Nervous about weigh tomorrow

[ardenbird]

DD lost just over 10% of her body weight at her 5 day weigh, and thus began a saga of top-ups with expressed milk, me panicked, mastitis, fissured & cracked nipples, etc. My milk was slow to come in (emcs) and things seemed to take a down turn during the mastitis.

At day 6 she had gained 60 grams and by day 8 another 120, all with top-ups -- but by day 10 no gain and I had been slowly losing the ability to express: what had started as 20ml per session went to 10 to 5 to barely 1 ml. This coincided with mastitis (which, for some bizarre reason, the MW and HV seemed to disbelieve that I had a bacterial infection despite high fever and severe symptoms?? And kept suggesting I stop the antibiotics and that it was probably just a blocked duct...). at the HV first weigh (day 12) she had lost 40 grams, but it was a different scale. 2 days later she had gained it back.

Since then I think we've been getting a lot better - I've taken fenugreek and the HV prescribed iron pills (I had been just on the borderline for treatment since losing 1L+ of blood but never treated as it wasn't below the cutoff). I feel like DD is eating more and is spending time alert but not hungry. But this Monday she had gained only 20 grams, and HV said "dropping down the percentile charts", but that she'd give to Friday to see if there was a problem.

I think we're doing well, but I'm terrified - what if we're not? What happens? I can't seem to let down for anything but baby, so if she suggests top-ups it would have to be formula and I can't express to keep up my supply.

And it's also occurred to me that I'm now suspicious of these measurements - I had 4 bags of IV fluid during labour and another in the operating theatre, and I've heard that can artificially increase birth weight. HV said she was on the 91st percentile - which made sense since we're American, apparently. Now she's dropped to 25th. (although looking at the plot myself the first X looks a whole lot closer to the 75th line than the 91st and the last X is smack between 50 and 25, and if anything closer to 50 - not sure if HV was exaggerating for effect? Despite the "warnings" about only HPs plotting, I'm pretty sure I know how to read the plot)

While DH is 6 feet tall, I'm not quite 5'4", so never thought of myself as hugely large. And then all the weight gain came from stuffing her with expressed milk. What if that was artificial too? How do I know what is a problem for the baby or not?

I'm really scared about what will happen tomorrow, and that if we top-up with formula that will be the beginning of the end of my breastfeeding since I can't seem to express on top of the supply problems I've had. I don't quite know what I'm asking here - what to do? How to know if there is a real problem or if the numbers are just skewed? I know we went through some problem periods during the mastitis (urates in one nappy and less wet than we should have), but I think we're on the road back now.

Please please try not to worry. Remember that your baby's weight will vary according to whether she's just wet her nappy, been fed etc. Also, your milk will have slightly more or less calories just through natural fluctuations.Your post brings back so many unhappy memories of my first born and the trials of BFing. If your baby seems to be alert and reasonably happy, then I'm sure she's doing fine. If you have access to a La Leche League counsellor she'd probably be a great help to you. The LLL people are very knowledgeable, more so than your HV and GP. You can have a phone or online consultation with them without too much of a wait.
My SIL's first baby gained weight very slowly for several months and consequently slid down the percentile charts but was still able to be exclusively BF for 5-6months. Her weekly weight gain was never usually more than 20-30gs.
When I was BFing my two DCs it always felt like my milk supply was poor compared to the other BFing mums I knew. I didn't seem to have a strong let-down reflex and rarely ever leaked. (I honestly felt like I wasn't much of a woman).The first baby had 'top up' formula from 5weeks to 5months then no more formula but BF for 13months.
The second baby was exclusively BF for 5 months despite it being difficult. He started off between the 50th and 75th centile and slid down the lines too. But he's stayed down there - he's a very healthy, fit skinny boy now(who eats like a horse).He is obviously meant to be a lightweight. (As am I- officially underweight but I've got really skinny limbs, small head etc). Charts, shmarts. Don't go by them too much.
I think that HVs are too quick to advise formula top ups. Some people are lucky and manage to BF with very few problems but I think that's quite rare, especially the first time round.
It sounds like you're doing a great job with your baby. Be kind to yourself and trust in your ability to feed her. I'm sure from what you've said that you can do it.
Try to relax as much as you possibly can (good for milk supply and letdown) and treat those darned weight charts as a very blunt tool.
You can do it.

Sorry you're still having problems ardenbird.

Interesting that you mention the anemia as this has been associated with poor milk supply. Kellymom suggests that eating oats which are high in iron can help with this. See here.

You're right about fluids in labour inflating birth weight. Would it be useful for you to ask the HV to look at the growth chart with you and run through it all? If it's more like 75 down to nearer the 50th as you suspect, then that's only a drop of one centile and even two would not normally be cause for top ups.

You mention that DD had gained 20g, over what period of time was that ?

Regarding what happens after tomorrow- well may be cross that bridge when you reach it, but nobody can force you to give your baby formula unless it is medically indicated. Of course, the charts are one way of looking at how the baby is doing but it is only one tool in the box. How does DD seem in herself?

I know exactly what you're going through - my DS lost weight and then failed to gain weight and I ended up mix feeding, giving bottles of formula every feed. I used to dread the weigh-ins as I always got my hopes up and until I started giving him formula he just never gained weight.

In my case, once we started giving him formula it became obvious how unhappy and hungry he had been - he stopped crying, started sleeping etc. Although I really hadn't wanted to give formula as I felt that I had failed, I realised it didn't matter in the grand scheme of things. He's now 3 and a happy, healthy boy who doesn't care how I fed him for the first 6 months. When DD was born, I was determined to try and bf, and have managed to so far (she's only 3 weeks old!), but I know that sometimes it's just not possible and that doesn't make me a failure.

There is already some excellent advice here, which I would second, but also try not to be too hard on yourself - breast or bottle, you're still nurturing your baby.

Thanks for the words of support. The 20 g was over a weekend - so 3 days. She's 2.5 wo now. I guess the thing is how do I know what is medically necessary? Can I get another opinion if the HV says top-ups? From who? Can I just ignore her unless some medical criteria - but what is that? I feel so ignorant. And sleep deprived and not thinking clearly.

DH and MIL - who's opinion probably means more, she having had 3 kids and 2 other grandkids so far, although the latter were FF due to medicine issues and back in the 60s and 70s there was some pretty odd practices (oatmeal to a 2 wo?) - thinks DD is doing fine, but I don't know how to tell. The periods of being awake and not hungry make me feel better - she started that before the mastitis and stopped during it, but now does so again. but she sleeps through feeds and I can't tell if she's really getting enough. I thought I had figured out how to wake her up, by sitting much more upright, but she seems to have acclimated to that and soon drifts off.

How do you find out about LLL councillors?

I want to do what is best for my baby, and if that is formula top-ups I will. But I don't know how to tell what is best - and I'm really hoping that once these early days are gone, that BF will be easier than keeping track of bottles and formula and such. So I want to give it the best chance I can.

OK, so she's gaining weight, just slowly. Is she back to birth weight yet?

You could ring any of the breastfeeding helplines to chat things through or ask if there is a feeding specialist in your area (NHS). Ours is called an Infant Feeding Specialist.

Another way to tell if what is going in is enough is to check what is coming out.... ideally about 3 yellow poos a day I would think.

Does she seem relatively happy between feeds? How often are you feeding?

Sorry, I'm trying to come up with some thoughts, but ideally you need tiktok to pop along.

Not back to birth weight yet - she lost 400 g and has gained only 200 by Mon. I doubt she'll have gained another 200 by tomorrow! She is making lots of dirty nappies - something around 4-5 per day (I'm losing count!).

Her feeding is still irregular - she tends to do a cluster feed with maybe 10-15 min of happiness in between each for a good 5 hrs each evening, or a bit more - usually around 6pm - midnight. then she'll feed for 1hr each at 3/4am and 6/7 and then again around 9am. Then it's anywhere from 2-4 hrs between feeds until the evening. Sometimes she falls asleep so much one 'feed' takes 2.5 hrs, and it gets really hard to count. She usually does two breasts, and I'm still struggling to tell when to switch - I've been putting her back on the same breast until it becomes hard/impossible for me to get a drip to come out after she falls off (she tends to either fall off, slip to a bad latch, or do this weird sleep-jerk thing which has her pull back then lunge forward sucking furiously, but in a bad latch - often just the nipple. I'm not sure what that is...).

Oh, and she either sleeps between feeds, is alert and looking about, or spends one hour alert and another 1-2 asleep.

It's really hard on you that the mw has given such short timescales for things to improve as it really puts the pressure on.

I know they need to keep an eye on things, but so many weigh ins mean that the bigger picture can't really be seen.

Your baby seems to have had a bit of a slow start and you've obviously not had an easy time of things with mastitis and everything. But, from what I read from your post, you think that things are starting to get better which is good news.

Regarding the switching, you can just switch when the flow seems to be slowing a bit. You can keep switching back and forth many time, no need to worry too much about it.

Hopefully things will go well tomorrow. If you feel pressured in to the top ups, then you could ask the HV to document the reasons for it in your red book.

One last thought - you could always ask to be referred to a paediatrician for a second opinion.

Well, she'd gained another 40 g, so we have a reprieve until next Wed for another weigh. That makes 80 g in a week, and she needs to gain 160g more to reach her birth weight. I did mention the IV fluids and how puffy she was at birth. Unfortunately there is no 24 hr weigh to get a 'real' baseline as a recent study suggests (found it here - I wish I'd known about that before as I could have asked for a weigh in the hospital). But I'd want 150 g in a week anyway? Yet Wed isn't a full week. HV suggested expressing from one breast while I feed from the other to deal with the let-down problem. Hopefully that will work and I can stuff her with some extra and get close to our goal. I know I'll be nervous again next week. I just wish she'd gain weight and we could leave this stress behind!

Great news that she's gained.

You're right though Wednesday is not that far away.

How receptive would your HV be to leaving it for the full week. You could perhaps explain that the stress can't be doing your letdown any good. What do you reckon.

Sorry, I don't know how to do links, but the website address for La Leche League is:
www.laleche.org.uk

Helpline is:
0845 120 2918

They are the most expert people on BF difficulties, infant nutrition etc. They will probably be much more knowledgeable than your HV or your GP as they are very highly trained and completely up to date with current research. (I'm not intending to be critical or dismissive of GPs or HVs but they're less specialist than the LLL people).
Good luck today. Remember that it's still very early days for you and your baby. BFing often takes several weeks to become fully established and I'm sure you'd know if your baby was really not thriving.

Thanks for the link/number weemumbelina. I think I'll call them tomorrow - I hope they answer on weekends? Also, I'm wondering how your SIL got by with only 30g gain/week - did she get pressure to top-up but somehow resist? When HV starts talking about brain development and kidneys and stuff it is hard to know if things are okay or not.

my dd has gone from born on 75th centile to now being on 2nd. took her 9 weeks to regain bw. my placenta was shockingly huge which is interesting. i'm lucky to have a fab hv who supports my decision to ebf. i've been on max dose of domperidone so that i can create an oversupply and express/top up. i've eaten so much porridge (got the microwave quick oats type those early weeks were not the time to be standing over a saucepan when i could be feeding/expressing.) i should add my dd is well and i've had wonderful support from then Infant feeding specialist at local hospital.
Just to let you know I know what you're going through. all the best.

dd is almost five months btw

oh........... and ds1 was born on 75th dropped to 25th due to slow wt gain and just completed his first triathalon two weeks ago.

Well done, ardenbird. Yes my SIL was under pressure to give her baby top ups - from the HV and her mum. She managed without them.

The LLL counsellors are based at home. If they don't pick up your call it is redirected to the next-closest-to-you counsellor.

From what you say about nappies, alert time between feeds, feeding lots in the evening and your baby's sleep it sounds to me like she's healthy. It's extremely common for BF babies to feed on and off all evening. The perfect excuse to watch tv, sit on facebook or whatever! Feeding at nighttime should help with your supply.

I don't know how much info you had before you had your baby, but I know I was SHOCKED by how difficult and all-consuming the BFing was. It was demoralising to have 'poor' weight gain, but the time passed and the babies turned out fine.

Are you okay? (I had an emc-section too). It's a bit of a rubbish start to having a baby and then having cracked nipples and sore boobs on top of everything..... You've been plunged headlong into a never-ending marathon of intense babydom!!!! It's no wonder you're feeling unsure about things! For what it's worth, I'm really impressed with your achievement. : )

Thanks, weemumbelina - it's all been way more of a trial than I expected. At least the section is healing well, although I haven't had time for the abdominal exercises they gave me. I keep feeling wimpy/inadequate and like I'm not handling things well. I've got friends who have gone back to work after two weeks - I can't even comprehend being capable of that. Or even at 6 weeks, as in common in the States.

I had no idea how painful the whole thing would be! I read all about 'breast is best' and one friend did say it was 'hard', but I imagined things about lack of sleep, not how much it would hurt.

I think we will surely ask for a referral if they start suggesting formula. I've managed to pump 15ml today and I'll give it to her, but I also imagine that if she is healthy and just gaining slowly, that stuffing extra food in her couldn't be healthy either.

I think, if you're successful in other areas of your life it's a new and horrible feeling to feel that you're somehow not 'managing' with your baby as well as other people you know. It's easy to forget that there's a large element of LUCK in the delivery you end up having, getting the feeding going, your baby's temperament and so on.
Honestly, even though it doesn't feel like it now, this phase of motherhood will soon pass and before you know it other mums who seem to be doing amazingly well now will be asking for your advice on things that YOU'RE doing terrifically well with your baby/toddler!

HV's are such a mixed blessing - great for some things but not necessarily for BF advice........Or their kidneys or neurological development. Baby's skin conditions, sleep patterns, crying etc are more in their field of expertise.

The 'discomfort' of BFing will pass - I promise. People who've done it before forget what it was like (or give up) or were just lucky.

As more days and weeks go by and your baby continues to look healthy you'll hopefully feel more confident and things will all begin to fall into place... : )

Well, it's weigh tomorrow again! I can't believe she'll have gained 160 g, but she is refusing the top-ups and seems happy to me. Maybe her weight will be okay. I've just seen other threads where people have had weight arguments for months, and I hope we don't have to go through that...

Good to hear from you ardenbird and fingers crossed for tomorrow.

Yeah! 4oz gain (for some reason she weighed in lbs/oz this time?). Not back to birthweight, but close enough HV is happy. She won't be back for more than a week, now.

Hurrah for ardenbird- that's fab news.