2 week old not gaining much weight, mw says feed LESS often?

[MrsPennyapple]

I'm confused by advice given by midwife today.

DS is 15 days old, he took to bf like a duck to water, no problem with latch, no nipple pain - bf is a dream compared to what it was like with DD, which was a huge struggle.

During the day I've been following his cues, and feeding on demand. (Cues include rooting, sucking his fists, trying to latch on to my face or any bit of my skin he happens to be near.) This means he has been feeding roughly every hour. But, he falls asleep on the breast a lot, normally after only 10-15 min feeding. If he then wakes up and still seems hungry, I put him back on the same side, to try and get the hindmilk into him, but if it feels like that side is empty, I put him on the other side.

At night he sleeps brilliantly - does a four hour stretch, wakes for a feed, then goes off again for another couple of hours, which is brilliant.

So today, the midwife said he isn't gaining as much weight as he should be, and suggested formula top-ups, which I don't want to do. She also said I should stretch his feeds out to every 3 hours in the daytime, but that his night-time routine is fine. (Contradicting the HV who was here on Wednesday and said I should wake him in the night for extra feeds.)

Mw said that when feeding hourly, he is not getting any hindmilk, which sort of makes sense. But if I only feed him every 3 hours, and he still feeds for only 10-15 min, he's going to be getting considerably less milk than if he feeds every hour.

When I had problems feeding DD I read everything the internet had to say about bf (including Kellymom which I know is a great resource) and got in touch with La Leche League, as well as the local bf peer support service, who I'm still in touch with. Everything else seems to suggest that the more you feed, the better, so I'm surprised by mw's advice to feed LESS often.

This has really knocked my confidence, I thought we were doing so well. I don't know what to do for the best.

I'm no expert but it sounds to me that you are doing brilliantly. My babies were both sleepy like yours and my wonderful midwife showed me how to stroke down the side of their jaw to keep them suckling through sleeping, or to tickle their feet just to rouse them enough to keep going a bit longer. It worked for us. Your midwife, frankly, sounds crap. Ignore her and carry on just as you are, follow your own instincts. Well done and congratulations.

Hi Mrs Pennyapple
I don't normally post but I couldn't not reply to your post.
Congratulations on your baby son and well done for getting this far with feeding. Sorry to hear you've lost confidence with some of the conflicting advice you've been given.
Your instincts re feeding often are right- your milk supply (which at this early stage is still being established) will suffer if you limit feeds and supplement with ff.
It sounds as if you've located great sources of bfdeeding info- particularly la lechce and kellymom.
Have you heard of switch feeding? This is where you feed your baby on one boob until he seems to lose interest/ get sleepy and the minute this happens you switch to the other boob, feed until he gets sleepy etc and switch again and keep switching until he doesn't want anymore.
It sounds counter-intuitive to the whole hi milk/fore milk issue but is a really good way to get the calories in and get the whole milk transfer relationship revved up. You wouldn't have to do this for all feeds. Is he getting 6-8 good feeds in over a 24hr period? This should be ur minimum number of feeds. The probable reason ur Hv advised u to wake at night for an extra feed is that prolactin(hormone which makes milk) is higher at night.
You don't say how much he lost and if he was jaundiced or how much he weighed at birth so I can't give totally specific advice but I would suggest you spoke to la lechce soon Esp if there is a group near you. Kelly mom will have info about switch feeding.
Is he settled at some periods during the day? And what colour is his poo? Canary yellow poo tells u the balance of hind/fore milk ok- spinach coloured poo might mean u need a tweak on ur latch positioning but no pain is good news.
Am sure someone who knows more than me will be along soon.
Good luck and well done! Sounds like you're listening to your lovely baby and using ur instincts which is always great!!

Your midwife sounds really confused about hindmilk. Hindmilk just means the fattier milk, which you get from an emptier breast, so actually frequent feeding on each breast does mean the baby gets hindmilk (the milk from a full breast has more water in it - foremilk).

The only thing I would do slightly differently to you is to stop putting him back on the same side when he falls asleep - once he's finished the first side, put him on the second side.

Speak to LLL and your breastfeeding counsellor, I think your midwife is talking crap.

At that age my two both fed for that long and hourly, they have tiny tummies and get tired quickly. He is gaining, just slowly, if anything add an extra dream feed in during the night to top him up . He may also be on a growth spurt, there is one around the 2-3 week mark.

You've already mentioned Kellymom, so you've probably already seen this page on feeding newborns but if not recently, it might be worth another look. It sounds like you already know about local BF support, could you get in touch with them again?

Congrats on your gorgeous baby. Sounds like you are doing great. I second switch feeding mentioned above. It really helped us. In fact I has forgotten all about it until I read this. DS is only 15mo - gosh how time flies!!
I am surprised by your MWs advice tbh..... the whole hind vs fore milk debate was supposed to have been binned. MWs were supposed to have been reeducated ..... Ie finish the first breast before offering the 2nd, even if it takes ages to finish the first.
Switch feeding helps as the act of swapping breasts frequently keeps baby awake for longer. Also they will get multiple let downs which makes it easier for them to get the milk.

Worth a go anyway. Along with getting support from your HV, going to the next LLL meeting near you and maybe getting a qualified LC to come round to give you moral support?

Whatever you do Try to avoid that mW. She sounds terrible - dangerous even. Spacing out feeds and toppings up with ff will surely decrease supply?
Once you are on an even keel perhaps you can complain about her to your local health trust? Before she ruins many other families chance of successfully bf......

I guess the point she is making is that if you leave it a bit longer the baby will be hungrier and want more. i did that last time as dd wasn't having any proper feeds (or latching properly as it turned out so there were bigger issues). id never leave more than 2 hours from start to start with that approach anyway.

maybe the only change I'd make is introduce at least one more feed in the night. but you dont say what weight and what loss/gain you are looking at.

Hi everyone, and thank you for the congratulations, and for so many lovely supportive replies. To answer a few questions, his weight has been as follows:

Birth: 3750g
Day 5: 3500g
Day 9: 3540g
Day 15: 3580g

MW said she would expect 30g per day weight gain, so 40g over 6 days looks pretty bad :(

His poo is a mustardy orange-y colour, and he is producing lots of dirty nappies. In fact, DH has queried whether the quantity is normal - I think it is, sometimes there is loads of poo, other times only a tiny bit, so it's not like he is pooing loads all the time. (DD was always a once-a-day kind of girl. I much preferred that arrangement!) DS does have a very windy bottom though, not sure if that's relevant. He doesn't burp much (although I wind him after every feed he doesn't normally bring any wind up) and has only been sick 3 times in total. I know he is getting milk as when he falls asleep, he has some in his mouth which he then dribbles down me.

I will try switch feeding and see if I can keep him interested for longer. I don't think he normally empties the breast though, which is why I was putting him back on the same side if he hadn't fed for long. He had a feed just now, fed for about 15 min and dozed off, so I put him on the other side and he latched on, but didn't feed.

Thanks again for the advice everyone, keep it coming.

Incidentally, I did space his feeds out after seeing the mw yesterday, before I posted here. During the night he fed at 8pm, midnight, 3.30am and 6am. That's probably the most times he has woken in the night. Co-incidence, or making up for fewer feeds in the daytime?

Did you see someone qualified eg from the LLL? It can never hurt to get your latch checked and make sure he is transferring milk as well as he can be.

This is a good article about weight gain. You can also ask on her FB page and you'll get some good advice.

Thanks for the link Thisis, some good video clips on there. I had seen a couple before, but definitely worth watching again. I am satisfied that he is getting milk when he feeds, and I can tell when he changes to just sucking, rather than actually feeding.

To be honest I didn't really get on with the LLL approach, they seemed a bit full-on for me. I went to a couple of meetings (when I had DD) but no one checked my latch. It was the peer support lady, who I am still in touch with, who helped me get that right. I haven't seen her since DS was born but hope to meet up with her soon so will get her to check my latch. I think it is ok, but it couldn't hurt to check.

I just don't want a repeat of how things were with DD, I was convinced we had every problem in the book, but we really didn't, she was just a hungry baby. I don't want to start obsessing, clock watching, etc, when just a couple of days ago I was happy and confident with it.

No of course you don't. But I know the Analytical Armadillo author always says - and she is about as expert as you can get - that if you are doing everything right (which you are) but with weight gain not as expected then there is ALWAYS a reason for it whether a sneaky tongue tie, poor latch etc even if it looks ok on the surface.

I'd just echo what the others says about swapping sides often, whether the fore or hind milk, they have the same amount of calories and calories are what you want to get into your LO at the moment.

Also are you doing breast compressions? They are helpful. Have you looked at cranial osteopathy?

I wouldn't worry about emptying a breast - the breast never empties anyway. It's fine to just follow your baby's cues.

This is a good article explaining what hindmilk is, and when you should swap sides - www.analyticalarmadillo.co.uk/2010/07/foremilkhindmilk-and-lot-of-confusion.html

Switch feeding is a really good idea to help weight gain though.

Have gone back to feeding DS on demand today, which has been hourly, except for a couple of times when he has gone two hours. I have been swapping sides when he has started to doze off, so he has had some longer feeds - still 10-15 min per boob, but longer in total. I've tried to keep him feeding as long as I possibly can. Just hope it makes a difference.

I will see the mw again on Tuesday, so I will ask her to check my latch and ask about getting in touch with a lactation consultant. (HV did check latch but it was a quick glance.) I must confess I have no idea what cranial osteopathy is, but I have heard my peer support friend refer to it so will ask her about it.

I have been stressing about this all day, the more reading I do, the more confused I feel.

Hi mrs penny apple
Well done for keeping going! Think it's a really good idea to get your latch checked. Also, pls get your midwife to watch you feed from start to finish- if she just has a quick look as baby is already on she cannot tell if latch/positioning is fine.

She needs to be asking you lots of questions about your little one and how often he is feeding, his nappies, his skin and muscle tone, his alertness etc. it's not just a case of how much weight he has put on.
As others have said, would be worth asking her to look for a sneaky tongue tie.
And ask her to show you breast compression and it would definitely be worth you trying lots of skin to skin with your little one.
There is loads of info on this on Kelly mom and Internet.
Glad switch feeding has been okayish.
Also, if you have to supplement, the it doesn't have to be ff.
You could feed ebm if you wanted to and had the time to express after feeds. But if that's too stressful with new baby and your dd then don't worry.
Sorry to hear the LLL meetings weren't for you, but they do have a helpline staffed by highly trained counsellors ( or leaders as they call them) who can talk you through all these issues.
You're doing great! Keep going!
X

Just a quick update, mw came yesterday, a different one who was very sympathetic, and more knowledgeable about bf. She apologised that her colleague had left me so worried and made me doubt myself and my instincts. She also weighed DS and he had put on 120g in four days, hurray! He's only 50g away from regaining birth weight, so she has signed us over to HV team. Thanks for all your help and advice, it really helped when I was frantic with worry that my baby was quietly starving (when he was totally calm and contented!)

Fantastic! Well done for keeping your cool and going with your instincts.

Keep it up, sounds like you both are doing brilliantly.

That's great news Mrs Pennyapple was wondering how you were getting on. So glad you're feeling better and little doing so well.
Well done you!