baby weight gain, breastfeeding and expressing advice

[Emhoops]

I exclusively breast feed my 4 month old. He has dropped nearly 2 percentiles in the last 2 months. I'm not too concerned as he is happy and alert and produces plenty of wet nappies. However my health visitor wants me to continue feeding a usual from both breasts but then also offer a bottle of expressed milk at the end of each feed. Anyone have any tips on when's best to pump. I can't see how I'm going to be able to produce enough milk to feed baby as usual as well as be able to pump enough milk so that I can offer him a bottle after each feed as well. Any thoughts or ideas would be appreciated 😊

Whatever her definition of "a bottle" is in other words 2 oz or 8 oz - a bottle after every feed is ridiculous speak. She may have meant that you express after every feed and store it up to give a bottle of that at the end of the day?

She wants me to give him a bottle after every feed to 'top him up' just in case he's still hungry, so I'm assuming only a few ounces. I just don't know how I'm going to pump the additional ounces needed for each feed as well as breastfeeding him full time.

I don't quite understand why you're being asked to top up. If baby is finishing feeding on their own terms, then why would they want a bottle afterwards?

If you are keen to express to make the bottles, I would wait 30-45 minutes after feeding (perhaps while baby is sleeping) to express. Because we just don't have enough to do each day already. But for the first day or two that might exacerbate the problem at the next feeding time (ie. insufficient milk) until your supply catches up. (NB. I expressed full time for 12 months, mainly while DS was asleep or on the floor playing.)

Was the baby big at birth? Are you/DH small? Is there any possibility they are just moving down to a natural, comfortable size?

As long as the wet nappies continue and you've ruled out reflux etc, I think continue doing what you're doing. Maybe instead of offering a bottle put baby on the breast more often to see if they'll feed more.

DS was heading towards being underweight, and also dropped from 50th to 10th centile, but he had very bad reflux (fortunately he was a 'happy chucker', so we didn't have the screaming and pain associated) and so we knew the reason he wasn't gaining enough weight was because he wasn't keeping any food down.

I don't want to frighten you, and it is unlikely, but it is possible that your milk is not 'good enough' and you may need to move to formula. I'm not a formula advocate by any stretch, and would only do this as a last resort of a GP or paed determined that baby really, really needed it.

Best of luck with it all. It's hard at times, but I bet in 12 months you'll be lugging around a heavy beast of a baby wondering what all the fuss was about.

Hi kp86 what do you mean by get milk not being good enough? I'm just wondering because it's the first time I've heard such a term/point from anyone outside the likes of my ILs who haven't ever breastfed

Milk not good enough? What a load of rubbish. The human race wouldn't exist if mother's milk wasn't "good enough."

OP, your ds may have a slight tongue tie issue. My dd had posterior tongue tie that caused her to struggle to feed and she consequently lost weight. She dropped centimes much faster, though, so even if your baby is struggling, it doesn't appear to be an immediate concern.

The trouble with the hv 's advice is that pumping is bloody hard work and not everyone responds to a pump. I was lucky when I was pumping and topping up dd with expressed milk; I respond well to the pump and had plenty of milk to give her via bottle. The stress and workload was horrendous, and I would avoid going down that route unless absolutely necessary (my dd had lost nearly 10% of birth weight, so things were precarious at 4wks).

I have 5 DC and have only ever had crap bf advice from hv's. I would strongly encourage you to speak to a LLL leader or find your local baby cafe. Diagnosing bf problems over the internet is tricky and it sounds like you need some real life support.

*centiles

Ignore the suggestion that your milk isn't "good enough", of course it is! (Also sounds like something my SIL would say, she told my DB it was impossible for her to breastfeed because she wasn't fat enough while giving me evil looks)

I would get some real life BF support to get a second opinion. The HV could be scaremongering if, as pp said, your DC is just finding their natural size. Could you do a session with a lactation consultant? Or go to a La Leche meeting?

Expressing is, ime, not much fun but if you do respond to the pump you should be able to get some milk 45/60 minutes after you feed.

However please get a second opinion before you devote your life to pumping!

Thanks for all the replies ladies. We have a breastfeeding support group at our local children's centre so I think I'll pop down there for a second opinion before I take the advise of the HV to heart.

Also kp86 what do you mean by this - "we just don't have enough to do each day already."?

Kp, you mean well, but really.....milk not good enough? In what way? Plenty of scientific research shows that milk is of more or less standard quality, whatever the mother's diet, lifestyle, body shape blah blah blah.

OP, very important you check with a second opinion. On the face of it, there is no reason whatsoever to express, and to have to go through all the faff this needs.

If your baby is thought to need more to eat, the easiest way would be to feed directly, and more often. Are you offering at least both breasts at each feed, switch nursing to go for one breast to the other and back again? Not saying you need to do this, but if it is really the case your baby needs more milk, giving both sides, more often, is the way to go.

Hi tiktok, thanks for your advice. I always offer both breasts and have started switching more whilst feeding. He usually feeds every 2.5 to 3 hours but I have been offering the breast to him more often today. He hasn't wanted it more regularly though and just gets frustrated that I'm trying to get him to feed when he's not ready and pushes me away. When he does feed he's always happy and settled afterwards and doesn't look as though he wants more. Definitely will go our support group on Thursday to get a second opinion as I'm not sure pumping and offering him a top up after every feed is going to help x

Sorry for the delayed response. Some women's milk isn't sufficient for their baby. It's extremely rare but I know someone (directly, not friend of a friend) who was breastfeeding but it ended up that her DD had to be out on formula because her milk did not sustain the baby. Highly unlikely to be the case, but I thought I would mention it as an anecdote.

By 'not have enough to do all day' I meant as Mums we put ourselves under a lot of pressure and now the HV wants OP to add yet another task to her daily to do list by pumping 3+ times a day? I don't think it was a particularly helpful suggestion from the HV, unless the real motivation behind it was to get OP's milk production to increase.

I've been there - as I said, I pumped for a year. I spent literally days or weeks attached to a pump so my DS could feed (milk allergies).

I was only trying to be helpful and supportive, I sincerely apologise to OP or anyone else if it didn't come across that way.

I am 100% behind breastfeeding, or expressing and bottle feeding. But OCCASIONALLY, no matter what mum does, it doesn't work out. Maybe milk supply isn't strong enough, or possibly there are nutrient deficiencies. I'm not a doctor, I'm not diagnosing here. But I have read a lot on breastfeeding (again, see above where I was attached to a pump for 12 months) and I know people for whom it didn't work. For whatever reason.

Mine did the same. Dropped from 25th to below 0.4th.

It just was a weight plateau coninciding with a devrlopment phase., at 5m jumped back up again. At no point was it suggested it was an issue with bf, as they were happy, healthy and hydrated.

If you're happy baby is healthy, they likely are. If theres any doubt, you should be referred to a paed rather than piss about with expressing. If theres a problem, it will be there whatever and however you feed. In fact i was told not to give formula to increase weight, as it can mask the real issue.

Sorry, KP, but while it is certainly true that breastfeeding does not always work out, and that breastfeeding is not enough because of an ongoing supply issue, it is not the case that breastmilk can be poor in quality or lacking in nutrients so that the baby does not grow.

I really don't think your friend-of-a-friend story is relevant. Mothers are told all sorts of misleading rubbish and she may well have been told her milk was poor quality - it will not have been true.

Hi OP,
Just giving you a hand hold, I am in the same situation with my 14 week DS. He was large (for me!) at birth and dropped 10% almost immediately. After initially being on the 75th centile, he is now hovering just above the 9th and has been for the last 8 weeks or so. He's a very happy, easy baby who sleeps and feeds (EBF) brilliantly, with loads of wet and dirty nappies. I was so proud of myself until I saw a HV who made me feel like I was doing it all wrong because DS was not putting on enough weight. After stressing and worrying and trying to feed more often, which he generally refused, I've come to the reasoning that that's where he is supposed to be and it feels like a weight has been lifted. He will tell you if he's hungry or if he wants more, as I'm sure you know. Talk to an expert by all means, but you know him best and it sounds like you are doing a fab job!

Thanks for the virtual hug jojobinx. It's so hard not to worry and stress about it all. I was perfectly happy with how everything was going until I saw the HV yesterday. My Little boy is generally so happy and as you say I'm sure he'd let me know if he was hungry. Trying to force him to eat when he's just not ready is just frustrating both of us and not making for a very happy house. Thanks for your comment . Think I'm going to go back to using my mummy instinct and I'm sure we'll both be much happier x