Supply issues?

[AllBoxedUp]

Hello. My DD is 13 weeks and I'm a little concerned about her weight gain. She was born the day after her due date and was between the 75th and 91st centile and since then she has been slowly dropping down and is now just below the 25th.

She is EBF and seems to be feeding fine. I normally just offer one breast each time as this is what I did with my DS. She feeds every 2.5 hours roughly during the day but at night will feed about 8.30pm, then ~3am and then maybe 6.30am (DS used to feed through the night but she seems to be a sleeper).

She has a slight posterior tongue tie but I've not had any pain feeding.

I saw the health visitor today and she advised me to get her weighed again next month and in the meantime to try pumping for 5 minutes after each feed to try and stimulate my supply. She is perfect in every other way and is really happy and seems to be developing normally. I was wondering if anyone thought I should be worried and if you had any other advice? She is a bit small but I wouldn't be worried if it wasn't for the numbers (and people quite often saying,"Is she really x weeks? She's so small!" which is starting to get irritating!). Thanks.

If you think she's well, is thriving and isn't gasping for food and you're feeding on demand then I really wouldn't worry. Having said that, dropping down the percentiles is one of the only ways babies can tell us something is wrong so keep an eye on it. My DS1 was small and dropped a bit so we topped up with formula (in his first 3 weeks) as it took him longer to get the hang of feeding. I always offered both breasts and have done the same with DS2 - my personal advice would be to try that before pumping.

Also, maximise your flow by drinking lots and lots (especially water) and resting as much as you can.

I think HVs are often worried that smaller appetites are self-perpetuating in the sense of once they take less they need less if you see what I mean. Honestly though, if you're not worried then go with your gut.

Easiest way for you to increase supply, and crucially, intake (which is the main thing!!) is to offer both sides each time, totally agree with marmitelover. I cannot believe the Hv is suggesting the faff and bother of expressing without suggesting that!

Extra water will not make a scrap of difference though you will hear this old myth perpetuated daily on Mumsnet, sorry, marmitelover! Some women believe it makes a difference to them, and it might feel like that, but it really does not and cannot. Ditto rest - not a scrap. Unless the resting allows more frequent feeding.

Your baby may of course be fine. Offering the second side is a good way to give her the option of having more, if she needs it.

Thanks for the replies. To be fair to the HV I didn't tell her that I was only feeding on one side. I do sometimes offer the other side but that tends to be in the evening when we're having a longish feeding session. I will try but I'm not always sure when to swap. I did think of you feed like that the supply would adjust (it worked before....) but am happy to try it out. I think I worry I will swap too soon and miss the hind milk. The HV keeps on saying I need to make sure she is getting this but I do leave her to feed as long as she wants to and that tends to be the first thing I try if she is remotely unhappy. Thanks again for the replies.

Hope that made sense - I meant supply would assist to one sided feeding but I will offer the other side now.

You just swap when the baby is finished on the first side - you don't have to judge it on a certain amount of time or anything. My oldest didn't often want a second side but with my youngest I swap once he comes off/stops swallowing/starts fussing and he always has the 2nd side (and sometimes a 3rd).

Supply is often fine with one-sided feeding. It adjusts to the needs of the baby. But given you are concerned about supply and intake (intake is more crucial than supply - what counts is the amount of milk going into the baby, after all :) ) the easiest way to increase supply and intake is to feed both sides...please don't worry about hindmilk, nothing needs to be engineered about this in the vast majority of cases.

People worry far FAR to much about the baby 'getting the hindmilk' - see thefunnyshapedwoman.blogspot.co.uk/2011/05/foremilk-and-hindmilk-in-quest-of.html for info on this :)

Thanks again. I think my problem is that she will feed for ages on a side but get less and less effective as the feed goes on. So she will feed well for say 10 minutes then bob on and off for 10 minutes. If I switch sides after the 20minutes she isn't normally that interested in the 2nd boob. So I don't know if I should switch sooner or keep her on the first side until it's "finished". I wasn't too worried before and wasn't paying a huge amount of attention to what she was doing - I just fed on demand until she seemed finished. We are maybe a bit rushed sometimes as it's my second so I'm going to try and take things easier as well.

Great link by the way. I did know that it gets progressively fattier but I love the experimental evidence!

Personally I would switch if she starts bobbing on and off. Switch feeding where you switch sides whenever they stop feeding effectively can be a good way to get more milk into them.

Thanks - will give it a go.

Definitely offer both sides (and I agree drinking extra water won't help increase a supply). You might find this link useful as an explanation about storage capacity One Breast or Two per Feed and try Breast Compressions the first time sucking slows before offering second side. And if in any doubt contact an IBCLC lactation consultant to check through everything with you.