Any ideas on foremilk/hindmilk imbalance?

[Annner]

Hello,
This is my first post here, so please be gentle with me!

We are at our wits end as to why our DD's (9.5 weeks)poo suddenly went, and stayed, green. This wouldn't have bothered me - except for that her previously good weight gain stalled the same week, and this has happened before.

We have had a very long struggle to establish breastfeeding: a loss of 2 lbs in her first week (yep, over 20% of body weight) followed by cup feeding and huge amounts of expressing in her second, leading finally to diagnosis of tongue tie when she was 3.5 weeks old. After her tongue had been snipped (I would recommend this if it affects feeding, by the way - no pain) we resumed bf with nipple shields and she slowly got the hang of it, while we juggled with expressing and ebm by cup to top her up during the learning process.

During the two weeks of the Chrismas period we fed normally, with good weight gain (on the 50th centile) and nice yellow poo. She is down to an 1100 pm ebm cup top up to keep her snoozing until morning.

Suddenly last week it all changed. We concluded that the nipple shields were now a hindrance rather than a help and ditched them. However, four days on and there is no change towards normal.

To complicate the issues even more, last night her last feed was ebm from the freezer and not from the previous day. To our premature elation this morning's poo was yellow, before reverting to green again this afternoon. This now suggests that her jabs last week or her current cold/sniffly nose have nothing to do with the current change - as was suggested by midwives and other counsellors.

We are baffled. I know that green poo should not be a cause for concern, but in our case earlier on in her life it did result in further weight loss and was because she wasn't getting enough calories in.

How can I ensure that I get enough calories into her? I am currently trying to express each boob until it squeaks at the end of each feed, she spends as long as she likes on one side, and I don't switch until it is empty. She poos four to five times a day (always very loudly and copiously and sometimes in the bath and produces lots of urine. She is happy and contented in herself, and very alert. She just seems to have this milk imbalance.

Any ideas?
Many thanks in advance, Annner

[tiktok]

Can't really comment on 'imbalance', Anner...I think this is often overstated and it's better to go for the more obvious and likely explanations, if there is an issue.

Like you say, green poo is not a cause for concern in itself. But yes, with what has gone on before, you need to at least consider other things.

If you get her weighed you will have another piece of the jigsaw.

If you want to get more calories into her, then it's just a question of feeding her more often.....but if she doesn't want it, then maybe she is absolutely fine.

You have done absolutely brilliantly to have overcome such a difficult start. You now need to get a clear picture of her growth, and I would be far from surprised if you find there is no worry at all about her weight gain.

[Annner]

Thanks for such a speedy response. What other explanations could there be? I ask, because I have been wracking my brains trying to work out what, if anything, has changed in my diet or lifestyle, and can't think of anything significant.

I have veered towards the imbalance idea on the basis of her constant wet and dirty nappies, and the fact that although I do not have too much milk, I have a good supply. When this happened before, expressing at the start of a feed did the trick for a while.

One thing that occurs to me is that she does go a long time (11 pm - 8 am)between feeds. Fab for our sleep, but would waking her up in the night mean that she took on more or that she spread the same amount over more feeds? Who knows!

I should also say that my confidence is still at rock bottom, and although I know that I should be more relaxed about things, I am still convinced that something has gone wrong with my milk, because things have gone well before.

Annner

She is due to be weighed on Friday, after a week in which she has learned (AGAIN!) how to bf, had her first jabs and had her first cold.

[miranda2]

What a star she is, sleeping 11-8! Lucky you. I'm sure she'd wake up if she needed more food, so I'd be inclined not to worry too much, but do see the health visitor for your reassurance.

[NotQuiteCockney]

I think a cold (or any bug) can cause green poo. It certainly seems to have with our DS2. It's probably not worth getting too bothered about.

Also, please try not to get too bothered about the specifics of weight gain. If she's gaining, at least a bit, and alert and happy, as you say she is, she's fine. It's easy to take a few oz change very seriously, but the difference between a small 2 oz gain in a week, and a big 8 oz one is 6 oz - which is a feed, or a good wee and a poo.

[NotQuiteCockney]

Oh, and please don't see problems as "something gone wrong with your milk". I had a horrid time with breastfeeding the first time around, and was convinced, deep down, that it was my milk, or breasts, that were the problem. (I did feed successfully, but DS1 was skinny, and I gave solids pointlessly early.)

DS2 is fat! Well, not huge, but he's got rolls of fat. The problem wasn't my boobs, it was the fact DS1 was put into SCBU for 30 hours and didn't get a chance to learn to feed.

Similarly, it sounds like your early problems were because of the tongue tie, and maybe the shields.

[Gem13]

No advice re the green poo I'm afraid but just wanted to say - don't wake her up! My DS was going 7-7 at 9 weeks (DD was a different kettle of fish ) and he was breastfeed and progressed up the weight charts just fine. Although he did change centiles. Everyone will tell you they are based on bottlefeed babies in the 60s so should only be taken as a guide and not followed too rigidly.

It sounds like you're doing a great job. I really wanted to breastfeed both my two and did but don't think I would have persevered the way you have. Well done you!

[Annner]

Thanks again for all of the good ideas and feedback

I think that I am sooooo hung up over this because we really believed that the move away from the nipple shields would be the final hurdle of our many, and that it would be plain sailing there on in. I'm just gutted that there seems to be something else to puzzle out and find a solution to.

I suggested waking her because she often doesn't seem to realise that she is hungry until she is woken up - she just doesn't do it the other way round, it seems.

We know how lucky are that she sorted out day from night at such an early stage - it happened because in her second week we had her on a very strict four - hourly feeding cycle to put on weight (it was that or a tube in SCBU) and so her little body clock clicked when she was about three weeks old.

Not sure about the cold/jabs as a cause, as the great poo change came before these happened, and we had the random yellow one this morning after the older milk.

Still, tonight's top up will just be "end of feed" expressed milk. Will keep you all posted! I wish that I had found this forum sooner. Although midwives, my HV and NCT counsellors have been brilliant, dealing with my down days and near descent into depression has at times left me feeling extremely isolated. I never expected bf to be easy; I just didn't expect to have quite so many problems that positioning couldn't resolve!

Annner

[tiktok]

Anner, you are right that your baby is sleeping a long time, and the fact you have now told us she still needs waking for feeds makes me wonder a bit more. Also, the fact the green poo happened after you stopped the shields....maybe she is not as well latched without the shields as with them, and maybe she still needs a bit of 'supervision' to make sure she is well-positioned. On the other hand, maybe there is nothing untoward at all, and she has green poo just because sometimes babies have green poo (it happens, by the way, not because there is anything different in the milk, but either because the baby is having milk with a lower proportion of fat in it, which does not mean there is anything wrong, as the baby may just take more in terms of volume to get the necessary fat, or the milk has been processed more quickly than before, and has rushed through before the waste has had time to turn yellow. Sometimes these two reasons are the same, in that milm with a lower proportion of fat in it does get processed more quickly. Anyway, not a big deal, as long as the baby is fine in every way).

[Annner]

She often needs waking in the morning, but only naps for at most a couple of hours at a time during the day before deciding she is peckish. At least her cold has not put her off her tucker.

We went to see the NCT BF counsellors yesterday, and they were happy with her position and latch and suitably impressed with how rapidly we had got rid of the shields. In fact, although they saved our bf in the early days, and were definitely the only way she could bf at all while tongue tied, we made the switch because as I grew more confident and dared to watch TV or use the PC while feeding, I didn't notice her slipping into a slurping, more bottle like position. Nice and easy for her, and no pain for me with a shield - but hardly conducive to good flow, stimulation and a later move to feeding au naturel! We went "cold turkey" as it were, as she was definitely confused by what must have come across to her as double standards in the rules - sometimes she could slurp, and the familiar silicone was there, sometimes there was something else (vaguely familiar?) and an abrupt end to a nice slurp for any slips at all.

Maybe she is just adapting to a lot of changes in her little life in a week. In any case, I slept through the night last night for the first time in ages, so I must be feeling more reassured. Provided she has not actually lost any weight on Friday, I will try to be happy!

[Annner]

OK, so we had a weigh-on on Thursday and ....... Isabel had put on nine oz! In a week when she had her first cold, first jabs etc. I presume that she is going to be a bit of a fits and starts baby.

So, now I don't know what to think, apart from that I am dead happy!!! Her poo is more yellow, but still greenish, but at least I have stopped worrying about her growth so much.

Many thanks for all of your help and advice - it helped to boost my confidence that I wasn't starving her.

Annner

[aloha]

Hooray!

[highlander]

flippin' heck - hats off to you after all that hassle, what a stonking weight gain!

[Annner]

Coo, taa!

Isabel loves 'her' boob ... If anyone out there is in any doubt at all, IT IS WORTH IT!


even when it took 9 weeks to get everything running.

Annner