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 :)

Just saw the midwife, who was absolutely lovely, one of the best I've dealt with. She's not too concerned (yet), providing that I can make some progress with feeding over the next 24 hours. I'm going to follow her tips and see how it goes. I now realise that there's no point getting a better pump if there's not much coming out anyway, will be aiming to get DD's stregnth up and hopefully more milk will come when she gets better at feeding.

zero just wanted to send you some unMN hugs. I know how hard this can be and what a worry.

I have been going through some of this. DD is 9 days old and by day 5 had dropped from 6lbs 2oz to 5lb (which I think is about 19% ) althought she did have wet/dirty nappies and our problems were related to a general reluctance to feed rather than poor latch.

The MW's were great - we adopted a three hourly feeding regime, with me pumping in between. The advice was to offer each breast, waking her as necessary and then topping up with 30mls EBM after each feed. I have had to pump after each feed and the whole process has been exhausting BUT DD has put on 3oz in 4 days

The pump should help stimulate your milk supply (although not as efficiently as actually offering the breast - which is why I was told to do both)

Although we've got a way to go, 4 days ago it felt hopeless now I can see that with some perseverence it'll work so good luck.

The only thing I would add is that if your baby continues to show physical signs of dehydration then you must take her to hospital.

This is exactly what happened to us. DS lost 16% by day five and was dehydrated. Also a planned c-section birth (can that delay milk?)
Anyway, we were given 24 hours to ensure he gained some weight, which he did - we gave him formula (on MW instructions). He was on that for the following two weeks.
Milk supply was massive by then because of all the latching-on and the pumping .
MW visited every other day just to check on him and to provide reassurance, for a few days.

I'd agree that what she has said is not reassurring that she has the required knowledge to assess or help properly. Quality of feeds really affects how much a LO gets and you can't see volumes with bfing - steady weight gain is the only real way to know they're getting enough in.

Given our experiences, I'm surprised the MWs haven't sent you to the GP at least for LO to be assessed for dehydratiom, signs of infection and anything physical that could be affecting feeding.

Definitely get your MIL assessing for dehydration imo - use what resources you have!

X-posted. Just seen you saw someone possibly okay.

Zero my heart goes out to you we had massive stresses with DD's weight in the first week.

She lost 13% after one week, and for us, the MW said 12% triggered hospital re-admission, so back we went for two nights. Whilst in hospital, she was fed a combination of expressed breast milk and formula - not what I had envisaged, but by this stage my baby just needed to get regular good quality feeds and by this point it was clear that BF alone was just leading to ongoing weight loss. As soon as DD started feeding from a bottle, weight gain was almost instant - 3 oz in the first 36 hours. I suppose I will never know what the problem was with BF for us, but we're moving on now.

I really would suggest pressing a bit harder for advice, as the MW saying if she is feeding regularly she should be OK isn't that reassuring. In hindsight, we wish we had known earlier that DD just wasn't BFing successfully. There are a number of things I wish I had known that pointed to DD not getting nearly enough:

• A 15-20 min feed taking almost an hour due to waking/sleeping - she was just too sleepy to have the energy to suck hard enough for long enough - maybe also poor latch although several MWs said 'it looks fine'.
• My bleeding had almost stopped - in general women who BF bleed faster and heavier to start with, I wish I had known that my very light loss might have been another clue
• MW kept asking for 'lots of wet and dirty nappies'. I didn't know that at this stage that meant almost every nappy should be dirty - we thought 3 ish a day was fine, but when DD started feeding properly we realised that around 7-8 a day was more 'normal'.
• 'Feeding on demand' is nonsense for small or sleepy babies with weight loss issues. My baby never 'demanded' to be fed, she couldn't be arsed, and if I'd truly fed on demand she would have faded away.

We are now feeding well on formula and whilst as I say it wasn't what I had wanted, DD is now gaining weight steadily (we have now passed birth weight, yippee!) and we feel like we did the right thing, for us.

Please push for more support, either with BF or with what other options are now. 17% is a lot and your baby needs something to change now - a day is a long time when you're only 6 days old.

Dx

At that weight I would expect her to be feeding between an ounce and 2 ounces an hour.

both my babies were between 8 and 9 lb, and Ds1 would drink 6 oz roughly evry 3.5 hours, and ds2 would drink 2-3 oz every 2 hours.

however as she is already dehydrated, she's going to need to catch up fast.

My ds had 15% loss at 5 days and we were readmitted to hospital overnight,but he also had jaundice so needed some treatment. In the end I spent 8 weeks feeding a mixture of bf, expressed milk and formula and then swapped to formula. BF is def best BUT don't beat yourself up if you need formula top-ups. Our ds turned into a different, livelier, happier baby once he was properly hydrated. Now 3 months and growing well!

Zero I'm not an expert, but when ds1 couldn't latch on to me in the first week, I had to pump regularly (every 3 hours, ie 8 times a day) to stimulate my milk to come in. not a lot came out at first but it was the pumping that helped get my supply established. have you tried speaking to a bf counsellor? they can't give clinical advice on your baby, but they can advise how best to establish bf if that is what you want to do.

Don't worry ladies, mw is only leaving me to carry on by myself for another 24 hours (19 now) and will be re-checking and weighing DD tomorrow.

We have a pretty good strategy now: feed from the breast every three hours and then express after every feed. If DD isn't fully satisfied at a feed (which is very likely), then top up with EBM or formula if EBM isn't available - or perhaps most likely of all, 1/2 ounce of EBM and then 1-2 of formula.

DD has had a lot to eat today so while things are obviously not perfect, I do feel that we're heading in the right direction.

It's really hard not to feel like a failure, though. I thought I was the most well read and clued up mum to be you could possible hope to meet, but this just goes to show that now matter how many books you read there'll always be some unexpected event that knocks the wind out of your sails.

Delia hello from the feb babies thread :) I agree that feeding on demand doesn't work in this context and I definitely feel that it is quite useful to go by the clock and wake DD if she hasn't had anything in three hours (and she is invariably hungry when I do this).

Can't quite remember who mentioned sections and milk being slow, but I have heard it rumoured that section mothers can find their milk coming through a tiny bit slower than vaginal birth mothers, although I admit this is just a rumour, I haven't heard a doctor say it yet.

Glad that you've got a plan Zero and you seem happy with it.

Don't want to step on anyone's toes but I would just add that if you can feed 2 hourly then that's even better. Don't forget that you can 'switch nurse' too. If she seems to want more after the first side, you can offer the other breast and then swap sides numerous times. This keeps up her interest and the stimulation of your breasts.

You most certainly have not failed at anything. If anything, you have been failed by your mw care who let things get this bad.

Still onwards and upwards . Hope you get some positive news at the weigh in tomorrow.

Don't feel like a failure and remember that lack of sleep can make everything feel worse. I healthy, happy baby and an unstressed mum is the mist important thing, no matter how you get there!

I second what CrikeyBadger said - 2 hourly feeds, and if she wants to feed again in the interim, then let her. Get yourself set up in bed with snacks/mags/TV and enjoy plenty of skin to skin and snuggling while you wait for MW to return.

Sorry to be argumentative but my second MW cautioned against 2 hourly feeds (although was initially recommended by another MW) she basically said that if you were feeding 2 hourly the baby was having no time to properly rest and with a baby that wasn't gaining weight it was important that they rested well to conserve energy. Obviously this is something of a balancing act when you also need to get energy in.

Anyway unlike the ladies here I am certainly no expert just don't wear yourself out either 2/3 hourly feeding + pumping is exhausting and unmanageable for any length of time so do what you can and don't beat yourself up.

Oh and finally we are 5 days post starting our intensive feeding regime and the difference is enormous. Almost as soon as the weight gain started DD started feeding better. I am still sore and tired but a big improvement on earlier in the week

Thought I'd chime in with similar experience to many on the thread- DD was born 8lbs 3, lost 15%, readmitted, had to pump and supplement with formula. After lots of perseverance, DD is EBF, no more pumping. If you want to continue BFing, get as much support as possible and remember it takes a long time for babies to lose their latching instinct!

What a lot of good advice. We have had quite a good night in the Zero household as DD has, for the first time in what seems like forever, done a couple of dirty nappies. They're not yellow yet but they seem to be heading vaguely in that direction.

Hopefully mw will have a positive story to tell when she brings the scales today.

Will also go to a bfing class on Tuesday.

Zero

Fingers crossed for the weigh in later on.

We also had issues with DD - and I! - getting enough rest between feeds. It ws partly why we had to top-up as she wasn't an efficient enough feeder after our rocky start.

I found that using formula to get one top-up ahead and then pumping each time for the next top-up meant that DD could have her top-up straight after a bfing try and DH could sometimes do it while I pumped.

Weigh in was good. She's gained at least 100g in two days. Things are going very well. Still will go to bfing class on Tuesday though :)

Fantastic news Zero :) Well done.

great news!

Great news . Keep it up!

Just wanted to offer words of support too. It can be so tough in the beginning. My DS lost 15% and my milk took five days to come in. It really does make you feel like your body is not doing what it's supposed to do.

I have had lots of good advice here and irl. One of the best suggestions by my bf counsellor was to take myself to bed for a day once in a while with DS, feed him as much as he wanted and have someone bring plenty of food and drinks for me. It felt

I also heard that having a c-section can delay your milk coming in because the hormones are not stimulated in the same way as with a vaginal delivery. Don't know if it's true as I know plenty of people who had CS and no probs feeding. However, I also discovered that a lot of the "liquid" drugs that you have during labour, like epidural, IV saline, syntocin make you and the baby absorb (or maybe retain?) extra fluid so the birthweight may well be false iyswim.

Anyway, I'm so glad your baby is gaining weight now!