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Infant feeding

Get advice and support with infant feeding from other users here.

Original poster

Advice needed please

29 replies

allisgood1 · 01/09/2014 17:34

DC3 is 5 days old. He was born at 3785g. He was weighed on day 3 and was 3520g. Mw came today and he weighed 3500g. Mw insisted he's lost 8% (he hasn't) and put him on a "care plan" which involves me feeding him on both breasts ( he's satisfied after one side) and expressing and topping up. I don't want to do either as he hasn't even lost 8%! Mw also wants to come back in two days and re-weigh. I don't want her to. What can or should I do?

OP posts:
AnythingNotEverything · 01/09/2014 17:42

Is he otherwise well? Weeing lots? Poo changing colour? No tongue tie?

I'm not an expert, but I suspect if you feed feed feed feed and feed a bit more he'll gain enough weight to satisfy your midwife. Id be tempted to continue feeding directly rather than king about expressing but I wouldn't like to advise someone to go against medical advice.

When DD was born (almost a year ago. Sob) I was advised to offer both breasts but not to worry if she didn't take the second.

Has your milk come in?

hollie84 · 01/09/2014 17:56

Offering both breasts is sensible but expressing and topping up when he's only lost 8% sounds nuts to me.

Personally I would agree to weighing again in 2 days though as you do want to know that he's started gaining weight now.

Original poster
allisgood1 · 01/09/2014 17:58

He is fine. No jaundice. Poo and weeing lots. Alert. He's not lost 8% and is very satisfied after a feed. She even observed a feed and said "I don't know it's a mystery". it's not mystery genius you just didn't do your maths!!

I want to cancel them coming in two days. I don't think it's necessary but my confidence is wavering.

OP posts:
hollie84 · 01/09/2014 18:03

You aren't under any obligation to have them come, but I think they won't sign you off until he is back yo birthweight. How about delaying the appointment by a few days?

Original poster
allisgood1 · 01/09/2014 19:18

I'm happy with them coming on day 10 which is what they would be doing if they weren't insisting he's lost 8%. I may call them tomorrow and inform them of their error.

OP posts:
hollie84 · 01/09/2014 19:35

I'm sure both of mine lost 8% anyway and no fuss was made at all! Isn't anything up to 10% normal?

AnythingNotEverything · 01/09/2014 19:39

Sorry OP. Can you explain your maths? I might not be getting enough sleep but to me he has lost 7.5%.

I might be being dim but it's always with checking your sums before you act.

Original poster
allisgood1 · 01/09/2014 19:56

All I know is that it's under 8%. So your 7.5% is probably correct. According to my calculations (and the mw who i saw sat) 8% would be 3482g. He's 3500 so therefore within the normal limit, no?

OP posts:
hollie84 · 01/09/2014 20:04

8% is within the normal limit too though, so not sure 7.5 or 8% makes any difference.

AnythingNotEverything · 01/09/2014 20:09

I don't think they really worry until 10% loss if all else seems well.

addictedtosugar · 01/09/2014 20:26

I get to 7.53%, which would round up to 8%.
The fact that he only "lost" 20g between days 3 and 5 suggests to me he isn't loosing weight any more.
Personally, so long as your happy with nappys and alertness, I'd have the mw back in 2 days, and feed him just before they show up.

AnotherStitchInTime · 01/09/2014 20:37

Two days is quite soon to re-weigh if they are looking for your baby to gain weight. Try to hold them off for 4 days, by that pointthe gain may be more noticeable. A 7-10% weight loss is normal for a breast fed baby anyway. By 10-14 days old your baby should re gain to their birth weight.

Some good advice from La Leche League here, they have a helpline and local groups that can help here.

tiktok · 01/09/2014 21:02

Extraordinary. You can call the midwifery service now and explain to them you are unhappy with what the midwife has told you and her maths. Get a second opinion. You will have been given a number to call out of hours. If not you can call the postnatal ward and speak to a midwife. From what you say here your ds is feeding and growing within normal limits. Hope you get it sorted.

tiktok · 01/09/2014 21:05

Babies normally stop losing by day four to five. But a loss of 20g is nothing worrying at all because it can be a wee or a poo. It's sensible to offer both sides but at this stage expressing and topping up with the ebm is prob ott.

Original poster
allisgood1 · 02/09/2014 04:03

Thanks tiktok, I was hoping you would post. I will call them tomorrow. What does not make sense is that midwife 1 said on Saturday "he's under 8% loss so I'm happy" and midwife 2 came along 2 days later and said the opposite. And what was she doing weighing him 2 days later? And then telling me I am feeding him wrong (cradle hold in crook of my arm). Ugh. This is hard work. Thank god I'm not a vulnerable first time mum.

OP posts:
stinkypants · 02/09/2014 04:17

I think 8 ish % is fine and if nappies are as they should be and baby waking to feed then there is nothing to worry about. Mine got weighed every 3 days after losing a lot more than that (twins). After 2 days seems too soon. Also letting him feed lots has same effect as expressing and topping up.

tiktok · 02/09/2014 06:40

I think she was prob concerned about the apparent continued weight loss.

But 20g in a term baby who is feeding well is too close to call, and general feeding support should be enough ie feed both sides at this stage.

Glad you are going to call and ask, OP.

Original poster
allisgood1 · 02/09/2014 08:17

I thought weight loss did continue until day 5?

OP posts:
tiktok · 02/09/2014 08:57

Day four to five according to the research so day five is still ok. Even after that you would take into account other factors like is the baby feeding well and often, in clear good health, that sorta thing.

Nothing in your posts indicates any cause for concern :) but obv the midwife was there and assessed the whole picture, so a second opinion is worth getting, rather than assuming she was panicking.

Original poster
allisgood1 · 02/09/2014 12:10

Thanks tiktok. How do I respectfully and tactfully ask for a second opinion and also ask that they not visit until day 10? And also that I don't want the same midwife?

OP posts:
tiktok · 02/09/2014 13:46

All: hi my baby's six days old and the midwife said something that's worried me a bit...,can I talk to someone about it?

Midwife: yes go ahead.

All: it's just she weighed him and said blah blah blah and I am a bit confused. I thought his weight and everything was ok. Bit worried now cos I have been asking around and it's been suggested I prob don't need to express at this stage. Could someone maybe say what they think? I don't want to go against her or anything but to be honest she's got me a bit upset.

Then if they think you are actually ok not to express you can just ask if they would think it would be ok to leave the weighing for another four days 'and could I ask if someone else could do it? Is that ok?'

Be polite, don't hide your anxiety too much, but be clear about what you want.

Good luck!

Imeg · 02/09/2014 15:56

Do you know the name of any of the other midwives? You might find it easier to say 'please could I see X' than 'please could I not see Y' though of course you are quite entitled to say the latter, In my area the midwives did weighing clinics as well as home visits (I had to trek in to see them at the hospital as day 5 was a Saturday...) so maybe if you feel up to it you could offer to go to a clinic if that gives you more choice of midwife.

Original poster
allisgood1 · 03/09/2014 09:53

Just spoke to them. I didn't have time to call yesterday as the day went so quickly and this morning they phoned to say they were coming

She said that the 20g loss is concerning Hmm she said by day 3 they expect them to have lost all they are going to and by day 5 should have been putting on 30g per day. Even though he's under the 8% it's now been hilighted as a concern so they have to act on it.

I explained this is causing me a lot of stress as he is weeing and pooing lots, poos are yellow, he feeds beautifully etc. When the mw came Monday he hadn't fed for nearly 4 hours as he was having a big sleep. She said even with him not feeding she doubts he will have put on 60g as expected. She said she can come tomorrow or Friday and will be putting down that I refuse to have him weighed today Hmm I explained I'm not refusing, I just need to understand the justification as this is really causing me anxiety when I was previously confident in what I was doing. She's left it as she will call me back with regards to coming tomorrow or Friday. I am really quite frustrated now.

OP posts:
tiktok · 03/09/2014 09:55

I will try to find the research on this for you to look at. Will post later.

tiktok · 03/09/2014 14:02

Have been checking out the published research on this, and it's not clear cut.

There is a paper from a few years ago fn.bmj.com/content/88/6/F472.full which says the median nadir of weight loss is 2.7 days (nadir = lowest point) - but that does not mean weight loss lasting more than this is a clinical concern. The same paper showed a wide range of timings of the nadir. There may be more recent papers, and in fact there are, but they don't all look at the same thing.

Papers discussing the whole issue of newborn weight loss and strategies to assess its clinical significance almost all stress that weight is only part of the assessment - HCPs should check for the baby being healthy, with normal wees and poos and demonstrating effective, comfortable feeding.

I have not heard of any UK protocol which automatically flags up babies who have lost 20g between day 3 and 5, when the weight loss is still within normal limits.

30g a day weight gain from day 3 is very prescriptive - again, I don't know of protocols which insist on this.

The midwife who discussed it with you can maybe share their protocol, and explain why the other aspects of your baby's well-being are not being taken into account. There may be research evidence to support their policy (though I don't think they will find any for 30g a day after 3 days and if not, the baby is flagged), but there is not a definite 'right' and 'wrong' here.