to persist with exclusively bf low weight gain preemie?

[fightingnun]

DP is very keen to canvass the wisdom of Mumsnet and asked me to post this dilemma (nc).

We are very lucky to have a beautiful baby who arrived by unexpected emergency C-section at 31 weeks. The baby has had no significant medical problems - breathing independently from day 1 - but stayed in SCBU for a while due to prematurity.

We were discharged home exclusively breastfeeding after trial rooming in when reasonable weight gain meant the feeding tube was removed.

In the first week home we were visited for weighing and I was told there was a very small gain but 'not enough'. At the SCBU follow up clinic a doctor observed & commented on how well baby is doing, alert, good latching on, tone etc. Then a few days later I had a phonecall from the nurse saying she had miscalculated and there had in fact been a small weight loss not a gain.

At a second visit for re-weighing yesterday there had been a definite gain calculated at 12.5g per day but apparently they want to see 20g per day so I am under a lot of pressure to start supplementing with formula.

The nurse said she would 'allow me' to wait for HV visit on Thursday and not insist on going back to the clinic today which she wanted me to do. I don't know what might happens if the baby fails to put on the desired weight by Thursday (DP is worried about this). Meanwhile I am doing all I can to encourage more and longer feeds and increase my milk production.

Am I being too stubborn or am I right to resist supplementing at this stage?

I'd be very grateful for pointers to any evidence or research as well as anyone's experience or opinion.

I don't want to be dogmatic when my baby's health is at stake but equally I don't want to be pushed into something which isn't really necessary.

The baby weighs approx 2kg and I would be 36 weeks if still pregnant.

[Hermione123]

Ah op, this is really tough for you both. Personally, if baby hadn't gained enough by thurs I would top up using those bottles you can switch between bf with. I do hope your baby has gained enough by thurs - remember you are a great mum regardless of what proportions of which milk baby gets.

[LolaDontCryOnDogTails]

Op is baby happy? Content? Lots of wet/soiled nappies?

[RunnerHasbeen]

A bit of formula at this stage will do no harm, you will not even think back on it when he is a few weeks older and everything is going swimmingly. If the baby gets ill you will feel terrible looking back. You sound a little bit more worried about being pushed to supplement than you do about your baby's weight, so it is possible you have got BF exclusively a little out of proportion. Go to a BF support clinic, they are as proBF as it is possible to be, but not at risk to the baby (IME). Good luck and congratulations on your baby.

[slalomsuki]

Congratulations

I had two prem babies, one at 34 weeks and the second at 32 and bf both of them for over a year. In our area we have a SCBU nurse in the community who comes to visit after you have been discharged. She had very different ideas from the HV who also used to come right down to disagreeing whose weight would go in the book to record growth.

My experience was that as long as your baby is feeding and having wet nappies then they are fine at this stage. It's hard especially as they have very small tummies at this stage and can not take a small feed so little and often. I used to try to get a time off the HV as to when they were coming and time a feed around that so there was a full tummy and more weight. HV struggle at times to understand prem babies and how different they are and to be honest I didn't really appreciate it until my third who was born on due date and fed and grew just like the text book says.

Good luck and don't panic. Don't switch to formula unless you want to and overfill a prem baby. That's worse and possibly dangerous.

[Buchanon08]

Obviously you don't want to put your baby at risk but as long as baby is settled and alert and having plenty of wet/dirty nappies I personally would persist with ebf. A gain is a gain no matter how small and any top ups will interfere with your milk supply (amazing how many health care professionals don't understand/care about this!) I ignored by HV advice to top up my (not quite so) small and (not quite so) early baby and he soon fattened up as he got bigger and latch improved. Maybe take it one day at a time, don't feel bullied into anything. You'll know if/when to intervene. Good Luck!

[betty10k]

I had this problem with my son, he didn't put any weight on until week 3 and we were under midwife care for the 1st month of his life with every other day visits and weighing sessions! (he wasn't premature though - born 41+4) - he had a tongue tie as well which didn't help, this was cut when he was 3 weeks old I don't know if i just didn't produce enough but breast feeding didn't seem to work for me, my boobs were hard and they leaked and i know he was getting something as they went down but i don't know how much + expressing didn't work either. I spent an hours trying and got less than 1oz time and time again. Our midwife showed us how to feed him using the lid of an advent bottle - sit him upright and effectively slowly poor it in, holding a muslin under his neck, some/most will come out but some will go in. She advised this so that he didn't get nipple confusion/reject the breast and i could try to carry on breast feeding but that it was imperative he put some weight on and he had some fluids (of course you don't know how much he is getting from you). It was this or she was going to admit him to hospital and he would have been put on a drip. So my advice would be try this and see? I did persevere with breast feeding until he was 16 weeks but we combination fed using a bottle and he was fine with breast and bottle - the breast feeding specialist advised breast feeding 1st and then topping up with formula. (I spent hours breastfeeding him and he was still hungry but no weight gain) Hope this helps and good luck.

[Musicaltheatremum]

Congratulations on your new arrival. This must be hard for you and it is easy for guilty feelings to come out.
You have been giving breast milk and continue to do so so he will be getting all your antibodies and goodness. You're doing really well
Supplementing will just give him a bit of a boost. You may even be able to stop as time goes on. Could you express some milk to increase your milk production you could then give this too as a supplement.
I supplemented my daughter with a bottle from about 6 weeks. Mad transition to cups and bottles later on easier and also meant my husband could put her to bed at night. She is nearly 21 and really healthy and slim.

Don't feel guilty about using formula. I believe breast is best but also feel there is nothing wrong with bottle feeding if it doesn't work out.

Good luck. Most importantly relax as it will help milk production.

[diddl]

How long have you been home?

Tube feed=no effort to baby so more weight gain!

What's the rational behind the 20g per day?

I would find it hard to follow the advice of someone had miscalculated tbh!

I'm sure I was given something to add to my mb to add calories to it(?)

So would express a little & add whatever it was iyswim.

[BigTroubleinSmallBoots]

Congrats fightingnun on the arrival home of your baby! My advice here is based on my own experience as a combi feeding mother of a 25+3 preemie and not from a medical person.
YANBU to want to try to exclusively breastfeed your preemie, and it can be done, but it is really tough. Are you expressing to get your milk supplies up? It will help as well as create milk to go into a bottle/freezer.

However, I would say if not enough weight gain by thurs then consider combi feeding. In my experience if you are set on getting breastmilk into your child (as I was and am) then don't stress about the method of transfer at first. They are so small, and tire so quickly, that a bottle of ebf milk - with perhaps a special high energy premature milk supplement like Similac prescribed from your GP/SCBU) would help your baby gain weight and not expend too much energy when she is tired and sleepy. Always offer your baby your breast first and then top up with a bottle if you feel they didn't have a big enough feed. They are such wee fighters, don't give up on it, but weight gain is vital for brain and organ development at the moment. My daughter was rubbish at breastfeeding when we came home, and I tried and tried to get her to do it, but she was too tiny. It drove me mad with stress and worry. So I expressed (lots), offered it to her at every feed and did combi bottles too. She is now eight months old (five corrected), 7kg, eats three meals a day and has four breastfeeds as well as three bottles over the night. If I can do it, I'm sure you can too! Best of luck!

[ILiveInAPineappleCoveredInSnow]

OP, can I strongly suggest you google Dr Jack Newman. He is a breastfeeding expert, and is strongly opposed to "breastfeeding by numbers".
My sil had a preemie in pretty much the same situation as you, and refused formula supplementation which was being pushed by the HV, again due to "slow" weight gain.
My nephew is now 1 yr old and nice and chunky!

You need to do what is right for you, but if you want to remain ebf, stickytoyo ur guns as long as you are having wet and dirty nappies, and some form of weight gain and baby appears healthy in all other apects.

[estya]

I'd get another opinion from breastfeeding councillors. in our area there is one bf councillor by 'profession'. She does a session a day at each children's centre and goes out to people who are really struggling.
The midwives and health visitors may be trained but really don't seem experts. even I knew some of their advice was wrong.
So I'd find out of your area has someone who just does breastfeeding. Then they may identify the reason for low weight gain and help fix it.
Or you could contact your local la leche league, ring the nct breastfeeding helpline.
And post of the breastfeeding board under feed the world. Lots of experts there.

[BigTroubleinSmallBoots]

P.s. Only take the advice of your health care professionals if you trust them, they are capable and they are willing to enter into a dialogue with you. You are your baby's mum, take no notice of the 'allowing you' bollocks.

[diddl]

! wouldn't do it just to satisfy some target of theirs.

I bf partly because I didn't want to fuss with sterilising bottles!

I would also ask for another opinion.

[TheBigJessie]

Hmm. I don't have proper experience with a true preemie. I had 34 week twins. I started off supplementing with formula, but they were exclusively breastfed by two weeks. The scbu nurse said she wanted to see weight gain of 100g a week for mine, when they were 36/37 weeks adjusted, not 20g a day. In the red books, they were a bit over 2kg at 37.5 weeks. One was 2kg and 20g.

[meddie]

There are supplements that can be added to exptrssed milk that just increase the calorie content. So it would still be your milk if

[fightingnun]

Thank you Hermione, yes Lola baby is happy, lots of wet/soiled nappies of right colour, very alert when awake but sleeping lots too as appropriate.

Good suggestion Runner, I will try to find one to go to.

Thank you so much to everyone else, brilliantly helpful suggestions, advice and encouragement - about to start following things up.

A bit teary at the power and kindness of MN

[meddie]

Sorry phone posted too soon. Just looked up the one we use and its only for use within hospitals as they need blood biochemistry monitoring.
A friend has suggested expressing at the end of a feed as the hind milk has a greater fat concentration and use this milk to supplement instead if need be. Maybe you could request a bf asvisor before you feel pushed into formula supplements.

[TheBigJessie]

You could consider hiring a breast pump. Medela symphony ones are good.

[Lillily]

To maximise breastfeeding you can keep the baby in constant skin to skin contact- go to bed for a few days if that's what you need to do. You can also use a sling topless and put a cardi/ hoodie I'ver the both of you,. The important thing is that the baby has constant access to the breast with ought having to give feeding cues.

[schroedingersdodo]

If the baby is alert with wet and dirty nappies I would continue ebf. It sounds like everything is going well, you and baby happy, why disturb this?

[LittleBearPad]

You could try cup feeding either ebm or formula. It's meant to avoid some of the problems with nipple confusion, supply etc.

But if he's got wet and dirty nappies and is alert he's almost certainly fine and taking what he needs at this time.

Give him a sniff on the head for me please.

[Lillily]

If you use a pump, make sure the baby could not be feeding at that time, as they can feed when asleep even. And when you give ebf could the baby be getting that milk direct at that time. You don't want a breast pump to get between your breast and your baby!

[cashmiriana]

Oh dear heavens this is my story exactly.
The difference being my DD was a whopping great 9lb baby born at 42+1

She took a whole 6 weeks to regain just her birthweight.

But my eyes told me she was doing absolutely fine. We fed and fed and fed on her cues. She had plenty of wet and dirty nappies. She was contented, latched well, and did gain - just not the magic numbers.

It was easier for me because even at her lightest she was still a big strong 8lbs + however the pressure was the same : was told I won't have enough milk to feed a big baby, not gaining enough, weighed before and after a feed and she had only 'gained' 10g so that's how little she was taking (such absolute and total rubbish)

Ring your local La Leche League branch asap and ask for support. They supported me - had an electric pump etc to show the HVs what I was doing (which in reality was building a store of milk for the freezer.)

HVs are notoriously unsupportive of bf in many cases - they like the certainty of the numbers game.

I hope it works out for you, whatever you choose to do.

[summertimeandthelivingiseasy]

I ebf prem twins. They had formula for the first few days until I started producing enough, then they had expressed milk.

Make sure you are putting your feet up in the evenings. A protein rich snack and hot drink is nice. This is the time you are most tired and milk production is at a lower ebb. Mine fed more often in the evenings, and I let them. They slept better at night with this.

If you are supplementing with a bottle, hindmilk suggetion above sounds good, and it should help your milk production, rather than slow it down.

I was told that the sucking reflex was the last one to develop. They were really good when they came out of SCBU at 2 wks, but not the experts DS was; it just took a week or so longer.

[Lillily]

Just another thought having retread your post, I how many sets of scales have been used? Scales are notorious for causing worry when they have not been recently calibrated. If you can, return to the same ones each time.