Concerned about formula top-ups

[MamaMary]

My friend is breastfeeding her newborn but when he lost 12% of his body weight (was a big 9 + pounder at birth) was told by the MW to top-up every feed with formula. She is doing this. What do you think of this advice? surely it's normal for a baby to lose that babyweight, and using formula will just compromise her milk supply?

That sounds entirely sensible. Don't tell her she's doing the wrong thing - I don't think sharing your opinion would be welcome.

No, I said nothing. I was not going to contradict the MW's advice - but she is struggling with supply and I was just concerned this won't help.

MamaMary, 12 per cent loss of weight is usually considered to be a sign feeding is not as effective as it should be. The usual 'cut off' is 10 per cent. Sometimes, with a bigger baby, or with a baby who is clearly feeding well after a slow start, it's not something that needs to be fixed, but more usually, the response of the midwife should be to fix the lack of milk super-quick; newborns need to feed, obviously, and too much weight loss can mean the baby can become seriously ill (dehydrated, low blood sugar).

In some circumstances, formula is needed while at the same time working on the breastfeeding, so the mother's choice to breastfeed is supported, so she can drop the formula once the baby's weight and health are normal. It does not have to mean the end of bf.

You can't really tell what's going on - maybe this baby was seriously compromised and the midwife reckoned top ups at every feed were needed. On the other hand, maybe a smaller amount of formula (ie not at every feed) would be sufficient.

Whatever....your friend also needs to have been given support and info on protecting her milk supply through this crisis, if she plans on returning to full bf. Maybe you can tactfully ask if she has been given this sort of support alongside the advice to top up.

topping up at every feed isn't going to help supply.

Depending on your relationship I would probably say something like. "gosh that sounds like a tricky situation have you thought about calling NCT/ABM/LLL to get some more information about returning to EBF"
Or
"It's great your midwife is supporting you has she been able to talk to you about cutting down top ups so you can return to EBF if you want to"

And it goes with out saying both of those work best with a cup of tea/slice of cake and possibly chucking the washing on and popping a homemade dinner in the freezer.

Tiktok, thanks for that. It sounds like she has been correctly advised - that's good. I know she really wants to bf this baby. I'll try to support her in any way I can, but I have little expertise or experience (I was in the fortunate position of my baby putting on lots of weight from b-feeding right from the start).

Any experience I do have of friends in this situation is that they always seem to end up exclusively formula feeding in quite a short period of time. However, not wanting to second-guess, I wonder if they are quite happy to f-feed and to have an 'excuse' to give up b-feeding. This seems quite common where I live.

MamaMary - topping up at every feed will certainly reduce her milk, no doubt about that. So the midwife does need to have explained to her that her supply needs protecting - and that prob involves frequent feeding; midwife should have observed a feed to ensure the baby is transferring milk; she might have to express if the baby is not yet transferring milk well; mouth should have been looked at to check for hidden cleft/tongue tie/other oral problem; other techniques eg switch nursing, breast compression; plus a plan to make sure the topping up is reduced as soon as poss.

It's very hard work to top up, to breastfeed, to express - prob the hardest way to feed a baby. But it may only need to last a short time :)

Yeah - I had this experience. Really big DS (10lb plus) lost a load of weight and the paediatrician (we are abroad) told me to top up. I did a mixture of formula top ups, and expressing and giving expressed milk top ups too.

I didn't get on very well with expressing, but did a bit, and hated giving formula top ups, but did, and after about 3 weeks or so he was clearly growing fast and I stopped doing all the top ups.

OK in the end.

If she does need to continue the top ups all the time, whats the disaster? Her baby is still getting the benefits of breast feeding. And its better than baby getting hospitalised for poor weight gain - or just watching the weight loss continue.

niggle the point is that top-ups risk taking away her choice to breastfeed. Her baby will not continue to get any benefits of breastfeeding if breastfeeding ceases because milk production has ceased.....

The baby may need some formula at present, to prevent the poor weight gain that could end up in hospital, but the plan should be to stop them, if the mother wants to continue bf - and the OP says she does.

That's how bf works.

Thanks all for your advice. :)