Breastfeeding: is this a problem?

[Thejoyfulstar]

I live abroad but am from the UK. I has a babyb4 weeks ago who was born with respiratory distress. After 24 hours in NICU she was fine but my milk didn't come in until Day 5 and I suffered from dreadful nipple pain which hindered feeding even more.

My baby was 3460g at birth. She dropped to 3165g at 6 days old. They gave me a plan to breastfeed on demand and supplement with expressed milk or formula but this was though as she didn't want anything extra than my breasts. I was syringing in every bit of expressed milk I could get into her and giving her formula in a bottle, which she often vomited. By Day 9 she was 3220g.

Regrettably I decided that I would then focus on just feeding her from the breast. As far as I could tell, I had milk. I've breastfed 2 other children successfully so thought I knew what I was doing.

I leak milk when I haven't fed in a while. My breasts feel hard and full and after she feeds, the feel soft and empty. I can see by the movement between her ear and jaw that she is drinking, and I can hear it too. Afterwards she is contented and is a very settled, happy and alert baby. I change her nappy every 2 or 3 hours and there is always wee or poo. She sleeps a lot but I wake her if 3 hours go by to feed and she is feeding almost the entire time she is awake. My husband and I have been joking that we feel how heavy and chubby she is getting.

I took her to the paediatrician for her 4 week check today and she is 3550g. He says that is not enough weight gain and I have to give formula. I said could I still breastfeed. He basically said what's the point as I clearly don't have milk.

I am so upset and confused. I was certain that my baby was transferring a good deal of milk. The initial latch is still painful but that was the same in the early days of breastfeeding my other 2. I fed my middle child until she was 1 and never had an issue like this.

I feel like where I am, doctors overreact about things that drs in the UK would not. At the same time I don't want to be so arrogant to think I don't need to take their advice. I feel like I have put my heart and soul into establishing our breastfeeding journey and feel totally floored that is has all been for nothing. Am trying to find an English speaking lactation consultant but am really struggling to do so.

Does anyone ahve any experience of this? I have received such little support despite asking for it and looking for it. I dont know where to go from here.

First of all hes clearly an idiot if he thinks weight gain is exclusively the point of breastfeeding. There's loads more advatntages so his response to you asking if you could still bf would immediately make me think he's a bit clueless. I'd get in touch with a lactation consultant.she's putting on approx 110g a week and she was probably weighed on two different scales. I'd see if you can get a support group with a weekly weigh in on the same scales if you want to keep feeding

Afterwards she is contented and is a very settled, happy and alert baby. I change her nappy every 2 or 3 hours and there is always wee or poo.

This plus the fact she is gaining weight would make me think everything is OK. I am not an expert though.

You clearly have milk, baby is growing, and filling nappies, those are all good signs.

DS2 was born at a good weight, gained straight away. On a HV check, they recorded the weight wrong and had a panic. He'd already outgrown NB into 0-3m clothes. The HV later realised that she'd made an error.

Honestly I'd trust your instincts. If you're happy and baby is happy- which from the sounds of it she is! Just keep going as you are.
I've found some paediatricians forget that it's normal for babies to lose weight post birth- depends on how you gave birth, IV fluids etc.
Shes pretty much back to birth weight and I wouldn't be hugely concerned- obviously as long as she keeps growing and putting on weight. If you don't want to start formula, don't be pressured into it, and give your baby a few more days before you make that decision. Her nappies, demeanour etc will tell you far more than a weighing scale!

The scales in the doctor's office might also be calibrated slightly differently. She's back to her birth weight and above. She has the correct nappies, you think she's fine as does your DH. So I'd say to keep breastfeeding . There are breastfeeding support groups on Facebook or you could try and get a La Leche/ lactation consultant appointment via Zoom.

Thank you everyone! I have contacted an English speaking lactation consultant who is coming out tomorrow. I've been in shock all day. Sounds dramatic but this has been a very different breastfeeding journey and I have persevered through literal blood, sweat and tears. The absolute agony I've gone through to get to this point only to be told I've no milk...when I know I have! I've been so upset that it's all been for nothing.

How does the paediatrician think she's been gaining weight, now above birth weight, if you "have no milk"?? It's a crazy comment if you've been feeding her only via breastfeeding for a couple of weeks and she's gained weight during that time. Not to mention is also weeing/pooing and content.

It sounds like it's going well! The nappies, the settled baby in between, the soft breasts after a feed. Weight is not the only indicator and there is quite a wide range of 'normal'. It may also just be the slow start has affected things, a little and she's not caught up from that yet. Is she following her weight centiles? In Britain, we only really start to rethink if a baby drops two centiles.

She's gained weight, is over birth weight and has lots of wet nappies.

She's fine. Where are you and what are their general views on breastfeeding. I know in some countries Drs have told women that we have 'evolved beyond breastfeeding and most women can't do it anymore'.

Thank you everyone! You don't know what your responses mean to me. I live in a European country where everyone is obsessed with how great breastfeeding is but nobody helps you with it. An example of the cluelessness is when I was distressed in the hospital and said I thought there was something wrong with the baby's latch. One of the midwives insisted that the latch was absolutely fine despite NEVER having seen me feed the baby! When I saw the Dr this morning he really celebrated the fact that I am breastfeeding but was pretty quick to tell me to stop. I spent a few hours there feeding on demand and giving her a little expressed milk. I weighed her in a very primative way: holding her on the adult scale and subtracting my own weight. This calculation put her at 3800g which to me is fine and the difference was because she hadn't been fed in a while before the Dr and then had been. This shows its hardly an exact science and yet could be so damaging to a breastfeeding relationship.

Would I be unreasonable to fill her up before she gets weighed again tomorrow morning? The Dr wants her back to weigh her on a different scale, as I could tell he did feel bad.

This sounds like such a first world problem but I honestly felt like such a terrible mother for feeling like I was doing a great job and then suddenly feeling that my baby was literally failing to thrive.

She does have a bit of a wrinkly forehead. Is that a sign of malnourishment at 4 weeks? Her length and head circumference are growing normally.

My experience of having babies in different countries is that in the UK there is much more of a 'wait and see approach'. Where I am, they are much more cautious about everything. During my pregnancy, for example, I was tested for toxoplasmosis every single month among many, many other tests that my pregnant friend in the UK didn't have to do.

So in my mind I'm thinking, let baby set her own growth rate (they don't seem to be plotting her weight on the centile graph thing) over a little longer. However the mindset here is just a bit more of employing an immediate, knee jerk response.

I don't know what to think ad I'm not a Dr!

I dont really have any additionsl advice but it did occur to me that if you are having trouble getting lactation support locally, could you find someone in the UK who would talk to you over Zoom? I know it's not ideal, but probably better than nothing, or trying to deal with a language barrier. A lot of Lactation Consultants started doing virtual consultations over lockdown and the time difference shouldn't be an issue for Europe so maybe consider that option?
Hope you get sorted out soon.

Why on earth is breastfeeding plus top ups of formula (or expressed milk if you can fit in the time to express) not an option? If the European country is France take her to a PMI centre for extra weigh ins and advice from a different dr or midwife. It’s a free service.

Some more tips (that you probably already know as you’ve done this before, but worth a try if you haven’t already) ; always offer both boobs at every feed. And keep switching back and forth between boobs when she unlatched until she definitely isn’t interested in drinking anymore.
Ignore all advice advice about how often 4week old babies are meant to feed and just offer a feed everytime she does anything vaguely suggesting she might want some milk.

Frankly, some doctors are idiots. And dangerous idiots, peddling nonsense dressed up as medical advice.

I remember a friend of mine being told her breastfed baby was “obese” by a Portuguese doctor and she should restrict breastfeeding to a timed number of minutes as feeding on demand was unhealthy (mum ignored idiot doctor, and child is now much older and a perfectly average size and weight ).

I also know another lady who took her baby to a hospital 3 times because she was sure her baby was very ill, each time the hospital sent her home with Calpol and told her to stop fretting. The infection turned out to be an unusual brain infection and the baby nearly died, and is permanently damaged from the illness after eventually spending 6 months in intensive care recovering. Sometimes, mum DOES know best.

I’m so sorry you have have this anxiety to deal with. I believe you are right; you can tell if your baby is satisfied and feeding. Do all the good things to keep your supply up - especially stay hydrated - and then trust your instincts.

You could try The Milk Meg. She's based in Australia but does consultations all over the world. Her online advice along with the website Kelly Mom got me through 3yrs of feeding my second.

Thank you.
Literally every time she is awake, I latch her on. She sleeps a lot and so I'm conscious that her waking time needs to be spent feeding as much as possible. I give 2 breasts and if she falls asleep after one I change her nappy to wake her. Another Dr said to always offer the last breast you fed from first (I had always done the opposite in the past) in order to ensure that it is properly drained and the baby gets the hindmilk. I do that too. I have a water filter jug that I refill about 5 times a day and just guzzle water. I literally sink pints at a time. I use breast shells and a haakaa to collect leaks and i freeze it. Not a waking moment or drop of milk goes wasted.

I called my husband in tears and he was so shocked. He said 'you literally can't feed her anymore, you're working hard day and night!'

I just met my neighbour and told her and she was surprised too as she had noticed the baby getting bigger. Yesterday my mother in law sent me a whatsapp message in response to a photo I sent, saying 'i can see she is really thriving, well done!'

I have been trying my very, very best and feel so confused. Im feeling a lot better now. You have all helped me so much.

@HereBdragons supplementing is a thing here but the dr doesn't think he doesn't seem to think there is much point in my case. He told me the quantities that he wants me to supplement and they sounded like a quick escalation to full time formula feeding.

By the way, I am not a breastapo type who is militantly against formula. Its literally life saving in many cases. I just dont want to be scared into it unnecessarily. It should be a free, informed choice based on properly educated advice. I don't feel like this is happening here but am too bamboozled to trust my instincts in case I'm wrong.

It sounds to me that you're doing absolutely fine The weighing methods seem a bit inexact but your baby is putting on weight, is contented, and the comments from your neighbour and mother in law are reassuring.

I'd say trust your own judgement. You have breastfed two other children and know what you're doing.

Are you in France? I remember a French paed telling me that 'most women can't bf', and that I should supplement with formula.

Unfortunately he missed that ds1 was severely cow's milk allergic, so our attempts to top him up with formula were beyond disastrous!

Sounds like you're doing great. Ignore the idiot. So long as she is gaining, you're doing fine.

Woek with your ibclc. There is no obvious problem here and the advice given is beyond poor. Speak to someone who knows what gains gain is, how to optimise milk transfer and you will be fine

Hire a lactation consultant. In the UK they are all registered medical professionals. Also my DS had almost exactly the same measurements and when he gained 300g (from 3.2 to 3.5) he was signed off from regular monitoring. So take what this person says with a pinch of salt

To be fair UK IBCLCs aren’t all medical professionals but they are all very well qualified in BF support.

I am not in France, no. The country that I am in is very pro breastfeeding in that most women do it but I've no idea how when the support is so dire.
The lactation consultant is coming tomorrow so hopefully we can work on a plan.

I want to say thanks again to each and every one of you who took the tine to respond. I've read each comment more than once but have just been too all over the place today to reply to everyone individually. If you replied to my message, I read it more than once and appreciated every word.
Thanks so much.

I'm sorry you are going through this. Hopefully the lactation consultant will be able to support you.

If you feel it would help you fight your corner, it might be worth buying some baby scales. I used to weigh ds before and after a feed so I could 'prove' to the medics that he was in fact getting milk from my breasts.

@CatherinedeBourgh I've ordered a set and they arrive on Wednesday! Thank you for your kind words

I wish you lots of strength, you will get through this! It sounds like you're doing everything that is humanly possible so try not to be hard on yourself. That's difficult, I know. I went through something similar. Oh the infinite feelings of guilt! It sounds like the doctor you have seen is wholly ignorant about breastfeeding and has no awareness of the many other non-nutricional benefits of persisting with it, whether it be EBF or with some supplementary formula. I would get her weighed again, definitely on a proper baby scale and it's great you've got an appointment with a lactation consultant. The situation I had with my DD sounds very similar to yours, similar weights etc. In the end I was going to a weekly breastfeeding group run by a pediatrician/lactation expert and I followed her guidance to supplement steadily but not excessively. The idea was to make sure she kept gaining but not cause the end of breastfeeding for us. We fed her formula using syringes to try to avoid her developing a preference for the bottle and rejecting the breast. I'm not saying this is essential but I would follow the advice of the expert you see. My DD stayed low on the percentiles until 6 months but I am so glad I kept breastfeeding and in fact still am once a day and DD is 2! I identify so much with what you say. I'm also a Brit living in Europe. It's such an intense stage but you'll survive it and you're doing your absolute best for your baby!