Under pressure from HV - do you think this is an acceptable weight gain?

[Liv77]

I'm after your opinions DC2 will be 4 weeks old on Thursday. She was 6lbs 1oz when born at 39weeks+4. Last week she was 6lbs 4 and today weighted in at 6lb 6oz.

HV wants me to top up feed with 4oz 3 times a day, I wouldn't be able to express that much and usually only get a couple of oz expressing so would have to use FF.

DC1 also had to be mix fed due to bad reflux and a similar slow weight gain not helped by tongue tie (where I live don't operate for TT unless it affects their speech in later years) DC2 has also got TT. I had really hoped to be able to exclusively BF this time. (It is the same HV I had with DC1, who advised top up feeds for him)
DC2 seems fine and pretty content to me, although her weight gain is slow. HV thinks that she seems content because she is exhausted from inefficient feeding so falls asleep but she is often awake and not always crying and feeds on average every 3 hours. Often when she falls asleep at the breast I take her off and she has a mouthful of milk, if she wakes i'll offer her the other breast.

What do you think, should I give it another week and see how she goes? I've only expressed a couple of times so far so I'm going to increase my attempts to a couple of times a day.

Am i being a bad mother if I ignore the HV and don't top up my BF with formula or is my HV just being overly cautious, she didn't tell me what an acceptable weight gain would be.
Your advice please

Instead of top-ups could you not breastfeed more often? 3 hourly isn't very frequent, maybe feed 2 hourly and swap back and forth between sides several times during the feed.

12oz in formula sounds like a huge amount to me as well - a fully formula fed 6lb baby would only be taking about 15oz a day in total.

Liv77, no you are not a bad mother if you ignore the HV, I have done that with nearly everything they've said so far .

If you feel fine going another week with ebf then go ahead and do it. One thing I would suggest though is trying to feed at least every 2 hours during the day if you can, just while you are concerned about the weight gain. Afterall the best way to top up is with your milk by feeding, feeding and feeding some more.

As for the tongue tie, if they don't provide the snip in your area, is there anyway you could afford to get it done privately?

Given that all three of my dc took three weeks to regain their birthweight, however they were fed, I don't see what the problem is with your dc's weight gain. I can only imagine that the HV is going strictly by the Red Book and has decided that your dc should be following a particular line. Which is nonsense, and not the way the graphs should be used.

Is there any chance of getting the tongue tie treated privately? Treating it could improve the baby's feeding.

It is true that a baby can seem content when they are in fact exhausted from not feeding well. But then they would not be contented and alert when awake, and would not ask for a feed at regular 3-hourly intervals, but more often and more irregularly.

What about poos and wees? Has she cleared the meconium? Does she give you nice yellow poos and frequent wees? They are a very good indicator of whether the baby is getting enough food - often a better indicator than weight gain alone.

I'm feedind on demand, it tends to be 3 hourly from 12am - 6am but we are usually co-sleeping so there is probably some sleepy sucking going on. It is more frequent during the day. I havn't been keeping a record of the feeds but I might start. I do offer both breasts especally when she's been on one for a while.

Have had 6 dirty nappies today, 4 with nice yellow poo, she also spits up if you don't wind her so it's definately going down.

Re: The tongue tie, I have enquired about the paed consutants here but we are not on the mainland uk so aren't connected to the NHS, all care is private, although our government subsidise some care. Both midwifes andd HV have told me they don't do the op here.

Keeping a record of the feeds sounds like a good idea, if you have the time that is.

Sorry, do you mean that you do have a Paed Consultant or would you have to go to the mainland? Would you be able to go private?

You might be able to find a lactation consultant who can snip tongue ties - it's a very small procedure, they literally just cut the tie with some scissors.

Sorry you're being pressured to top up Liv- that really is a huuuge amount that your HV is suggesting and is likely to have a detrimental effect on your milk supply.

Sounds like it's the tongue tie that is causing the slow weight gain though doesn't it. Like RitaM says, some lcs do snip tts. Not sure where you are, but you can search for one on their website here

One more thing that you could try is breast compression (google it - Dr Jack Newman does some videos).

Hope things get better for you soon.

I just had a quick look at my DD's red book. It doesn't look like particularly slow weight gain. If I'm right she was born on the 9th centile and is now somewhere between the 2nd and 9th. She hasn't even crossed a centile line. My DD was born on the 50th, was on the 9th at 3 weeks and stayed between the 2nd and 9th to 6m. And that was fine and healthy for her.

There isn't such a thing as an acceptable weight gain. Babies are either healthy or they aren't and poor weight gain may be an indicator of when they are not. But it is only an indicator.

So I don't think you'd be a bad mother not to follow the HVs advice. You might want to just talk the situation over with one of the breastfeeding helplines, or your GP if you have a good one, just to see if there are any other indicators of poor health you should be looking out for (lethargy, poor skin tone, poor muscle tone, difficulty settling, constant grizzling, frequent frothy green poos etc) but otherwise it sounds like you are doing a good job.

^I'm feedind on demand, it tends to be 3 hourly from 12am - 6am but we are usually co-sleeping so there is probably some sleepy sucking going on. It is more frequent during the day. I havn't been keeping a record of the feeds but I might start. I do offer both breasts especally when she's been on one for a while.

Have had 6 dirty nappies today, 4 with nice yellow poo, she also spits up if you don't wind her so it's definately going down.^

This is a textbook baby - what is the HV's problem?

hi 4 weeks seems a bit early to me to even start worrying about weight gain when she is actually gaining, if she was losing or not gaining anything i might be worried. When you express do you do it at the same time you're feeding? I couldn't believe the difference it made, i got loads more, thanks mn! Good luck anyway, where are you just out of interest?

thanks for your posts, especially the links crikey. I'm in the Channel Islands so unfortunately couldn't see a lcs for my area but there was some really useful information there so thanks.

I have a very nice GP so when I take DD for her 6 week check I'm going to ask her about the TT. (maybe she'll do it for me ). I'm going to try and EBF at least until then and hope my GP gives me the thumbs up. DD has only had 1 yellow nappy today but a couple of nice big wet ones. Hopefully that's not unusual for EBF babies.

DH gave DD 1oz of EBM when I was putting DS to bed, I have expressed another 2oz to give her but she's been happily asleep since I BF her and I don't see the point in waking her to give it. Will save it for tomorrow as i will BF in bed during the night.

I'm not very good with expressing, i never get much milk out and trying to fit it in with DS(3yrs) isn't easy. Today he's been to 2 birthday parties and I havn't found the time. I bought a Medula mini electric, I got 1oz from each breast but it left red rings around my nipples so I think I will need to get a bigger funnel size. Used my manual Avent but only got 1oz total .

Unfortunately I can't express when feeding as I need both hands to keep DD on with any kind of a decent latch.

As for my HV, although she is my designated HV there are a couple of different baby clinics I can go to for DD weigh-in, so I'm going to visit the one near my in-laws for the next couple of weeks, I know my HV won't be there as it's the same time as her clinic.

Liv don't know which island you are on but there is NCT Bfing Counsellor mentioned on the NCT webpage for Jersey.

Thanks Jilted I'm in Guernsey though. Our maternity unit runs a weekly BF clinic so I might go along to that next week, it's run by a nice midwife who's been doing it for years and she knows her stuff. Our NCT group does have a bumps and babes group but I havn't been yet this time around as it clashes with collecting DS from preschool, I might see if my in-laws can pick him up for me next time it's on though.

Might be worth going along to the Mat Unit and the NCT if only for a bit of support.

My post wasn't very good this morning sorry, was a bit early for me. What I meant to say is that the Bfing Counsellor may know how to contact someone who can do the tongue tie.

Hi Liv and congratulations on the birth of your dd. You don't say how much if any weight your dd lost after birth but, provided she has been consistently weighed naked on properly calibrated scales, the weight gain you describe isn't a lot.........however as I think you are aware the size and frequency of top ups your HV has suggested are likely to mean an early end to breastfeeding.

I would suggest that you continue to look for expert help on the Tongue tie - a (relatively) nearby BFC can suggest some options even if she is not on the same island (btw I do know how far Jersey is from Guernsey!). Note that it is rare for a UK trained MW or HV to be trained to do TT division, as this is normally only done by paediatricians so it is probably better to pursue that route. I do know that Southampton General is one of the places that has a regular TT clinic run by Mr Griffiths - and again I recognise that this may not be a straightforward option, but it is there.

Speaking to a breast-feeding counsellor in real life can also help you get some support with other ways of supporting your dd's breastfeeding.

HTH

Hi Lizzy
Thnks for your post, DD regained her birth weight within a week. Thanks for the info on Southampton but TBH i'm just fed up of it all now.

I've really started to doubt myself and my ability to feed DD sufficently, i've spent the last 3 days wondering if everytime she cries it's because she's not getting enough from the BF so yesterday she was topped up with her first 3oz formula . I did get a 2nd 3oz bottle ready for overnight but she settled after her midnight BF and slept for 5 hours so I didn't need to give it .
I'm just quite at the HV's ability to make me feel like crap and that she seemed to decide in a 5 minute visit that I was obviously starving my baby because 1) she had a slow weight gain, 2) she was crying at clinic and 3) she knows my DS history of feeding problems and seemed to just assume DD will be the same (DS also had bad reflux, however DD does not).

I'm going to get DD weighed on Tuesday and depending on her gain may slowly increase the FF if necessary. I mix fed DS from when he was a couple of weeks for the same reasons and he breastfed until 8/9 months when he weaned himself off the breast so this shouldn't cause the end of breastfeeding with DD either.

I am still putting DD to the breast lots and am only going to give her a formula top up if she's still really unsettled after a good go on both sides.

(DD has just gone to sleep after another BF so I'm off now for an early morning and )

OP have yopu thought about bedding in for twenty four hours? it will increase supply, also take a good multivit, pregncare breast feeding is fantastic,

it sounds as if dc is feeding well but maybe she needs to feed more offen due to her size. go to the bf group they will provide you with information as well as a bit of personal experience,

the weight gain isn't great but not too worrying yet at least you are aware of it and can act now before its a problem good luck, and ff isn't the end of the worldxx

Liv - just wanted to pop in and add some support, the HV sounds wrong, to be quite frank.
Luckily you are on DC2 so know more about what you're doing.

DS1 also had TT, and they don't snip here either, grr.
Luckily his 'stretched' and we carried on BF until he was 13months old.
It was bloody painful at the start though.

I paid to see a pead about his TT about 6wks in who showed me that because his tongue could reach over his gumline, he would be fine to carry on BF. That reassured me - though now I think I would push to find someone who would snip, it's so unnecessary to battle through it when it's such a small procedure.
(trying not to rant!!)

Try not to get DD weighed so often would be my mian advice, trust in your body, keep feeding her on demand and keeping an eye on 'output' to reassure yourself :)

Liv, I am not surprised at your feelings about the HV's attitude, it does sound dismissive and unsupportive of your breastfeeding your DD. Will post later at more length but just wanted to respond.

I agree with gkys - bed down with DD for a day and see what happens.

It's horrible that your HV has undermined your confidence like this, and I really do think you should go to your NCT group or BF clinic (especially your BF clinic) to get some better advice.

I reckon it's the TT too - your BF clinic will be better placed to help you decide what the best option is there.

I don't get the obsession with top-ups - I was advised to do this with my little one and expressing/trying to persuade the baby to drink from a cup/bottle/syringe was ridiculous.

My DH put his foot down (I was rather frazzled, emotional about starving my baby, tired, and just not able to think sensibly) and just had me feeding him whenever he opened his eyes for a couple of days (I was sat down, and DH delivered snack/glass of water) and that sorted his weight out, got bfing totally established (and turned me into a pro who could feed anywhere).

I think your HV is being very unhelpful. I would really, really try and get the tongue tie done if at all possible. If it were me and I had an option I would even travel over to the mainland to get it done, although there must be a maxillofacial surgeon somewhere on one of the islands who could do it, surely?

Formula feeding is not generally a good option for babies where there's a family history of reflux. The combination of a higher volume of milk needed (than breastmilk) and it being more difficult to digest contributes to this. Also, if your son was very vomity - and especially if he had anything like eczema or diarrhea, then it's possible he was sensitive to cow's milk protein - the symptoms of which are almost identical to reflux. Your silly HV should therefore be offering you more support to keep BF, rather than trying to scupper your chances by encouraging you to offer formula.

Don't take the fact that your baby will drink formula after a BF as an indication that your DD is still hungry. Most babies will down formula from a bottle regardless of hunger because it's very difficult to control the flow of milk.

Please don't increase formula unless it's what you really want to do. I get the feeling you'd far rather keep breastfeeding.

i totally agree with the posts especially gkys. weight gain is ok for a bf baby mine all dropped down to centile TWO and were fine. toppong up will make worse instead have a duvet day drink plenty fluids three litrrs if u can and feed. eat well esp protein andhave calcium supp as well as pregnacare. good luck it will br fine try to sleep whenever u can as well

How are you doing Liv?