Help with weight gain for 14 day old?

[igggi]

Hello. Putting lots of - boring - info in here in the hope that someone can help.

My baby 2 weeks today. Was 3.54 kg at birth, dropped 9.1% of birthweight by day 4 and has been around 3.16/3.19 for a few days.
Given a plan to follow at BF clinic (feed for half hour, give ebm, give formula if still hungry, then express more) which I've been following, well bar giving formula which I really don't want to do yet.
In 24 hours of doing this weight has gone up to 3.23, midwife still very concerned though. He is also slightly jaundiced still.

My questions being.. Should I just be giving him the formula rather than waiting? How long can I hold off without harming baby? How can I express more milk (really struggling to get much out with medela mini pump)? And are they right to tell me to only feed for 30 mins a time? (The thinking being that he's using too much energy feeding longer than this).

I have a lovely little baby and am just getting so stressed about doing the right thing by him. I have successfully bf his db so can't understand why it's not working this time. Any advice gratefully received.

Have you tried breast compressions while feeding? They can help increase the amount of milk baby gets without increasing the energy the baby expends to get the milk IYSWIM!

Are you 'allowed' to swap sides within the 30 mins or is the plan to feed one sided at each feeding? How often does the plan ask you to feed or is it 'on cue but no longer than XX between feeds' or just 'on cue'?

Was baby's positioning and attachment checked at the bfing clinic?

How are baby's poos and wees - is he doing at least 6 wet nappies (heavy and clear/pale yellow wee) and 2+ poos at least the size of a £2 coin (yellow to greenish, liquidy but not hard/scant or brown/mec. looking)?

Baby has gone up from 3.19kg to 3.23kg - which is a gain of 40g in one day - this is pretty good going. I just wonder if the HCPs involved have fallen into the trap of 'more weighing = more weight gain' rather than 'ensure baby is feeding effectively with good milk transfer at all feeds, monitor nappies and monitor baby & mum for signs of ineffective milk transfer' - I really hope this isn't the case though!

First thing i would suggest is to dump the medela mini pump and try something else. FWIW, and I know MWs rave about medela, I have one and I think it's terrible

I also have an avent hand pump which I find mire efficient, more user friendly and a whole lot bloody quieter.

I can express off 4oz with the hand pump in less than half the time it takes with the medela mini.

Well fine you for persevering with bf though, it does get easier.

I think the 30 minutes thing is rubbish. Babies are far more effective at removing milk than any pump, unless they have some problem. Just feed as much as he wants.

Could he be tongue tied? I wouldn't actually be worried about that weight gain alone for now, but if you have other symptoms like blanched/misshapen nipples, pain etc it could be that.

Presuming that your latch has been checked and that baby isn't tongue tied...both worth checking but hopefully unlikely as 40g in a day is great and you don't mention pain... then you could try switch nursing. It is a massively effective way of getting a baby to take more milk.

When feeding watch your baby and the minute the sucking gets slow or disorganized swop sides, then repeat aiming for at least 4 sides or two feeds per breast.

The movement wakes baby. The latching stimulates your milk flow and as they return to a breast recently used your milk is fattier but your let down helps baby access it more effectively.

It wouldn't usually hrlp to limit time at breast, feeding more can help. More sides, longer feeds and more feeds:) you don't say how many feeds you are doing...at least twelve a day would help. if you aren't pumping much it can just be easiest to get more milk in via feeding directly. if top ups have been significant though prob unwise just to stop.

Worth trying a diff pump, you can rent hospital grade ones or mw may be ble to provide.

Good luck.

Oh and there is no upper limit to how often you can switch sides during switch nursing.

It may not be 'rubbish', Ihavequestions.

This is a mum who's been seen, with her baby at a clinic, where specialists have assessed her, her baby and her feeding. No guarentee they get it right, but what she has been told is not way off the mark, either.

With compromised babies who are not gaining weight as they might do, there is sometimes a good reason for not keeping them feeding at the breast indefinitely - they do use up energy and this can make things worse. Obviously, in time this guidance can be dropped - but at the moment, these people who have seen the baby and observed a feed, have judged that feeding 30 mins is about right, and it allows time for the ebm to be given before the baby zonks out to sleep.

OP, you are probably better off with a more efficient pump or hand expressing. It sounds to me that what they are saying at the clinic could be very helpful to you and could get you on track. I agree with TruthSweet's suggestions, and yes, the 30 mins feeding should be both sides at least once.

Oh Babylon, I threw out my hand avent pump (from ds1) and "upgraded" to the electric one for this baby! It did seem to be doing the job yesteday, today is a different matter though and I just feel like I am over-milked I think!
Breast compressions I have just started today (is that just a case os squeezing?). Truthsweet I am supposed to swap sides in the 30 mins if he comes off, yes. Afraid this afternoon I went to sit in bed with him and have just let him nurse whenever he wanted. I've to feed on cue but 3 hourly if that comes sooner.
At the clinic they showed me a better latch, I'd say I've felt a difference in feeding in the past day, eg nipples less sore and nappies heavier.
Thank you both for the advice, very stressed here!

More replies.. Thank you.
I'll google hand expressing to see how it's done. And I didn't realise switching meant doing it so often, so I'll up the number of swaps.
There's a lot of pressure to have a very quick weight gain, which may or may not be realistic - obviously the midwives I've spoken to have more experience than me and they have all bar one suggested formula. Which would help in the short term but perhaps cause me problems bf in the longer run.

Hello,just an update - baby weighed today and has put on 80g in last 2 days, so will keep going with all the suggestions till next weigh-in on Monday.
Thanks again for the advice :)

That's really good news :)

fantastic news

Thank you
Hopefully I won't screw it up in the next few days!

Weighed again today (3 weeks+1day) and baby is 2 oz over his birth weight. Very pleased to have been able to bring his weight back up myself. Many thanks for the advice.

That's great news! Well done!

well done you

You have done so well igggi have some and a for all your hard work