Feeding Worries

[Moosetache]

Hi All,

First time posting here as a new dad and looking for some advice.

Our little boy was born by planned cesarean at 39 weeks (my wife has a chronic pain condition and this was felt to be the safest option for her). He was born weighing 3.2 kg but dropped to 2.7 kg after birth - we have since been told this is normal, especially with section babies as he wasn't "wrung out" by birth. We were put on a feeding plan two days pp and told to quit breastfeeding and switch to formula as baby wasn't thriving - my wife's milk hadn't come in properly at that point and it was a very disheartening time. The milk came in soon after that appointment and he started to steadily gain weight.

After care and breastfeeding support in hospital was non existent and my wife struggled for the first three days or so as we were told there was no help for her latch etc until 4days pp when a community midwife visited and spent time with my wife working on her latch, positions etc and she also tore up the feeding plan in front of us, and told us not to worry - that some midwives are very driven by charts and numbers and that, holistically, baby was doing well. It took until about 4 weeks for him to get back to birth weight.

We're at 5 weeks now and we had our 6-8 week check up from a HV yesterday (she isn't able to come at 6-8 weeks as she's on leave) and he is weighing just over 3.4 kg. My wife sleeps 4 hours per night and feeds on demand when awake. She pumps up to 5oz milk daily which I feed him with a bottle when she sleeps. She's been working on her latch and has started switch feeding (not sure if that's the right term) and is joining a bf support group next week.

The reason I'm posting is that the HV wasn't at all happy with his weight - she didn't measure his head or length as she said it was pointless before 6 weeks (even though we now wont see her until after Christmas). She feels baby isn't thriving at all. For context, he does around 4 big healthy poos in a 24 hour period and lots (hard to be accurate on number) of clear wees. His newborn babygrows are getting tight and he's alert, responsive, makes eye contact, starting to smile and holds his head up fully. He's strong all around with a good colour and his hair/nails are growing.

HV really got a bee in her bonnet about his weight and told us to switch to topping up with formula, which we're hesitant about as we've read it can affect supply. She rang us yesterday evening after work to reiterate that he needs topping up, and at one point suggested switching to formula entirely to bulk him up, saying to forget everything else and get him nice and chubby. She's sent us weekly appointments at the local children's centre for weigh ins and has said that if we continue to bf and he doesn't bulk up significantly in the next week we'll have to see a paediatrician.

It's really upsetting - my wife is working so hard on breastfeeding and we can see it working but our confidence in what we're doing has absolutely died. Are we wrong to continue breastfeeding? He was slow to get back to birth weight but he's passed that now and is gaining weight. Up until the visit we were confident in what we were doing but now we feel like bad parents. Has anyone else experienced similar?

Lots of people mix feed without supply problems, and lots of others top up with formula for a bit and then taper off the formula, so I wouldn't assume topping up for a bit will automatically lead to supply problems. It can, but it's not by any means definite. You might get more replies from people with experience doing this if you post a shorter message under 'Infant Feeding'.

In terms of weight, I'm afraid I can see why the HV is worried. Yes, C-section babies tend to lose slightly more weight, but typically a percent or two more. It's still a relatively small percentage of C-section babies who lose more than 10% of their birthweight (the typical UK threshold for concern), and your lad lost over 15%. In terms of gain since birth, he was born between the 25th and 50the centile (allowing for the week early), and is now between the 2nd and 9th (again, correcting a week) – he's crossed two centile lines, which again is the usual threshold for concern. His weight gain also remains a bit slow – you say he regained birthweight a week ago, which means he's gained about 200g this week. That's good, but typical gain in that week is 300g, so 50% more. That means he's still dropping centiles. www.rcpch.ac.uk/sites/default/files/Boys_neonatal_and_infant_close_monitoring_growth_chart.pdf is a good chart to see in detail.

Now, this may just be him – someone has to be on the 2nd centile, that's how centiles work. This is more likely if you and your wife are quite small, and so are your families, but can happen even if you're more average. But I think it makes sense to monitor closely and make sure that's all it is –it seems a sensible precaution. If I were in your wife's position, I'd definitely go to the BF group and take the extra weigh-ins (and the paediatrician appointment if it comes to that –it didn't with my DD, as she started following her new centile), and give serious consideration to topping up after each feed. Does your wife have a haakaa-type pump? That might allow more top-ups with breastmilk rather than formula.

Is your wife sleeping for 4 hour stretches at night?

@skkyelark's advice is really good but I'd also advise feeding LO, or at least offering, every 3 hours at night and every 2 hours in the day if she wants to ebf.

I'd also recommend having the baby whilst she calls a BFing Helpline this evening.

What was his length at birth?

In my experience health visitors don't know alot about breastfeeding, breast fed babies are very rarely fat and chubby like formula fed babies. Being fat and chubby is not a development measure, you should be looking for weight gain and dirty and wet nappies.

If you get referred to paediatrics this is actually really positive because then you will seeing doctors with greater knowledge and expertise than any health visitor. I would welcome this personally.

We had a similar issue at birth, our DD dropped a couple of centiles too. I was exclusively breastfeeding and it was extremely worrying to say the least. If you do start topping up with formula it will effect supply but it will also potentially effect breastfeeding as a whole because it is much easier to feed from a bottle than the boob and you may find that baby doesn't want to breastfeed. We decided not to top up and hold out for a bit and our DD started tracking her centile so all was fine.

Go to the breastfeeding support groups, offer more feeds. A private lactation consultant may also help, in my case I found the one I saw gave so much confidence - she checked weight gain, latch, positioning - she was actually a complete god send.

How are you all getting on now @Moosetache?

Hi all, thanks so much for taking the time to reply - we've had a weekend of being really worried but had a positive visit from a different HV today, who is a breastfeeding champion. She spent time with my wife, checking the latch and watching her feed, discussed techniques for a while and discussed expressing. My wife uses a Medela pump and we bought new flanges over the weekend which have contributed to much more comfortable pumping which has helped alot - we have a haakaa as well but she doesn't get on with it at all. Baby has put on 100g over the weekend (although he was only weighed a few days ago we realise this may not be a totally accurate picture) and his height/head circumference are proportional.

@skkyelark thanks for your reply, particularly mentioning baby's size in relation to ours. My wife is quite small, as is her family and I'm very short for a guy, not much over 5', but none of the men in my family are much taller. First HV was adamant that this wouldn't have an impact on baby size but the second was much more pragmatic about it and said that he may well consistently follow the second centile due to our size, which makes sense to me.

@PanicBuyingSprouts my wife sleeps generally in 2, sometimes 3 hour stretches at night, with some small naps in the day (we know it'll get better) so he is fed regularly. In the past few days he's started sleeping in three hour stretches himself and my wife feeds him when he wakes up and I top him up with expressed milk while she gets a bit more rest - he doesn't always take it but it's there.

@Mattieandmummy it sounds like you've had a similar-ish experience! The new HV advised we didn't go onto formula at all for the reasons you've said - she had no major concerns, just a couple of tweaks to make. The private lactation consultant is something we're looking into as well. She did also mention that bf babies tend not to be as chunky so wasn't particularly worried about his weight, as long as he continues on this new centile, the worry, as skkyelark pointed out was the drop over a couple of centiles but this may well even out.

Overall, after an hour with the new HV, we feel much better. We discussed his health overall and there are no concerns about that, he's meeting his 6 week milestones and we've got a couple of tweaks to make with the switch feeding and position and are looking for a local lactation consultant and will be joining the BF support group although probably the online sessions for now until we've had our booster jabs in a few days.

Thanks for the support and advice everyone, there's alot to think and worry about with your first one!

Good, I'm glad everything is looking more positive. Switch feeding is a great way to build supply quickly - your wife might find she ends up with one hell of a supply!

Breastfeeding can be hard first time round but once everyone has the hang of it, it's easy.