Supplementing with EBM

[belindarose]

Having a difficult (ish) start to breastfeeding. DS is 5 days old today. He'd lost 9% of birthweight at 3 days so is being reweighed today.

I'm worried about his feeding. I'm waking him at least every two hours in the day (and he had one 3 hour sleep in the night). But he's not feeding for long when I do wake him, and would rather sleep.

He can only latch onto one breast at the moment so I'm expressing from the other. The one 'good' breast has either a wound or thrush (no symptoms in baby) so is excruciating at every feed. Positioning and latch has been improved since getting that - I think it was caused by desperation on the second night. Of course, the pain makes it so hard to encourage extra feeding as I'm so grateful when he comes off that I'd be happy for him to stay asleep! I'm doing as much as I can.

When he comes off the breast, still fussing and won't go back on, I'm assuming he's emptied that one so am offering whatever I've expressed from the other side.

I'd like to be forearmed with info about supplementing with own milk in case anyone tries to pressurise me into formula. Poos are too infrequent for my liking too.

Sorry if you're fed up reading my daily 'issues'. I've lost the local support I had with last DC. I had lots of problems with her too but did bf her for 20 months.

belindarose, 9 per cent loss of birthweight is within normal limits...fine for him to be weighed again today, and I hope the weight is reassuring. You would be looking for no more than a very slight further loss, and it may be that he is the same as he was at 3 days which is fine.

You don't say if you are holding him close/skin to skin between feeds - this is the easiest way of feeding frequently as you are less likely to have to wake him. He stirs and you are aware of the early feeding cues, and he is more likely to feed better then.

You need good, real life help to sort out the pain on the one side, and the non-latching on the other. Thrush would be highly unlikely at this stage and on one side only, and what you say about a 'wound' indicates some damage.

Your baby needs to be checked for tongue tie.

It's good to be expressing from the non-used side and yes, you can give this to your baby......but all this is a faff and getting to the root causes of the difficulties is the way forward.

Good luck today.

morning belinda, sorry you're having a tricky time. day 5 is just the worst in my experience.

a couple of things - first, 9% of birthweight is within normal, healthy limits for a newborn breastfed baby so there is no indication to reweigh, and I would argue that is causing more problems than it's solving. Is your baby weeing plenty? You say that poos are infrequent - how infrequent? is he very jaundiced? (some is normal). Was he a healthy, term baby? If yes and not jaundiced then your midwives are being overly anxious and unhelpful, and you could argue that he doesn't need to be reweighed because he is within normal limits as per WHO and NICE. and then tell them to bugger off. I'm finding that midwives are intervening at 9% more and more, when it's normal.

When did your milk come in? if it was only a day ago it may be taking him a while to catch up - there is a big difference between milk coming in on day 2 and day 5 where both those babies are weighed on day 5, hence the 10 % guideline, which you baby is, and i'm not sure if I've said this, WITHIN.

2 hourly feeds day and night is a lot for a woman with sore nipples, where there doesn't seem to be good cause. I would go back to demand feeding. because your baby is normal, and within normal ranges. did I mention that?

re the pain - if you think you've got thrush do get it treated as it will eventually go into the breast and cause horrendous pain or get to the babies mouth and then transfer to the other side. If it is the poor attachment then it may be painful still where there is trauma but should be less painful if the attachment has been fixed. Is the pain during or after a feed? thrush pain usually starts during and continues after a feed.

Has he been checked for tongue tie?

Is your milk supply good? when you do express and give him the ebm is he satisfied?

When he feeds do you hear long sucks and swallowing of the milk?

Are you doing lots (and i mean looooots) of skin to skin? if a baby won't feed from one side then continuous skin to skin can really help encourage them, as well as improving milk supply. I understand it's your 2nd child so you may not have the luxury of lounging around with your top off but if you have the support to enable you to do it then it can be very helpful.

Finally, if you do think your baby needs more milk (and if 9% loss is the only reason then I would argue that he doesn't - did I say that? :-) ) then he needs more breastmilk, not formula. Under no circumstances agree to give your baby formula unless a) you want to or b) he is very poorly and you cannot provide enough breastmilk. I consider the latter to be a very very rare case so unlikely to apply in your situation.

I consider over weighing of babies to be harmful, personally. I'm not sure if that came across.

nb I am a midwife and a breastfeeder.

HTH.

sorry, xposted

Thanks to both of you. I know I probably appear over anxious. I did/ do have antenatal depression/ anxiety so that's probably not helping hugely.

It's both the weight and poo that's making me worried about how muchilk he's getting. And also that I can't just swap sides. Poo is one in last 48 hours and that was dark green.

He can't feed from the left as the nipple is much more inverted than the right. DD never managed to feed from it, even when older, despite it producing lots of milk.

I'll try more skin to skin today. Sending DD and DH out for the morning.

Milk came in yesterday.

i misred that he was weighed at 3 days - i thought the 9% was at 5 days - why was he weighed at 3 days? anyway, your milk's only just come in so he needs a little while of that to start gaining weight properly. If it turns out he has lost more weight today which puts him over the 10% then continue topping up with ebm. ensure good latch, listen out for lots of deeps sucks and swallows. call la leche or bfn helplines for support, ask the mw if there are breastfeeding drop ins in your area. there should be! still remember at this stage he's normal. IIRC one of the reasons that routinely weighing babies at 3 days was stopped where I work was because so many seemed to have lost a lot of weight and it was causing too much intervention and anxiety with otherwise healthy babies, whereas a 5-7 day weight is a better indication of wellbeing. let us know what happens today.

apologies for getting my 3 and 5 days in a mix up. obviously too early on a sunday for me. I still think the midwives are causing you anxiety over what could be nothing.

whatin, wouldn't you say there are reasons, sometimes, to weigh at 3 days, and the OP does not say this was done 'routinely'.

The jury is still out on the 'best' time to weigh in the early days and if weighing is causing 'too much' intervention, then this is a training issue for midwives, who should learn to put the weight in context, and judge with other factors if intervention is needed. I agree - there can be a tendency to over-react and mothers then get worried, but that doesn't have to be the case.

Babies should not lose a lot of weight by 3 days - but if they have, then it's early enough for the bf to be improved before a crisis.

OP - hope the m'w visit helps you today.

Hi Tiktok. I'm just not sure it's helpful in a term, healthy neonate (and I know i'm assuming that's what were talking about here). yes, of course there may be problems but we can see that and sort them out without weighing. we can diagnose whether feeding is going well by taking the time to observe a baby and a whole feed and listen to its mother. I think we'd serve women better by spending more time helping with feeding and less time getting the scales out.

so in this case the op who is an experienced mother could have (and i'm sure did) tell the midwives that she was worried about poos, very sore, and could only feed from one side. If (and I know i don't know exactly what happened) their response was to weigh the baby then that's not good enough imo because what they should have done was help with the feeding. They don't need to see what the baby weighs to see that there's help that can be given to make things better. Without proper feeding support, all weighing does is increase a mother's sense of failure, or at least anxiety, and so undermine breastfeeding.

I'll probably regret saying this, but I'm not aware of any evidence that supports early weighing. But I haven't even looked as I've just walked in the door so do put me right if I'm wrong.

obv I have no idea what those midwives actually said, maybe they were amazing. Did they come back, OP?

Interesting to hear your points of view. Thank you.

Same midwife weighed him again today, same scales. He's back up to only 2% less than his birthweight.

If he hadn't been weighed on day 3 (and deemed to require reweighing, which I may have perceived as some kind of test), I may not have been so anxious about that particular issue over the two days. However, it may have been that it prompted me to feed as much as possible and therefore may have prevented further problems. I don't know if I'm making sense!

Anyway, he appears to be perfectly fine so I shall try to just enjoy his loveliness for a while. Thanks again for your interest and advice.

Just to add. I don't know why they weighed on day 3, but it might have been because I expressed my own concerns. I think it was routine though as he was accidentally also weighed on day 2, due to the midwife thinking it was day 3!

I've had extra visits because of the risk of PND, so maybe they're trying to provide extra reassurance.

hoorah, and I'm so glad he's thriving. I do see what you mean about how lots of feeding helped, but a little bit of me wonders whether, had he not been weighed, you would have demand fed, had a baby that was a bit more than 2 but not more than 10% below his bw today and been less anxious and less tired! aaaaaaanyway, hopefully you can now get on with enjoying your bundle, and well done for making such good milk. you are obviously marvellous. x

oh, just realised I completely repeated what you said. sorry.

Fab !
Congratulations on your new baby, belindarose

Glad breastfeeding is settling down well - wonder whether there's been a bit much weighing and re-weighing going on - but good to look after our precious bundles in their first few days I guess !

Hope things continue to go from strength to strength ! - some flowers for you

Yes, "enjoy his loveliness for a while"

whatin, sorry, there is quite a bunch of research to support weighing at day 3 :) but there is prob room for discussion; NICE guidelines recommend weighing day 5 ("Babies should be weighed naked at birth, 5 and 10 days as part of assessment of feeding" www.nice.org.uk/nicemedia/pdf/PH011guidance.pdf. There are a number of studies which indicate a weighing at day 3 is beneficial - some of the neonatal hypernatraemic dehydration stuff gives very powerful evidence that early weighing would be useful (www.ncbi.nlm.nih.gov/pubmed/17475691 shows the results of a study that weighed babies 72-96 hours, and showed longer breastfeeding with this policy).

But of course what should be avoided is weighing without it being put into context - all the other stuff you mention should be part of the picture.

belindarose, sounds like things are going much better for you. I don't think they were wrong to weigh your baby on day 3 and 5, personally - as you say, it focussed your attention on feeding him often, but I hope you were also given help with positioning and attachment so it's all comfortable for you.

tiktok, why sorry? It's always good to learn something new. that's so interesting. those breastfeeding rates are really something, and surprising to me. I'd like to know the background. paediatric practice being what it is where I work, babies referred in to hosp with weight loss or similar always seem to come out bottle feeding. Perhaps that informs my practice, so of course it's good to look at the evidence.

whatin, if the babies where you are, are getting referred back to hospital with serious weight loss (actually, dehydration) and are coming out bottle feeding, then I would say that is a very powerful case for early weighing....clearly, the care you are giving mothers (observing feeds, listening to the mother, assessing the whole thing without the scales) is not replicated by your colleagues, and babies lose weight because of ineffective feeding that no one has spotted.

As a breastfeeding counsellor, I come across the occasional mother who has been told everything is fine, and then there is a panic on day 5,6,7 when the baby is clearly ill. Usually, the mother has been told all is well - but closer questioning and careful observation of the feeds would have indicated things were not going well at all.

Weighing early on can spot problems before they become serious, and give time for the mother and baby to feed better. It's also a safety net for midwives who may not yet have the skills (or the time) to observe and assess breastfeeding.

I don't know a huge amount about this weighing issue, but iirc my two weren't weighed again after birth for several days by which time they'd both put on a bit of weight - which was obviously encouraging (as was BFing). I think one HV even said they don't like to weigh them too quickly as they do tend to lose a bit of their birth-weight during first few days. I guess if that was fully taken on board and understood by everyone then weighing earlier need not be discouraging even where weight has dropped slightly from birth.

Point is, juggling, that if a baby loses a lot of weight at first, it's an indication that feeding may not be as effective as it should be.

Done properly, by HCPs who understand what they are looking for and how to fix anything that might indicate a problem, it should be fine.

tiktok yes, we have a huge problem where women are being told, often on the ward , that the baby is feeding well, but on observation is clearly not feeding well at all. It's a bf training issue as far as i am concerned, which we are as a unit addressing now. Almost always women report that a midwife (or nursery nurse, or hca) leant over and said 'yep, that looks ok' or similar. there's little proper observation of feeds, particularly to observe a FULL feed.

When babies are admitted the first line of intervention is almost always to formula feed. i work on the border of 2 trusts - one baby friendly, one not, and the baby friendly usually discharges babies in similar situations breastfeeding, the other one they are usually bottlefeeding.

I can see how the case can be made for early weighing in one sense, to identify problems early, but I would argue that we would be better sorting out the feeding support rather than changing weighing policy, which would be adapting ourselves to cope with existing poor practice. I do also feel that although it may spot problems early, it may also see problems where there are none, and undermine feeding unecessarily. Again that goes back to good training.

It also highlights how important ward midwives and staff are to the breastfeeding journey. Often much of our time is spent correcting what's happened on the ward, where midwives are often busiest, often agency midwives (so training patchy and inconsistent, although some are great), and where the emphasis is on bed management rather than anything else. I am lucky to work in a team where it's considered absolutely fine to spend 2 hours with a woman to support feeding, and indeed to return multiple times in one day to help if necessary. We are a very very busy and understaffed maternity unit. It's just considered important (in my team, not the unit as a whole) so we get away with it. my manager doubles up as the infant feeding coordinator so that helps :)

Juggling, interesting to hear your viewpoint. i know of one area where babies are weighed at birth and and 10 days only. I don't feel hugely comfortable with that as it goes against most guidelines I have read, and it's a London trust so I wonder if staffing is a lot of the issue.