Was your breast fed baby ever re-admitted after birth due to weight loss?

[Writerwannabe83]

I'm asking about this as a professional as I'm curious what people's experiences were due to me trying to improve standards of care in my own workplace setting.

What led you to take your baby to A&E, how old were they and how much weight had they lost?

What treatment did your baby receive and more importantly what emotional support did you receive? Were you still exclusively BF'ing on discharge?

Thanks in advance for anyone who has a story to share

[SDTGisAnEvilWolefGenius]

Something I should have said was that ds2 went on to thrive, despite his admission and the 'failure to thrive' label.

He is now nearly 22, knocking on six foot tall, in his final year of university, where he plays and umpires hockey, and generally fit as the proverbial flea.

I beat myself up a lot for my failure to breastfeed my boys (none of them did well in my milk), but I have come to realise that I did my best, and that how a baby is fed in their early months is just a small part of building a healthy child and adult.

[MissObsessed]

Can I just say that although it is obviously shocking that so many women have had similar experiences I'm also finding it helpful to read that this has happened to so many others. When my DS was admitted I was made to feel, by some MWs, that it was all my fault and something that could have been avoided had I just 'got on with it.' I still find the whole thing quite traumatic to think about but reading this thread is helping me feel a lot less guilty.

[BigWeald]

This was 6.5 years ago so a bit patchy.

DS was born by EMCS, had infection markers, suspected Group B Strep. Was put on 5 day IV antibiotics. By day 5 infection markers were still too high so it was extended to 7 days, then 10. So we spent the first 10 days in Transitional Care.

We had two bouts of feeding problems, one during those first 10 days so we were at hospital already, and the second one causing us to go to A&E on day 20.

First of all, they took DS away from me very soon after the CS in order to get a cannula fitted, which they failed to achieve but only admitted after a long time trying. So a few hours later they took him again, this time successful. When he was away, a MW told me to express colostrum manually. She made me feel embarrassed that I did not already know how to do that. And she made me feel anxious about being able to express enough ('if you don't manage to express 3ml by x time, we will have to top him up with formula'). That was within a couple of hours of birth, with him being away from me, me super scared as there was a problem and they'd whisked him away, and unable to move any part of my lower body so unable to get into any kind of comfortable position. Luckily my mum was there (DP had gone with DS) and she helped me syringe colostrum off my nipples. We managed 2ml which was grudgingly deemed 'ok'.

After that wobbly start we managed to establish feeding, though it was filled with anxiety and I was asked to keep notes of how long he was on the breast and at what time.

When my milk came in on day 3 I became engorged, and DS was no longer able to latch. He became weaker and dehydrated, which caused a lot of concern, also he went down from 3300g to 2950g so just over 10% loss. They were worried there was something else going on, had to do urine samples which is tough with a dehydrated baby... he became weaker und less responsive, couldn't feed anymore, dehydration became a real worry so a NG tube was fitted. So from day 5 I think, I attempted breast feeding, then he was fed by tube while I expressed, in a three-hourly schedule as described by PPs. Utterly exhausting. Formula was not suggested at that point, I was supported in expressing (as in, provided with equipment, shown how to do it, and how to sterilise, provided a fridge for storage), but the nights were really bad.

Day 8 or 9 the infection seemed to have been beaten, but no discharge possible as long as NG tube still fitted. Most MWs/nurses were just letting me keep doing what I was doing (that mad 3 hour schedule) but one fantastic one supported me in getting him off the tube and re-establishing BF. She suggested a 'sink or swim' approach but also promised that she would stay with me and support me through the first 24 hours and then we would re-evaluate, which she did, she even supported me in gradually reducing the amount I was pumping without becoming to engorged.
So on day 10 we were discharged with 5 days worth of oral antibiotics and feeding established, weight just below birth weight. Took a small stash of EBM home with us, which was put in the freezer.

Things seemed to be going well. We fed on demand, roughly every 3-4 hours. We had no MW follow up at home as 10 days since birth were already over. HV dropped by but was wholly ineffective. But on day 17 DS was noticeably becoming weaker. He was too tired to feed properly, cried for the breast, went on and immediately fell asleep. On day 18 he slept 8h through the night - hugely restful for us, but in hindsight a massive red flag. By day 20 he was so lethargic and feeding so little that we took him to A&E. We were also worried as he started getting worse 12 hours after we completed the course of antibiotics, we thought perhaps the bug had not been completely defeated and was now re-surging.

The visit to A&E was quite traumatic in itself. We were seen really quickly. We knew some of the people we saw from our lengthy stay in Transitional Care. But then we were basically told to get a urine sample off him (the previous time it had taken us over 12 hours to achieve that) and to feed him, because he was being starved. So for 4 hours or so I was trying desperately to BF him while at the same time holding his bare bottom over a vial to catch any eventual wee. That was simply never going to work - the feeding, I mean. We were set up to fail. Rather than supported to BF.

After four hours we caught a wee, it was analysed and seen to be fine, the consultant then saw us and stated that DS needed to be fed and if he was not feeding from the breast he needed formula. She said we could not leave before he had fed, had someone bring a bottle of formula, and left us to it.
DS guzzled most of the bottle, then threw up most of what he had drunk. After that the consultant said, there was nothing wrong with him, he just needed to be fed, and sent us home.

We stopped by the shops on the way home and got formula. But as we still had a stash of EBM, we fed that at first (by bottle), and started expressing again, and by the time the stash was used up my expressed supply was good enough to avoid the formula. But we were back on that crazy 3h schedule.

A week later we went to see a lactation consultant, at the same hospital where we'd been both for birth and A&E. She was superb. She gave us the emotional support and practical advice to gradually come off the mad schedule onto something more sustainable. Slowly gradually we moved from feeding expressed milk by bottle to BF. At 12 weeks he had his last bottle, ever. When we tried him on a bottle of expressed milk at 4 months, in order for me to go out, he point blank refused, he refused bottles ever since. I BF him until 21 months.

There are two things that make me cross:

• The superb lactation consultant was there, in the same building, both times we were having feeding problems. No-one ever mentioned her or suggested she could pop round or we could go see her. We didn't know she existed; all the MWs, nurses, consultants were keen to give us advice but clearly thought they knew better or just as well as the specialist.
  
• The way the consultant in A&E insisted we were to feed him formula and made it a condition of us leaving. We had expressed milk at home. DP could have popped home and fetched it. But no, it had to be formula.
  

Looking back, what I think may be learned from our experience:

• I was really scared of introducing formula. I had read that even a single top-up of formula puts you on a slippery slope, your supply will go down, you will need more and more formula and will end up exclusively formula feeding. I wish I had understood that sometimes a bottle of formula can be just the thing needed to give the baby strength enough to continue with BF. I was also overly worried about nipple confusion, and thought it was a given that if DS had a bottle or two, he would no longer want the breast. I know this is a risk but I think it is often overstated.
  

• When 'starving' babies are put onto the 3h 'attempt BF, feed expressed milk (by bottle or cup or NG tube), express, sterilise equipment, sleep for 20 minutes, start again' schedule, the mothers need support; or else you are setting them up to 'fail'. This schedule is unsustainable for more than a few days. You can't just let them get on with it; or you might just as well say to them 'you can try, it won't work, why not just give the baby formula anyway'. So in the short term, they need support, and in the mid-term, the need a supported plan to move away from this schedule. This can be back to BF, it can be to exclusively feeding expressed milk (saving the time of attempting to BF), to mixed feeding, or whatever - but as the mum in that situation you need a way to move away from the mad schedule, and because you are utterly exhausted you need someone to help you/show you that way.

[farfarawayfromhome]

Writerwannabe83 i remember you from the sleep threads, congrats on the new pregnancy!

i don't have anything to add here but just wanted to say what a great project you are working on. best of luck.

very moving stories up thread.

[juni]

Yep, discharged day after birth with DC1 without midwives checking he was feeding properly. Had a lactation consultant visit at home when told MW I was struggling - had to pump then bottle feed (and repeat so didn't really sleep for a week). But had been told the wrong amount of milk DS needed (about half of what he should have been on). Re-admitted and husband had to help get a tube down his throat to feed him - when I questioned this after DH and DS had been through the trauma one of the nurses was shocked to hear he would take a bottle. They hadn't taken our full background and just assumed he wouldn't - cue tube being taken back out and him guzzling a bottle of formula. All because I'd been told the wrong amounts by the lactation consultant. Things didn't really improve - only once my cousin sent me nipple guards and he magically latched on and we never looked back.
I'm still traumatised by these first few weeks and that was 9 years ago.
Second time around (new area) fantastic support through local free breastfeeding group and a support group at the local hospital.

[Paperthinspider]

This is interesting to read as I didn't realize my experience with DS was so common.
I BFd but he lost weight days after birth, so we had to be constantly checked.
I had to formula feed in the end so he gained weight, but continued with the BFing as well, so many well meaning professionals just couldn't understand why there wasn't enough milk being produced.
When he was 6 months he was sent to the hospital as he wasn't heavy enough (not ill though) because I had returned just to BFing.
I still would BF again but I wish I'd known that it isn't necessarily going to be straight forward and that there is the option of mixed feeding.

[chuntersalot]

Details a bit scarce but as much as I can remember:

ELCS birth weight 7.7lbs
4 days stay in hospital
Milk supply sufficient from very early
Problem establishing BF
Had previously been successful BF twins with the use of nipple shields but this time was 'told / advised' not to use them
Was supplementing with high calorie? formula by day 3
Suffering really badly with engorgment
Admitted to childrens ward day 7 by community midwife for failure to thrive - not sure about weight loss
After 6 days on the ward baby was diagnosed with UTI 😢
Discharged home having not been able to establish BF
Carried on trying and expressing- supply was still good at this point
Was fully formula feed by about 7/8 weeks

[Spindelina]

I haven't got time to rtft, but we got readmitted on day 3, with 13% weight loss.

My experience in the ward was as good as it could have been - great staff, crap situation. But there was a plan, we did pumping / feeding from breast / bit of formula and she gained quite a lot in 36 hours. There was a plan, we were following it, it appeared to be working.

So we were discharged... to an abyss. Community midwives were patchy in their knowledge. HV was useless. We were basically told that there was nothing medically wrong, so we should just get on with it. With what? What's the plan? How to we get from relying on formula top ups back to EBF? Just get on with it. So we tried, and DD was still at her birthweight at six weeks. Back in the formula top ups, and there we stayed until 12 mo.

That complete lack of support after discharge not only failed to support us to get back to EBF (which I firmly believe we could have, if the support had been there), but also knocked my confidence and contributed massively to my poor MH in the next few months.

Tldr: even if you are fab in the hospital, think about what support is there after discharge too.

[ACatCalledFang]

So sad that so many of us have had such rubbish experiences. Apologies for length.

Failed induction at 40 + 12 (no other issues bar being overdue) followed by an EMCS at 42 weeks. DS was born on 50th centile with no issues at birth, and hospital encouraged me to try to feed in recovery. Some support on post-natal ward.

In hindsight, DS was in trouble before we left the hospital on day 2: he filled five nappies in the first 24 hours with meconium poo, we didn't know whether he'd done a wee or not, and nobody suggested any way we could try to check. I suspect his birth weight was distorted by this and induction fluids; he dropped to 2nd and levelled out at 9-25th centiles, where he remains.

He also got extremely upset on the second night on the post-natal ward to the extent that a midwife helped me to finger-tube-feed him some formula.

First few days at home were awful - he latched OK, midwife thought all fine on day 3, just wanted to suckle constantly, don't think I got more than an hour's sleep, he cried a lot. Got very dry skin, which I now know was dehydration, and a sunken fontanelle, which everyone else told me wasn't anything and that I was overreacting.

He was weighed on day 5 and found to have lost 17% of his birth weight and was clinically dehydrated so we were referred to A & E. Our hospital had no paediatric beds so had to go out of area.

The next two days were beyond awful. My milk came in more or less as we arrived at the hospital. They basically left us in a room and told me to feed him formula every three hours. I asked if I could breastfeed as well - yes. No advice or support available. I wasn't even offered any water. The one thing they did which was good was to give us a private room.

I was told I'd have to go to the nearest supermarket if I ran out of formula before DP was able to visit the following day (a multi-bus journey taking around 90 minutes) - 5 days post-CS. Had to send DP out for supplies before he went home.

I got shouted at by midwives for having the bed too high, because it was the only way I could get him out of his crib. They told me off for getting them to check his latch twice (I had decided we were not leaving hospital until we'd cracked feeding) because "your little boy knows what to do". They didn't even realise I wasn't the patient and kept trying to take my blood pressure. They put a cannula in for DS which was never actually used. It was all quite upsetting.

But the worst was that there was no support available to establish breastfeeding despite being surrounded by those fucking posters saying "it's OK to ask for help". I asked for help - to see a breastfeeding counsellor, to be shown how to use a breast pump - and it either wasn't available or nothing happened. Nobody checked him for tongue tie.

Basically, no practical support was available and as for emotional - don't make me laugh. The paediatrician was very kind. Many of the midwives were downright nasty.

We were discharged after 48 hours by which time DS had regained enough weight to satisfy them.

Once home, nobody was able to give us advice on mix feeding; that included the health visitor (her priority seemed to be making sure DP knew to examine himself for signs of testicular cancer ). Every midwife had different suggestions.

We went on to have a lot of problems with wind and green poo, and constant cluster feeding. Got some emotional support from La Leche League but no practical advice. Health visitor beyond useless. GP no help.

We muddled through. Within six weeks we were exclusively breastfeeding and still are breastfeeding 18 months later. We found out shortly after DS's first birthday that he has an 80% tongue tie. I have post-natal PTSD and depression, mainly due to how the birth was handled but I suspect the first few weeks played a part.

This was all in summer 2015. The hospitals were Whipps (birth) and Newham (readmission). I ended up making a formal complaint about our care - Whipps were outstanding and met us, did a birth debrief and apologised for where care had been lacking; fair cop. Also put me in touch with infant feeding coordinator. Very cathartic.

Newham never acknowledged our complaint, even when chased by Whipps.

If we ever have another child, I will be paying for a lactation consultant (IBCLC) to visit within the first three days, and will not be afraid to use my own judgement to top up with formula to "make a bridge" between giving birth and my milk coming in.

[Writerwannabe83]

Sorry 43 - I meant we're working towards full accreditation. We have level 2 at the moment and have assessment for level 3 at the end of April.

It is mainly the Maternity and Neonatal units that are assessed, I have never known anybody visit our ward or pay much interest in what we do. I just assumed UNICEF were only interested in what happens when the babies are born or when they are Neonates not about what happens when babies get readmitted.

I work on a general ward in the Paediatric Unit and in the whole time I've been here I have never known any specific changes being made specifically to our ward following a UNICEF inspection.

I'm the breast feeding link worker on our ward and have been for the last 12 months and it's something I'm really passionate about which is why I'm not implementing lots of changes to ensure we are providing the correct care.

Our infant feeding team consists of two women, one who is based in Maternity and one who is based in Neonates. If we contact them to see if they have time to spare to visit a Mom/baby on our ward then they will happily come down but it isn't always possible due to their own workloads and the hours they work. I think the plan is to have another member on their team who will be based in Paediatrics and A&E and I'm hoping I'm being lined up for it.

There is so much room for improvement on my ward and in A&E but to fully implement everything and ensure all women/babies get the best support and care they need someone whose sole job role is to do that.

[RayofFuckingSunshine]

Will pop back to this later to contribute.

[43percentburnt]

Writer - how long does it normally take to get baby friendly level 3 accreditation? Did your department have to undergo much change to reach standards?

I hadn't heard of it until last year (after delivering), I had seen posters but just thought it want they were happy for you to feed on the premises!

[sundaysunday]

annandale I also have pcos and am annoyed that I was never warned it could affect breastfeeding. It didn't occur to me that it might.

[WinkyisbackontheButterBeer]

Not AandE but sent to children's assessment unit.
Very long, traumatic birth ending in emergency c section and high level of blood loss. Baby latched well. All seemed well.
Once home baby cried almost constantly. I spent hours with her at the breast. I kept being told that she was cluster feeding at it was normal.
Day 3 midwife weighed her and said that she had lost 14.3% and sent us back in.
Once in the assessment unit they struggled to take a blood sample but did realise that baby had a tongue tie. Eventually reweighed her. After a few hours they realised that the numbers didn't match. She'd actually lost 9.3%.
(We think that the mismatch was because the mw weighed her on the rug. I have insisted since that it is done on a table)
Sent home. Tongue tie clipped 3 days later. Baby weighed again, she had still not gained so we were sent back.
Once in we were put on a breast feed, formula top up, express cycle and kept in overnight while latch etc was checked again. Each feed cycle took 2 hours. By the time I had finished it was time to start again and I wasn't managed by to express more than a teaspoon.
The nurses were lovely and very supportive but no one actually checked me or the baby over to see if there was a physical reason for the lack of weight gain.
Three days later and she was gaining well but was continuing to take a lot of formula, even after nursing. She was becoming more and more distressed at the breast and was often refusing it altogether.
One Day my dad was watching her crying and realised that her tongue still wasn't completely free. We had a posterior tie clipped at 3 weeks and I hoped to establish breast feeding properly as the bf, top up express cycle was unmanageable. Baby had other ideas though. She completely refused to breast feed. Would scream and turn her face away and eventually my anxiety levels became so high that I couldn't cope with not knowing how much she had fed. I was terrified of her losing weight again and I was dreading each feed.
I hated giving up and felt that I'd failed her. Even once I'd stopped completely my boobs never got full or hard, never leaked. In hindsight I realise that the combination of me having so little milk, the c section and her tongue tie combined to make nursing impossible for us.
I realise that I have waffled and not really answered the question. Sorry.
For us the main things that would have improved our experience was

1. Tongue tie routinely checked for and treated at birth.
   
2. Midwives always weighing baby in a hard surface (I argued with one who said that it didn't make a difference. When she reweighed on the table there was a 3oz difference).
   
3. Continuity of care. We saw 12 different midwives between dd's birth and being discharged and all 12 gave different advice especially about bfing. By the end I was so confused by conflicting advice that I had no chance of continuing.

[sundaysunday]

Hope I'm not too late to add our story, unfortunately mine was very similar to many others here.

DS1 feeding fine on discharge but after 3-4 days we noticed heavy pink stains in his nappy. We were reassured on the phone by the postnatal ward this was normal urates but it was actually the first sign he was dehydrated and they should have picked up on it there and then. I had also rung twice the previous day because DS was unsettled despite feeding continually.

On day 5 DS had lost 15% and was admitted. There were​ no beds on the postnatal ward so we were admitted to the children's ward (3 nights on a lumpy camp bed for me with a 4th degree tear). We were advised to continue bf with formula top up which I was happy with because DS was very drowsy and had high urates in his blood test, as it was Saturday we waited in until Monday to see the hospital infant feeding coordinator.

She jumped to the conclusion that it was a latch problem when it wasn't and complained about me topping up with formula. As it turned out I had lactation failure due to IGT but I was still encouraged to express to increase supply even though I would never have been able to exclusively breastfeed. I ended up mix feeding and expressing for 4 weeks then moved to formula soon after as I never produced more than 20mls bm a day and it was just too much to cope with for such small gains.

Main points I have fed back to my hospital are

• dehydration and bf problems could and should have been identified earlier
  
• infant feeding coordinators should be available 7 days a week in hospital, and on-call 24/7 for telephone advice for staff with patients needing help (however there is only one feeding coordinator at my hospital!)
  

Personally, I should not have been pressured to try and breastfeed at any cost because it wasn't​ anatomically possible for me and caused so much sadness and stress during those first few weeks.

[Toddlerteaplease]

*bottle or tube feed.

[Toddlerteaplease]

I've been a pears nurse for 13 years and still feel very out of my depth with newborns admitted with poor feeding. I just want to give the babies a bottle, let the usually exhausted parents get some proper sleep and try again with BF in the morning. I hate having to wake them to pump etc.

[trilbydoll]

Writer if it helps, my two nights on the transitional care unit were awesome.

• Medela pumps for each bay
  
• only 4 bays rather than the 6 in post natal
  
• trolley with bottles and teats that you just took as you needed for expressing, and a dedicated little fridge for us.
  
• decent food and the catering ladies made sure you always had water
  
• they had a proper bedtime, turned the lights off at 10pm and told you off if you were noisy. Post natal was like Piccadilly Circus in comparison.
  

The only bad bit is TCU is for poorly babies and well mothers. I was only 5 days post section so I think "well" might have been overstating it slightly - walking down to the kitchen to wash up the pump took a long time!

[tiktok]

Nacho, how awful :(

Writer, happy to help if I can.

I'd urge you to get stats if you have not already - a general hospital maternity unit has about 5000 births a year of whom maybe 4000 will start BF ( obv massive variations). If your unit is like this, then something like one in ten of them are whizzing back in - and there will be a bunch more who don't come back because they have been given formula in the community.

This is hugely expensive to the NHS and massively upsetting to the mothers (and to staff, too, I am sure) - work like you are doing to improve things is so important.

[ItsNachoCheese]

Pushed send before finishing. I think though my milk had a lot to do with his weight loss as although it was never tested as such even with the electric hospital breast pump i was getting next to nothing out. Ds must of got accustomed to so little milk. It hasnt put me off bfing in the future though but i may express so i know how much has been taken for my piece of mind

[ItsNachoCheese]

Ds was 11lb 0.5oz when he was born. He was bf from birth and at his admittance at 6 months he was just under 13lb. He looked skeletal and had problems with bowel movements too. Could easily go a week between them:(. His clothes and even his nappies were too big. My hv at the time said there was nothing wrong with him and he just needed feeding up 😡. After spending a few days in hospital with him he had the most awful bowel movement that was like an adult, he was screaming with it. It was heartbreaking to see my ds in so much pain. He got put on infatrini high calorie milk to help his weight for a while and fast forward to now at almost 2 he is a strapping wee boy that loves his food and thankfully has better bowels than back then. So while scary at the time things sorted themselves out. Including changing to another hv who is a lot better.

[Writerwannabe83]

Hi tiktok

I'm currently pregnant with DC2 and I'm hoping things will be easier this time round - although I still expect all the negativity from my family members

I'm having a few health issues at the moment which means I've been taken off clinical duties for 4 weeks and have been given the time to dedicate to improving our breast feeding services. It's a huge task, bigger than I thought, but I'm loving it.

I'm meeting up with the Infant Feeding Team again tomorrow to discuss where we are currently "at" and then I probably will PM you for your thoughts on various matters

[tiktok]

Writer, I remember some of your story. You and I had lots of exchanges here on MN.

I think it's great you and colleagues are working on this.

I do think that more needs to be done before babies get to being hospitalised. Early feeding probs can be spotted day one or two - day four or five is prob too late.

Writer you can pm me on this. I have a lot to say and much experience but I don't want to go on and on about it in public

[Writerwannabe83]

Dessie - the last eight years of my career have been working with young babies and infants. I worked with Health Visitors for 2.5 years and I've worked in my current setting of caring for newborns up to 2 years of age for over 6 years. Prior to having my son, in jobs I've done extensive training in breast feeding and offered lots of breast feeding support to new mothers.

When I had my baby I thought I would find breast feeding so easy because I'd spent many years surrounded by it, learning about it, supporting mothers to do it etc.....oh how stupid I was.

I found it very, very difficult and the first 8 weeks of being a new mother were so bleak, I was so unhappy and down and it was all due to breast feeding. I beat myself up so much because I thought "How can someone in my profession and with my experience not be able to do it?" I felt so disappointed in myself.

Breast feeding did work out in the end but I empathise with the feelings of inadequacy. I'm sorry you had such an awful time with it

[DessieSaysDiy]

I'm a heath visitor (hide)
I had a horrendous time trying to feed my children.
Readmission of the 4 of them and felt awful.
I tried everything each time from pumps to homeopathic meds to private consultations.
It didn't work out for us.
Hope other reading this thread feel better now.
I felt really inadequate for a long time xx