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!

sorry, meant to add, my post only refers to bad eating habits and weight gain. my dd doesn't have tt so can't advise on that but the plan does work for ineffective feeders.

When I started expressing, my HV suggested that I feed from one side and express from the other, then do the same on the opposite side at the next feed.

I was able to build up a supply of expressed milk while still demand feeding.

I don't understand how expressing, and all the faff that entails is supposed to help with your exhaustion? [hconfused]

I have no idea re the managed bf thing and don't feel qualified to dismiss it but it does sound counter intuitive to me. Not to mention the risk of nipple confusion, seemingly for the sake of not snipping the tt... Did your mw use the term "managed bf" bongo? I would seek a second opinion.

Hmm, are you sure that the scales he was initially weighed on were accurate and/or that the weight was accurately recorded. A friend of mine was told to top up with a bottle as her DD had lost so much weight. Friend was unconvinced as the clothes her DD was wearing were big on her compared with what they were on her friends supposedly heavier baby, IYSWIM.

If your baby is happy and alert at times that's a good indicator that the feeding is going well. Have a Babymoon over the weekend. Rest, eat and drink and see how he gets on next week.

WRT the tt, can I just reassure that it is possible for him to feed really well with it. DNephew had (and still has) a tt and fed until he was about 11 moonths. I dont think you would be producing as much milk as you are if he was not attached well, as your supply meets the demand.

Chillichill, when DD1 lost weight over the first two weeks as was advised to 'bunk up' and feed as much as possible. This worked for me. I dont know if the managed breastfeeding would have also worked as I havent experienced it. However, no teat can precisely match a mothers breast, and sustained bottle feeding almost always interferes with sustained breastfeeding. How long did you need to top up with a bottle for?

It's partly to manage my exhaustion (but yes it's an utter faff and therefore not that helpful) but mostly to help him get easy calories - he doesn't have to expend as much energy to get the bottle milk so he should put on more weight.

I think I'm going to tweak it and go with the cues a bit more but stick with the general plan seeing as it worked for you, ChilliChill.

Chilli - have just reread and see you're only in second week. How long did your MW suggest this would need to be done for?

MW did not say how long it would take. Im in the second week and she is taking less at top ups than in first week. first week taking 50-70ml at top ups, now only 30. MW said could take a number of weeks but its worth it, baby is more awake and alert and gaining.
I don't express at the night feeds unless dd did not feed well cause I need my sleep too.
when you bottle, were you shown how to do it with baby lying on pillow on its side and bottle going in straight and flat? hard to describe without showing but the idea is that with bottle lying flat, milk only comes out when sucked so baby doesn't get lazy on the breast. you don't have to do that with the bottle I recommend and I highly recommend it. you can only get it at mother care. I think its actually made dd suck stronger.

I think it's a bit to be using words like 'lazy' and 'bad eating habits' when referring to a two week old baby.

Let's not forget their stomach's are only the size of a walnut after all.

OK, 'breastfeeding management' may work for some people, and clearly it's working for chillichill's baby, but IMO breastfeeding is not a science and solutions should be tailored to everybody's situation.

You'll always get lots of differing advice on a talk board as everybody has had various experiences, so try not to get bogged down in it all eh Bongo?

Perhaps speaking to bf help line might give you some impartial, expert advice.

ballstoit - yes it is possible for a baby to feed efficiently with a TT and it never cause a problem however this baby clearly isn't feeding efficiently/gaining weight and despite having a good latch it could be preventing the baby stimulating a decent supply of hind milk in an efficient manner.

If there is any problem that could be related to feeding and there is TT (even if only partial) then for such a simple quick procedure it's worth doing to eliminate it.

:( at 'bad eating habits' and :( at 'lazy'....for a tiny baby.

I have not heard the term 'managed breastfeeding'.

However, sometimes, if a baby is really not gaining weight and ineffective feeding is the root cause (nothing to do with badness or laziness )it may be useful to top him up with whatever means is most effective. This is to prevent a downward spiral whereby the baby conserves energy by sleeping a lot and thus feeds even less well. The topping up (preferably with ebm, natch, if it's possible to express) makes sure the baby gets enough energy to start to feed better on the breast.

The terms the MW has used with the OP ("decided he must be burning as much as he's taking in in sessions like that") sounds as if this is what she has been thinking has happened.

I have not heard that ignoring feeding cues is any part of this - and chillichilli, you are not ignoring cues, from what you say. Seems to me what you have been told does make sense - you are watching your baby's reactions carefully, and when the baby stops feeding well at the breast, and before falling asleep, you get in there quick with a top up. This makes sense,as I say, and I would expect a weight gain in a baby like this - just as you've seen.

This sort of 'management' can be done alongside keeping the baby close and feeding unrestrictedly - it's not an either or thing. It does involve a bit of close observation, to make sure you pick the right moment to offer the ebm.

I don't know about the time limits or ignoring cues- sounds odd to me- but I do know that topping up with expressed breastmilk was the thing that turned both my dcs around

and yes, it was about ineffective feeding- low body tone so not really strong enought o suckle effectively

Thanks all. I think TikTok has it right - that's what the MW meant. She didn't mention feeding cues, but did stress the 2/3 hourly feeding (initially it was 30 mins 2-3 hourly then when he didn't gain, she changed it to 20 mins 3 hourly). So now if he is hungry and it's close to 2 hours, I'm going to feed rather than clock watch.

He does sleep a lot, but has been much more active and alert since the top ups - for the first time he has long periods of being awake interacting with us - this seems a positive to me so he does seem to have more energy.

Chillichill I'm going to take some of your tips on board - have been watching for the bit when he stops actively feeding and then giving top up rather than clock watching. Also got a Calma bottle - much better! He takes longer to get the milk and it looks more like normal BF sucking.

Have also spent lots of time with him on my chest skin to skin today which he seemed to love.

We're supposed to weigh-in again tomorrow (ie after 2 days!) but thinking of refusing that as I don't see how helpful it will be - just more faff and time away from relaxing with him and feeding him easily at home.

One positive of the feeding plan so far seems to be that I can express more and more milk each time even with same amount of good feeding beforehand - does this mean my milk supply might be increasing??

Lots of positives Bongo - well done.

yes, your milk supply is increasing, that's partly why I'm on the plan, to increase mine. what pump do you use? I'm still only getting 30ml after a feed, sometimes not even that.
glad your seeing more alert behavior, means its working. your right not to clock watch, watch baby instead.
the plan is a pain with all the faff of top ups and expressing but so worth it. like my midwife said, were the mums that are doing an impressive job. someone who runs a marathon in 2 hours may be a great athlete but those of us that take twice as long are more impressive cause we worked harder for it. well done us!

I use a Medela manual pump. I was hand expressing a bit after pumping but MW told me not to.

thanks for all your replies, Chillichill - has made me feel so much better.

My ds had a mild looking tongue tie but I insisted on a snip at about two weeks in. There had been no weight gain prior to this, and 15% (I think?) loss since birth. Birthweight reached following week..

no prob bongo, very glad to help and nice to know im not alone.
I medela swing but might try manual and see if I get more.
let me know how you get on when you get weighed but sure you will see result. your doing a great job :-)

Glad you can sense a difference already, enjoy your baby moon x

Update - had another weigh in on Sunday and he'd put on 190g! So pleased (and relieved)!

Thanks for all your support - it really helped me keep going.

ChilliChill - I read somewhere that a combination of pumping followed by hand expressing helps you get lots of milk. I did that originally but it's pretty tiring - but I got about the same amount again from the hand expressing once the pumping was done. Hope it keeps going well for you.

Great news Bongo- thanks for the update!

so glad he's gaining, and a really good amount too.
tried my manual pump and still only getting 30ml or even less after a longer feed. ill try the hand expressing, thanks for the tip.