BF Newborn not gaining weight

[Karmin]

DS is 9 days old, EBF,
birth weight was 3.284kg,
Day 3 - 3.060kg
Day 5 - 3.045kg
Day 7 - 3.046kg
Day 9 - 3.056kg

During pregnancy I had GD (diet controlled) and also was on codeine for spd and sertraline for depression. He swallowed meconium and had to be given oxygen when born. As such I didn't leave hospital until day 6, I was forced into giving top ups in hospital on days 3&4 which I found upset his latch a bit but now we are home that hasn't been an issue.

He has plenty of wet and dirty nappies, but regularly falls asleep at the breast at which point I unlatch him let him wake up and continue. He tends to feed like this for about an hour and then has about a 2 hour gap and repeats. Skin is clear and he seems settled and alert.

But I am still concerned as to the lack of weight gain and the midwife who has come out wants me to top up with formula and has told me I'm not making enough milk for him. I do generally leak a bit and can nearly always hand express a bit so I do think I have enough. Latch is not painful except for a few seconds of pain when he first latches if the breast is full and he makes the milk drunk expression as well. But I am worried that I am not helping him thrive by refusing to top up.

Oh you poor thing. I've been there. Twice. It's incredibly stressful, your hormones are all over the place and in sure you're beyond tired. So firstly,

Now. I'm not an expert by any beans and am still having a tough time BFing DC2 at four weeks. But I got through it with DC1 and fed to 13 months, and hope we're coming out the other wise with DC2.

So. The midwife may (or may not) be talking shit. If you can still squeeze milk off then sounds like she's wrong. By far the most likely issues are time at the breast - baby needs more than you could ever imagine - and/or ineffective transfer of milk. If the latter, then it's iften match related. No matter what you've been told by midwives, get yourself to a breastfeeding drop-in (NCT do them, no need to be a member, but most councils/NHS trusts employ specialists who run sessions in cafes, community centres, etc. check out your local La Leche League. Or try a lactation consultant but that'll cost you up of £50 for a session) and get anyone and everyone who knows about breastfeeding to check on latch and positioning. Are you having any pain?

On top-ups, I get that you don't want to. But it can help - with my first I sobbed as DH gave her a bottle of formula but after a few days she became less sleepy and started to feed better from me. If you don't want to give formula, you could try expressing. And if you're worried about giving a bottle, insist that a midwife or BF support person shows you how to cup feed - it's a bloody faff but doable. Or you could try a tiny (5ml) syringe - I was told to stick a clean little finger in baby's mouth till they suck then slip the syringe in the side. (Boots pharmacies sells the syringes.)

Finally, have a good look at the smazing Kellymom website - everything you could ever wish to know abiut BFing, and actually evidence-based.

Most importantly though, find an expert in RL to help.

Very best of luck. It's really tough - nobody ever really prepares you for how tough early BFing can be.

The bit after ineffective transfer of milk should of course say LATCH not match. Sorry - BFing and typing on phone!

Difficult start for you both - and stressful :(

Yes, at 9 days we can't really be talking about volumes of milk being sufficient or not, and leaking and hand expressing are no guide, anyway....the crucial - CRUCIAL - thing is, 'is it getting into the baby i) effectively and ii) frequently enough' ?

The good news is that your baby has stopped losing weight, but of course by now he should be gaining, and usually the easiest way to ensure this is to get more breastmilk into him. Yes, have your attachment checked, but at the same time, feed him more often - three hourly feeds are not usually sufficient for babies who need to gain weight better, so you could certainly look at ways to increase intake and frequency (surely the midwife has suggested this....???).

Ways to increase frequency: lots of skin to skin so you can respond to all feeding cues; switch nursing; using at least both breasts each time; waking to feed; co-sleeping (safely) so night feeding increases.

Hope this helps.

You could also try breast compressions when he falls asleep feeding, to get more milk into him.

This situation is a horrible one to be in, but I promise it can most likely be fixed!

Firstly, as above - feed more. I know it probably feels like you're already attached to the baby constantly, but it will settle down eventually. For now feed, feed and feed some more if you can. Encouraging the cluster feeding will increase your supply because milk is produced on a supply and demand basis. This is also why it's not necessarily a good idea to top up with formula at such an early point, I'd ask your midwife or HV to refer you urgently to an infant feeding coordinator/"lactation consultant to check the usual latch/tongue tie/positioning, they are also likely to advise not topping up with formula. If you can't get an urgent referral for them (my HV got me an appointment with a LC within 4 hours when it came to weight issues), le leche league are fantastic and have a helpline and forum. Their leaders are all trained and really know their stuff, give them a call.

Finally, try to relax. I know it's hard, but you're doing brilliantly. Take a bath (with baby, they quite like it usually), rest when you can, drink plenty and remember to take care of yourself too.

I had this with ds, he didn't gain until day 21. What seemed to help was breast compressions and switch feeding for a couple of days. Also, when he started falling asleep I would wiggle his arm to keep him feeding. He fed often.

Of cousins it could have just been that he was getting stronger and more efficient but these things I did and after a couple of days he had gained a noticeable amount.

^all great advice

In the absence of any extreme physiological reasons, you WILl make enough milk. Your body will adapt if you just let your baby feed, feed and FEED. Whenever my baby has a growth spurt, it can take my body three days to catch up with his increased demands. I have found that fenugreek capsules will boost my supply in 24 hours. Drink loads of fluid, rest, do skin to skin. That ought to take care of how much milk you are making. If you do all of this religiously and there is still a problem after that, then it will likely be down to how your lovely abundant milk is being transferred (or not).

In terms of technique, are your ensuring that the baby completely finishes a breast before you offer the other one (to ensure the baby gets a good proportion of hind milk?) Kellymom is great on this. Good luck, will you let us know how you get on? IMO there is nothing wrong with formula top ups if they are truly needed,but I think that they are often recommended when they really aren't needed. It's a midwife's lazy way of discharging their duty to ensure that the baby is gaining because they often do not have the resources or expertise to assist with the BFIng issue and to treat the cause rather than the symptom,

CityMole, you say "In terms of technique, are your ensuring that the baby completely finishes a breast before you offer the other one (to ensure the baby gets a good proportion of hind milk?) Kellymom is great on this."

This is not really correct, sorry, and it's a misinterpretation of Kellymom's generally good breastfeeding information.

It is not possible to 'completely finish a breast'....thinking this way leads to mothers wondering when the heck the breast is 'completely empty' because they can still get a few drops (or more) when squeezing/expressing.

Instead, when a baby is breastfeeding normally and without problems of weight gain (unlike the OP's baby), it is fine and normal to switch sides when the baby shows he's finished on that side ie had what he wants (he massively slows down his sucking and swallowing, or he comes off the breast, or he starts fussing a bit). Then you offer side two.

If a baby is not gaining weight normally, and is also perhaps falling asleep after a very short time, then deliberately switching sides as soon as the baby slows down his sucking and swallowing, and then doing the same again from side two to side three and then even again to side four. This is not 'completely finishing the first breast'....far from it. It's 'switch nursing' which is a very good technique for boosting the volume of intake and supply. It's not something most mothers need to do, but as a fix for the baby who needs to gain more weight, it's effective.

Thank you all I will take a look at Kellymom and try the breast compressions as well, the health visitor is coming out at 2 pm so we will see if he is starting to gain and go from there

I'm in the same boat - also looking for answers. DD ( 9 days old ) quickly regained her birth weight ( 3.7 kg, born on Tuesday, was back to her birth weight on Friday ) and the practically stalled. 50g plus. She sleeps a lot during the day, has to be woken up for feeds. Keeps us awake for 4 hours each night between 11pm and 3 am.
A lactation consultant suspected a tongue tie but my midwife checked today and could not confirm it. DD has trouble latching so I was given nipple shields but I find they negatively influence my milk production. She starts each feed drinking rapidly but then usually falls asleep after max 15 mins - could it be that she is not getting the hind milk?

Tiktok, I have to say that I am feeling a little confused and patronised by your post. I said absolutely nothing about the breast being empty. I am well aware that this is an unhelpful fallacy and would NEVER suggest that it was a signifier of successful feeding. You are reading something into my post that is just not there at all! I suppose I should have said finished WITH rather than " finished", and I do apologise to the OP for the unhelpful confusion, but I quite clearly meant that the subject ( the baby) was finished rather than the object ( the breast itself). I agree with your list of signs that a baby is finished WITH the one side and ought to be switched. What I was asking the OP about and warning against us the practice of preemptive switching which often leads to the baby being removed from a breast too early and before it is ready for the other breast (something commonly done in early days by mothers who are in pain.)

Didn't mean to sound patronising, CityMole, sorry :(

Yes, a better way of phrasing what you meant would have been 'finished with'. 'Finished' is just incorrect.

My long explanation of why 'completely finished' was unhelpful was based on that, and not so much directed at you but at anyone else reading the thread who might have benefited from a better understanding :)

I really admire your keenness to ensure that information being shared is correct. I really wasn't suggesting ( and never EVER would do so) that an empty breast was a trigger to switch, and so was a bit over sensitive about your comprehension of my post. Sorry!

Op, switch nursing as described above was how I eventually got my sleepy Dc2 to start gaining - it felt really relentless and groundhog day-ish and tiring, but it did the job in the end. Best of luck.