Advice on MW's strategy re baby not gaining weight

[BongoWinslow]

Hi - bit worried about baby not gaining and whether MW's strategy is good - any advice/views gratefully received. This is my first baby and I'm a total novice on the BFing (which I really want to do).

DS is 16 days old and not gaining weight. Weighed in at 4040g initially, then 3800g at 5 days, 3720g at 10 days, 3740g at 13 days then down to 3720g today.

I'd been demand feeding which meant some monster cluster feeds, culminating in an 8 hour marathon on Monday - MWs up to this point had said just feed feed feed so I was.

By day 13 doctor and MW both worried I'm so tired and that he's not gaining. MW decided he must be burning as much as he's taking in in sessions like that. She suggested on day 13 I feed 2/3 hourly for 30 mins only then express and use the expressed milk to top him up at the end of the next feed.

Did this for 3 days and no gain today. Now she says reduce to 20 mins every 3 hours and express/top up. It's so he gets milk easily plus so I rest.

He takes the bottle well and we've had loads of help on the latch, which I'm told is fine. He has a slight tongue tie but doctor and MW don't think it's an issue. I did a yield to check milk supply on day 13 - could express about 60ml but seems milk is increasing - could only express 25ml after 30 min feeds on first day, now get about 50ml and as much as 70ml after the 20 min feed.

Ok, so that's the long back story.

My questions are:

1. Does this strategy make sense? Are there better options?

1. Do I feed earlier if he's really desperate for it even though she said 3 hourly?

1. Sometimes when I put him to the breast now he fusses (didn't use to), spits the nipple out a lot and generally seems frustrated - is this because he's learning bottle is easier and doesn't want to work at getting milk from breast? He takes the bottle easily.

I'm trying not to worry but it's hard. He's very strong, awake, happy baby and he produces a couple of decent poo-y nappies each day.

Any thought would be very welcome!

I don't really understand why you should limit feeds if he's not gaining weight? If it was me I would be feeding as much as possible I think.

Was he always weighed on the same scales? Could it be a blip with the scales rather than his weight?

If you're worried about him prefering the bottle, it could be possible to cup feed the top ups instead I think.

Oh, and although you have been told the tongue tie isn't a problem, does his latch feel ok? Sometimes even mild looking ties can cause a problem.

The slight tongue tie could mean he's not getting a deep enough latch, I would ask to have it snipped.

I would babymoon - lots of skin to skin contact in bed together 24/7 feeding and sleeping as much as possible.

I am just a mum though not a health professional.

I agree, I'd just feed as much as possible, to encourage supply. It might be worth doing a 'babymoon', i.e. spending as much time as possible in bed with baby and skin-to-skin.

whoops cargirl x post (takes me ages to write a post!)

Sorry things are confusing and worrying, ongo :(

Was there no suggestion of keeping your baby close 24/7 and responding to feeding cues, then?

3 hrly feeding is usually nothing like as often as a baby of this age needs, and especially not if there is concern about weight.

Hsve you tried calling any of the bf lines for a fuller discussion?

Expressing is not a good measure of production - the baby (who is the only one who counts!) may take more, or less, than the pump.

I agree there is cause for concern about his weight.

Yes - that's the answer to question 2. You do indeed feed him if it sooner than 3 hrs.

Hope you will get more help - sorry I have to go.

Agree with others about latch. Might be worth seeing a breastfeeding counsellor, just to get things checked over and a second opinion.

Agree with the above- if your baby needs more milk then feed more frequently, not less.

Are you switching sides once he has come off one side?

Breast compression is supposed to be good for poor weight gain too (see Dr Jack Newman videos) and the article here

Maybe the latch needs looking at again as there does seem to be something not quite right with the milk transfer.

Could you get a second opinion on the tongue tie?

Good idea to have a babymoon- can you spend tomorrow in bed with DS? Strip him down to his nappy and just cuddle him up to your naked chest and feed whenever he murmurs.

Thank you for so many quick replies.

I feel that way about the latch/tongue tie too. Was very frustrating when the doctor said not to fuss about the tie. He said baby is sucking hard therefore should be fine.

Latch feels ok but I don't know what to compare it with. We've been to four breastfeeding counsellors now plus my doula is a BF counsellor and she (plus other counsellors) said latch looks good.

MW/doc said feed less because I think they're worried I'm exhausted - esp. since the 8 hour non-stop feeding session, which did leave me shattered. I think they're worried that I get so tired, I'm not producing milk plus he's worn out so better express and give him some easy milk (which he doesn't expend energy for and hence should help him gain) while I get rest and hopefully produce more milk.

Since we've been doing this, he is less fussy and more alert when he is awake but it still feels wrong to put off feeding him when he's clearly hungry.

Gah. This is so confusing and miserable!

OK, BongoW- don't feel down
Just feed him at the first sign of hunger.

Resting doesn't produce more milk (in never runs out) although rest will obv make you feel better in yourself.

Can you feed lying down then you can feed and rest.

Is your baby close you at night?

I would just ask to the TT snipped it doesn't matter how the latch looks there is clearly "an issue" it would be one more thing ruled out, it's very quick and my baby certainly went straight on the boob afterwards and instantly stopped crying, no more bleeding etc.

sorry - close to you at night? ie. are you co-sleeping and giving DS every opportunity to latch on.

I would really feed him when he is hungry, even if it's expressed milk from a cup or bottle - making a 16 day old wait for food seems wrong to me too.

Agree that having the tongue tie snipped is so minor there's no reason not to do it - my ds pretty much slept through the snip.

Get the tongue tie snipped asap.get a lactation consultant to see you and assess the tongue tie. get a lactation consultant who is qualified in tongue ties and who can snip if necessary. do it asap! a tongue tie is still a tonge tie. he could be working really hard with his sucking but beacuase the tongue isn't working properly, he is not milking the brast properl.

I find that advice really odd tbh.

I would babymoon, co-sleep for at least part of the night. Have you got the hang of feeding lying down? It is worth persevering because then you are resting while feeding.

Make sure you stay well hydrated and are eating regularly to keep your own strength up - your milk will be there regardless but you need to look after you too.

Personally I would ditch the pump and bottles, and get that TT snipped as soon as possible.

Oh you poor thing, how frustrating and confusing.
I'm not a health professional, but 16 days old it's all still very early in the grand scheme of things - altho I appreciate ideally babies gain weight without any issues. Try not to panic.

I think your MW sounds like she could be more helpful and is being a bit confusing.

IME if a latch is wrong you do quite quickly get pain altho I don't know if that's true to everyone. Can't hurt to get the TT dealt with tho.

I too would say go with your instincts - which don't sound like they could be that damaging even if it contradicts MW and see how that goes. Skin-to-skin is good. Perhaps look at your sleeping/eating/drinking patterns and make sure you're getting enough of everything to help with the tiredness? Tbh being shattered 2 weeks after birth is not massively surprising for any mother so not nec to do with the feeding... Focus on you and baby and get somebody to keep you supplied with nourishing meals and drinks.

Also wanted to mention that a friend had a slightly premature baby who was tiny, very grizzly, slow to gain weight and feeds seemed to take hours - she's utterly thriving at 6 mths.

DH agrees re feeding when bub says he's hungry. Feels horrible and wrong to pacify him in other ways when it's clear he wants food, so we're going to do that.

We don't co-sleep, but he does sleep in a bedside cot with the side down and me pressed right up next to it all night with hand next to him (he sleeps on my chest or DH's chest during the day). I'm too nervous to co-sleep just yet.

Feeding doesn't hurt, and from the videos I watch online it looks like he's sucking properly. But agree the tongue tie can't be helping.

I think babymoon is the right way forward, and getting the tie assessed by someone else. I agree re snipping it - I don't see the harm in it.

Thanks so much everyone for the advice/encouragement. I feel a bit better. TBH I felt shattered that one night, but mostly I'm just what I think is normally tired for this sort of situation but that MW and doc are over-reacting a bit by worrying about me. I'd rather worry about bub!

Right, cup of tea, bit of chocolate and ready for the next feed!

Will let you know how it goes.

Good for you! Sometimes hard to get the right balance between over-interfering and completely hands-off medical professionals, with babies, I find!

Best of British.

Whereabouts are you? I know in certain areas it's very difficult to get a tongue tie seen to. Here you need to travel to the next county to even find a consultant who is qualified to do it (WTF!) and it takes forever (with a lot of badgering) to get a referral. I've heard women told that it's a "new fangled idea" or that it doesn't affect BF

I didn't realise it was such a lottery! We got referred really quickly for ds's tongue tie even though it didn't affect feeding - the doctor had to talk us into doing it really. He said it can cause speech problems later, and it's better to snip it as a newborn than wait til they're toddlers when it's necessary to sedate/anaesthetise them.

I'm in Oxfordshire. Our doctor is normally really great, but seems pretty down on the idea of doing anything about the TT. No idea why. The MW was the one who pointed it out as a possible problem.

YOUR MW IS RIGHT! its obvious no one giving you advice on here has actually had this problem but I have and I can tell you it works. dd wasn't gaining and after one week of this she put on 280 g. Its called managed breast feeding. I am in my second week of doing it and have tweeked the plan a bit but stick to the general idea.
I feed every 2/3 hours depending on cues. I feed for 30-45 min and only stop when she stops active feeding and is just sucking. I then offer top ups and express.
I know it seems counter intuitive to limit feed time and then top up but this is how to make them more effective feeders. also show them what s full tummy and empty tummy feels like, that's why you space the feeds.
what bottle are you using and what position? I use the medela calma.which is like b feeding and only releases milk when they suck like on the breast.

Hi, hope things pick up for you. There does seem to be mixed opinions between Drs as to whether ties are worth doing but my ds, now 2, had his done at 5 weeks & there was a definate improvement to his feeding. We were referred to the childrens hospital in Oxford so you might find you are in just the right place. I can't remember the name of the consultant though, will try to look it up in the morning. Hope you had a good night.