Really struggling - one issue after another. Now what?

[aamia]

So - LO is now 10 days old.

• Bf fine when just colostrum, latch checked and good. Comfy for me, he maintained weight.
  
• When milk came in was initially too much/fast and spurted down his throat. So lots of unhappy feedings, colicy baby etc etc. Finally worked out the problem and expressed a little first.
  
• So all went well for a few days. Then he started a proper growth spurt - almost getting longer in front of my eyes. Fed more and more, proper emptying the breast between each feed. Soon was hungry and feeding every hour. At today's 10 day check had lost weight since the 5 day check. Advised to top up with formula and review in two days...
  
• Two feeds since that appt. First one fell asleep after bf, then took 30ml formula about 15-20min later. Second one started to chew my nipple towards end (now killing me, soooo painful!) so unlatched him and offered bottle. He drank about 20ml. That would seem ok, except that he's just vomited at least that 20ml back up.
  

I seriously don't know what on earth to think now. Is he getting enough then off each breast if there isn't room for the formula, just he's growing too fast? In the womb he'd have enormous growth spurts then nothing for days, and I'd eat like a horse and still lose weight while he did so, then stabilise, put on a bit, and off we'd go again. Seems to me like he's just repeating this pattern now.

So how to supplement if there's milk going in? Bf every 3 hours (what he used to do) and formula in between? How do I stop the chewed nipple from killing me (don't think I can face to feed him again from it till it at least doesn't hurt just sitting there!)? The chewing is new, since he's been so hungry - will it go? Anyone else experienced this? What if he's not gained by the review on Thurs???

[ZuleikaD]

My own inclination would be:

1. to ignore the speed of his growth (yes, babies grow in fits and starts and three weigh-ins in ten days seems excessive to me for a thriving baby)
   
2. not 'top up' with formula - there would seem to be enough breastmilk going in as otherwise he wouldn't have vomited the formula
   
3. stick to breastfeeding as he's probably trying to boost your supply and you won't get it up enough if there's formula going in as well
   
4. not have him weighed until he's at least 4 weeks old as long as he continues to thrive, and not more than once a month thereafter
   

FWIW my own were feeding every two hours at this point and starting to cluster-feed in the evenings.

[Mandinga79]

Agree with above completely. I do not get this 'top up with formula' rubbish if breast feeding is going well. It's the number one culprit in perpetuating the erroneous belief that so many women have that their milk quality/supply is inadequate if baby loses a little weight, and which can ultimately lead to unnecessary cessation of breast feeding.

Keep it up! Weight loss is really not a significant problem if poos and wees are fine and baby is happy in himself.

[mawbroon]

aamia, I have read a few of your threads in the last couple of days and wondered about tongue tie.

Oversupply, chewing at the nipple, colic, rock hard stomach, vomiting up after feed, these are all things that a tongue tied baby might do.

reflux/colic and tongue tie

list of tongue tie symptoms on here

Sadly many HCPs miss tongue ties because they lack expert knowledge, so you may well have been told there is no tongue tie, but I think it would be worth getting it checked out by an expert.

[aamia]

Thanks about the tongue tie info - will look into that :).

Update - for now, we're alternating bf and ff every 2 hours. Got to show weight gain tomo at mw clinic!! Having done a fair bit of research, and having got on the scales myself, I think I'm probably not producing enough because I'm not eating enough. I've lost a fair bit of weight trying to keep up with him and he's not even 2 weeks old yet! There's still too much foremilk, but with the current routine I can express that off, so he's not too windy and uncomfortable. I'm amazed at what he's eating - 60ml formula on those feeds then his fill of breastmilk on the others, hungry every 2 hours or just before. I hope he has gained weight for his check tomorrow, as I don't know that we could get more into him!

Want to keep bf at least in part so will ask about ways to keep supply going. I don't think I could manage when he got bigger to ebf though, so combi seems the way forward!

[HappyAsASandboy]

Aamia you sound like you're working so hard to get through all these early issues - well done you :)

There are a few things you could stop worrying about, which might help! Unless you are severely undernourished (far more undernourished than you'd ever be in the uk without being hospitalised), what you eat doesn't impact your ability to make milk or the quality of that milk. Not eating might be a symptom of stress, and stress might affect supply, but you skipping meals won't in itself affect your supply.

The second thing to not fret about is the foremilk and hindmilk. Just try to think of it as milk. Yes, the milk gets progressively more fatty during a feed, but it is a gradual change. It's not that you have to 'get through all the foremilk to reach the hindmilk' (though you might hear MW and HV saying things like this . So feed your baby on one side until he gets wriggly or sleepy and then offer the other side. If you have oversupply, there are things you can do to help that later, but in these early days I would just feed feed feed.

Topping up with formula has a huge effect on your supply. Quite simply, your body makes milk to replace what has been removed, so for every oz of formula you give him today, your body is not expecting to have to make that oz tomorrow. You can then work hard with your baby to persuade your body that it should make more, but its much harder work to increase supply than it is to decrease it. Your body will adjust very quickly to a change in demand, so these early days when your baby is going through growth spurts and putting in an order with your body for the milk he needs is the worst time to be topping up.

I can understand the MW/HV advising top ups to help with weight gain. But there is no reason at all why those top ups should be formula. You could express (particularly from your damaged-nipple side while it recovers) and give that as a top up. Or you can just feed feed feed all day for a few days. I would take the feeding option personally - cancel visitors unless they'll wait on you and do your cleaning and take your baby to bed. Stay there all day watching movies and feeding your baby every time he moves. I'd be aiming for feeding at least every hour and a half to two hours through the day and at least every three hours overnight as you're looking to build supply and gain weight. Three days of this might mean a mountain of washing accumulates, ready meals for tea and a dirty house, but I am fairly confident it'd also mean an increased supply and a good few ounces of weight gain. A three day investment now really could set up your breastfeeding relationship for the long haul if that's what you want to do.

Good luck! And remember to relax, breathe and nuzzle your baby while he's so tiny and new :)

[Seriouslysleepdeprived]

Such a lovely post Happy

Some brilliant advice there. I fed DS pretty much hourly during the day for weeks in the beginning. He was tongue tied so i would definitely get that checked.

Topping up with breast milk is by far the better and easier option long term. I spent the first 6 weeks topless & in bed while we got things going. It does take a while but really worth the initial input now. And my ouse was a mess too but c'est la vie. It's tidy again now

[aamia]

He IS tongue tied! Got MW to look under his tongue and there's a strip of membrane there that should not be! She said it 'wasn't severe so don't worry too much' which I countered with 'would it be worth fixing if I paid to have it done privately...' Her whole attitude changed then, she got a more senior MW to check it, then recommended the local bf clinic that can refer him, and said one of the options there is to refer to a private service that does it quickly. Have also looked online and there's a clinic in the next town that does this on Fridays privately, so that's an option if the other route doesn't work. The MW watched him feed and said he's using his jaw more to compensate for the lack of tongue movement, which is why he tires so easily and doesn't eat enough.

Weight-gain wise, he's put on 15g in two days, so we'll keep doing what we're doing until the tongue tie can be fixed. Before the 10 day appt I was pretty much feeding constantly yet still he'd lost weight, so I know we can't do it without a bottle of some sort. Depending on how long we'll have to wait for the tongue tie to be snipped, I'll either stick to what we're doing if it won't be long, then gradually reduce formula so my supply increases again, or buy a pump and start expressing. I've been told to make sure I'm bf at least twice between 11pm and 5am to keep the supply I have. The formula seems to be giving him the energy to bf as we've gone from 10min feeds to 30-40min and actually managing both breasts before falling asleep - massive improvement!

So - bf clinic tomo for a referral, back to MW clinic Mon for weight check and we'll go from there! MW was kinda - why not just bottle feed? I wanted to do at least six weeks though, and I'm not giving up bf at 12 days of age if there's anything I can do about it!

[mawbroon]

Wasn't severe, so don't worry too much. Jeezy peeps. What about all the problems it's causing! Sometimes the lack of knowledge about this drives me crazy!!

Where in the country are you? You don't have to say, but just to let you know that the Cote Royd Dental Practice in Huddersfield does laser revision and will also do a lip tie if there is one.

Also, there is a really good tongue tie support group on Facebook.

[Seriouslysleepdeprived]

We got DS's TT done privately in the end as they refused to refer us as he was gaining weight. The paediatrician was when I told him.

He said too many midwives aren't referring appropriately & to complain. I don't know why as they are so hesitant as it really impacts on breastfeeding.

[aamia]

Getting somewhere! Have a number to phone of a local, recommended clinic that'll sort the tongue tie within a week (I'm paying, obviously - NHS waiting time about 4-6 weeks they said. Seriously? My child can't EAT!!!). Lady at the bf clinic was like 'ooh yes, that's a 75% tie and look how he can't even suck my finger properly!!!!' WHY, when they check everything else the day after babies are born, do they not look for this??? So - about to get on the phone and book him in. They've lent me a pump too to keep milk supply up. Progress!! :)

[mawbroon]

Good news that it's been identified aamia.

Not so good news that your baby is tongue tied, often it is not just as simple as snipping it then everything is hunky dory. I suggest you have a look at the facebook group for reliable info on aftercare etc

Lip tie is also important. But as far as I know, there's only one place revision lip ties in the UK (i might be wrong though)

Dr Kotlow on lip ties

[Iwillorderthefood]

I have nothing to add but am amazed that a tongue tie that impacts as much as your baby's would not be treated quickly. I suppose with ff as a back up the NHS just does not see it as serious, so much for supporting breast feeding mums. Hope it all gets resolved soon. If it helps I EBF my first, and kept my supply going by pumping each time DD fed. I wish you luck.

[aamia]

Well - the lady who does it locally wasn't answering her phone yesterday so can't get anything sorted 'till Mon. There're also some clinics run by private doctors/surgeons within reach. They say they don't have occurrences of the tie re-attaching, where she obviously does as she says she'll snip them for free if they re-attach on her website. Helpfully (not!) one of those doesn't have a clinic now 'till the 12th, and the other didn't have anyone in the office yesterday. Price is the same for all three options. Not sure whether it'd be better to wait and have it done by a clinic where it won't re-attach for sure. The local lady offers bf support straight afterwards but that's the only advantage to her. I've found a set of exercises that you need to do afterwards to regain mobility/prevent re-attachment. Going to ring round on Mon again - tempted to go for the doctor/surgeon route...

Glad I got a pump though - I'm only producing 30ml from each breast per feed. Now I know he'd be able to get more than that but with his tongue the way it is, I doubt he does tbh. Going to pump as much as I can to try to keep what I have/increase it a bit if possible. So wish this had been picked up earlier. So many doctors/midwives saw him cry in hospital when he had antibiotics put in and things - it's so obvious when you know what you're looking for!