Bf and topping up, am I doing the right thing?

[Sarahbear1]

I am so confused and have received so much contradictory advise.

My lo is 2 weeks old.
Born 6lb 8 and lost 9.1% in 5 days. Through breast feeding alone his weight increased to a 5.4% loss, we did this by feeding on demand or at least every two to three hours start to start. He would sometimes suck for 50 mins on each breast and at times appear to still be hungry.

By day 11 his weight hadn't increased and was basically the same. So the paediatrician suggested we feed maximum 25 mins on each breast, then express 15 mins and feed him the expressed milk (ideally an extra 30ml). Once he had fed on both breasts I could only express about 5-10ml, so the paediatrician told us to supplement with some formula. We continued this for two days, feeding every 3 hours and returned to see the doctor today and the weight is still the same. The paediatrician has now advised to only give one breast for 20mins, followed by 10 mins expressing on each and giving as much formula as he will take. (Expressing seems to yield very little, I get more from manual expression than with the electric pump)

Obviously we want to do whatever we can to get his weight up, but we are concerned that supplementing with formula will reduce my milk production and that we will not be able to give up the formula once his weight starts increasing.

Has anyone else had a problem with weight gain stagnating and taking longer than two weeks to regain birth weight?
Should he only suck for a maximum of 25 mins on each breast? This to me seems like my supply won't increase if I do that.
Btw he has a good latch and I can hear and see him swallowing.

Please help me I don't want to make any mistake to do with bf this early on.

I should add that any supplement feeding either breast milk or formula has been feed through a syringe.

My DS took 5 weeks to regain his birth weight (around a 10% loss). I tried expressing after a feed to give as a top up and hardly got any thing out.

I was lucky in that I had a midwife and HV who were ok with my stubborn determination to not top up with formula but it was very stressful.

At 10 weeks he had a posterior tongue tie diagnosed.

I'm sure there will be some experts along but I don't think the way to do it is to time feeds. I found it difficult to spot the typical cues (DS never really pulled off and would often fall asleep) so ended up offering at least 2 sides per feed and did a lot of switch nursing - where as soon as they start to lose interest swap to the other side and keep going back and forth.

The biggest thing though was the tongue tie diagnosis which we got from going to a bf support drop in. Have you got a local support group you can go to? I would try to get a proper trained bf expert to take a look and give advice (ie a La Leche or NCT bod rather than just a health visitor). I know you say there's a good latch bit they be able to spot if there are any things slowing down the milk transfer and also give Road on increasing supply if that's what's needed.

Personally I would try and resist topping up with formula as I think it would impact your supply at this stage add most people I know who've started topping up have moved to more and more formula as time goes on. However I also think that for some of them the reassurance of knowing how much the baby has had was very useful in the middle of a stressful situation so it depends on you and your baby.

Good luck!

I would suggest feeding more than every three hours. Can you spend some time in bed doing skin to skin and feeding every one - two hours?

Do you have a local Breastfeeding clinic, that can check both you and your baby for tongue tie and latch etc?

Breast compression may also help.

Get some expert bf advice from a lactation consultant and maybe get checked for Tongue tie which can be associated with prolonged feeding. That said feeds are all over the place in the early days and do regularise out in time. I think pumping and topping up brings a whole range of problems, not to mention how time consuming it is, that can sometimes be necessary but often are not even when recommended by well meaning health professionals. I think a lactation consultant who was able to watch feeds would be able to see if it was normal or problematic.

thanks you for your advise. On the tongue tie bit, he must be getting milk as he is peeing at least 6 times per day and we regularly get 2 or more poos.
He does look healthy, has energy, poos and pees enough, but just hasn't gained weight. Is it possible everything is fine? And that weight gain will take a little longer or is lack of weight gain an indication that something is wrong.

I have very limited access to any sort of professional that I trust mainly because they don't speak english.

I would also suggest feeding every 2 hours, as 3 hrs is probably not frequently enough. I wouldn't want to go against what your paed is telling you, but from the outside it seems that they are moving you away from bfeeding towards formula.

The advice to only offer one side for no more than 20 mins seems particularly puzzling to me. All the advice about bfeeding that I have seen would seem to suggest switch feeding - offering both sides repeatedly switching between them as necessary.

Have a look at the Kellymom website - it had loads of evidence based advice about breastfeeding. This page about poor weight gain might be helpful.

I would also say that using formula need not be the end of bfeeding. I had to give my ds formula due to various issues when he was born, and we went home from hospital mix feeding at 7 days old. We then managed to gradually move back to 100% bfeeding - not easy, but it is doable.

Hello OP my baby lost 10? of his birth weight in the first week, I was terrified.

He gained the weight back within 2 weeks and gained 45% of his birth weight within 4 weeks.

My HV gave me great advice BF every hour or 2 hours and co sleep to help him use my breasts for comfort.

Don't worry your doing great OP, try increasing the number of feeds.

Good luck and congratulations.

Your instinct on working by time being dodgy is correct! Babies vary so widely in the time they take to feed that it's pointless to do it this way.

If you are happy to move to FF, great. If you want to keep BF as the main source of nutrition, this paed's advice is awful. At this age, lots of the sucking is baby does is giving your breasts the message to make more milk. Formula supplements prevent that message getting across, so you will end up with dwindling supply.

Also, your baby is much more efficient at getting milk out than any pump, so I'm not sure why the Dr thinks switching to pumping at the end of each feed will help.

By offering milk on demand, you make sure your supply is able to meet his needs. At this age, many babies will feed every 2 hours as an absolute minimum. If I were trying to increase supply, I'd be offering every hour during the day (in addition to whenever baby shows ginger signs), with skin to skin where possible, and switch feeding - that is swapping sides whenever baby loses interest, as many times as necessary until the baby unlatches itself.

The nappies, combined with weight gain should tell you most of what you need to know about if enough milk is going in. Two poos/six pees a day is on the low side for a baby this age if there are weight concerns: sources vary a lot, but around 6-8 soaked nappies and 3+ poos is a 'normal' baseline.

I think if you let baby feed as long as he wants, you may well see all these things improving - it can help to bear in mind that doctors receive very little training on BF, and some tend to offer advice without much knowledge. Kellymom is a great source of good info, and many posters on MN have a great depth of knowledge.

Keep going, because you can do it, well done for getting this far!

Has your paediatrician explained the reasons for his advice? Obviously he is trying to help you and your baby, but why does he advise that you express milk?

I sympathise with the stress caused by contradicting information (seemingly about everything!) when you have a 2 week old baby.

We found that for breastfeeding, our lactation consultant gave much better advice than the paed, and that we also needed to feed every 1-2 hours for a while (I did a babymoon, all tucked up in bed with loads of DVDs and my mum doing the cooking ). Are you seeing a lactation consultant at all?

But ultimately the most important thing is that your baby gains weight, milk supply can be increased later, especially with someone who as clearly so committed to bfing as you are! Formula may not be ideal in the early days if you want to bf, but a little is not the end of the world if necessary.

My DC3 did not put weight on in the first couple of weeks. I was also advised to express and top up but wouldn't use formula due to family allergies. I managed to express twice I think as it was quite tricky with other 2 children. The midwife also said 20 mins each side. I think this was because after that time they feel the baby is not really taking much milk.

What eventually worked for me was a maternity support worker who the midwife arranged to visit me at home. She repositioned my DD and she latched much better and obviously took more milk and gained weight.

I had breast fed 2 children previously for 18 months and 1 year and several midwifes had said she's latched ok and we had wet and dirty nappies but still I really needed the specialist advice.

Stick with it, don't panic you are doing a great job. The early days of bf are tough but now at 9 weeks my dd is an expert feeder and gaining weight nicely. I know this because she grows out of clothes, I have only had her weighed once since the first few weeks.

OP it could be perfectly fine definitely but my 3 were all badly tt and gained plenty of weight so it is difficult to tell. In my case 2 of them left large gash wounds in my nipples which gave the tt away. The other one left a less open wound. Your English is fine here and while it may be difficult to understand everything you will probably get the general idea. I had to trek the country to get good bf advice because some of the local advice was terrible but in the end it really paid off.

Neun, I think the OP was trying to say that she isn't in the UK and the doctors don't speak English.

I find the advice you've had crazy - the longer baby feeds on one breast the more of the hind milk he'll get which is fatty and helps him grow - the fore milk is more watery and mainly to hydrate rather provide calories.

I agree with others that you contact a breast feeding specialist and check for tongue tie. My baby gained weight by exclusive bf after the normal weight loss in the first two weeks - I offered my breast at every wimper and he suckled for as long as he wanted. There are days and nights in the early months when all you do is bf - do it on demand even if that is every 20 mins and for an hour at a time - baby knows best - and as he gets bigger then he'll settle into more of a pattern. Its common that new mums cant express much, even though their babys can get the milk flowing perfectly well when suckling. Nature's quite clever really -maybe get a new doc!

Can I also say, having just read her comment - I agree with mummyweatherwax very much!

I hope these posts help - the early days are so tough and made more stressful by dubious medical instructions.

My friends bf baby really struggled in the early days because she'd assumed she was meant to feed every 4 hours. She eventually got help and her boy was ok, but sometimes its easy to get a bit muddled, as the whole, 2, 3, 4 hours stuff comes from older bottle feeding practices and not really relevant for on demand bf babies. Bf newborns don'y come with any schedule - offer milk as much as possible and let them suckle to sleep if he wants too - its all good bonding time, so snuggle up and enjoy

Thanks for all the advice. I went to see an experienced mid wife today, who checked the latch, feeding and tongue. She was perfectly happy with him and said that we should not worry too much about the weight again that it can take many babies longer than two weeks to regain birth weight. She agreed that the doctor was over zealous and reacted to quickly to the stagnated weight again.

Her advise was to increase feeding times to 2 hours or less during the day and maximum 3 hours between the 12 and 6 am night feed. Don't ff and bf instead of pump where possible. Which is pretty much the same advise as mums weatherman said. I'll being seeing the doc tomorrow so will try to get to the bottom of her puzzling advice. Will let you know. Thanks again everyone.

Good to hear that the mw was helpful Bear. If you can do lots of skin to skin then all the better. Dr Jack Newman has good video clips of breast compressions which may be useful too.

Glad to hear you've had some good advice OP, there's no substitute for someone knowledgeable actually seeing you and your baby.

Good luck, and give your little one a sniff from me

Sounds like you got some good advice in the end, babies are usually far more effective at getting milk than pumps so don't feel like you're only getting this much because that isn't necessarily what the baby would get. Breast feeding is all about supply and demand so feed feed and feed! Good luck, it can be tough at the start but lots of cuddles and good food and drink for you too are all beneficial.