help newborn not b/feeding, when do we worry?

[Scoobi6]

My sister in law had her ds the day before yesterday by c-section. She is concerned her baby is not getting enough colostrum/fluid. He latches on but only sucks 2-3 times then comes off, and he is very sleepy, he could go 4 hours without trying to feed. Last time they tried to wake him for a feed he screamed for 2 hours! When she tries to express she only gets a few drops and the most he has eaten was half a teaspoon full.
The bf specialist in the hospital told her the baby should be getting at least 5 ml colostrum every few hours and he is getting nowhere near that. Is he in danger of getting dehydrated or does she just have to hang in there till her milk comes in? Any reassurance and tips would be gratefully passed on.

If he is very sleepy she should take him to A&E to get him checked over. He may be jaundinced and too tired to feed or he may be unwell.

Is your SIL still in hospital? If so then the staff should be keeping an eye on things and be aware that her baby has not fed that much. If it's any comfort most babies have a supply of fat which they utilize in the first few days after birth (which is why many babies lose a little bit of weight in the first few days)which keeps their blood sugar up and keeps them going so chances are he is absolutely fine and just taking his time.

Hi, they are still in hospital, it is less than 48 hours since he was born. But the hospital is extremely busy - all beds full and not many staff! They've had an unusually high number of deliveries in the last couple of days so I'm not sure how much support she is getting.

Bless her - probably bugger all support.

Babies do definitely use their fat supplies in the first few days though. I am a bit hazy on the exact facts as it's been a while since I did any midwifery. I do know that it's rarely a problem though if the baby is full term and otherwise healthy.

You say he is sleepy and screamed for two hours last time they tried to wake him for a feed. Just a thought - was it an emergency caesarean section after a longish labour? If so he might be still recovering from the birth.

Hopefully milk will start coming in today so your SIL might find she gets more from expressing.

Get her to ask if she could use a large pump but also remidn her that expressing is not a direct indication of supply. ds was very sleepy and became jaundiced, which made it owrse, and I expressed colostrum but they also topped him up with formula blinding me with science about blood sugars etc. It was only the dedicated help of one mw who turned it around so that we left breastfeeding and I regained the determination to persevere. She needs to pester the staff, perhaps there is a trained bfc who visits ?

No expert, but my ds took a day or more to really take to bf (and then continued fine for the next 11 months). Babies born by cs tend to have more fluid in their lungs/stomachs (no expert, just what I was told). This is usually forced out during a natural labour, but can take a little while to clear after a cs. My ds took a while to cough this up & was a bit sicky for the first few days. In the meantime, he wasn't hugely bothered by feeding.

I'd say obviously follow medical advice, but don't worry! I propped the head end up in ds' cot to help ease congestion & put a muslin under his head to make clear up easier. And persevere, too, I'm sure your nephew will pick up interest soon. Ime boys can be greedy little things!

Thanks for posting. It was an elective c-section, baby was breech and SIL is a very petite first time mum. I'll tell her about the fat reserves, baby was 7lb6 so hopefully that will reassure her a bit. I guess dehydration is a concern for her, 2 days seems a long time for a newborn baby to go without fluid.

thanks lizs and tiredandgrumpy, I will pass on those tips too.

oh and to make him more wakeful , she could try just holding him skin to skin, on her chest, and stripping him down to a nappy when she tries to feed, changing him and tickling/blowing gently , to rewake him if he nods off. She could also leave some colostrum to dry on her nipples for him to scent.

i found this on MN a long time ago and saved it: Maybe print it out and take it to hospital for her. Pester the staff for help. My dd became jaundiced on day 3 and i think these tips could have avoided all that. Staff was no help too.

Expressing Colostrum during Pregnancy

Hypoglycaemia Policy
Most babies have no difficulty in adapting to life outside the womb. However, some babies have an increased chance of developing low blood sugar, sometimes called ?hypoglycaemia?. Babies at increased chance of low blood sugar are:
Babies born early or premature ? before 37 completed weeks of pregnancy
Babies, who are lighter in weight than expected for the number of weeks of pregnancy, sometimes called ?small for dates?.
Babies who need extra help to breathe at birth
A baby who is ill
Babies whose mothers had diabetes during pregnancy
Babies whose mothers have had to take medicine for blood pressure (betablockers).

If any of the above applies to you or your baby, then we will encourage you to feed your baby as soon as possible after birth and then to feed often, at least every 3 hours as this will help to prevent low blood sugar in your baby. Your expressed colostrum can also be given to your baby after breastfeeds. Your baby will be carefully monitored and we will check his/her blood sugar regularly.

Is there anything I can do during my pregnancy to prepare for this?
Sometimes as early as 28 weeks of pregnancy, women find that they leak colostrums. The midwives will offer to teach you a very simple technique for expressing colostrum and provide you with sterile equipment for collecting and safely storing it with labels for dating it.

How much colostrum will I be able to express?
Colostrum is present in the breasts from about sixteen weeks of pregnancy onwards. Some women leak colostrum and some don?t, both are normal. Don?t worry if you don?t leak colostrum, it is not an indication that you won?t have enough milk or a reflection on your ability to breastfeed. The amount of colostrum will vary from woman to woman. It can range from a few drops to as much as a teaspoonful or more.

When do I start?
A good time to start would be when you reach 36 weeks of pregnancy.

How often can I express?
A good time to have a first practice is when you are in the bath but you can express as often as you like.

How is it Done? In 4 Easy Steps!

1. Prepare ? gently stroke or use circular movements with your fingertips to massage your breasts, moving towards the nipple area. (It is not essential but sometimes a back massage can help. Ask someone to stand behind you with a fist either side of your spine, level with your breast and rub their fists up and down, gently and firmly).
2. Finding the place you need to press ? You need to find where your milk collecting ducts (sinuses) are in your breasts. The best way to do this is by feeling for them. They may feel like peas or peas in a pod or just a change in the texture inside your breasts. They are often found a few centimetres from the end of the nipple or where the darker tissue around the nipple area (areola) meets the skin of the breast.
3. Removing colostrum ? Place the flat your thumb above and the flat of your first finger below, in a ?C? shape, over the sinuses and gently press and release, building up to a rhythm. A few drops of colostrum may appear at the end of your nipple. When the drips stop move your thumb and finger around your breast to the next set of milk collecting sinuses, repeating this process of rhythmic press and release. You may need to swap hands to express colostrum from the other side of the same breast.
4. Collecting and storing colostrum ? You will be given a package containing equipment for collecting and storing your colostrum. There will be small sterile syringes with red caps, which you can use to collect the colostrum directly from your nipple. If you chose this way to collect colostrum, carefully replace the red cap and place the syringe at the back of the fridge. Alternatively, you may wish to use the small sterile gallipot for collecting colostrum, if so when finished re-cover the gallipot and place it in the back of the fridge. If you are expressing more than once in a day then use a new sterile syringe or gallipot at each expressing. At the end of the day, you can put all of the collected colostrum into one container (universal container) and store this in the freezer at minus 18 degrees C. When you are coming into hospital to have your baby put all of the collected colostrum into the plastic bags provided, pack the bag(s) with ice. Once at the hospital give the bag(s) to your midwife who will have it stored in the hospital freezer.

My DS was similar - though he was a ventouse delivery. He went for about 36 hours with nothing at all, they did a heel prick test to check his glucose levels and they were fine so they didn't see any need to supplement until the levels dropped.

Then suddenly he just perked up and latched on and fed like a train after that. So it may be fine, but tell her to pester the staff and to keep telling them that it's not working and ask them to keep an eye on the baby's glucose levels. My friend had a CS baby who was too sleepy to feed, was discharged, and he went into a hypoglycemic state and was very ill and had to be taken into hospital and tube fed. Basically no-one bothered to check that the baby was properly feeding and being a first time mum she thought if they were happy to discharge her he must be fine.

He was totally fine in the end but it was a scary start and could have been avoided, so just tell your SIL to keep badgering the staff as they don't always keep an eye on things.

I wouldn't be put off by the screaming when they woke him to feed, he might have screamed anyway

She should wake him and try to feed him more frequently.

Oh and I agree with tiredandgrumpy about the fluid - I'd never heard that before but DS had loads of fluid in his lungs and tummy (the midwife said he was a "very mucosy baby" - yum). Anyway he sicked lots of it up before he finally fed - maybe they just have to make enough room in their tummies?

Scoobie - baby should not be in a crib at all. Shd be skin to skin with your SIL; co-bathing shd help. No need to panic, but expressing colostrum is good.

Thanks for all your posts. Baby now seems to have livened up a bit and he is making more of an effort to feed. SIL now has the support of a very good breastfeeding counsellor in the hospital and she is much happier.