1 week old, help please

[tmc14]

Hi,
My gorgeous boy was born last Thursday. It was a very long labour with last minute complications so we were both exhausted. Friday feeding was a struggle. Saturday morning my midwife came and helped us feed. Saturday/Sunday went much better and he took to feeding really well. However, he started to get sluggish and was sleeping a lot. By Tuesday he’d lost 13% of his body weight. So, on MW advice (who is really pro breast feeding) we started some mixed feeding to get his weight stabilised.
Unfortunately now of course he’s preferring the bottle. I’m still feeding at each feed, both breasts, and expressing after each feed, and just mixing in some formula, but I’m worried this is the beginning of the end, at only one week old.

Any advice on how to move forward please? My milk is coming in but my breasts don’t get the engorged feeling I was expecting. I’m expressing around 10ml each time. I just feel so sad that I’m not feeding my baby :-(

It is actually very difficult for most women to exclusively breastfeed especially at the start

No it isn't.

My DD couldnt latch on for 3 days so I had to give her a bottle of formula which I was initially really upset by, but realised that realistically, feeding her by syringe of the little I could hand express wasn't going to cut it.

I managed to combo feed her for 8 weeks until she completely refused the boob and will now only take a bottle.

Yes, I was upset; I'd always thought I'd EBF only. But you know what? DD is 4 months old now, happy, nice and chunky and my DH can do night feeds because of taking a bottle. Don't be hard on yourself. Your baby is getting fed and that's the important thing

@thecatismyenemy
Show me the evidence

"Delayed lactogenesis II (DLII) is defined as lactogenesis II onset more than 72 hours post partum.3, 4 DLII can contribute to early breastfeeding cessation. In various populations and non-emergent cesarean births, incidence rates of DLII range from 17% to 44%." *

So up to 44% of women don't produce enough milk in the first 72hrs to nourish their babies.

*www.ncbi.nlm.nih.gov/pmc/articles/PMC3670592/

.... and that's just milk production and doesn't take into account any anatomical issues that might affect milk transfer.

I think things must have changed. When I had my first baby 22 years ago, I didn't expect to have much milk until day 3, and nobody worried about it- the idea then was that there would be enough colostrum to keep the baby going until "your milk comes in" on day 3. But now there seems to be real concern if there's no milk straight away.....

@bertrandrussell thats because even a 7% drop in weight can be associated with markers for brain damage. The American association of paediatrics now recommends interventions at 7% weight loss (updated recently from 10%). Not sure if UK advice has been updated yet?

Feeding issues (jaundice, dehydration etc) are the number one reason for hospital admissions in babies.

1sttime - it’s been explained to you on other threads that the paper you are linking to does not say what you think it says. It’s also the case that a seven per cent weight loss is not dangerous. Please look at the NICE guidelines on faltering growth published just a couple of months ago for more info about this.

@lunaluvpud thanks! One of our issues is that is isn’t constantly looking. We have to wake him up to feed a lot of the time. I’m being careful to at least breastfeed a bit at each feed, to try & establish/keep supply. Sometimes it’s a decent amount, sometimes just a couple of minutes before he’s fighting it. I think I was just worried that even a few days could ruin my chances of breastfeeding well, but you & other posters have cheered my spirits.

@thecatismyenemy I did have IV fluids, my labour was really long and I was drinking loads but still got really concentrated urine so they gave me fluids. That’s an interesting thought.

He is taking the boob more today. Yesterday each time we tried he just fought back so much it was really distressing. I will keep trying. Thanks x

@foodiefood that’s what my husband says. The end of his birth was an emergency situation & my husband says he just feels so lucky to have a healthy baby that we shouldn’t worry if it doesn’t work out. Il give it my best shot though.

@bertrandrussell that’s what my mum says! But it’s hard when healthcare professionals are telling you something else.

@tiktok this is a different paper to the one posted on a previous thread. It references a study by Dr.Kramer a world renowned researcher on breastfeeding (of the PROBIT study which I'm sure your aware of?)

I like scientific evidence and I seek it out.

Information presented to the World Health Organisation in Sept as part of their review of the BFHI guidelines
^At this time, the scientific literature has shown that 95% of hypernatremia occurs by 7% weight loss and at this time over HALF of all EBF newborns lose > 7% of their birth weight.
Currently, hypernatremia is considered to be rare because it is not screened for in EBF newborns.
The effects of hypernatremia on brain development are severe. A study of 116 cases of breastfeeding-related hypernatremia showed that more than 50% of babies exhibited abnormal development by 12 months of age. This is perhaps the rationale for the 2012 update of American
Academy of Pediatrics Breastfeeding Guidelines recommending no greater than 7% weight loss in newborns.^

I will post references for the above shortly.

www.ncbi.nlm.nih.gov/m/pubmed/17674254/

academic.oup.com/tropej/article/53/5/347/1667599

7% weight loss is not dangerous. Stop scaremongering, or people will start to think you are a shill for the formula milk industry.

@1sttimerounder hi, I’m not sure why you think it’s ok to post about the dangers of a 7% weight loss to someone who has a baby with a 13% loss. I followed medical advice, my baby is now putting on weight & I’m just looking for ways people have transitioned back to exclusive breastfeeding. If you don’t have any anything to say to my query then please stop posting. Thank you.

1stTimerounder, how exactly are you planning on explaining to the newborn babies that they're not allowed to lose more than 7%? Unless you're weighing them every day how will you possibly know if it's heading that way? It's not a controllable when things appear fairly normal and therefore baby is home and not weighed until 5 days old.

OP, I'm sorry not to have any advice for you, but hang in there! I didn't have such a complicated time, but I did find feeding really bloomin hard the first couple of weeks, and it has got easier. We did have a lot of writhing and fighting at the breast even without bottles being involved, I was told it was quite normal and part of them encouraging supply. Not the most comfortable thing though!

Thanks @madbee it’s really distressing when he fights & shouts and claws at my breast!! It’s good to know that’s not necessarily abnormal. We had some good mixed feeds overnight, I’ve mabaged to do at least some breastfeeding each time. We are up and going to go to the drop in breastfeeding clinic so will hopefully get more good advice in real life.

Tmc- I remember dd doing that. When there was someone else there, it seemed to help if they took her for a little (a very little) walk round, then brought her back to try again. I think it worked because I had had a minute to compose myself and take a breath.......

Thanks @bertrandrussell I’m lucky in that my husband has a good few weeks off with us so he can definitely try that! There’s been several times where I’ve just cried & got as stressed as the baby, which obviously does not help.

I've only glanced through the thread. My baby had a 13% weight loss, cue panicking community midwives, we were sent to hospital and kept in but the hospital weren't bothered as they left us 6 hours before we saw a doctor. My baby was absolutely fine throughout (I wasn't but that doesn't matter). I was told to feed every 3 hours and top up afterwards with formula, my milk came in and weight gain started and continued with no further drops. The formula top ups decreased and were dropped within a fortnight.
I didn't bother expressing just fed DS, so I was fairly full when he wanted to feed and the milk came out easily. I also went through DS preferring the bottle but a blood test later and he was wanted to breast feed for comfort. I found undressing him quite good for getting DS to breast feed. I kept in my mind the whole time we top up lambs whose mothers don't have enough milk and it gives the lamb and ewe the best start. Good luck, don't beat yourself up over it, bf, mix fed or formula fed all have advantages and disadvantages x

1stTime, it might be better to start a new thread. I am happy to engage away from this one and explain further why the 10 year old Turkish study you choose to reference is not the last word on early weight loss and to direct you to better evidence from elsewhere.

I like science and research too. I think it’s important to be able to evaluate and assess as well as liking.

Meantime take a look at the NICE guidelines I mentioned before, and check out the UK work by Oddie et al.

I think you are not being helpful in the context of this thread - but elsewhere there might be a chance of a better discussion.

Thanks for everyone’s advice. We had a great session at the drop in clinic, every feed today since has been really good breastfeeding followed by the top up formula & expressing. Our technique is getting better and he has a small tongue tie which will be investigated next week. I’m concentrating on improving my supply as I’m not producing that much milk. I feel quite positive, even if we end up needing to keep the top ups. At least my gorgeous boy will be getting some breast milk each time. x

tmc why do you believe that you're "not producing that much milk"?

Expressing is no indication (but get a Hakka/Naturebond because they are amazing!!!)

Your baby's weight loss could simply be normal breastfed loss plus the adjustment for the inflated birthweight due to fluids

Or

Your body is producing as much as your baby is asking for. Get that TT looked at, feeding with a TT is knackering for baby so they don't feed as well. If you can afford to go private then I recommend you do. ASAP! Don't do as I did and wait until 17 weeks. It's harder for baby to relearn to latch when they're older!

Or a combo of both!

Well done with pace feeding.
Are you pumping to stimulate the feed time you're "missing" when baby's topped up to increase your supply?
A really affective "cheat" way of topping up baby and stimulating the breast for that missed nursing time is something called a "supplemental nursing system" (SNS)
Don't buy the super expensive Medela one, google "homemade SNS" and you can make one for about 1/5 of the price!!!

All the very best to you x

@tmc14 You are doing so well!

I am so pleased for you that things are going better... DD had a TT when she was born and when it was released it really made a difference for us... Her latch got loads better and the milk transfer was more effective so she was on the boob less. By less, I mean I had enough time to go to the loo and have something to eat in between feeds for the first couple of weeks!

One other thing... When DD was a newbie, feeding was sore even when her latch had improved but I think that's because she had such a little mouth. As she has got bigger, latch and feeding has become a doddle - we have both learned what we are doing now. Good luck with everything!