to persist with exclusively bf low weight gain preemie?

[fightingnun]

DP is very keen to canvass the wisdom of Mumsnet and asked me to post this dilemma (nc).

We are very lucky to have a beautiful baby who arrived by unexpected emergency C-section at 31 weeks. The baby has had no significant medical problems - breathing independently from day 1 - but stayed in SCBU for a while due to prematurity.

We were discharged home exclusively breastfeeding after trial rooming in when reasonable weight gain meant the feeding tube was removed.

In the first week home we were visited for weighing and I was told there was a very small gain but 'not enough'. At the SCBU follow up clinic a doctor observed & commented on how well baby is doing, alert, good latching on, tone etc. Then a few days later I had a phonecall from the nurse saying she had miscalculated and there had in fact been a small weight loss not a gain.

At a second visit for re-weighing yesterday there had been a definite gain calculated at 12.5g per day but apparently they want to see 20g per day so I am under a lot of pressure to start supplementing with formula.

The nurse said she would 'allow me' to wait for HV visit on Thursday and not insist on going back to the clinic today which she wanted me to do. I don't know what might happens if the baby fails to put on the desired weight by Thursday (DP is worried about this). Meanwhile I am doing all I can to encourage more and longer feeds and increase my milk production.

Am I being too stubborn or am I right to resist supplementing at this stage?

I'd be very grateful for pointers to any evidence or research as well as anyone's experience or opinion.

I don't want to be dogmatic when my baby's health is at stake but equally I don't want to be pushed into something which isn't really necessary.

The baby weighs approx 2kg and I would be 36 weeks if still pregnant.

Health visitors can be very obsessed with numbers. Once I had breast-feeding established, I got asked at one of the numerous weigh-ins "how much are they taking at each feed?" I said, "I don't know" because erm, I didn't. Then I was asked, in the most patronising fashion ever, "well how much are you putting in the bottle?" I could have realised faster what she meant, true, but how much sleep do you think I was getting with twins!

I understand that they have loads of clients, but I had to take my babies for weighing every week and then every fortnight, and I had twins. I wasn't that forgettable and if I was, she could have asked, instead of assuming I was bottle-feeding, and getting a bit aggressive with me. At the same centre, my friend got told her breastfed baby was putting on too much weight, and that she should express the milk first, so she could limit feeds.

I had the same problem with an exclusively formula fed child.

It's bollocks. Keep doing what you're doing.

Friends had a very prem boy. He had to be weighed by the same person on the same scales as the margin for error was so small.

Also slightly worried by a nurse who gets confused between whether a baby has put on or lost weight. It's not that challenging!

DD was prem (33 wks) but that was 14 yrs ago so advice may have changed. I do remember getting so much conflicting advice though, even when she was still in SCBU. The doctors would say one thing, the nurses would say something else, and after leaving hospital, I was given 3 different opinions on when to start solids. At one point I did need to supplement with formula as I came down with a bad cold while she was still in SCBU and my milk supply dropped significantly. They used an open cup to give it though, rather than a bottle. With a cup the baby does a lapping action which is similar to breastfeeding. After that, milk went back up and DD was exclusively bf for about 13 months.

I'm no expert but I would say it's important for you to rest as much as possible, have as much skin to skin as possible, and for you to keep your fluids up too. Lots of other advice here on technique etc, but essentially I'd just go to bed and disconnect the doorbell for the next two weeks and focus on snuggles (which is the secret to supply imvho).

Congratulations on your baby!

I was prem 50yrs ago & one consultant I saw whilst pregnat told me I was lucky to be alive

I was one of the ones who just needed feeding & keeping warm.

I'd like to think that medical personal were capable of that even more than 50yrs ago!

My eldest was term but slightly jaundiced. I must have been more firm than I realised as there was "No formula" all over my notes . However, it took quite a lot of time (36 hours for her to even have a feed from the breast, and they wouldn't let us go beyond 48, even with cup feeds) for us to get the breast-feeding going. I wasn't going to jeopardise her health, but I really did want to bf. Anyway, I am slightly uncomfortable at the pressure you seem to be under from the people who are meant to support you. It might be wise to canvass wider professional opinion, e.g. I hope the HV visitor you see on Thursday is helpful and not dogmatic. The fact the Baby is gaining weight is great and I hope it has gained more by Thursday.

I would seek advice from L.A. Leche League perhaps?

I was expressing for my 36 week small girl as she couldn't breastfeed. She lost 10% of her body weight in the first few days. The Health Visitor advised I supplement with formula which I now regret. But at the same time you should do whatever you think best for your baby. Good luck!

By the way, my dinky girl has stayed dinky. In age 3 clothes at age 5.

Congratulations OP! I say trust your instincts. Don't top up on their say so if baby seems ok but equally don't worry about it if you do need to top up.

could you express bm and top up with that if you're worried?

I have a 34 weeker with a shockingly poor suck reflex and small appetite and he gained weight equally slowly on breast, ebm or formula! He's now 7 months and still small but doing well. So adding formula may well not make any difference.

1. Please don't feel that you are doing anything wrong.

1. I second the recommendation to research Dr Jack Newman before making a decision.

1. It's always good to get a second opinion (if possible).

1. Meet with a lactation consultant.

1. In theory, you could test their suggestion re increasing weight gain by giving one full formula feed a day. However, if you wish to maintain your milk supply you would have to be very strict about a)eating healthy full meals yourself and b)expressing milk with a decent pump after each feed. Most ladies find that taking fenugreek supplements will assist in increasing their supply and I would recommend this.

Note that the above could still reduce your milk supply though.

1. If you do end up formula feeding please don't feel like a failure. Everyone needs to do what's right for them and their babies.

Good luck OP, you've had a stressfull time. Make the best decision for you with as much information as you can.

Congratulations for the birth and that you are home now.

I don't have any premie experience but I have bf experience, I found my supply was better and milk looked thicker when I was eating tons of calories, make sure you are eating lots and regularly and drinking constantly, I found it was good to have high calorie, easy to eat with 1 hand snacks in the fridge. I know it feels odd as we try to be sensibily with food all our livesbut I really think for a short time at the start of bf it helps.

If you do supplement try to find to to pump those missed feeds.

Good luck! If my baby was alert, developing and had regular wet nappies I'd continue with bf with the idea that if anything changed, if the baby was less alert or started loosing weight I'd add in formula feeds.

Is there a reason they want you to introduce formula? Are they suggesting a special high calorie formula? Normal formula isn't more fattening than breastmilk, and lacks all the other advantages of breastmilk, so as you have milk available I'd question why they want to switch.

YY re confusion of weights and different sets of scales being used by different people. I am quite sure I don't have a really accurate picture which makes it even more difficult to know if I should be worried. Given the miscalculation I do find it difficult to completely trust the advice of this particular team of nurses. When I read the 100g per week I actually wondered whether she had divided 100 by 5 to get 20g...

Having said that there is no doubt the baby is little and not getting bigger all that fast.

I am going to try as many of the suggestions as possible over the next couple of days and also follow up the informatio n. I think my best strategy is to be as well informed as possible.

HV will use yet another set of scales but I will take it one day at a time and see what happens then. She may be a useful ally or a source of further confusion but by then I will have a plan :)

Meant to add before kids distracted me, at this time partner support is essential! You need to be resting all day long, spending lots of time in bed with your baby. Partner needs to be waiting on you hand and foot!

Rest, good food and skin to skin contact all aids milk supply.

Fortunately DP is reading the thread Pixie

I had 26 weeker who was exclusively breastfed. But I'll be honest, at 36 weeks he wasn't yet sucking efficiently enough to get all the milk he needed, even though his latch was good and he appeared to be taking 'full' feeds. They just weren't as full as you might imagine!
So we topped up with expressed breastmilk via ng tube until term. I made my own 'gold top' by letting the milk settle and just giving him the high-fat part.

It may be that your baby needs supplementing, but if you are prepared to express, it needn't be with formula. Ditto the ng tube - you could use a cup, or supplementary nutrition system. If you do express, make sure you use a good hospital-grade pump, either borrowed from hospital or hired online or from local NCT.

Your baby is gaining weight, so you aren't talking about an immediately urgent situation - don't be pressured into deciding instantly what to do - but on the other hand, don't just assume that because s/he seems to be sucking well that s/he is getting all he needs. S/he may not be quite strong enough yet.

Incidentally re-reading my post, that looks like a typo but isn't! - DS was born at 26 weeks, started bf (as opposed to ng breastmilk) at 33 weeks, ditched ng tube top-ups at term. At 3, he's still v. small (right at bottom of centile chart) but has followed his curve from term onwards.

Love the idea of breastmilk 'gold top' genius!

This all sounds so familiar - DS was a bit prem at 36wks, and the community midwife and HVs had us panicked about his weight, it was ridiculous. The amount they wanted us to get into him was vastly beyond his capacity. They were basing everything on their 'official guidelines' and not looking at my DS as an individual.
His feeding issues were compounded by jaundice, terrible latch, and tongue tie, so we did supplement EBM with standard Aptamil for the first month, until the other issues were sorted and he could finally BF.

We used to weigh DS daily on our digital kitchen scales, in a colander. :)

I'm pg again now and if this one comes early I'm afraid I'll largely ignore the HVs, I found them officious and blinded by stats.

My sis swears blind that the milk she expressed in the evenings was much richer with hindmilk than her morning/daytime expressings (she had to freeze a lot and could see a big colour difference, night milk was yellow with fat, daytime was thin white like skimmed milk).
If you express and can see a difference, you then know what time to try to get every last ounce out!
(Have been told by others that this must be bollocks, but I saw the freezer bags myself, so it was true for sis's milk).

Good luck!

Best way to increase milk supply is to fed, formula works against this - if needing to top up with formula then you can buy a breastfeeding supplement thingy that the milk comes down a tube to the nipple as the suck they get top up and breast milk at same time - resulting in stimulating milk production and also baby continues to associate breast with milk.
however, from what you say baby is having wet and dirty nappies and seams content so may not need topping up anyway.

I think the weight gain graphs have been designed on formula fed baby expected gain and that breast fed babies dont follow same arc

good luck and well done for getting feeding established so well

12.5g is about half an ounce isn't it? Or about 1lb a month.That sounds ok to me

Had a 6lb 7oz baby who took 4 weeks to return to birth weight. At lowest was on 2nd percentile now at 7mths on is on 75th. Exclusively bf.

I had no pressure re supplementing. Has to actively seek support. Hv was largely indifferent maybe because she was my second.

Do what you feel is right but be guided by professionals you trust.

The weight charts are all based on breastfed babies troublegirl