Not sure i'm producing enough milk, my son not gaining weight. Very confused..

[Freyathecatt]

My son is 3 weeks old today and is ebf. He lost approx 10% of his birth weight in the days after his birth and is yet to regain all that he lost. Last week he regained 150g in 5 days (great) but in the following 5 days only regained 20g.

He goes through days of cluster feeding where he will literally feed all day and night non stop, bar an hour or two's sleep. He just goes from boob to boob and cries and roots if he is denied breast when he wants it. Then the next day he will feed for 30-40 mins one boob and then sleep for 3-4 hours. I think he is comfort sucking so we have introduced a dummy to pacify him.

The midwife has advised that i express milk and top him up with breastmilk, if i have it, otherwise formula.

Other matters i think have bearing -

i had a breast reduction 2 years ago so wonder whether that has had an impact on my ability to produce sufficient milk.

He is pooing and weeing normally, he's done 4 poos since 6am today.

This may not be the most coherent post but i'm so confused about what is going on and what i should do. Any advice/guidance would be wonderful.

Thanks

My advice to you would be to allow him completely unrestricted access to your breasts. Babies suck to make sure there's enough milk there for next time. That's how it works, sucking makes milk. Using dummies and top ups will just reduce your milk supply. Reduced sucking means reduced milk, it's as simple as that.

His erratic feeding pattern is normal for a three week old, at three weeks old it's very early days in establishing feeding and your milk supply. I don't understand the advice to express milk. Your baby is much better at getting milk out of your breasts than expressing will. If he's wanting to suck allow him to do that. The stimulation of your breasts will really get your milk flowing. I doubt very much that your surgery will have impacted, as you are evidently producing milk ok. If he's pooing and weeing normally, that's a good sign.

Make sure you look after yourself. Eat three healthy meals a day, with some snacks in between. Drink plenty of water and make sure you rest when your baby takes a nap. These early days in breastfeeding can seem very hard, but it's worth it as once everything gets established thing get easier. There's nothing easier later on, when you're faced with feeding day and night, than being able to pop your child on the boob rather than having to sterilise endless bottles and make up feeds.

Definitely stop the dummy. Maybe he is comfort sucking - at three weeks old though is that so terrible? And he may not be. It's such early days that your supply is still being established. Agree with the advice to allow completely unrestricted feeding. DVD box sets, cake healthy sndvks and lots of water are your friend. I sympathise as I have 2 week old dd and she also feeds almost constantly at times, but she is dc2 and I know that this too shall pass and things will settle. Just put your feet up, see feeding as your main job now - more than housework or anything else - and let him do his own thing. Avoid formula if you possibly can as it's such early days that this may well compromise your supply.

A breast reduction can certainly dramatically affect yor ability to have enough milk - it depends how skilled your surgeon was in preserving your ducts.

Was it the classic anchor reduction you had?

I've also had a reduction. My dd is ebf. She is my second DC. DS had to be mix fed for a while - both my children have tongue and lip ties, and DS's was missed. He couldn't stimulate my milk supply, which was perilous due to the reduction anyway, and he was generally not arsed with feeding, so it was generally just a bad situation.

With dd I had already done all my research thanks to the horrible experience with DS losing weight and having to mix feed. Here are my tips:

Allow him unlimited access to the breast.

When he isn't at the breast, pump ten minutes on each side. If there is milk there, pump 10 mins after your last drop of milk.

Take yourself to bed and do nothing but feed, express, and sleep.

Try biological nurturing - this can aid in a better, deeper latch to increase milk transfer.

Do breast compressions.

Check for lip and tongue tie - don't trust someone else to do it for you. Look for Laurence kutlows presentation and check for yourself. Health professionals in the uk are woefully inadequate at identifying ties. As I said, both my children were badly tied. Both had the ties missed, by midwives and paediatricians at 2 different hospitals each. Luckily, second time round I had the confidence to say they we're talking shit and get it sorted.

How is your latch? Are your nipples sore at all? Are his poos nice and yellowy?

If you need any more help/advice regarding feeding after a reduction, feel free to pm me. Dd is now 16 weeks old and has never had a drop of formula. :)

(Also, there is a growth spurt around now that you may be in, accounting for the cluster feeds).

Oh, and if all else fails - research and print jack newmans protocol on domperidone usage for increasing milk supply and get yourself down the doctors. I used this with my DS, and was able to move from mix feeding to ebf thanks to it. DO NOT be fobbed off. It is a safe drug, and it works.

Also worth trying before hand are fenugreek, blessed thistle, goats rue and anything oat based.

Hi

Thanks very much for your responses, i fully intend to keep offering him te breast as much as possible because i really want to bf, i enjoy it and i know he benefits from it. Having said that, sometimes a dummy is the only respite i get- he doesn't seem to like going for walks in his pram, hates car journeys and squawks if he goes in the sling, unless he's virtually out. The dummy is all that allows me to get out!

To date he has had totally unrestricted access to the breast, but still isn't gaining as the health professionals would like, hence the advice to express, as much to check how much i'm producing as well as to top him up.

Did have a go at expressing last night and managed 1 oz (woohoo?!). Gave this to him as a top up after the breast and he passed out and slept for 5 hours (he had only slept 3 hours during the day due to today being one of his needy days). He's just had a 30 min fed and has gone back to sleep.

I did have the classic anchor reduction, 500g from each breast!

I have tried breast compressions but i think i must be doing them wrong because i dont see any increase in his gulping. Having said that manual expression only gets a trickle rather than a squirt out of me so that may have an impact?

Thanks for the other tips, shall definitely be looking into those. Have some fenugreeek so shall start that today. I'm also going to a breast feeding drop in today to make sure my latch and positioning are correct. I know he likes to 're-do' the latch mid feed which has led to a sore lft nipple.

3 lovely big mustard coloured poos yesterday and one 'farty poo' as i call them.

I'm basically willing to try anything to get this sorted. Your advice so far is really very much appreciated.

He is gaining weight and I wonder if it was a supply issue he wouldn't gain a lot in one week, then not so much the next. (which can be a totally normal pattern for weight gain BTW and is why once birth weight is regained it's not suggested to weigh more than monthly)

Obviously a reduction can cause supply problems, but it doesn't always and even knowing that I think it sounds like there is a possible tongue tie/latch problem.

Can you speak to a lactation consultant at all? (Milk Matters is one way to find one and they could check for and snip or recommend someone to snip a tongue tie if there is one) Or perhaps your hospital has a supportive feeding advisor/BF counsellor? I think more specialist help than a midwife or health visitor would be good here.

Certainly 1oz is an average amount to be able to express, but expressing is never going to be able check how much milk you are producing or give any real indication of it.

How did you get on at the drop in freya?

Hello all

The drop in was really useful. My latch was wrong, i was jamming my nipple into my son's mouth rather than bringing his head to my nipple. I'm trying to correct this, however my son doesn't really like a good deep latch and readjusts every time! A battle of wills has commenced which at the last feeding actually ended in him squawking and pushing me away! (I may be in trouble!!).

They also referred me to a couple of good American websites authored by a lactation consultant specifically for women who have had breast surgery. I found them quite helpful so that was also very useful.

He has gained 20g a day since the last midwife visit so while he's not back at his birthweight, everyone is ok with his progress, his poos are lovely (when he forces them out-wind issues) and lots of wees.

Fingers crossed we'll perfect the latch shortly and he'll continue to go from strength to strength. Thanks very much for your advice and support ladies.

Has your son been checked for tongue tie by someone who really, really knows what they're looking for (e.g., a lactation consultant with specialism in this area?) DS's was missed repeatedly - it was a posterior one. They aren't uncommon.

If there is anything like clicking or slipping off the breast, then this could be an indicator of TT. Sounds like he's heading in the right direction though. 5oz a week is not bad going.

Whoever told you to express to see how much you were producing doesn't know much about breastfeeding, as this is not a good way of estimating supply. Some women can express nothing and still feed their babies perfectly well.