As with all health-related issues, please seek advice from a RL health professional if you're worried about anything.
Newborn breastfeeding and >10% weight loss(12 Posts)
Hello, I'm looking for some words of wisdom. I feel this may be a long post! I had baby number 2 last Friday - normal birth following induction with pessary for 24 hours, then waters broken for me and then the Syntocin drip for 12 hours, I elected to have an epidural, but by the time it came to push it had somewhat worn off! Once I'd given birth I was up in the stirrups twice for about forty minutes each time to be stitched up - 2* tears and grazes. I also lost 1.5L of blood. Should also say was hooked up on insulin sliding scale throughout due to gestational diabetes.
Anyway, breastfeeding was established whilst in the labour suite, and we were subsequently discharged the following day. On day three daughter was weighed and found to have lost 12.4% of her birth weight - she was 3480g or 8lbs 8.5oz. We were instructed to head to SCBU where bloods were taken and we were told that her salt levels were up and that we should head to a private room on the antenatal ward where a plan would be put in place with an aim to stopping the weight loss. On the antenatal ward, the midwives appeared with an armful of Aptamil and teats, and we were told to continue breastfeeding and once she was finished she'd be topped up with 72mls of formula. At this point I made a point of letting them know that I wasn't keen on the bottle feeding as I wanted to continue breastfeeding. The midwives agreed that they would feed via cup, whilst I attempted to express for 20minutes on each side with a view to topping up with EBM rather than formula. Overnight we followed this regime, waking baby every 3 hours. She remained incredibly sleepy throughout, jaundice tested for and levels found to be just below treatment levels. Cup feeding took the midwives over an hour, a lot of it went down her front. Expressing made it clear that on day 3 my milk hadn't come in yet, all I managed to express was froth. However it did start coming in and the expressed quantities gradually increased. Cup feeding continued to cause frustration to the midwives. The day after admission baby had put on 80g ( this was after a feed from me and 60ml EBM top up), the following day she had lost 80g, and the third day she had gained the 80g back and we were free to head home for community midwife visit the following day for weighing, she had lost the 80g again.
I am now feeling pretty frustrated, whilst in hospital we had about seven different midwives, all with different views, none of them were particularly helpful with regards to breastfeeding, other than a couple who did look and agreed that baby had a good latch and was keen to feed. We saw the breastfeeding councillor eventually on our second day in hospital and she was brilliant, this was after the second 80g loss of weight. She was very positive and told the midwives that my expressed milk must be used as the top up, not the Aptamil and my mum and myself voiced our concerns regarding the inconsistencies in care, and also the way in which baby had been weighed. She was very supportive and listened.
Since we've been discharged I've seen two community midwives, yesterday we were -80g again. The midwife left and spoke to Paediatricians, and told us to revert to breastfeeding, and top ups. I explained that we didn't have a pump, so she said she'd make enquiries about a community one, she never phoned back. My husband and I decided that we'd try another 24 hours breastfeeding, as this was the situation when we'd left hospital the previous day and we felt that I was producing sufficient milk and baby seemed to be feeding every 2-3 hours, waking herself up and we all felt far more relaxed and happier at home in our own surroundings and see what her weight was the next day.
So today we've had a visit from another midwife and baby's weight was static. I was beyond frustrated and was told that I must top up with formula, midwife told me that baby must get enough sustenance for her brain development and by me ignoring advice to give top ups I was therefore at risk of affecting her brain development. Unfortunately my husband went back to work so he wasn't there to back me up and I took what she told me and silently fumed as she asked me condescending questions about whether or not I was concerned. She then suggested that I could feed baby who was fussing at this stage, I just wanted her out of the house, but struggled in a very unrelaxed fashion to get baby latched on and feeding. Midwife then suggested that she wait until baby had finished feeding and she'd weigh her again, I explained that normal feeds had been around 40 minutes in duration. After about 15 minutes I unlatched and she weighed her again - no change.
Obviously we are concerned that our daughter has remained the same weight now for six days, every day she's +/-80g. I have sourced a breast pump from my SIL and have given a 30ml Aptamil top up this afternoon after a 20 minute breastfeed as suggested by midwife. I then spent 40 minutes expressing and accumulated about 90ml EBM. This evening she's had a 20minute breastfeed and my husband has topped her up with 65ml with a bottle and teat (I couldn't watch). To me it seems crazy to keep her off my breast only to pump it into a bottle to give to her in a different fashion. It's our intention to continue this overnight tonight. I'm hoping that come tomorrow when the same midwife returns that we might have put on some weight.
I just wondered if anyone has any words of wisdom or thoughts or views. I've no idea whether we are doing the right thing anymore, I fed our first daughter exclusively for around 8 months with no issues that I'm aware of (think this is why the last week has been so hard). I really want to exclusively breastfeed this daughter and believe that I have the means to do it, unfortunately our first week as a family of four has not been what I'd anticipated.
I'm no expert but are you getting plenty of wet nappies? That would reassure me. Have you contacted la leche league, also dispelling breastfeeding myths group on Facebook had some very knowledgeable posters. Hope someone will be along soon to.help.
Wow you poor thing. What a rollercoaster. I experienced very similar with DS1 who was born by CS after a failed induction. I remember all too well the frustration of a different plan with every shift change. We came home when he was 6 days old on a regime of feed, express, top up which nearly killed me.
My milk was really late coming in properly. Whilst I was expressing some whilst in hospital, I can clearly remember it being our 2nd night at home that I got that 'full to bursting ' feeling and it was only from then that his weight gain really took off.
If it's remotely possible try to do loads of skin to skin and feed her at the slightest sign she's interested. Don't let her go longer than 3 hours without a feed.
I also remember the HV coming on day 10 and tutting at the hysteria of midwives with regard to the 10% loss. If she's weeing normally that's a good sign too.
I've probably been no help at all and I'm no expert by any means but your post rang so many bells that I couldn't leave it unanswered.
So the blood lost and the diabetes will both have an effect on your milk supply so I'm not surprised you e had weight gain issues. It sounds like your milk is fully in now? How are the nappies?
Has the baby been checked for tongue tie? I would seek some RL support from a lactation consultant if you can afford one.
Otherwise, just feed, feed, feed and work on getting a really good latch, use breast compressions during feeding to maximise the amount of milk going in. Try feeding in different positions and hopefully the weight gain will come.
Can you see a Lactation consultant at home either NHS or private? She can check whether baby has a good latch and whether transferring milk effectively.
Be aware that different sets of scales can be calibrated differently to give slightly different readings. Is baby still being weighed on different scales? Can she be seen and weighed by same person from now on? Assessment should not be just her weight but also whether she is well hydrated, nappy output, any jaundice, behavior. Are there other current concerns that her milk intake is sufficient? Her birth weight may have been artificially inflated by iv fluids in labour, baby wees this out. Although should be gaining weight now.
Watch the Dr Jack Newman video on milk transfer- is baby taking a big coordinated swallow after each suck? Try breast compressions to increase milk transfer.
The rationale for expressing and giving via bottle is that if baby has a milk transfer issue eg tongue tie, or baby is too tired to continue feeding at the breast, bottle feeding is 'easier" and will get that milk in. Using a cup, syringe or supplementary nursing system would be better. If baby is actively feeding at breast I wouldn't take her off to bottle feed though.
Ardo rent very good breast pumps if you are not getting much out with current one
Sorry to hear you are having such a tough time of it. If it helps I remember my DD ( now 4) lost 12% of her weight in the first week. After that first week a midwife threatened to hospitalise her if she didn't start putting on weight and suggested formula but I stuck to my guns and refused. After day 8 she eventually started putting a little weight on. Obviously she wasn't weighed every day like yours so I have no idea what the fluctuation was. I could check her red book if you would like me too as she must have been weighed a few times during that first week. Don't forget the health professionals have their rigid guidelines and all babies are different. Fingers crossed you see some improvement soon.
I had a similar experience with DD1 5 years ago, though I got good, professional input from midwives. That made all the difference.
Others will help with practicalities ( I can't remember). What I will say is DD had a couple of formula top ups and about a week of solely expressed milk (she had facial injuries so couldn't bf). We then went on to bf for 2.5 years. Short term top ups don't have to be the end of bf.
One of my community midwives suggested I got in bed with DD, laid her on my naked chest and lazed about reading and eating chocolate! Great advice. I think the point was to promote easy, frequent bf, and it worked. Just have some pads to hold on the breast not in use.
I had my DS at home 3 weeks ago and he lost 12% of his birth weight by day 4 went from 8lbs 6 to 7lbs 6. i have had a number of midwives, a bf specialist and two HV all giving me different advice ranging from 'he needs to go a plan' to 'don't worry he is on the right percentile'. I know he is fine do have stuck to my guns and said no to top ups and EBF (like you I think it is better he goes straight on the boob). They were also weighing him too much in my opinion (every bloody day - so he was up and down some days). He was last weighed on Thursday and was 8lb 3 - so not back to birth weight. Seeing the midwife tomorrow and praying he is back to birth weight so they can leave me alone. Trust your instincts and try to relax - I know that is hard. Also make sure you that your baby is getting the fatty hind milk - so after the thirsty sucks they get fluttering sucks - that is the fat milk. Good luck I hope it goes well for you
Expressed milk top ups can be a real help but really you have three ways to boost intake as you feed directly. First you offer more feeds, second you switch nurse trying to get in at least four sides each feed(the more sides the more milk transfer) and you can also do Breast compressions.
Get lots of skin to skin and feed at every wiggle.
Thank you all so much for your words of wisdom, they were much appreciated. Our community midwife returned yesterday and fortunately daughter had gained 100g (she'd just had a feed from me, and an expressed top up of 50ml) anyway, we're being left in peace today, but she'll be back tomorrow. In the meantime I feel as if I'm hooked up to the pump constantly which isn't easy with a toddler and a newborn. I also hopefully have the breast feeding councillor coming tomorrow so will pick her brains. Am keen to stop with the pumping and just feed daughter on demand. The pumping seems completely counter productive!!
Glad she has put on 100g - I know the relief. My DS is back to his birth weight on day 25 so finally been discharged today! Keep at it you are doing a brilliant job
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