Dehydrated 6 day old DD with 17% weight loss, please advise me, a clueless first timer

[ZeroMinusZero]

Ladies, I've been having quite a few problems with 6 day old DD (born by section if that makes any difference). She seemed to be doing OK in hospital and was a fat, happy baby at 8lbs 11oz so I came home on Wednesday.

Since then she's been a bit of a nightmare crying all the time. She's definitely dehydrated - sunken fontanella (spelling?), she did have a dry chapped mouth and was producing a lot of orange crystals in her nappies and hasn't had many dirty ones, and none of the famous dirty mustardy coloured ones yet.

Yesterday the mw doing the heel prick weighed her and she had 17% weight loss. MW realised that DD has a very poor latch and spent quite a lot of time showing me tips, but I still can't do anything to get her to open her mouth wide enough :(

On MW's advice we went out to get a hand pump and since yesterday have expressed a bit and DD has absolutely loved getting that. I don't get very much when I express yet though, so last night we resorted to giving DD about 3 or 4 ounces of formula.

Currently I'm hand pumping about 1oz in about 20-30 minutes. I'm pretty sure this isn't enough so we're thinking about getting an electric one today. Although I'm not 100% that my milk has fully come through yet as my boobs aren't very hard, although I think it is getting there as milk expressed this morning was yellow, whereas the day before it was much clearer.

So does anyone have any thoughts on all this? Things I am thinking about are:

1. Would an electric pump make much of a difference? I find the hand pump quite exhausting at the moment.

2. How much should she be eating, in mils or ounces? I am guessing that 1 ounce per feed is not enough

3. If DD hasn't established a good latch yet, what are the chances of her magically, suddenly getting one?

Any thoughts would be very, very gratefully recieved :)

Congratulations on the birth of your baby!

When will your midwife come again? it sounds as though your baby needs to be seen daily as dehydration can become serious quickly.

Do not feel like you've had to 'resort to formula' - it sounds like the formula is necessary for your baby at this time.

That does not mean to say you will not be able to breastfeed.

An electric pump is better then handing pumping; how much she needs is hard to say, a healthy baby will drink as much as they need but if she is dehydrated, then you need professional advice.

I suggest that as well as your midwife, you contact a bfing counsellor to help you with the latch. Latch is something that can get better with practise, practise for both you and the baby. Plenty of skin to skin and resting in bed will help with bonding and bfing.

X-posts with teh Second coming, if you midwife is not coming out today, then go to hospital. Your baby does need to be seen as soon as possible.

Congratulations

I had the same with DC1, ended up expressing then switching to formula.

With DC2 i saw a BF counsellor before he was born and took him in when he was 8 days old to get the latch checked etc. Still BFing at 7m now.

Seriously, call a BF counsellor, they will come out to you, and are so helpful.

One thing i did find that helped to get DC2 latched on was to express with the hand pump first to pull my nipple out a bit, made it easier for him to latch on. Good luck with it all

Oh, and the BF counsellor will also come out to the hospital if you need to be admitted.

Thank you very much for your replies so far, I forgot to mention a couple of more positive points in my original post, one is that when mw saw her yesterday DD was at her very worst with the chapped lips and so on, but since we did a bit of expressing and a bit of formula that has got quite a bit better. Also, while she hasn't had a mustardy nappy yet, she did do one last night that was a lot looser and had a greenish tinge to it, which is presumably a step in the right direction.

I have a MW phoning today and visiting in person tomorrow. Also, my MIL is a paeds nurse so I will get her to come over today too and if things haven't improved we will definitely go to hospital.

Will try to get hold of a bf counseller asap as well.

1. Would an electric pump make much of a difference? I find the hand pump quite exhausting at the moment.

I found an electric pump much more efficient than a handpump. You don't necessarily need to buy one. Call your local NCT branch and see if they can hire or loan one to you. This is still early days, you don't want to spend loads of money on a posh double electric pump because bf-ing will hopefully get easier soon and expressing becomes something you only do occasionally.

Do not worry about how much milk you manage to express - it is not a good guide to supply. Some women can pump loads, others not so much. Babies are much more efficient at triggering milk production than pumps.

Also don't worry about your breasts not being hard. Mine never were and yet my milk still came in just fine. If you are able to express an ounce you are clearly already producing more than just the colostrum.

2. How much should she be eating, in mils or ounces? I am guessing that 1 ounce per feed is not enough

I don't know the answer to this one. They don't need much when they are this tiny. More important to look at whether she seems relaxed and satisfied after eating.

3. If DD hasn't established a good latch yet, what are the chances of her magically, suddenly getting one?

No need for magic! Latching is something you and DD need to learn, and for most people it takes a while. I think my DD was at least 4 weeks old before I felt confident that I was achieving a good latch with every feed.

Getting through the learning process will be harder for both of you if you feel tired or anxious so you clearly need real life reassurance that DD is safe and adequately hydrated at least. Once you have that things which may help:

Get a BF counsellor to come and visit. They often know far more about supporting bf-ing than MWs because it is all they do. Call NCT on 0300 330 0771
(8am?10pm, seven days a week) and ask if there is someone in your area. Or try...

La Leche League 0845 120 2918
Breastfeeding helpline 0300 100 0212

Take time to snuggle together, skin-to-skin if poss. Your baby will feel more relaxed and so will you. If putting your baby on to the breast in some way (which I am guessing is what the MW advised) isn't helping then biological nurturing can be good. All this means is popping your baby on your tummy and letting her find the food herself. I found it really helpful in the early days because when DD was rooting she didn't cry and when she stopped crying I felt more relaxed so it became a virtuous circle.

You still have time to make this work. Lots of people encounter problems like this in the early days and still bf successfully. But it is critical that your DD's weight and dehydration are very closely monitored.

Good to hear you have support at hand.

Yes latch can/will 'magically' improve the more you practice - keep taking her off and on if its not right. Its a faff but worth it. As they grow and the mouth gets bigger, they can take more of a gulp of breast which helps.

Some people find electric pump difficult and painful especially in the early days. You might be able to borrow one from hospital. Have you tried hand expressing - some find easier to get more milk this way.

FWIW colostrum is yellow or clear, milk is white or clear-white. So it's possible your milk hasn't come in fully yet - in which case getting an ounce is very very good going!

But my boobs didn't go hard when my milk was coming in - possibly because I was already pumping regularly (DD in SCBU) so they never got overfull at that stage.

If you're going to be pumping for a lot of top-ups a double pump could really help - I needed one. The Ameda Lactaline is really good and far cheaper than the Medela double - look on the NCT website

Dehydration is a real issue, but it sounds like you might have dealt with that already? She definitely needs very close monitoring. Daily weighing can help monitor dehydration if nothing else.

Get as much help as you can with latch - MWs rarely are very good with breastfeeding issues unless they're also infant feeding specialists or happen to personally be experienced bfeeders. Green poo would concern me simply because when DD was losing weight she had bright green poos as latch/positioning issues meant she wasn't getting enough fattier milk - which was part of why she was losing weight.

It is possible to overcome these issues, but it takes a lot of help and support (and determination on your part).

What wonderful advice, thank you for your replies everyone, it is really conforting. I am about to ring bfing support line and MIL is coming round after lunch to check on dehydration, and we will be offering more formular in about five minutes.

DD seems fairly relaxed but the big cause for concern right now is the nappies so will ring hospital about that soon.

Thank you again :)

I think you do need to be aware your midwife will have assessed the situation and will have judged whether your baby needs hospital treatment or not - if she is happy that what you are doing over the weekend, with a phone call, then there is no reason to assume your baby needs to be in hospital.

There are some misunderstandings about breastfeeding counsellors on this thread. Breastfeeding counsellors can support you, but they cannot make clinical assessments about ill babies. You also can't assume a breastfeeding counsellor will visit or come to the hospital if your baby is there - this might happen, but it depends on the counsellor's availability, where you live in relation to her and so on.

It's likely that once your dd starts to get sufficient calories in, her feeding effectiveness will improve. Meantime, it is as you know essential to maintain regular expressing - by hand or pump, whatever, though the research shows that when hand expressing (with no pump) is done properly, it is better at getting/making more milk. You need to express at the very least 8 x in 24 hours inc at night - this is essential to maintain and build your milk.

Hope things work out.

Someone should have seen your dd was not feeding effectively - you have had poor care, I think :(

sorry you're having problems- loads of good advice on here already.

Deffo yes to skin to skin, biological nurturing and pumping to top up (try hand expressing too).

Just wanted to post the following link which is great- it has step by step instructions for latching on. There's an exaggerated latch which may be worth a go. See here.

Also google Dr Jack Newman for latch videos.

sorry for rushed post, hope things go well.

Yes - I'd also agree it's pretty unusual for a baby with this amount of weight loss to be admitted.

But this baby is being seen again tomorrow....

Sorry, I mean not to be admitted.

Thanks again am ringing hospital now for second opinion on seriousness of weight loss

Can you ring the midwife first? If she's seen your baby yesterday, she is more likely to be able to assess how your baby is today.

Have now spoken to duty mw who says she's coming round later in person, which is good. But she didn't think much was wrong, oddly. She said 17% is OK for such a big baby and she can't be dehydrated if she's being fed every few hours, which she IS, but we just don't know how much she's getting from the breast.

Oh well, at least she'll come in person today. Just really really want to see that yellow nappy.

Make sure you are keeping all the dirty nappies for your midwife to see.

I was feeding for about 19 hours out of every 24 and DD1 was rushed in to hospital with dehydration at 9 days old. It's not how long you spend feeding that matters but the quality of that feed - if you're not producing or baby isn't getting the milk due to poor latch, you can feed 24 hours a day and still have a dehydrated baby.

The best sign is lots of wet nappies - cut into them if you can't feel wetness on the top layer (sometimes the "stay dry" effect of nappies can trick you).

Hope you and your DD are OK - don't be afraid of using formula while you get yourself sorted if you feel you need to.

Zero, I don't find what she says very reassuring, to be honest.

'Every few hours' is normally nowhere near enough for a baby of this age especially one who has shown signs of not feeding effectively...it's also too vague.

17 per cent weight loss is never 'ok' no matter what the size of the baby. It always needs acting upon in some way.

It's good she is coming to see you today.

Good that the mw is going to come and see you today.

Was 8lb 11 her birth weight or the weight she was when she left hospital? Had she gained or lost weight previously or is this the first time she's been weighed?

Are you happy that she was weighed accurately at home? (nappy off, hard, flat surface, numbers read properly).

8 11 at birth, definitely correct readings both times, the 17% loss one was done again to check.

With hindsight I agree that mw was a bit crap over the phone but it was hard to convey everything to her in a couple of minutes so hopefully it will be better when she comes in person.