people accepted low weight (newborn) before using formula (long)

[RainAndRoses]

We are having a difficult time feeding DS1, who is now 11 days old, and I would value advice, and experiences from anyone else who's had a similar situation re: waiting a while during a period of poor weight gain before giving formula to a newborn.

He was born at 41.5 wks weighing 3.3kg, no meconium lost during the (home) birth, and he passed copious amounts in his first few days.

We thought everything was going well with feeding as he asked to feed often, and I thought latch on was good as had no pain (in fact latch pretty bad, poss partly due to tongue tie which we had removed at 6 days).

However he was down to 2.9kg on day 5 (12.1% loss) and at that point we realised he had not been getting much food at all. I had wondered on day 3 whether my milk had come in, as no sensation of this, and spoke to someone on the phone, but was reassured that it would. However when saw lactation consultant on day 6 she diagnosed breast hypoplasia, and thus it's quite likely I will never produce a full supply.

From day 6 we have therefore been doing 2 things intensively: 1) trying everything possible to increase my supply (cluster pumping with hospital grade pump in between all feeds, fenugreek and domperidone, trying to improve latch altho still not v good); 2) supplementing with milk donated by a relative.

Yesterday was my best pumping day, when I pumped >70ml. Key for me seems to be emptying very often, as my storage capacity is small. My supply is increasing but who knows what it will reach. We're supplementing with between 100-200ml donated milk a day.

Since day 7 DS1's weight has been static around 10% loss. He is being weighed next tomorrow morning and I think that is going to be the point at which we may decide to use formula. We are investigating getting more donor milk as that seems preferable, but of course who knows if we could arrange this in time. We had him checked by the GP yesterday who agreed he seems very well (good colour, tone, no heart problems etc).

He is doing 1 large mustardy poo a day and a few wet nappies. He is sleeping a lot, but also having at least two alert and awake periods each day. He's not getting very distressed at any point, although you can tell he is still hungry sometimes after breastfeeding from me (if he hasn't fallen asleep).

Am I too hung up about using formula? If baby is well how crucial is weight gain in the early days? Trying to balance the negative effects of formula on the gut vs the positive effects of calories on the baby seems a very difficult call.

[KatAndKit]

If you have breast hypoplasia you will almost certainly need to use formula and if your baby is not getting enough milk I would start right away. Carry on the things you are doing for your supply as even partial breastfeeding is beneficial, but I would forget ebf, it sounds like you are one of the 2% who physically will not be able to produce a full supply. Weight gain is crucial. It doesn't need to match up with charts exactly but the baby does need to put on weight steadily. Donor milk is great if you can get it but is unlikely to be a long term solution as your baby gets bigger.

[NotQuiteCockney]

Congratulations on your baby. It sounds like you're having a bit of a hard time.

Have you seen any bf specialists other than the IBCLC?

In a baby of your son's age, I would expect to see more poo (as in pooing more often). Your early milk has colostrum in it, which is a laxative. The donor milk may be making a difference, but still. That, combined with the lack of weight gain, is a bit worrisome.

Things that may help:

• skin to skin
• feed as often as possible
• breast compression (this can make a huge difference - Jack Newman is the expert)
• using a SNS for all supplementing (your expressed milk, donor milk, formula if it comes to that). This ensures that a) your son doesn't get used to tests and b) all his feeding also stimulates your breasts. I think Medela sell a SNS.

The donor milk is better for your baby than formula is. But ideally you want to get your supply up, I think...

[NotQuiteCockney]

I know very little about hypoplasia in breasts. Are IBCLCs qualified to diagnose that? Kellymom suggests that some mums with hypoplasia manage to get full supplies.

It does sound like there is a supply issue - but if your son's latch was bad at the start, and continues to be not quite right, that would also explain it.

[MotherOfInsomniacToddlers]

Hi, don't know if this helps, my dc1 lost 10% of her birth weight and we were re-admitted to hospital, they were worrying about her rehydrating too quickly so they only allowed me to pump and give her expressed milk a other could monitor what she was getting. I was only getting about 30ml every 3 hours with no actual breastfeeding, they said she needed 60ml every 3 hours so until my supply increased she had 30ml bm and 30ml formula every three hours, when I returned home I increased pumping to every 2 hours day and night, ie setting alarms all through the night to get up and pump. I increased my supply relatively quickly and after 3 days I had enough to feed her solely on my milk and after a week I was storing milk I was given the ok to breastfeed properly but my confidence had been knocked. I would feed her normally but always pump after, I was producing enough to feed 4 babies! Then I could slow the pumping to 3 hourly then 4 hourly, if my supply ever started dropping I'd go back to 2-3 hourly. When she was 3 months I decided to just feed her with expressed milk. Managed to do this until she was nearly 6 months, had about a months freezer supply when I stopped too! Double electric pump was a must though. She's still not a big eater at 3 years old and weighs the same as her (enormous!) 18 month old brother.
Hope you sort out what's best for you! Congratulations

[Erroroccurred]

Rain you are having a tough time and need to talk this through in real life but milk in does matter more than bm solely. There is no benefit to your baby in gaining too slowly and your baby may be so sleepy as he needs more calories in before he really wakes up. The intake apparent from your post is low for a bf baby at 11 days and whilst wees are hard to count a few wet nappies is probably too few.

Your bm will continue to give a massive boost to your baby's immature immune system, ff will not negate that.

[KatAndKit]

Hypoplasia means some or all of the glands that produce milk are missing. If you do not have sufficient milk glands you will find it difficult or impossible to fully breastfeed. Have you contacted la leche league? I remember reading an article in their magazine bwhere they supported a mother with hypoplasia.

[RainAndRoses]

Thanks KatandKit, I agree am certainly expecting won't be able to ebf, but had hoped might be able to continue with supply from generous relative for a while. Baby has gained weight from lowest point, but agree if not good news tomorrow will need to suppplement further straight away.

[RainAndRoses]

Thanks NotQuiteCockney, am doing all those things (and supply is increasing) except SNS so far, but prob going to purchase one of those today. If anyone has one they'd recommend do say.

[RainAndRoses]

Thanks Erroroccured, have been in touch with lots of people in real life (incl. a mum who had hypoplasia), and going to talk to some local LLL leaders today about donor milk and SNS systems.

[KatAndKit]

I wonder if LLL or another bf organisation might be able to help you get a SNS? Or your hospital maybe? I think its a great idea as you still get the closeness and the skin to skin, your supply is being stimulated but you also know your baby is getting enough milk.

[KatAndKit]

Cross post! Good luck, hope you do manage to find a solution that works for you.

[Erroroccurred]

Medela do a decent one but they are all very similar, quite a faff but worth a go if you feel up for it. Great that you have people around you- it's horrid when you realise you might not be able to feed how you planned though it gets better, you are bf, your baby is getting all the lovely skin to skin etc and if you give ff or use bottles you can do it all responsively and with cuddles.

[geekaMaxima]

Rule number 1 is feed the baby, which you're doing with the donor milk from a generous relative to supplement your own bm. It sounds like your lo could so with a greater quantity of supplement, though, if weight is holding static.

Have you looked at human milk 4 human babies (hm4hb)? It's where women freely donate bm direct to babies who need it, often long-term, though since it's an informal, voluntary arrangement you need to make sure you're happy with the donor's medical history, etc. The hm4hb UK Facebook page gives all the guidelines.

I second (third?) an sns to deliver the supplement so you still get stimulation in these early days. Good luck

[kalidasa]

How are you feeling rainandroses? I expressed a bit in the early days but to be honest I absolutely hated it, and I could not have tolerated intensive pumping of the sort you are having to do for more than a week or so (I was admitted to hospital for a couple of days when DS was about six weeks old so obviously I had to pump all the time there). Breastfeeding is exhausting in itself I found - both emotionally and physically - and pumping on top was just too much. We had nothing like the sort of difficulties you are facing, but DS was very hungry, wakeful and wanted to suck/feed constantly and I was weak and exhausted from a very difficult pregnancy. We gave the occasional 'top up' bottle of formula - once every two or three days - from very early on to give me a break, and I mix fed more equally (formula during the day/bm morning, evening and night) from about four or five months when I went back to work. This worked well for me and I continued to bf until ten months.

I realise your situation is very different and you sound very committed to breastfeeding, it is obviously important to you, but I would say make sure that you are not totally draining yourself emotionally and physically. In retrospect I would have worried less about how I was feeding DS and concentrated more on making sure that I was as relaxed and rested as possible - difficult I know when they are so tiny, every decision seems so important and in your case you're worried about the weight as well. But I don't think it is selfish to give serious thought to how you are coping - the emotional 'feedback' between a mother and tiny baby is so intense and complete.

[RainAndRoses]

Hi kalidasa. I am ok, tearful/emotional at times (generally getting less so each day) but not feeling at the end of my tether... the pumping is ok tbh, but of course with all this going on it's definitely compromising our family time, and of course we won't get these early days back. This also seems a difficult balance as breastmilk isn't the only thing this baby needs, he also needs two parents able to have fun with him :) I keep remembering how lucky we are to have a healthy baby in the first place. You're right that every decision seems enormous, and probably when we look back I might want to have been more relaxed, but hard when you've felt so committed to bf, as you say, you want to make sure you gave things your best shot.

[soundevenfruity]

My DS was born with a much lower weight and was trailing at 0.4 percentile. We bought scales and weighted him every day. If he dropped significantly below it I don't know what I would've done. I just pumped after every feed and fed it to him after the next feeding. His weight percentile jumped when I had his breast attachment sorted at 3 months and at around 8 months when we got to proteins in his weening (I did staged weening as I didn't want food to replace breast milk). The best thing you can do at this point is to find a good breast feeding consultant but also be open to suggestions if your baby's weight drops significantly below.

[eagle2010]

Have you had a look at some of Dr. Jack Newmans articles? If you Google him you'll find a wealth of info. You can also email him and he'll reply directly. He has a homemade SNS that you might try.

I had a horrible start to BFing for loads of reasons, not least an EMCS under general anaesthetic. But DS is 23 weeks now and we are still BFing up a storm!

Every breastfeed makes a difference, you are giving your baba the very best start and don't be hard on yourself. It's tough going physically so don't forget to mind yourself too. Best of luck!

[kalidasa]

It sounds as if you are coping brilliantly rainandroses. What's the news today?

[tiktok]

Breast hypoplasia is not a definitive diagnosis and it is not correct that someone with this will be unable to produce a full supply.

My opinion is that it is far too soon to be sure of i) hypoplasia ii)inability to produce a full supply. I have seen many women with (apparently) hypoplastic breasts and they bf just fine. (they had had no diagnosis).

OP - I think the concern is warranted, for sure. A weight loss remaining at 10 per cent at 11 days old despite intense focussing on increasing intake plus supplements is a sign you need to continue this focus.

On what you have said here, I would suggest that it is still early enough to stick to what you are doing now, and reassess in a few days. That reassessment might include further human milk supps and/or an at-the-breast supplementer.

Hope things go better.

[RainAndRoses]

Morning all, still awaiting midwife for weighing so no major update, apart from baby seems to have been very well over the last 24hrs, no real points where I thought he was going hungry which we've had before, more time awake and alert, but still lacking on the poo front. 1 big one Fri, 1 big one Sat, nothing yest... as he's getting less of the newborn milk which has more laxative wondering if this is partly why?

soundevenfruity - how much had your little one dropped below birth weight, and was he gaining, even if slowly?

eagle2010 - thank you for the encouragement. We have now rigged up a homemade SNS which seems to be working well, and may buy a proper one today once I've heard back from some others who've used them. Did you give formula while you were having difficulties or did you stick with ebf?

tiktok - thank you, that is reassuring. We now have one definite and one possible further donor, and planning to increase supplementation from today. We'll see whether we have enough bm to do it solely with that or whether today is the day for first formula... if we do go down that route I will still be trying to do everything we can to reduce it down again in future/ideally go onto exclusive bm.

[MrsArchchancellorRidcully]

Hi OP.

Congrats on your baby. You are having a tough old time of it I think.

I just wanted to add my experiences. I tried and failed spectacularly to feed DD so when DS arrived I was DETERMINED to ebf.
It didn't work out and he was hospitalised at 5 days old for losing >10% of his birth weight. It was an utter nightmare and totally ruined his first days with us due to stress and trying everything we could. I had several home visits from all kinds of lactation specialists. He would not/could not latch on (it was hidden tongue tie - diagnosed finally at 5 months - way too late).
I managed to pump and top up for 4 months. It almost killed me and my 3 yr old DD did not get the attention she needed as I was always feeding DS then pumping (he would take 90mins to feed and then want another feed 90 mins after that).

I wanted you to know this as I wanted to say that not bf is not the end of the world. I was so upset about it but soon realised it was only a small part of loving and caring for your baby.

I just wanted to reassure you that if it doesn't work out for you and you end up ff, it is not 'failure'. Your son's health and your own health are more important.
You are doing your absolute best so be proud of yourself whatever happens and I hope things go well.

[kalidasa]

Heroic pumping MrsArchChancellor! I could not have done that!

I do think there is a lot of (well-meaning) pressure on women to breastfeed at the moment, and it catches women at such a vulnerable time. My DH is French and it is interesting speaking to his friends/family members because rates of bf are much lower over there and the attitude towards it (among similar educated, professional women to me/my friends) is very different. His mother saw it (in the 70s) as a point of feminist principle NOT to breastfeed! She was very supportive of us doing so and we explained all the health benefits but she couldn't ever get to grips with the practicalities - for instance, she was constantly offering to have DS overnight!

I think what's really difficult about it is that a year later you have a sense of what was or wasn't 'worth it' about a difficult start, but at the time you have no idea whether you are investing all this effort at the beginning for something that will turn out to be a wonderful easy rewarding part of your life for many months later on (as lots of women find); or whether it is actually always going to be a struggle. I suppose it is a bit easier to make that call with a second baby but it is still a difficult decision to make, not least when you are exhausted and emotional and have just given birth.

Good luck with the weighing rainandroses. I'm at work at the moment but we had a great book called 'your baby week by week'. Do you have that one? It was v. clear about things like how many wet and dirty nappies they should have at any given point. I'll check for you this evening if you haven't had an answer about the dirty nappies.

[RainAndRoses]

Weighing update:

DS has gained a little, thank goodness. Weight this am 3020g, which is 120g up from last Mon when he was weighed on the same scales, and means he's now on 8.5% below birthweight at 12 days. Weights are:

birth: 3300g
day 3: 2950g (10.6% loss)
day 5: 2900g (12.1% loss)
day 6: 2900g (12.1% loss)
day 7: 2980g (9.7% loss)
day 9: 2980g (9.7% loss)
day 10: 2960g (10.3% loss) - different scales from day 9 tho
day 12: 3020g (8.5% loss)

Health visitor tomorrow, then midwife again Thu or before. Today's midwife assistant assured us he was def not dehydrated, and seemed happy with how things are going. Also not overly concerned about poo situation, as long as we're getting wet nappies (and DS had decided to wee on daddy immediately before she came so that was good!)

MrsA/kalidasa thank you, this is exactly where we are now, trying to work out what is 'worth it' on the feeding front, and what is not. We've had a week of complete turmoil, and I think that is enough, so have been trying to have a much more normal day today, which so far is going well.

[plummyjam]

My DD lost 14% of her birth weight by day 3 following a long labour and emcs. My milk didn't come in until day 5. The community MW was quite experienced and because DD looked well she just advised to continue feeding. She managed to regain all of it by 2 weeks (no small feat as she was 9lb 3oz at birth).

Looking back now I'm amazed they didn't try to admit her and give her formula top ups. We're still BFing now at 13 months and DD has remained 91st-98th centile. So hope everything works out ok for you too OP.

And as an aside, if anybody can link to any evidence about where the 10% expected weight loss figure came from (and outcomes for BF babies who lose/gain more than this in the first 2 weeks) I'd be interested to read it. There seems to be a lot of health professional anxiety about this - and I say that as a health professional myself. Sorry to hijack thread!

[eagle2010]

rainandroses - yes, we gave a few formula top ups inthe first few days. My DH (who's a HCP) was v worried about dehydration and we had a nappy with some urates so we topped up about 5 times I think (using a syringe or a cup) .

I was exhausted from a long labour that went pear shaped, my boobs were ginormous rock hard J cups, DS has a tongue tie which has meant quite frequent feeding and a constant watch of the latch and my milk didn't come in for 6 days. BUT, BF was (and is) so important to me. I finally relaxed and had faith in my body and all began to work out.

I'd read all about "the virgin gut" and was obsessing over it but I know that topping up DS was the right thing to do in the beginning. From the time my milk came I just sat under him and fed him! He was 7lbs leaving hospital (down from 7lbs 10oz) and at 23 weeks he's now 19lbs 5oz.

I'm waffling now but what I'm trying to say is that you will work out what's best for you and for your baby be that EBF, mix feeding or supplementing with donor milk. Kudos to you because the BF journey is hard