Advised to top up. Unconvinced. Am I wrong?

[Expectans]

Sorry, long.

At baby clinic this morning the weigher asked me about feeding, then suggested we top up with formula.

Baby was below the 4th centile when born, now on the 9th. He has gained 300g this week (6 weeks old). Plenty of wet and dirty nappies.

At the later feeds in the day he fusses a bit at the breast after a while and when I squeeze when he does this only a few drops will come out. He feeds a couple of times during the night and breasts feel quite full in the morning. She said I probably do not have enough milk and should start offering formula instead of BF for this last feed, and whenever I seem empty.

This just seems wrong to me. I have nothing against formula feeding but was not planning on doing it daily until I go back to work. Friends who have started topping up have ended up with problems BF. And I thought Breasts were like milk factories, ie constantly producing, rather than milk tanks. So, am I wrong? I don't want to starve DS!

I'm not an expert (there are others here that are) but I have to jump in and say you are right - you don't need to top up. If your baby is going up in centiles and has wet and dirty nappies and overall fine (fussing in the evening is v common) then I'm sure you don't need to.

And don't worry about the "few drops" you can squeeze out, your baby will be getting much more.

Sounds like you're doing a grand job and I wish whoever this person was had told you that too.

You are right; that is wrong!!
From what you said, plenty wet and dirties, growing well (4th to 9th is brilliant - well done!). They do fuss a bit from time to time. He might just have had enough! He is more efficient than you at getting milk out. If he's healthy in all other regards, ignore the silly woman. If you're offering every time he asks, he will be getting enough. You'll be making to match his demand. It scares me that they have such ill-informed people at these clinics, wielding potentially such power over potentially vulnerable new mums.

Ummm...300g a week is above average weight gain at this age. We're aiming for roughly 30g a day or 210g a week.

He's gone to to the 9th centile from the 4th.

The evening fussiness and 'emptiness' is completely the biological norm at this age. That's why cluster feeding at this age is so so common. A young baby feeding on an emptier breast sends signals to help develop supply and tanks up on tiny sips of high fat content milk. During the evening cluster feeding phase, it's common for babies to switch nurse backwards and forwards from one breast to the next and they do seem fussier and breasts do seem emptier.

Breasts can never be completely empty. We know from ultrasound research only about 66% of available milk is removed at any one time. You are right - they are not 'tanks'

Whoever you were speaking to doesn't know the basics of expected weight gain nor the basics of normal breastfeeding patterns. What you describe is no indication of low supply but disrupting cluster feeding to offer formula in the evening is an effective way to REALLY diminish your supply at this stage.

I wonder who they were. I doubt they were an HV or even HV assistant

That is interesting about the ultrasound.

She definitely is not a health visitor, as there are 2 there and I have met both, and both are really helpful and seem super competent. So I am not sure what she is. It does perhaps explain why there is never a queue at that weighing session though!

Thank you for the reassurance. So far BF seems to be going well, and I do not want to sabotage it niw.

Could you maybe complain about her "advice"? You were fortunate not to take her advice on board but lots of more vulnerable mums might have done. If she isn't a HV she shouldn't be handing out her un-asked-for personal opinion!

What everyone else said ie. assuming there are no other medical reasons then from what's you've said, zero need to top up.

On the info you have given here this advice is extraordinary and needs to be challenged. Please tell the Hv you were told this. You don't need to make it sound like a complaint. Just say you want to check out what you were told as it seems strange to you.

Please please make a complaint.

Agree with everyone else. You seem to have super milk, and sound like you're doing a fantastic job.

I think this 'advice' is definitely worth challenging. You can definitely do it gently, but it's important that this sort of advice stops. I wonder if she is a nursery nurse? I've had to challenge ours once or twice about bizarre baby advice. I've pretty much stopped listening to her altogether.

I will be going back there tomorrow for a second attempt at baby massage (last time was not a success), and will mention it, and see if I can work out what her job title is too.

I would definitely mention it...that weight gain is great and a sign that its going well! In terms of fussiness, that could be lots of things, wind, growth spurt, tiredness, nappy needs changing, etc.

Its not cool when people suggest such things at a time when women are quite vulnerable...and we feel vulnerable when our babies are being weighed as its a sign of growth. Shame on whoever mentioned it.

some people seem to think that breast is not enough. When my last one was born the nurse in the hospital said she looked hungry and gave me a bottle to top up with. I poured the formula down the sink and when the nurse came back she smugly said how much better baby was looking now she had had a proper feed. Grr it made me angry then and still does.

I'd have told her that joanne!

I had the exact same comments with my DD who was born on 25th centile and stayed there. It was as though they thought she was aiming for the top!

FWIW I ignored the 'advice' and started getting DD weighed at a breastfeeding class where I wouldn't have to listen to such advice.

I'm making light of it now but it upset me a lot at the time as I felt I was doing my best.

Just keep going and feed whenever he wants to. I listened to similar 'advice' with DD1 and as a result she started refusing to BF and I struggled with expressing and mixed feeding for months until I eventually switched to only FF at 5 months. With DD2 I just fed whenever she wanted, even when she dropped from the 50th to 9th centile. I ended up BFing her until she was 3 and she is now a happy healthy 75th centile almost 4 year old!

I know our HVs have / used to have a NNEB assisting them with weighing and with weaning advice sessions (she was the one who told me that DS had "a bad temper" and I'd need to "deal with that" when he was 4-5 months old or so...). This might be similar, perhaps?

Well, I mentioned that I had been advised by the weigher to top up, and the HV seemed uninterested and just said not to. So sadly I do not think anything will be done re reeducating her.

Anadventure, in hospital I was told by a very grumpy midwife that DS was a lazy baby. He was less than one day old, and struggling to latch on.

if HV not interested then you need to complain. This is exactly why so many people don't bf as long as they want to. Poor advice and not in line with research.

If you don't have energy to formulate a complaint I'm sure mn could help you word a letter!

Whether she is a HV or not makes no odds- there are plenty crap HVs giving bad breastfeeding advice.

Sounds as if Bfeeding is going brilliantly. Breasts don't feel so "full" as the weeks progress and your supply settles down- this is perfectly normal and not a sign of a low milk supply. Most of the milk is produced "to order" during a feed and not stored.
Giving a formula top up will impact on your own supply.

You may like to give one of the breastfeeding charities a ring on their helpline, just to get some reassurance. La Leche League and NCT are good, and will be happy to talk just to put your concerns to ease.

If you want to complain then do- but you may want to just save your efforts into continuing the great work you are doing feeding your baby.
we are not all crusaders.

I know its a hassle but I think it is important to report this person, your response in having the confidence to question what your being told and open it up for discussion is what maybe 1 in 10 mums would do. I am sorry to say a lot of new mums are not as confident and would mistakenly think the formula would solve the fussiness and lead to more sleep at night.
I am sure that her advice does not represent the nhs party line and I am sure her superiors would be shocked if they knew this was the advice being given to someone with a healthy happy weight gaining baby.
I know it seems mean to report her but think of the babies and mum's that want to breastfeed and don't succeed because of lack of support and bad advice.

We are not all crusaders is a very rude comment.

Probably explains why we have such a low breastfeeding success rate.

OP I hope you are feeding more confident that feeding is going well.

My god crashbang we can't win can we.
If we do speak up we are accused of being militant or other less far ruder names.

All I am saying to the OP is that she doesn't have to challenge this- she can just move on and find help where she can.
New mothers are vulnerable and don't always want to challenge advice, especially if given by a HV. I know mine was a dragon and I would do anything to avoid her.

Don't accuse me of being responsible for low breastfeeing rates- you know nothing of me. What have you done to improve rates?

atthestroke- this is the second thread I've read in the last week where you have appeared argumentative, it's quite strange.

twelve, I agree with you - not everyone wants to go on a mission to winkle out bad bf advice, and no one should feel they have to. Mothers have a lot on their plates and it can be daunting to challenge even rubbish advice from a healthcare professional :(

When mothers can ask/complain/challenge/query, then all power to them!

But it's not compulsory and it is ludicrous to think, as crashbang seems to, that non-complaining mothers are responsible for low breastfeeding rates....ridiculous notion!

Thanks tiktok- I made that comment because I do know how difficult things are for new Mums with a tiny baby, trying to get breastfeeding established- it can all be very daunting. Even the most self confident capable and vocal women can have their foundations shaken by the life changing circumstances of having a new baby and trying to overcome breastfeeding problems.
New mothers can be fragile, emotionally drained, tired and sometimes making a complaint is a step too far.
I made this comment simply to try not to add to the burdens of the OP.
Her priority is sorting out herself and her baby, not to take a HV to task over bad advice.
If she wants to complain then that's fine, but so many posters are telling her that she ought to complain that I was trying to defuse some of the pressure she may be under atm.

There others that are happy to "crusade"- me for instance, and plenty other mothers perhaps with 6 months successful breastfeeding under their belts who feel they do want to challenge bad advice- and that's great.
If the OP feels he want to complain at a later date- or even never - that's her call and she shouldn't be judged for it.

I think crashbangs comment was unhelpful.

I think your both overreacting and being unnecessarily rude.

I recongnised OP may not have energy to formulate a complaint and suggested asking for help if necessary.

I maintain the lack of complaints and challenging health visitors/assistants contributes to low breastfeeding rates.

If not challenged they continue to give poor outdated advice. Women also pass on the advice they received to others in similar circumstances and then pass it on through generations.

The sooner they retrain the better support they can offer.

If a mother doesn't feel they can complain that's there call.