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

[RaeSkywalker]

Sorry, to add: I was given no emotional support whatsoever, even told I'd regret giving up BF, until I collapsed in SCBU and was sent back up to the postnatal ward to be checked- they somehow missed that I'd lost a lot more blood than they thought during the birth, and I was severely anaemic. They wanted to give me a blood transfusion and I sat and sobbed because I needed to get back to SCBU and feed DS. The midwife who was assessing me gave me a huge hug and said she thought I needed an afternoon off from stressing about BF to get myself healthy again. I am so grateful for her kindness.

[KevinKeegan]

Tiktok the poo thing is interesting, I was told that as we hadn't had a poo before being discharged from hospital (stated in 1 night) we should go to the GP if nothing in the next 24 hours. So we dutifully staggered to the GP, me barely able to walk after c-section, to be told the she didn't know why they said to come as there had been meconium in the waters so pooing was clearly possible. She seemed to think she was looking for an anatomical defect but maybe it was a feeding reason after all. That has never occurred to me. I was being asked if wet nappies were 'heavy' but I had no idea what that meant. Heavier than what? With your pfb you have no frame of reference. The line changed colour which I took to be a good sign but now I know it only takes a few drops for that to happen. It's so hard as you have no idea what to actually look out for and everything outwardly seemed fine.

[KevinKeegan]

*stayed in 1 night

[tiktok]

kevin, your story is shocking but not unusual. The hospital were right to say if nothing in 24 hrs to get advice, but wrong not to explain why so you could take action i.e. Get the feeding looked at. I roll my eyes at GPs who do not know this basic stuff.

[tiktok]

www.nct.org.uk/sites/default/files/related_documents/What's%20in%20a%20nappy%20(ENGLISH%20VERSION)%20FINAL%20WITHOUT%20BLEED.pdf

Every mother and every hcp who cares for mothers should know the info in the above.

[Writerwannabe83]

Thank you everyone.

Yes Tiktok I am a HCP and the ward I work on probably sees about 7-10 babies admitted every week due to breast feeding struggles and related problems.

I'm currently relooking at every aspect of care we give these babies and families (including the care they get in A&E) to improve outcomes.

I see some very shocking cases, including one mom who was sent home from the hospital without anyone having even watched her breastfeed or talked to her about latch and attachment etc. Mother and baby were then sent in to us when baby was 4 days old with about 12% weight loss, dehydrated, hypoglycaemic and he also required phototherapy for jaundice.

It's just crazy how much deteimrntal impact poor breast feeding support can have on a baby's health and the emotional implications for the mother can be really upsetting.

[annandale]

{This is going to be long, sorry}
13 years ago now. DS born, straightforward, with hindsight mildly jaundiced, observed having first feed in the delivery room, felt quite odd, no sensation in particular tho I was expecting pain or a feeling of fluid coming or something. No comment from the mw that I recall but she was quite busy trying to stitch me up and in the end sent me to be stitched up in theatre so dh with ds. Difficult night in observation area, stone-faced midwives appearing at various points when ds was crying and doing the baby/boob push. DS would go on for a bit then come off again asleep. Again no particular words or description of what I was trying to achieve. Postnatal ward for 36 hours, similar except that they took ds and fed him some expressed milk for a few hours so I could sleep, otherwise similar short feeds, advice to me varied wildly with the person attempting to help, including dm and dmil neither of whom managed to bf any of their children. Home, ds still a bit jaundiced with hindsight. One night of sleep, then after that a sequence of days asleep and nights of 45 minute feeds then dropping asleep for 10 minutes then 45 minute feeds again. Told by the mw that he was still jaundiced and I must wake him every 3 hours to feed but I didn't understand how important this was - I did do it, but didn't struggle for ages if he just dropped off again. Tried a range of breastpumps, in every case I was lucky if 40 minutes pumping would give enough to cover the bottom of a bottle, but I was reading info by that point and knew that not everyone can pump effectively and it doesn't necessarily mean I didn't have enough milk. We limped on like this for four weeks, including being discharged by the postnatal midwife. I got random amounts and types of advice, all based on 'you're doing fine, looks good, maybe try X' and eventually sent to the GP by the HV as ds was losing (can't remember how much). GP sent us to A&E and the paed admitted us as they were concerned re the persisting jaundice. On the ward round they said they weren't too worried about the jaundice but he was failing to thrive and I would need to top up with formula. DS wolfed down a bottle and slept properly at last, and so did I, at last.

36 hours later we were doing absolutely fine and discharged, still bfing then topping up. BFing checked by specialist nurse on the paediatric ward, absolutely fine, doing well. Asked them if I should go to the specialist bfing clinic at the hospital (run on a VOLUNTARY basis by experienced midwives) and they were quite sniffy about it and said that a lot of mothers found the midwives there very brusque and hard to take, though I could go if I wanted. I didn't.

After 11 weeks, when I was still mixed feeding but decided I would like to try to increase the amount I was breastfeeding, I finally went to that breastfeeding clinic. They took ONE look at me, pulled out a picture and said 'you're doing it wrong, you need to do it like this'. For 11 weeks I had had no idea what 'nipple to nose' meant, and with one look at an actual picture of how to do it, I finally understood. DS probably got more milk in that clinic session than he had for about a week beforehand.

Having said all that - I tried twice to reduce the amount I was breastfeeding and ds lost both times, and eventually at 21 weeks I just said 'enough of this shit' and formula fed, but at least it was my decision and I was OK with it by the end.

I simply don't know what the answer is. It is incredibly frustrating, and clearly a common theme, how many people will tell you you're doing fine when you're not - I don't know what specialist breastfeeding expertise really looks like but if a specialist tells you your latch is OK I would like to know how they know. It is frustrating that nobody said to me that women with PCOS sometimes have a bit more trouble getting bf established and may need more support, but a) maybe this is not true and b) presumably they think it can be a self-fulfilling prophecy. I personally think that in fact I did not have enough milk, at least partly because ds and I never got established, and partly because realistically there must be a range of milk production levels among women - from copious to nonexistent only-just-enough-if-everything-goes-right, and I was on the thin end of that range. It is easy to take things the wrong way in the early days - so I was much impressed by Libby Purves' description of the chaos of the early weeks of breastfeeding, so that I didn't see that our 45 minute 'feeds' and 10 minute sleeps, all night every night, were not normal - not ALL the time. Your frame of reference is so nonexistent as a first time mother.

[Bear2014]

DD was born by ELCS at full term. I lost a lot of blood and I suspect this delayed my milk coming in. She latched on ok in hospital but never stayed on long and at home did so less and less. On day 5 the mw said she had lost 13% and had severe jaundice so sent us back to hospital.

While we were waiting for the doctor, the community MW helped us finger feed DD's first bit of formula. We waited hours but no one thought to tell me that there was a dedicated expressing room down the corridor, despite knowing that I wanted to EBF. So on day 5 not only was DD only having formula but my boobs were getting no stimulation whatsoever. When DD was admitted to SCBU (and put on a strict 60ml per 3 hours) I was admitted back to postnatal and given access to the pumps. I took my 5ml of breast milk into the nurses and they added it to the bottles. They wouldn't let me cup feed or finger feed as she was too sick and it took too long. 2 days later she came back to postnatal with me. I still tried her on the boob as much as I could but she wasn't having any of it. The midwives were at a loss and pretty much all suggested I should give up. The 'dedicated lactation midwife' wasn't available as I was admitted on a Friday night.

We were discharged 5 days later with a carrier bag of aptamil and finger feeding paraphernalia that I had begged for. I point blank refused to give another bottle. As soon as we got home, we got a recommended lactation consultant to come to round and within an hour she had DD latched on. We continued to top up with finger feeds then reduced the top ups and dropped them within a few days. DD was then welded to me for about 20 hours a day at first and was EBF until she was 22 months old. It was the hardest thing I have ever done but so worth it.

(This was at St Thomas' in Jan 2014)

[silkpyjamasallday]

My DD lost just over 10% of her birthweight and we had to go back to hospital to check for jaundice, which was apparently within normal levels but she is mixed race so I think that the nurses and doctors assumed that her skin tone was due to jaundice entirely when they saw us without her dad. She was just too lethargic to latch properly at first or would fall asleep on the breast immediately after latching, didn't get much help the one night we stayed in hospital, they made me hand express into a syringe for her but wouldn't let me feed her with it which upset me a bit. I was pretty much ignored by the midwives as many of the other women on my ward had had more difficult births and needed more help, but I didn't even get any pain relief or shown where the loos were etc. I continued feeding using the syringe at home every 2 hours as I had to wake her up to feed and once the jaundice wore off she fed perfectly and has now jumped from 25th centile to the 75th with exclusive breastfeeding and is a proper chunk now. I discharged myself from the ward as it was 27 degrees and baby and I were much happier at home, I could at least sleep without the disturbance of buzzers going off every two minutes! I wasn't too worried as my mum had told me I was exactly the same, and dd certainly isn't failing to thrive now!

[43percentburnt]

I'm shocked at how many people are saying their babies were given formula for hypoglycaemia, I have read quite a bit on hypoglycaemia (including 2 hospital written hypoglycaemia policy) and my understanding is formula does not help, it is colostrum that raises mmol levels.

[Writerwannabe83]

43percent - in my Trust the policy is that if the blood sugar is below 2.6 then we need to give the baby a supplementary feed. We have mum's on the breast pumps but the reality is that some of these moms can't get anything initially and so we have no option but to give some formula. We only give formula if we really have to though and it is never plannd to be a long term fix, hopefully just a one off to stabilise baby whilst we work on the expressing and breast feeding.

[43percentburnt]

Writer until I researched this (last year) I didn't realise how different hospitals follow different guidelines. Some see 2.6 as the cut off (UNICEF guidelines)others 2.0 (WHO guidelines) I am glad your hospital encourages the use of breastpumps. Do they show how to hand express too?

UNICEF baby friendly guidelines for hospitals also suggest formula can hinder 'For all breastfed babies, the aim should be to ensure that needs are met as far as possible by breastfeeding... Also, it appears that breastmilk enhances the baby’s ability to counter-regulate whereas large volumes of infant formula suppress this ability.'

Sadly my hospital experience was awful despite having colostrum 2 hours post csection and despite being able to feed then express 20ml within 24 hours.

[chocolateisnecessary]

It wasn't a and e but his sugar was low so they gave him one bottle of formula while I pumped and worked to get it established.
In truth, the midwives panicked and there was something wrong with the equipment. We had too much support. They kept pulling him off, putting him on, saying it shouldn't hurt and really wrecked the first few days.
When he'd take from a cup, we got to go home and established breastfeeding without more formula.
It was just lots of different midwives all saying something else. He then fed until 22 months.
I think more honesty is needed in that it can take a while to establish.

[Liara]

Not in the UK, so may not be relevant to you.

Baby was losing a lot of weight in first week, and did not do a poo after his meconium in 10 days.

We went to the hospital as it was NYE and couldn't get hold of my mw. Was not admitted but told I could not bf and had to ff, and that my baby being unwell was a result of my arrogance in thinking I could bf, when 'most women can't'.

Attempted to ff, baby was projectile vomiting everywhere. Went and saw at least 5 other hcps - mw, paed, gp, lactation consultants, other gp, osteopath, you name it. None had an answer, other than there must be some problem with my milk supply. Some encouraged me to improve it, others to ff. I did both to the best of my ability. Was on an exclusion diet for potential allergies. Got mastitis a couple of times from overstimulating my supply with the pump. Ff was a failure, as ds usually threw it all up through his nose and then cried for hours.

At 3 months, ds was only a pound above his birth weight, and completely off the charts, as well as very unwell (crying constantly, sicking up all his food, etc.). We took him to A&E where they decided they would admit him and stated they would remove him from me and feed him themselves. Bf would not be allowed to continue.

I refused, left and went abroad. In that A&E they were sympathetic, and had me see a paed gastro. He admitted ds to hospital, gave him a ph probe and said he had never seen such an extreme case of acid in a baby this age. Put him on meds, encouraged me to carry on bf (on a strict dairy exclusion diet) and start introducing solids.

Within 6 months, he was at the 99th percentile.

The gastro paed we got to eventually was incredibly supportive of me as well as sorting out ds. Most of the others were either well meaning but useless or positively evil.

[Writerwannabe83]

I work in a Baby Friendly Hospital and I work closely with the Infant Feeding Team to try and endsure the best care we can.

The problems that stop us from being the best we can be are:

1. We are a very busy unit and unfortunately we just don't have enough time to spend the time with these mothers/baby that they so desperately need. Sometimes each nurse has 5 patients each and so out time is spread very thinly.
   
   
2. We have doctors who think formula is the answer and want to cram lots of it into the baby ASAP.
   
   
3. A good number of nurses aren't that bothered about BF, don't see why formula isn't just as good, so spending time trying to establish breast feeding isn't always a priority.
   
   
4. No set care pathways or guidelines as to the best way to manage these babies leading to all sorts of mixed messages being given and different nurses and doctors doing different things. However, this is what I'm currently in the process of changing.
   
   I think a high number of the babies we have admitted to us are discharged on formula top-ups when it could easily have been avoided with the right care and adequate time to allow us to work closely with the mother/baby.

[Writerwannabe83]

liara - that is horrendous!!! I was reading your post with my mouth open in shock!!

[Writerwannabe83]

I think more honesty is needed in that it can take a while to establish.

Absolutely!!

We have babies admitted at 2 days of age and the doctors are telling us to give them formula. We're all like, "Just give the baby a chance!"

The youngest I've ever seen be admitted for feeding problems and 'prescribed formula' was only 16 hours old. It just shows how inadequate Maternity Care can be sometimes.

[Liara]

It made for a fairly traumatic start to motherhood.

The fact that a number of them said it was my fault for having a home birth didn't help much either (birth was fine, smooth and without incident).

I was lucky to have the option to go abroad when I finally had had enough of this shit. It's a good thing I did, and fell on my paed gastro, or I'd still be blaming myself (and who knows what state ds1 would have ended up in).

[SauvignonBlanche]

I was discharged at day 4 after an EMCS, I thought I was BFing but DS was very unsettled and fussed at the breast.

It was a BH weekend and when DS was weighed he'd lost 20% of his birthweight and we were told to go to hospital. When I got to the Paediatric ward the doctor was waiting for us saying she was expecting a very poorly baby.

They passed an NG tube and he was FF overnight. I was expressing milk all night and was taught to cup feed. We were readmitted to the Maternity ward where one midwife can in and said 'right, this baby's going to feed!' and stayed with me through the whole feed and taught me how to get him to latch on property.

That one midwife, who gave me all the time I needed ensured I was able to BF for a year.

[Writerwannabe83]

The long term plan for our Trust is to create a unit for weight loss babies to be admitted to as coming to a busy acute medical ward really isn't in their best interests. I hate the fact we can't dedicate enough time to them but the environment just doesn't allow 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

[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

[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]

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

[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.