Confused about top-up instructions

[ardenbird]

5 day-old DD lost just over 10% of birth weight at today's weigh. She was EMCS, is jaundiced, and milk only just came in Wed night / Thu. She can't seem to stay awake at the breast.

MW said to top-up with expressed milk from a spoon: 30-60ml every 4 hrs, or as much as I can. She also said to let her feed, then pump the other breast, and start DD on the pumped breast next feed.

I was alone (DH out in emergency run for pain meds before everything closes over holiday - hospital said they'd given enough thru weekend but count showed not) and tired and only now realising instructions confusing to match DD habits and I'm not sure when to give top-up.

DD tends to nurse every hr for a few hrs at a stretch, then sleeps 1-2 hrs, and repeat. Since we've had the instructions: I've nursed one breast 30 min but didn't have time to read the pump instructions before she wanted more 20 min later. So I pumped the first breast when she was done with the second (got maybe 10 ml), but that took 20 min. She woke hungry again only 30 min after I'd emptied it pumping. I gave it to DD first as instructed, but soon switched to other breast.

We tried to wake her and give top-up, but she wasn't hugely interested. Although then did nurse 5 min again before falling asleep.

I'm very confused about when to give the top-up: after a feed doesn't seem ideal, more like to waste it. But would giving it before a feed mean she will suck less? Or should I just wake her sometime in between? Also, the pumping pattern seems very confusing and to lead not to fill up the pumped breast before putting DD on. I'm going ahead and finish pumping the one she ended on, as it seems a waste to leave it not fully emptied and there is no 'other breast' this time.

I'm just so confused and in a bit of a panic as MW said she had to gain 30g tomorrow or they'd recc formula top-up and I feel like a failure. Plus hitting the weepy period and everything seems so hard. Sorry if this all makes no sense.

Sorry you are facing this struggle ardenbird.

Are you sure midwife said 30-60 ml every four hours? That is an incredible amount for a 5 day old - that would mean expressing 180-360 mls which would be virtually impossible for anyone.

Getting it into your baby would be very difficult.

Can you call the maternity unit tonight and check this out?

I wonder if you have misunderstood?

Just feeding direct, frequently, as long as milk transfer is effective, would be the usual advice in your situation.

Crumbs, that does all seem rather confusing ardenbird, I can see how that would all seem a bit much to take on.

I think they recommend the top up after the breastfeed so that you are not filling them up with milk and therefore they are less likely to want the breast. They obviously want you to pump to build up your supply, but direct breastfeeding will be more effective than the pump.

Don't worry about wasting the milk, you can store it in the fridge for quite a few days- some sources say up to 8 days is fine. (in the main fridge, not the door)

Also, you don't need to be concerned about waiting for the breast to fill up. An emptier breast has a higher fat content in it anyway.

I'm surprised the mw suggested topping up every four hours as you would need to feed much more frequently than that (as you are doing).

You could also try breast compressions to keep DD awake when she seems to be dropping off. I think that's been mentioned already actually.

It's so hard when you have a target to get to and I'm not sure why a formula top up would be better than a top of your milk.

Personally, I would just keep going with lots of frequent feeding, expressing and topping up where she'll take it.. and lots of skin to skin of course.

Hope that helps, and I haven't just confused you even more.

Bumping for you, but this seems to me like it's unnecessary and you isn't need to feed whenever she looks like she's hungry! DS2 was just over 4 wks early and I kept being threatened by the MW that they would need to top him up with formula and it really hacked me off and stressed me out, so I know how you feel. If you think she is feeding ok, taking in milk and being satisfied after a feed I would doubt you need to express and feed that as well.

Sorry that meant to say "you just need to feed", bloody autocorrect

Yeah, 30-60 mls every seems impossible given what I've expressed so far. I'm willing to believe I got memory wrong, but DH was on way out when she saiid that and reports hearing same number. Well, all we can do is as much as I can get.

And experience has shown we can't get more than 4-8 mls into her at one instance anyway. So I think I'll ignore that 4 hr thing. So far she's taken maybe 12 ml top-up - 4 ml in first session and another 8 ml before a feed. We might have to do both?

Nothing seems to wake her up - I've been doing breast compressions which do make for deeper swallows, but she still appears asleep! I've got her skin-to-skin, and blowing on her seems to make for more active feeding too.

I am worried we're not getting enough nappies - although yesterday MW Not concerned. She's gotten considerably better - shorter feeds (less than 30 min, rather than 1.5 hrs) and I think drinking better even if still asleep.

It's just so hard and I really want her to be okay.

Speak to a NCT or LL breastfeeding councillor if you can. May not be easy over a bank holiday.

This sounds stupidly complicated.

All sounds very confusing on top of recovery from birth and you must be exhausted. Congratulations though .

Offer breast as much as poss. I'm not professional expert (bf dd2 at mo) but I would wake baby regularly to feed as well, maybe every 2/3 hrs if she doesn't wake herself. She's only 5 days old. Feeding will pick up. Don't let them pressure you into doing something you don't feel is right/necesssary.

If your MW says formula top ups necessary tomorrow and you don't want that, tell her you want to wait another day or two.

Good luck and let us know how your dd does.

DS was a fairly efficient sleep nurser with breast compressions. As long as milk is coming out and she's swallowing, and she's awake and sucking some of the time, does it matter that sometimes she seems asleep at this stage?

Yeah! She gained 60 grams!!! :o

MW came at same time as BF counsellor, and I asked lots of questions about practicalities of the pumping/top-up schedule and they discussed things between them, and I now have a plan.

Hopefully we can keep the weight gain up and see some more wet nappies. Thanks for all the advice in my panicked night.

60 grams is fantastic weight gain ardenbird- well done.

Glad you have a plan to take things forward.

Great you've made an improvement! Just to let you know we were in a similar boat and you are not alone!
Our lo lost 18% and at 6 days we were topping up in hospital through a tube. They were adding 70ml every 3 hours formula to start then bm as I managed to get expressing going. By the time we left 2 days later we were offering the breast at every feed, topping up with 40ml ebm and then I was pumping from both sides afterwards. From the time she finished feeding we woke her after 2 hours for the next feed, 3 at night. She is nearly back at birth weight at nearly 4 weeks.
Happy to answer q's if you like, otherwise hope all improves!