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.

I could not bf my 29 week preemie. I think part of the problem is professionals not underdtanding preemies and their requirements well enough to make judgements. Seriously, is bf that much of an issue under the circumstances? You're doing well enough already: do what's necessary to safeguard your littlun's health and don't let yourself be pushed around. It's your baby. If you can manage bf, fine, but don't beat yourself up. In the grand scheme of things, is a bit of formula really that bad?

Op, whereabouts are you? There's an amazing lactation consultant who helped me ( SE London). Not with a preemie, but still with pressure to supplement because of jaundice.

If you're not in my area, I'd suggest calling la leche league for advice. There might be a lactation consultant who could join you for the mtg with the HV, to make sure you get the best advice possible and make sure you don't get steamrollered? HVs are not known for their bf expertise!

I agree with the PP though - don't put yourself under undue pressure. A bit of formula is fine!

The key is to find out how important that 20g a day really is.

Is it an arbitrary threshold the nurse has been given before she has to refer back or is there some genuine medical sense behind it?

Could you call the SCBU paediatrician, explain how you feel and that your baby is alert, happy, wee and pooing fine and see if those good signs outweigh the numbers in their opinion?

If an experienced paed tells you that you can stop worrying you may feel more relaxed which will help the whole process

I was bullied into giving formula when slightly prem DD was a day old and regret being pushed into it. If you can express, do that. We used a cup to give EBM top-ups until the BF coordinator at the hospital agreed to try a bottle, and DD was much happier with that. She was back to birth weight after about 2 weeks and they backed off on the top-ups about a week later. She's EBF at 16 weeks and growing well.

Then Op I think you know you can keep feeding him!
Books, charts & numbers are all fine as guidelines.
But only up to a point, you are happy to feed your baby
(except from them nagging you)
Your baby is happy, your baby is healthy and everything is fine.
The health visitor and anyone else are just wanting to go by the books.
On Thursday no matter what baby's weight is, you go in and you say "baby is happy and healthy has lots of wet nappies and will grow at his own pace, will call you if I have any concerns though"

Congratulations OP, if your baby is not well or seems unhappy or has less wet nappies then you ask for advice as you see fit.

Calling the SCBU he was in is a good idea, I'm pretty sure they will say the benefits of being breastfed outweigh the need to put on an exact number on the scales

We tried cupfeeding with DS1 and found it pretty demoralising - a lot of the milk seemed to spill and we weren't convinced he got anything at all. The breast feeding adviser at the hospital suggested using a large syringe to give milk that I had expressed after he'd fed from the breast and we found that much more effective.

DS1 was different in that he was quite lethargic when he was born (36 weeks but was very small). The community midwives were concerned that he wasn't gaining weight and someone suggested that I try to feed him every two hours instead of every three during the day. That seemed to make quite a difference too.

To be fair cup feeding wasn't great with dd. Despite having no real control over her arms she seemed tone able to whack the cup in such a way that it tipped over her. She looked like she was doing shots. Not the calm lapping drinking the NCT bf adviser said would happen.

I was also told by a HV that many babies lose the lapping instinct at about 36 weeks, so that not all will lap at a cup.

I ebf a prem baby and loathed this idea of "bfing by numbers" as someone said upthread. Fortunately I had managed to express loads of milk when he was still taking very little so had a freezer store to top up with, but the obsession with tiny volumes and minuscule weight gain seemed absurd to me.

20g a day is madness. How can anyone accurately measure that? Let's assume for a second that you're using the same set of scales which are perfectly calibrated (I bet they're not); how much do you think an average feed weighs? Or a poo or wee? I completely agree that you should not put your baby at risk by slavishly insisting on bfing at all costs - however, I wouldn't personally give formula top ups over something as ridiculous as insisting a gain of 20g a day, I'd need a more convincing reason, or at least one that was actually measurable!

Sorry this entire thread is a really bad idea.

I mean, come on OP, who's advice are you going to take? The advice of trained, qualified health professionals who know your sons medical history and are accountable if anything goes wrong?

Or a load of randoms off the internet who have no in depth knowledge of the case, no verifiable qualifications and potentially all kinds of nutty axes to grind?

Follow the advice you're given. Or possibly even your own intuition if you must. But I find the idea of making important decisions on a tiny babies health based on advice given on the net really worrying.

Drinking fennel tea several times a day will increase your milk supply if that is what is needed.

Avoid any foods with sage in - it decreases milk supply.

My DD was a 32 week preemie.
I wanted to ebf but due to bad weigh gain and too much sleep (ie. not waking for feeds) I had to top up with formula.
If your baby is waking up and has nice full nappies then I wouldn't worry too much.
But know that this is your decision, don't let anyone push you into anything you are not sure about.
I had to stop bf at 4 months because DD decided bottle was the way to go and refused breast but we managed combination feeding until then. Just to let you know, she is 3 now, taller than her peers and so full of energy you couldn't believe it!
Congratulations, enjoy your baby.

Speak to your neonatal nurse again. She's more idea about your baby and the supplementation she may be thinking of is possibly a thickener for your expressed breast milk. When my triplets were in SCBU, there were a few mums who were using Similac in their BM to help with weight gain. I agree that the sucking reflex still isn't brilliant at 36 weeks and the baby will get more efficient.

Agree with seasick im afraid

You could try feeding more often and feeding on both sides each time if you're not already doing that. Otherwise if you still need to top up there is no reason not to use expressed milk as others have said.

kellymom.com/health/growth/growthcharts/

according to this i take it that charts are based on formula fed babies

kellymom.com/health/growth/growthcharts/

OP, I really sympathise. I tried to EBF but simply wasn't producing enough milk. I needed to supplement, and there was no so-called "nipple confusion" at all. DD liked breast from me and bottle from DH, and eventually gained weight.

However, I must say there was a sense of bullying by HVs. They were constantly on my case about weight gain, and wanting to me to drop the BF altogether, and just shove as much formula in my baby as possible. She said that I wouldn't have been "allowed" to leave the maternity ward with my baby if it had been up to her. And then hinted darkly that "measures may have to be taken" if weight wasn't gained to her satisfaction.

This got me in such a state I went to a pediatrician for a consult. He looked at my DD, played with her for a minute and pronounced "she's absolutely fine". I said, "aren't you going to weigh her?". "I never weigh babies", he said. My jaw dropped. "there's no need. Look, a baby is either fine, or not fine. Weighing a baby makes as much sense as going into a bookstore and asking for a book that weighs 300 grams."

This is all to say that there is a lot of hysteria about weight in babies from HVs etc. It feels very much, as one poster pointed out, target driven. Please don't feel you have to do what you're told, especially by people who can't measure. Get a second opinion from a doctor, or someone you trust. And don't feel bad about topping up if you have to. Your baby will still have the benefit (physical and emotional) of BF, and your DP will have the joy of feeding his baby too.

Whatever you do, congratulations on your baby! Best of luck to you.

Kellymom seems to be talking about the US. The UK uses WHO charts based on breastfed babies and has done so for some time.

I managed to mixed feed (both breasts then formula at every feed - they were very hungry) both my babies for 5 months before they started to prefer just formula. So you can get the weight gain and enjoy the snuggly breastfeeding.
I think you should do what the medical profession suggest as they are accountable for your baby as someone up thread said. Wanting to exclusively breastfeed come hell or high water is as misguided as feeling cheated if you end up with C-section rather than a more 'natural delivery'.

What counts above all in both situations is the baby's health and all other preferences are secondary.

Seasick, the problem is that most neonatal staff don't know the first thing about breastfeeding, and that goes most especially for consultants. So few prem babies are ebf that the guidelines and protocols and experience of hcps in neonatal units are all based on formula. I had neonatal nurses saying to me 'so, do you think he had a full feed?' (I apparently have transparent breasts ). And if I said 'dunno, I think so', they then wouldn't give him another feed for four hours!!! At the time he weighed 1.6kg, even an 8lb newborn needs to bf more than that!! This, bear in mind, was at one of the top neonatal units in the country. They utterly poo-poohed the idea of hindmilk topups. If I'd left it to them, there is 100% certainty he'd have gone onto formula, and id have failed at breastfeeding. As it was, advice from kellymom and some prem baby forums meant that he put on a pound in the week we got home!!

I trusted the neonatologists 120% when it came to keeping my 26 seeker alive in the weeks after birth. That is their expertise and the miraculous science involved I could only guess at. But when that 26 weeker got to 36 weeks and it was a question of getting him feeding the way I thought best, their expertise was insufficient, and the internet proved to be the best source of specialist advice. Im not suggesting that op should ignore them saying her baby is getting dangerously underwwight, but that is not the case. Breastfeeding is simply not a subject they know much about, and in cases of doubt their first line of defence is always formula. It neednt be that way.

cingo I like your doctor's style.
OP you don't need anybody's permission to continue to EBF. HVs and nurses have no authority to "allow you" to do anything. Weigh up their opinion in the light of their training (and ability to do simple maths) and then make your decision.
If the paediatrician is happy and you are happy that baby is thriving then don't be bullied.

DS2 was born five weeks early but only 3lbs 5ozs due to IUGR. He was in hospital for 3 weeks and after a LOT of effort was discharged EBF.

He also put on weight pretty slowly; sometimes only 3ozs a week although he was so tiny that that proportionally wasn't too bad.

I put enormous emphasis on bf, I think because I felt such guilt over having stunted his growth (I realise now how mad that sounds). I wept at weigh-ins, flinched every time he was sick - often, he had silent reflux - and was generally a wibbly mess for the first year of his life.

Anyway, we went from a collection of sticks covered in skin to robust toddler in a year, and he was EBF for six months. I think it might have been the transition to solids when he really started packing the weight on.

He was 3 on Saturday, had his 3 year check last week, and although he's still only 9th centile for height he's, er, 75th for weight . He's not fat, just extremely sturdy.

It worked for me, but I'd still say that although getting out of SCBU EBF is amazing and I could understand your being especially keen on it - your LO will be fine regardless, and if a bottle of formula or two might ease your mind there's no reason at all to beat yourself up about it.

I think in some ways getting home from hospital is as traumatic as being there - it's terrifying and you've lots of time to worry about the long term. Try to go easy on yourself and not turn into an obsessed loon like I did...

Sorry for the essay. On a purely practical point, the blog Analytical Armadillo is brilliant and the author was so kind and helpful if you want some really expert advice.