Advice for my lovely friend

[threelittlebabies]

My friend delivered her daughter on Wednesday and is having a bit of a time of it. She was induced at 40+2, and delivered normally, then had retained placenta AND a fairly serious pph. Quite understandably she is knackered.
Came home Sat, and community midwife came round yesterday and weighed baby, which I thought wasn't done until 10 days. She said baby has lost a pound in weight and needs to be topped up with formula!!
Obviously said friend is trying to breastfeed, but has been discharged without help or feeding being established. She is under the impression that she has no milk, because baby is screaming for most of the night, and also because she is low in iron due to the pph. I do not think this is the case, but realise that it's easy for me to say and less easy for her to believe.
Any advice, general ideas gratefully accepted. Have told her dh (she was too tired to talk) that to establish milk supply she should just take to her bed and feed on demand. Thought milk may not have come in yet? Also thought that a pound wasn't too bad at this stage, and for a breast fed baby.

threelittlebabies - there is nothing wrong with weighing, and in fact it is helpful, as long as the person weighing the baby does it accurately and with knowledge of how to support breastfeeding.

If this baby has lost a pound by day 4 (presuming the baby wasn't a whopper to start with and weighed an average amount) then something needs to be done pronto....this shows feeding is not going well. A pound is a lot of weight, and needs to be taken seriously. There may be other stuff going on here, and if the midwife has said give formula maybe she is concerned about the baby's immediate health....OTOH, the fact your pal has not been helped with any info about bf may mean the midwife just doesn't know how to help.

Your friend needs help to fix the breastfeeding as soon as possible - if the baby is screaming all night then she needs to feed him all night as a response - hard, exhausting, and she needs support and the chance to catch up on sleep at other times, but a screaming baby may well be screaming to feed.

The baby should be held close, skin to skin, for as much of 24 hours as possible, with plenty of opportunity to feed as and when she wants.

If there is any chance of retained placenta, this could well affect milk supply, too...needs checking out.

Keep us posted.....your friend or her dh can call any of the helplines, too.

This is actually a serious situation. It's good you are involved.

Ask your friend about wees and poos, too.

Baby is expected to lose 10% of bw IIRC, and by day 10 should be back up around bw, but ime within this time, an allowance should be made. An error was made with my friend on discharge and mws were v concerned, almost had her on formula but her dh made them check, all was fine. Milk should come in around day3/4 as you say. Otherwise I reckon you're giving her great support, good for you.

tiktok- re a pound being worrying, also a little that I thought midwife was wrong and being unhelpful.

Baby weighed 8lb 2oz at birth. A mutual friend's baby had lost 13oz by day 3, so felt a bit reassured by that. Interesting that retained placenta could have affected milk supply- though they did remove it all in theatre. She has had a v stressful pregnancy and birth for many reasons, maybe that's not helping.

Thanks as always for your advice, and again at my ignorance.

brambalina- thanks for reply. Hope I am doing the right thing by advising her to continue breastfeeding. Got the idea she is feeling too weary to carry on, just wish I could speed up time for her to the part where it gets easier!

Hi threelittlebabies,
Your friend is lucky to have somebody worrying about her, it is so hard when you have just had a baby, you forget all about being rational.
I had dd2 at the end of January and really found it hard to breastfeed, I was just constantly tired.
The other thing to check, is your friend eating and drinking well. My milk supply went really low after a few weeks and I couldn't work out why. Then all of a sudden it dawned on me that I had not been looking after myself properly. As soon as I drank around 4-6 pints of water/squash and ate really well my milk came flooding back in. Sometimes it's just the little things.
I also tried to feed my daughter every 3 hours during the day which helped, as I was waking her up, rather than her crying to be fed.

There are some really good helplines, I found the best was the Breastfeeding Network, www.breasfeedingnetwork.co.uk

Hope she feels better soon, and keep up the support. :)

Hmmm...babies who are breastfeeding well do not lose 10 per cent, though I know some maternity units and some midwives still have this as a rule of thumb. This paper - Livingstone VH et al (2000) Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. CMAJ 162 (5): 647-52 - which is on the web in pdf form is just one study that indicates 10 per cent is outside the acceptable range. Your friend's baby has lost more than 14 per cent - this is potentially dangerous, sorry to sound dramatic.

This isn't to say that babies who lose 10 per cent are doomed not to breastfeed - not at all. But if a baby loses as much as this, or worse, more, then it's a clear sign something needs to be done to fix the breastfeeding, and quick.

Bramblina is right to think of error - I have seen this happen several times. The birthweight has been recorded wrongly, or mistranslated to imperial from metric. Another error is taking weights done with a spring balance scale, or with the baby clothed, and then expecting them to be accurate.

threelittlebabies, it's great you are supporting her, but I can't be sure whether this baby needs formula or not....you haven't seen what the midwife has seen. If the baby is already dehydrated and poorly, and if the mother is not managing to bf effectively, then it may be the baby does need something else. Of course even if the baby does need something else, bf should continue and it should be supported and helped to work better. My point is that saying this baby really doesn't need anything but breastmilk, while leaving the breastfeeding 'unfixed', may not be a safe approach.

A baby who has lost this much weight already is showing that breastfeeding has not gone well right from day one...so she has been unsupported in hospital, too.

is there a La Leche group, or similar, near her that she could go to?

Glow, this baby is only 6 days old....I don't think her num's gonna be up to going to meetings yet, though it will be good to do it later.

I'd rather she just stayed in the house and got support and encouragement to feed a lot :)

num=mum

:)

only 6 days old...why dont I think before I type

My public health nurse was, previously, a lactation midwife. She used to come out to see me everyday to make sure I was feeding the baby properly (I wasnt for the first week as the hospital staff were worse than useless). Her advice was invaluable.

I dont suppose there are any simialar people in UK? or is it just pot-luck with your HV?
I think it something along these lines I was thinking of when I suggested LL. I dont suppose tiktok could pop in and see her

Thanks everyone.

Eventually spoke to my friend, she says she has no milk when she tried to express, though did tell her baby will be more efficient at getting to it.

She says baby is noticeably thinner now, weeing but not pooing so she is putting her to the breast and then giving formula when she conks out- she also is jaundiced. Poor lamb, so much going on.

Don't know what you think of this tiktok, but my friend is convinced that she has no milk because she lost all her hormones through her massive pph, and the blood she was transfused doesn't have them?! She seemed pretty adament about this, so maybe a midwife has told her this?

She has also hired an electric breast pump to help increase supply. In short she is probably doing everything possible (also skin to skin, eating and drinking well herself, everything you suggested) to help establish feeding, so thank you once again for your help.

That's sad, threelittlebabies.....it's good she is expressing (and I don't agree that the pump might be worse than the baby at getting the milk out - an ineffectively, sleepy, jaundiced baby may not be good at all) but she really has to do it often enough to build up a supply. She needs to express at least 8 times a day inc at night, otherwise it just won't happen.....:( Expressing when she gets round to it isn't enough.

I would be very worried about the baby not pooing and the fact the baby looks thin. From what you say, this baby does need formula at this stage, because for whatever reason, breastfeeding just isn't working.

Now, why is it not working? The pph will certainly have slowed things down, so a mother with a pph may well find her milk comes in later. Delayed milk production is a known effect of pph and your frind's was certainly serious. There is a rare condition called Sheehan's syndrome which is actually caused by pph - it affects the pituitary gland (which drives milk supply) and low milk production is the result. This is, I stress, very rare, and I have only ever read about it, and not come across anyone who had it.

I am not a medic, and I don't know if it is correct that it's the loss of hormones that causes the milk problem (and the replacement blood not having the hormones exacerbating it) but actually, it sounds plausible. That would only cause delay in the milk coming in, not wipe it out, though, and the literature suggests that if your friend continues to express often, and to put the baby to the breast, things will start to happen after 1-2 weeks.

This mother and her baby are not well. It sounds from what you say that she is doing her very best and that she has got some good medical and midwifery support - breastfeeding is obviously under threat here, but it can be saved. Immediate concern is ensuring the baby is fed, however this happens.

Hope she feels better soon.

Thanks tiktok, forgot to say she also has a protein deficiency, for which she has been taking clexane injections long term (her words so not sure about what that entails). She is expressing as often as you suggest. I am bemused, as with both my children I had a pph and was able to breast feed, though more successfully with the smaller pph IYSWIM.

Thanks again

clexane is an anti-clotting substance, works on the blood. I don't know if it would have any effect on breastmilk production.

It seems to be the case that the worse the pph, the greater the effect on bf, at least initially.

I really hope someone is looking after her at home, so she doesn't have to do anything but feed, express, cuddle....

She has her husband there, I suggested he be up in the night when baby won't sleep, and mayeb let her get some sleep in the day too, but she said they both have to be up- her to feed then express, him to get bottle ready then take over feeding! Think they are overwhelmed by the sheer hard work of it, is their first living child that they have got to bring home and care for.

TLB, wish I had someone like you around when I brought dd home although dh was very, very good. The breastfeeding thing is hard at the beginning and I had no friends who'd done it. Didn't find the hospital staff helpful about it either, one nusre had dd in hsyterics one night trying to get her to latch on and when I was leaving they gave me some small bottle of SMA with the sterile disposable teats 'just in case'.DD lost weight and was slightly jaundice but once milk came through she thrived. I hope it gets easier for your friend and that when it's all running smootly they can sit back and enjoy their new addition.

TLB, I lost quite a bit of blood during birth, had a jaundiced baby and mixed fed at the beginning too, but with patience and loads of expressing we were onto exclusive bf by 4 weeks. It can be done! She should continue to put her dd to her breast at every feeding, i.e. before the bottle of ebm (when she - hopefully soon - gets some)/formula. Has she got a sling? If she needs to move around the house, she could put dd naked apart from a nappy into it and wrap a shawl around dd and herself. But at this stage itz would be best for her to lounge in bed with her dd, sleep and feed, feed, feed (and, of course, express). Is there anyone available who could check her latch and so on?
dh and I did 'teamwork' too at the beginning with the night feeds - dh was never up for long at a time, though, as he would just get the bottle sorted, so could take over domestic stuff in the day. I'm sure they would both appreciate it if you could pop round with some food for the freezer and do a bit of hoovering, though!

Oh, another thing - when she gets to the stage of having enough ebm to feed with, the benefits of bm are at their best if ebm and formula are not given at one and the same feed. She should collect enough ebm to make a complete feed and give formula at the feeds when/if she hasn't expressed enough.

Just to update everyone who replied and gave advice, spoke to my friend yesterday. Baby is 2.5 weeks old and now weighs in at 8lb 12oz. She said that she managed to get through Fri night just breastfeeding so is cutting down on the formula now things seem to be working for them. Good news, hey! Am seeing her for first time on Tuesday, can't wait

Thanks again for all your advice