hypernatraemic dehydration

[Monkeymonstermum]

Hi
Just wondering if anyone had an easier time second time round after a first baby with hypernatraemic dehydration?
Imminently due with baby number 2…and so thoughts are coming flooding back of the early days with baby number one – the worst of which I’d tried to forget about for as much as possible….
We had a fairly awful time with hypernatraemic dehydration - hospital admission (17%wt loss, acute renal failure), all HCPs clearly thought it must be my poor BF technique but had surprised voices saying ‘no – it looks ok’ when was observed….but basically my milk didn’t come in until day 6-7….. the Community MW had been asking about milk coming in and feeling uncomfortable…and I said I didn’t feel like much happening (but didn’t know as not done it before) but wasn’t followed up on. She asked about nappies, we said one yellow nappy - we weren’t asked again and didn’t realise significance but then turned back to black. We had awful nights – but just thought that’s what we’d signed up for as everyone says it’s tough to begin with….and the day time he was fairly happy with 3 hrly feeds pre admission…when he was examined on admission they didn’t think he was too bad….but then the medics were very shocked when his bloods came back at how poorly he was. 5 day admission later things were back on track and just a few top ups, lots of expressing and lots of filling me up with fluids worked – discharged BF.
In retrospect I think the contributory factors were that I had D&V for 48 hours transmitted by a lurgie filled younger relative (kept telling MW this is what I’d had but kept getting the condescending – oh it’s prob the start of labour – you are a first time mum aren’t you comments…arrgh the whole family had it, don’t think the men were in labour!!) followed by a 48 hr labour – so didn’t eat or drink much for 4 days….my little boy was quite big (8lb 14oz) and very overdue (10 days by scan but over 2 weeks by our dates and MW who delivered said looked v v overdue) which I wonder may have contributed too as he’d used up some of his reserves in utero (? My theory). Also, I had some blood loss, which wouldn’t normally be enough to be significant but I think on top of my prior dehydration made a difference. On top of this…..I believed the (awful) breast feeding woman who did the pre-birth NCT session who basically said that if BF doesn’t work it’s because you’re not trying hard enough so get on with it and babies will always get enough milk breast feeding….so lots of factors but of course I also completely blame myself for being so stupid and thinking my baby was ok when he was clearly starving….

We did actually manage to continue to BF after some fab advice/support from the paeds ward (much nicer than the midwives!!) – added 1 bottle a day from 5 weeks as I really struggled to keep up with his milk demands and I just wasn’t happy to risk him being under-fed given the scary start but carried on with some BF right up until 9 months. Just as the impending day approaches starting to wonder how we’ll cope this time – any experiences of others who’ve been through this would be really interesting, (and thanks for reading if you’re still going)!

:( :( .....that's absolutely awful care, and no wonder you are so upset and worried.

The nappies thing should have been a HUGE red flag to the midwives (whose job it is to listen to you, observe the baby, and assess all is well).

This time, you already know a whole lot more, so you are in a much better position to alert your HCPs to anything not right....but they need to know that what went wrong last time was as a result of breastfeeding not going well, and their colleagues not spotting it.

here's my suggestions:

• get your baby weighed on DAY ONE. There is good and up to date research which shows early weighing predicts babies who may lose more weight later on....will try to find the paper and will post the ref.
• weigh again on day 4-5
• watch those nappies :) You'd be watching for several yellow nappies a day from day 3-4
• get someone who knows what they're looking for to assess the effectiveness of the feeding
• if feeding is not effective within a few hours, hand express colostrum until it is going ok

Hope this helps.

My experience was no where near as bad as yours, but it took a long time for my milk to come in first time round (day 5), and even then it was fairly un impressive (my first experience of being engorged was when DD1 was 5 months old and randomly slept through the night..)

DD did need some formula top ups (absolutely insisted on by medical staff, and in breast feeding obsessed norway, so I don't give a monkeys what any so called expert says about needing to try harder....).

Anyway the important bit here is that when DD2 (and later DS) came along my milk came in quicker and better and we had a much more 'normal' experience with no need for top ups, 2 hourly feeding, weighing before and after feeding etc.

wishing you a much better experience this time round

OP, I'm an NCT breastfeeding counsellor and I have never heard of any colleagues saying 'babies will always get enough milk breastfeeding' or that if they don't it's because 'you're not trying hard enough'....honestly we don't say that and if some rogue person did, you need to complain.

What we may well do is explain that in order for babies to get sufficient milk, they usually need frequent, effective feeding, and not feeding often enough, or not feeding effectively enough, can lead to problems. It's possible, though, that someone might interpret/mishear 'not often enough' as 'you're not trying hard enough' but it's not what's intended, believe me!

Tiktok - I felt more just our inexperience and being too laid back rather than awful care...... We are both HCPs so think we didn't want to bother people too much and so asked a few q's butwere easily pacified (partly I think as we didn't want to be overly stressed first timers and it's amazing how you revert to patient mode) - in retrospect a bit of paranoia may have been a good thing..... I think being HCPs made it worse actually as in retrospect we both felt so stupid we'd let it happen and worst of all not realised. Paeds were amazing (medics and nurses) - seems like they are seeing more and more of it, esp with older professional parents incidentally..! My poor husband was worried senseless (but in a manly not telling me way - only admitted it months down the line) as he was doing medline searches finding these awful case report outcomes with Na not much higher than our son had.....but not telling me.

Re the NCT counsellor - she didn't use those exact words but she was this extremely strange American woman (felt like she should be in a cult!!) - was a while ago now but my resounding memory of the session was her saying that there are tiny nos people who in reality can't BF, basically only ones on certain meds and that it's just tough and people don't stick at it enough. I have no recollection of anything in the session about how to know if baby is getting enough or the possibility that they may not be. All just about baby regulating what they need and your body responding. If its painful you're not doing it correctly etc. I'm sure no mention of a problem with feeding being a possibility. All my NCT friends agree that the session was RUBBISH. I've thought about feeding back but just never got around to it (and tbh didn't think NCT would be interested as they are so militantly pro BF).

Yes, I think we will be much more clued up (paranoid!!) this time so hoping we wouldn't miss anything again but just as the time gets nearer starting to feel a tiny bit apprehensive.

V interesting what you say about early weighing - would be great if you have any refs (gosh the MWs are going to LOVE me waving clinical papers at them!!). I asked my MW about extra weighing this time given our prev experience and was told there was no way they'd do anything outside protocol - and the protocol was to weigh at day 5 only...and that weighing any earlier would be pointless as it wouldn't show anything.... She did day that it's worth asking for a Paeds examination rather than a MW Paeds check prior to discharge (not sure what a Paeds SHO is going to add a few hrs post birth to be honest though).

Viking - thanks for your story - really good to hear it was all easier 2nd and 3rd time around. MW said milk likely to come in earlier this time so good to hear that was your experience.

Thanks both for the advice and support.

Wish me luck!

OP our NCT BF counsellor said the same & refused to answer any question or even entertain the thought of it not going well.

I suspect you've hit the nail on the head with your own dehydration in this case. I found with DD2 I was so much better prepared and able to appreciate problems much earlier which for us meant formula top ups earlier (2 weeks) which conversely means we are still breast feeding 50:50 at 19 weeks, long after I'd stopped with DD1. Lots of fluids for you!!

Splatt a bfc refusing to answer questions....??? How did she fill the 2-3 hour session? I would say about a third of the content of the sessions I do comes from people asking questions and wanting explanations. And refusing to entertain the idea it might not go well?...most of a bfc's work is spent supporting and helping mothers for whom it is not going well. If it's not too long ago in the dim and distant past, then you should complain, honestly.

NCT position on breastfeeding is not militant at all, and most women are happy with the service they get - satisfaction surveys run at something like 95 per cent. But given that bfcs reach something like 20,000 women a year and all the women who go to antenatal courses meet a bfc (and I can't remember the figure for that but it's a lot!) 5 per cent being less than happy amounts to a large number. The organisation takes complaints seriously and all bfcs have supervision and in-service training and updating, so if there is something wrong, it would always be looked at.

Honestly tiktok I believe she was new or in training. we spent ages in groups discussing how we feel about it. Watched videos of the perfect latch. were told it was natural & everyone could do it if they really wanted to & tried hard enough. (we all thought she was probably still feeding her 5 year old)

But when any of us asked but what if the baby won't latch, or won't feed, or nipples too painful or want to give a bottle so can share with partner or how to express etc etc she basically said put baby on the boob often and it will be fine. it really coloured my views with DD1 who is 3 next week and I felt I was an absolute failure of a mummy when we had to introdusce formula top ups at 6 weeks.

I was also turned away from the breast feeding group I'd been attending for help & support, when i started combi feeding as it would set a bad example. You can see why my views on feeding have been quite badly coloured!!

Bad experience, Splatt :( :(

Students at the end of their training are permitted to take a bf session, and sometimes there is a bit of a disaster where they are just not ready :( But she sounds especially inept :(

The thing about being turned away from the bf group for using formula is a tricky one....my personal feeling is that bf support groups should remain open to them, but I haven't always thought that, and I am still not 100 per cent sure. If it's done should be done with tact and care and an explanation - and the explanation is not that it sets a 'bad example' :(

Bf support groups are safe places for breastfeeding mothers - some of whom come from families or situations where they literally don't have a safe place to breastfeed, in that they face criticism or judgement. When formula feeding takes place in the group alongside the breastfeeding, it can dilute this 'place of refuge' and can affect the sometimes fragile confidence of the mothers attending.

That's the argument, anyway, and as I say, I no longer think it's strong enough to make it justify turning someone away. But other people disagree and it does not mean they are judging you.

It is why I am such a strong advocate for combi feeding if ebf isn't going well. It doesn't have to be one or the other. I am so proud to still be breast feeding DD2 at 19 weeks & I would't be if we hadn't mix feed.

OP - we had a very similar experience. DS v overdue, weighed 8lb12, a long & traumatic labour ending in EMCS, a massive weight loss and after 3 days of what we thought was just usual unsettled behaviour he became very lethargic & unresponsive, uric crystals after 24 hrs of dry nappies & readmission to SCBU. Ended up mix feeding, always felt so guilty & awful for not having picked up on his feeding issues sooner. I've just had DS2 and honestly the hindsight has been a massive help, BF been 100% easier no latch issues but I've been very careful to preempt any problems by being hyper vigilant, waking him to feed if he's drowsy, monitoring his weight from the start & I've also been expressing in between feeds to bring in my milk quicker (only took 3 days this time). I feel much less laid back but at the same time calmer this time IFYSWIM, and the whole experience has finally laid to rest the ghosts of DS1s first few days in this world. Hope all goes ok

Splatt, supporting a mother to combination feed is something more HCPs and mothers should know about, IMO....if formula is used, alongside bf, there are ways to do it so its impact on the milk supply is minimised, enabling the mother to continue the choice to breastfeed for longer.

What tends to happen, though, is that formula use increases over time, sometimes quite quickly, and takes the place of bf....and then it's a case of whoops, where's my milk gone :( :(

OP: here's the paper that supports weighing on day 1:

fn.bmj.com/content/98/6/F488.abstract.html?etoc

Thanks Splatt, yes, drink, drink, drink! Will remember that! Good to know your experience was better 2nd time. Just out of interest, were you supported by MW second time given previous experience or did you need to make formula decisions yourself second time?

Tinytumble: thanks for your advice. So god to hear that for you too, seomd time around was better. Were you advised to express to speed up milk coming in or is it something you decided to do?

Tiktok: thanks so much for ref, v much appreciated, will have a good look at it. Bit apprehensive what MW is going to say given the response when I first asked about extra weighing but have antenatal tomorrow so will discuss with whoever I see there!

X

I think with DD1 she had only gained 5oz at 6 weeks despite a hideous fortnight of domeridone and a continuous cycle of feeding, pumping & topping up. I knew I couldn't put us through all that again especially with a toddler.

At 2 weeks DD2 was 12 oz below birth weight and had lost an oz from 1 week old. it was the same delightful health visitor & bf counsellor I had had with DD1 so they knew what I'd been through first time round. But it wasmy decision (well & DH, he was very keen to avoid repeat)