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.

@RoseslnTheHospital no but I wanted to keep a close eye. Regardless, today is Wednesday and she hasn't gained anything since Sunday. She should had gained about 60g and she has gained 0 in 3 days.

@Smellyporcupine I know what you mean. I just dont want to go against medical advice when I'm not trained. I feel like I can't enjoy breastfeeding her in good conscience knowing that she isn't gaining.

@Thejoyfulstar are you feeding to a schedule or on demand ? It's a tough one, I would try to feed her more and see if it helps . Always offer both sides. I definitely wasn't looking after myself at the start and I think it affected my supply a bit.

Make sure you are eating enough carbs and drinking enough water.

Growth will not be linear each day though, and you have the accuracy of the scales to factor in as well. You're halfway through the week, she could gain weight for the rest of the week and record a decent weight gain on Sunday. If you continue to weigh daily, I would look to consider her weight gain on a per week basis, say taking Sunday as the week end/beginning point. Then try not to worry about day to day weights.

What centile is she on atm? I'm guessing somewhere around the 9th centile given what I can piece together from the weights you've given and a little over 5 weeks old?

@Smellyporcupine I offer her the breast every 2-3 hours as she is a very placid baby who likes sleeping so I have to make sure that (absolute maximum) 3 hours never goes by without feeding her or at least emptying my breasts. If she wants to feed more frequently than that then happy days, but so far I often need to initiate regular feedings. I always offer both breasts and she normally drinks from both. If she leaves one empty because she has gone back to sleep, I express it and give it to her later. I drink litres and litres of water and am very mindful of my diet to ensure good milk production. I also take two supplements suggested by my lactation consultant.

@RoseslnTheHospital I'm not in the UK and the paediatrician who saw her or her check up didn't mention her centiles. He just told me that she should have gained 600g by that point but she had only put on about 80g.

As I said before, I've put my heart and soul into fixing this problem. There were days when I was almost delirious because of the feeding schedule. I feel like I've been ignoring my other kids a bit. I've not left the house except for essentials in 10 days so that I am always available to feed and/or pump. Skin to skin. Power pumping. Relaxation techniques. Supplements. I've been absolutely busting myself and pushed through because I thought that short term pain would lead to long term gain. Now my supply seems fine and I've seen no gain at all. Its depressing. I'm finding my mood very much correlates to her weight gain and its exhausting.

I hadn't wanted to leave it a full week between weighing her because I want to know what's going on in the meantime. I want to know if I need to intervene as a full week of my baby not having enough calories seems difficult for me to accept.

Does she have any kind of baby record book or notes that is left with you, like the "red book" in the UK? That might have growth charts in, or if not, you could have a look at the ones used in the red books in the UK:

www.rcpch.ac.uk/sites/default/files/Girls_0-4_years_growth_chart.pdf

You can plot the weights yourself and see if she is tracking a centile line, or falling down centiles.

I'm sorry to hear that.

You can get centile charts from the WHO here:

www.who.int/tools/child-growth-standards/standards/weight-for-age

Generally speaking, it is a matter of concern if they are dropping down the centiles, rather than what particular centile they are on.

Thank you both. I was thinking of plotting it myself but am feeling a but too zombified at the minute to do it.

Maybe try every 2 hours then. I feel 3 hours is more a formula feeding schedule. I know some say time is from the start of the feed but I would just endure once she's finished / snoozed off you wake her in 2 hours if she's not up and feeding before that.

But I know it's never straight forward each baby is different, my two were. Keep at it

Agree that weight gain is not exactly linear and a decent poo/feed could account for 40-50g+ (each!) - if she was fed just before her previous weigh in and/or had a poo building up vs just done a big poo before this one and/or was hungry. You will see normal fluctuations in weight due to fluid intake and output, and this is why weighing should be spaced far enough apart so that these fluctuations are not getting in the way of the actual gain. Or conversely, you can also actually do weighted feeds - weigh immediately before and after - although this is not really recommended as it can be inaccurate and stressful. I did it with DS2 in hospital and saw a benefit in it, but it has to be done carefully and I don't think it should be standard practice.

Most experts including NHS guidance recommend weighing no more often than monthly, of course if weight gain issues are apparent then more often would be correct, however, the important point being these more frequent weigh ins should be overseen by a professional who has the training to take into account all the signs, feeding behaviour, weight gain, nappies, potential fluctuations due to fluid intake/output, you can never simply go by the number on the scale alone.

So wait and see what your LC says, and try not to worry x

I can have a look at centiles for you but I'm not medically trained. I just know a little bit about centiles due to my eldest's weight patterns.

Hi OP, I'm sorry you're feeling so disappointed and I can understand why. I would agree with PP that baby's weight gain sometimes comes in fits and starts. I'd keep doing what you're doing and don't weigh her for a few days.

@Smellyporcupine yes I'm doing that- the 3 hour thing is only if something is beyond my control, like if something comes up and I have to see to one of my other kids it might delay me in waking her to feed. Or if I'm exhausted at night after a feed, i'll set my alarm for in 3 hours time rather than 2. I try to do it every 2 hours but sometimes she takes ages to wake up and I spend a long time undressing her, ticking her feet etc. That is happening less and less for example. So 2 hours is the aim, but it averages out at 2.5 depending on circumstances. Sorry for the long explanation!

@BertieBotts she has been doing several massive poos a day for a few days now. I don't know if that an impact but she always seems to be working on something these days. Right before I weighed her today I removed her nappy and it was very heavy. I don't know, I feel like I could clutch at straws all day. Its funny you should say that it's not just about the numbers as the paediatrician said to me that "it's just simple mathematics; the number tells the story". Thank you for offering to plot the data. What do you want to know? That would be really helpful and there is no rush.

I've been working so hard at this that I feel I'm going to make myself sick. I so, so, so wish I didn't care! I don't even know why I do!

@CatherinedeBourgh I don't know if you can relate to the doctors outside the UK who get really cross with you and tell you off like a child. I still feel so vulnerable after my c section and definitely don't feel strong enough to argue my case to the professionals here. I'm going to a different paediatrician for the 2 month check but I know she will be the same. I also can't just stand by while my baby doesn't gain weight...it just feels so irresponsible and prioritising my wish to breastfeed her over her over her health. Its making me so anxious.

Going forward, to fatten her up: I guess I should just top her up whether she seems hungry or not? That's the only way I can think of doing it? Start with the breast, top up and finish with the breast a few mins later maybe. That way I can keep my supply up 🤔

Right. Sorry for that. I'm sleep deprived and desperate and actually feeling homesick for the UK where I know the attitudes are a bit more 'wait and see'.

It's been a few hours since I weighed my daughter. Being the crazed woman I am, I lifted her while half asleep, removed everything but her (sopping wet) nappy she lay on the scale calmy and didn't flail around as she normally does. The number came up immediately and didn't jump around like it usually does when I put her on (she hates the scale normally). The only movement was as she peed herself on the scale. The number that came up and stayed on the screen was 70g higher than the number on Sunday. That makes sense, time wise. I'm not going to weigh her tomorrow but will try again in a few days. I know I sound totally neurotic (I am, about this!).
I'm going to go for a quick walk now and be less crazy!

Is your baby growing (yes), and content (yes).
It took my son ages to get back to his birth weight. No one panicked. I exclusively breastfed. You know better than the doctor how your baby is feeding. If he thinks the baby needs more you could supplement, but I do not see why he thinks it's pointless to keep breastfeeding - that's not logical at all.

(Apologies if I have missed relevant info in the meantime - kids have been freaking nuts.)

OK so centiles.

First of all we don't look at centiles for the first 2 weeks. Anything before that age is ignored, as it's about whether they are putting their birth weight back on after the expected drop. You just start from the first weight taken after 2 weeks old.

You didn't say anywhere what gestation she was born at, this is slightly relevant for birth centile, as in it can be calculated from that. However this is mainly for information as the birth centile isn't really relevant in terms of long term weight gain.

In the first few days, you had a drop by day 6 of 295g, which is less than 10% of her birthweight. About 8.5%. This is good. It's actually excellent considering your milk didn't come in until day 5/6! You then had a gain by day 9, which is great.

I noticed that your paediatrician said that she'd "only" put on 80g and was supposed to have put on 600g. That's not quite right, he should have started from the lowest weight point, not her birth weight. There is a very old, outdated, "one size fits all" but still used (particularly for some reason by paediatricians??) rule of thumb that babies are supposed to put on "about" 30g per day, but this is a very rough average, babies who start off small simply won't be putting on this amount, plus it won't literally be 30g per day in any case - it simply means that it takes babies a bit more than a month to put on 1kg. But in any case, if you had calculated it from her lowest point, then she had actually gained about 400g in less than three weeks. That's much closer to the 600g figure (wherever that came from) than 80g, and actually sounds about right for a baby on lower centiles.

You also noted quite correctly that later that same day at home on your scales the weight difference was huge. Of course different scales, different clothes, rounding errors, feeds may all have factored in but you can at least see that there is some difference expected in weighing. 1-200g could be neither here nor there, which is why it's very difficult to measure small expected gains like ~20g per day.

I've tried to plot on the charts and really it's much too small scale to get much from it, which probably means that centile charts aren't a helpful metric for weight gain over the period of a week or two. But she was sitting pretty much on the 9th by your post on the 7th, with your posts on the 11th and 13th these weights were in betweeb the 9th and 25th centile lines. The weight today puts her back to the 9th, which is generally considered OK. Babies do not grow in straight lines; it is normal for weight gain to bob over and under a line and this is classed as "following" that line. Or they may "bounce" between two lines - for example the 9th and 25th. These are normal and expected patterns of growth.

Lastly, you said that you do not want to go against medical advice without being trained, but your most up to date medical advice (from the LC) has not been to stop breastfeeding, and she has not (I assume?) asked you to weigh every 3 days, nor make decisions based on that. Your paediatrician has not requested another weigh-in yet either. So I would say that following medical advice would be to continue with the plan from the LC, in the absence of any other info from her.

In terms of weighing, if you really struggle with holding off for longer intervals, and find the fluctuation stressful, would weighed feeds be helpful for you, to reassure you that something is going in? This is how I did it:

Weigh baby before a feed you want to monitor, in the clothes and nappy they are wearing. Record weight. Be sure to have any dangling items (he had monitor etc wires on him, any dummy clips etc) on the scales, not hanging off.

Feed baby. Sometimes I'd do multiple feeds, if he was cluster feeding or feed/sleep/feeding.

Without changing any clothing, and before changing nappy, weigh again. Subtract earlier weight from this weight. The nappy part is important because it doesn't really matter if a wee is in their bladder or their nappy, if a poo is in their colon or the nappy, it needs to be counted the same as the only change you're measuring is the input ie the milk. You don't have to weigh immediately after a feed, you can let them sleep if you want to. It's just important not to change anything else weight wise so no clothing or nappy changes.

@ukborn thanks for the reassurance!

@BertieBotts I don't know what to say...what an absolutely wonderful thing for you to do for me. I can't tell you how grateful I am for you taking time out of your day to calculate the data of a stranger on the Internet. I'm beyond touched, I cannot tell you. I have no words other than thank you.

Also, I want to reiterate to every poster just how grateful I am for all of the kindness. I'm so hormonal and all over the place and you all rallied around me in the most sisterly way. I can't repay you all personally but I decided to pay the kindness forward by making a donation to Save The Children, in everyone's honour (if that makes sense!).

Thank you all so much again!

Have you seen the documentary ´babies’ on Netflix OP? In the firsts series there’s an episode where they interview a researcher who measured babies every day or every 3 days or something and she found that their growth was absolutely not linear. The babies were literally staying the same size for a couple of weeks, then growing a centimetre overnight. Weight gain is likely to be similarly non-linear.

Oh no, really, it's just mumsnet. Lovely people did similar things for me when I have been in various dire situations. It's how it should be :) Thank you for paying it forward :)

Early feeding and weight struggles and so on can absolutely fuck with your head and it's so important to recognise that and hold onto whatever helps you not spiral. For some people that will be stopping the whole thing and going onto formula, and that's fine. For others it will be clarity over weighing and guidance and understanding why advice is being given. It's OK to want to continue, it's OK to want to stop. But that said, step back when you can. Do what you need to do to stay sane. Get as much sleep as you are able, eat/feed your older DD convenience food absolutely guilt free and if you have time for a sit in the fresh air or a bath on your own or a glass of wine or whatever your personal "OK, now I can relax" trigger is, then do it, because you are working so hard and doing so well and you deserve this. Whether your DH / family / doctor sees that effort, we see it.

I can absolutely relate to what you are saying about foreign doctors. I consider myself a strong, confident woman but I was in tears more often when ds1 was a baby than at any other point in my life.

At one point, when yet another doctor accused me of starving my baby because I was obsessed with bf, I shouted 'I'd feed him McDonald's if I could get him to put on weight you idiot!'. That didn't go down well, I was classed as the hysterical mother.

When I eventually found the paed who diagnosed him and treated him, and he told me 'you did a great thing bfing your baby, you probably kept him alive' it was as if the biggest weight in the world had been lifted from me.

I really missed the UK too at the time, even though I have in fact lived less long there than abroad during my life. But in the end the doc I found was abroad and a foreigner (from a South American country). It's just down to finding the right person, and not allowing yourself to be ground down by the wrong ones. Easier said than done, I know.

@BertieBotts and @CatherinedeBourgh thanks for your empathy and being able to relate to me so well.

Baby has gained 90g since Monday. I was delighted but LC wasn't over the moon and just said let's weigh again on Monday. She reminded me to make sure I feed 8-10 times a day, which I very much do!

I read today that anemia can cause low supply and I ran out of iron a few weeks ago. I still had pregnancy anaemia when I left hospital so I'll see if taking the iron helps. If that doesn't work, I'm going to consider throwing the towel in and just picking a feeding method. The chopping and changing between breastfeeding, expressing and giving formula is very stressful. Next Tuesday she will be 6 weeks and so she will have had my milk for that time, which is something.

This sounds like a good plan. The most important thing is that you feel in control. I wouldn't want to be in limbo triple feeding forever either - fine if it's a short term thing. And yes absolutely you've done brilliantly even if you stopped right now!

That sounds pretty good to me, I'm sorry that the LC wasn't quite so positive. I can understand why you're considering a change but I would say consider just doing combi feeding but don't bother pumping. I think that's often what is absolutely draining and awful.

@BertieBotts limbo is the right word! That's exactly how I feel! @Nightwithhertrainofstars yes the pumping adds another element of difficulty to it.

This afternoon my milk just dried up. What on earth??? Any feed past 2pm, there was nothing there. My milk is drying up before my very eyes and there is nothing I can do to save it as nothing works. Even my eyes felt dry today and I drank my usual rivers of water. I have no words.