Bollocks ... HV wants me to top up with formula

[bushymcbush]

DD2 was born 5 weeks early with IUGR so was already under the normal centiles. She is now 6 weeks old and is EBF.

Took her to baby clinic today to get weighed. She has gained weight but not as much as they want. Her curve is flatter than the ones on the chart. Basically, she was 3lb 4oz at birth, and now she is 4lb 5oz. So just over a lb weight gain in 6 weeks. She appears well and has plenty of wet and dirty nappies. She feeds regularly - every 2-3 hours - although she also has periods of cluster feeding and we do sometimes struggle to get and maintain a good latch.

So the hv started talking about top ups with fm. When she saw my reaction to that (tears! how pathetic am I!) she went to phone the paediatrician at our local hospital for advice. They basically said the same thing but also suggested if I was really unhappy about using formula that I express my milk and bottle feed her with that so that I can keep a record of exactly how much milk she is taking. I said something about nipple confusion and she said I could cup feed instead.

I asked about lactation consultants (thinking this would be a more sensible starting place) and she was a bit vague but referred me to my red book for details of local baby cafes and baby bistros (she couldn't really tell me the difference between these two things). She also wants me to get DD weighed again on Friday and see the paed at the hospital next week.

Should I express and cup feed? Or should I try and get to see a lactation consultant first? Should I be worried about this or is it typical hv overeaction?

Help

Just spotted an error - she is 4lb 6oz today (every bloody ounce counts!)

What do you think?

It's a tricky one, but in your situation I would also feel like I had not yet received advice from someone who actually knows what they are talking about.

The trouble is, just because the advice and reasoning is shot, it doesn't mean you don't need help, although you may not.

Bottle feeding expressed milk for the reason given is stupid btw.

Can you call one of the bfing helplines?

Also, can you say how many times a day roughly you are feeding and how many sides are taken each time?

bronze what do you mean? I'm asking you for advice.

It seems odd that they would go to formula/expressed milk as a first resort (not surprising, though, it's very common) when there are other things you can try first, techniques to get more milk into her directly from the breast, for example. (The most efficient way to get milk into a baby, after all!)

Kellymom is down at the moment so unfortunately I've lost my go-to for these kinds of things, but I'm sure someone will know offhand or have a book to look it up in, or something.

Starshit I'm feeding roughly 12 times a day, usually draining one side and sometimes giving the other side too, depending on whether she seems satisfied.

WHen I say 12 times, that's a minimum.

Hi, sorry you are being made to feel so low. Just a few questions. Are they plotting her weight back 5 weeks to account for the prematurity. Also are they using the charts that are for low birth weight babies?
If the paed has also recommended top up then I may be wrong but if baby is well, alert, settled between feeds and having good regular feeds and lots of wet and dirty nappies then i would be tempted to give benefit of the doubt if not an actual weight loss. Also weighing again on Friday is a bit soon. I would want to wait a full week if baby not unwell.
Another point with giving ebm is that sometimes you don't get as much of the hind milk as an actual breast feed which may alter the weight gain. Will the baby not feed at the breast?
I would also agree with trying to see the breast feeding lead. The number should be on the breast feeding info I hope you have been given.
Hope I haven't added to your confusion.

Because I think a lot is whether your baby is thriving or not. You will be the best to know if they are happy and seem to be content after a feed.

I speak as someone who had to go against doctors advice for my prem and she did fine but I wouldn't have continued on my path if I had felt she wasn't doing well. I knew she was though, she is my daughter and I could monitor her in ways that others just couldn't

Sorry about the question (was going to come back just putting my children to bed) my mom always says this to me when I ask her questions about how should I look after my children and she always asks me 'what do you think and actually my gut is generally right

bushy what do you feel when you look at your child? Is she alert, hungry to feed?

I think that your HV and the paed (who hasn't even seen your child) have looked at the charts and decided your DD doesn't conform, and that therefore Something Must Be Done.

Looking at it another way, she has gained 30% weight in a month. Which is pretty good going IMO.

Greatherbert what is a breast feeding lead? No I don't think they are using a chart for low birth weight babies - just the standard chart in the red book. I didn't know there was a chart for low birth weight. Where can I see one? They are plotting it on her corrected age though. Yes she does feed at the breast and loves it. I really don't want to bottle feed, even ebm. Sometimes she is not settled between feeds but wants to feed constantly for a few hours - usually in the evenings. I remember the same with my older daughter and didn't think it was an indication of a problem. Mostly she is settled between feeds.

bronze I can appreciate your question now. I think my baby is fine. But the hv and paed have made me doubt my judgement.

Alibaba that's a good way of looking at it, thank you! But if I don't Do Something will they refer me to SS or something?

Bushy, you need to see someone who knows about bf - there will be a breastfeeding lead somewhere in your PCT,and your maternity unit (where you gave birth) should know.

If your baby needs to gain weight more quickly, then upping her intake of breastmilk is the first step - that means not 'draining' the first breast, but making sure she has at least two breasts at each feed, 'switch nursing' to make sure this happens (google switch nursing or look here on mumsnet), in addition to breast compression, and feeding more often day and night - 12 times in 24 hours is prob on the low side for a baby who needs to gain weight.

Hope this helps - you can also call any of the bf helplines.

There are lots of ways to get more milk in. A visit to the baby cafe should be a good place to start or the hospital may have an infant feeding advisor who you can also speak with even though you your baby is a bit older. Firstly they could check your latch and see if it could be optimised in anyway and they could go through different plans to increase weight gain in an ebf baby. There are lots of ways and your hv's ignorance about this is poor.

If you usually offer one side then the most immediate thing you could try is switch nursing where you swop your baby over from side to side during the feed. You need at least three sides but often the more the more effective. Switch the first time there is a pause or the sucking has less pressure or rhythm. Babies take more milk through a combination of being stimulated by the switching and your let down being more effectively stimulated so the baby gets more help accessing fattier milk.

At the moment you are responding to your baby but there are lots ofs babies who don't demand as much milk as they will happily take if they are offered more. If your baby is like this then doing the above could make a difference to weight gain.

You could combine this with a day or two of staying in and offering as many feeds and as much skin to skin as possible. A period of time like this can hugely boost supply and if your weather is like mine a few days on the sofa or in bed with a great box set could be a pleasure:)

You could express and do some cup feed top ups but this isn't obviously necessary when your baby is transferring milk without problem.

Good luck, hope you get help that makes you feel confident in your decisions.

If you go to a breastfeeding advisor, please ask them to check for tongue-tie, just in case she has one. It can really affect the latch, and she could start taking larger quantities if it's fixed.

My DS was early and the HVs put the frighteners on us about hs weight too, unecessarily imo. They wanted us to get ridiculous amounts into him!
What with his size, bf problems, tongue tie, reflux, jaundice etc etc we ended up giving him formula for the first month, but he's been EBF ever since, nearly a year old now, so if you do decide to give a bottle it won't necessarily cause any problems at all.

As long as you keep an eye on her weight and think she's feeding well, I don't think it sound like you need to 'top up' - HVs do go overboard about early babies, regardless of how sensible the mother is. You're clearly a sensible one, so don't worry about SS!

I have no advice that hasn't already been given but just wanted to say you are not pathetic for crying when they suggested formula, I'd be exactly the same. I did switch nursing when my DD was - in HV's opinion - slow to gain and it worked wonders for her weight gain. It really increased my supply and took a few days to sort out but it was my first lesson in following my gut. Good luck and congratulations on your new baby

know exactly how u feel i feel like im being accused of neglect i am bf on demand all day n night have started toppin up with formula twice a day now hv wants me to do every feed!! hes has dropped 2 centiles but never lost weight hv wants me to put on more formula so she can come out and weigh him dont think his health is as important as the dot on the weight chart to her!!!!

Out of interest do you know what she weighed at a week old?