Low milk supply, baby is losing weight. Any advice or similar experiences?

[dkinlondon]

I have a six day old baby who has just been admitted to the hospital because he has lost 18% of his body weight.
We did have a rough start (baby and I were separated for 24h on his second day because he had medical examinations at another hospital), and he was on IV fluids for one and a half days as well as antibiotics.

Now it seems I am not producing enough milk, either due to a bad start And this although I am literally feeding my baby constantly on both breasts with only 1 to max 2 hours between feeds and each feed taking half to one and a half hours.

I would really love to breastfeed exclusively and not having to top up with formula, so would love to hear if anyone has any advice or similar experiences they want to share? Is it unlikely I will be able to breastfeed exclusively or does anyone have any experience on that? Thanks

I didn’t have this experience (twins who were breastfed for two weeks but one wouldn’t latch so ended up moving both to formula) but didn’t want to read and run.

It is perfectly normal for babies at this age to want to feed a lot. They have small stomachs and they also cluster feed to help build up your supply. Them wanting to feed very often for long periods is not a sign that you have a low supply.

My initial thoughts are lots of skin to skin which will help and let your baby feed as much as he wants.

Also get someone to have a look at your latch to make sure he is latched correctly and doesn’t have any sort of tongue tie. A local breastfeeding group will be able to help. A lactation consultant would also be able to provide this support. I’m not sure where you are based but Kathryn Stagg is really good. Search for her on Facebook and if she isn’t local she should be able to recommend someone close to you and/or provide video support.

The hospital may also have an infant feeding team who might be able to help. Perhaps ask the nurse/doctor if they have this?

Hang on in there - you have had a rough start but are doing f really well. It is so tough at the beginning but it will get easier. It is all about getting the right support.

Thanks for the advice TwinMom89. I think speaking to a lactstion consultant is a really good idea and we'll spend. I'll also be doing more skin to skin.

Hopefully perseverance will help bringing in enough milk. It's surprisingly frustrating and disappointing not being able to breastfeed when it's something you really wanted to

Make sure you are eating and drinking enough and try not to stress as that effects production too

Yes. My friend went to Neal’s Yard and got me Goats Rue, it really sorted out my supply .

Some formula need not be the end of your breastfeeding relationship! It saved mine with both my children, I fed my first until almost three and he had formula too for first year. My second bf seemed to be going perfectly until she’d only gained 200g over birth weight by 11 weeks. So we bf and formula feed now she’s 8 months at a year I’ll drop formula and just bf with cows milk to drink. I totally understand not wanting to, having to with my first drove to PND which is ridiculous looking back as we bf until he was almost 3! And another downside I was so determined second time round I ignored my weight gain concerns and was just devastated when she had gained so little at 11 weeks she is still tiny now and I blame myself.

Definitely speak to someone but honestly with an 18% drop I’d think seriously about a bit of supplementation.

I had a similar experience with DS2 - we were apart for about 24h as he had to be transferred to another hospital and they gave him what I felt were massive amounts of formula so my supply struggled to keep up for a while.

He is 16 months now and still very much breastfeeding. We stopped giving formula at about 4 months but could probably have stopped earlier. We just carried on because DH had come to enjoy giving the evening bottle feed. So don't worry, it absolutely can be done :)

What I did was:

Every 4 hours (day or night) or whenever he requested in between, put baby to breast. Allow him to take as much time as he wanted but look out for that switch from active sucking/swallowing/"schoop, schoop, schoop" sound into fluttery, asleep sucks. At this point swap sides. To be honest he was very sleepy, and I would usually have to change him or get up and walk around the room with him to get him to wake up enough to take the second side. When this changed to more fluttery sucking, that was the point at which I'd give the top up.

I was always careful to give the top up in the way of "paced feeding" - this is a method of bottle feeding which negates the way that a bottle uses the baby's instincts to keep them drinking. So you hold them almost sitting upright, as close as seems to be secure for them bearing in mind they can't support their own head. Bottle as close to horizontal as possible. Let them take breaks and allow the pace to be very slow. This way sometimes it would take him a really long time to finish a very small amount of formula/EBM, but I didn't mind because I felt this allowing him to go at his pace was important. BTW, it doesn't matter if you haven't been doing this beforehand - none of the SCBU nurses did it for DS2. He didn't seem to mind. We were in hospital, so I had to note down how much he took for the top up. They wanted me to aim for 30-50ml - I just gave him as much as he would take using the paced method. Sometimes it was 50ml, sometimes it was 10ml. I trusted that if he took less it was because he was full enough from my milk - easy for me to do, because he is my second and I'd breastfed before, but I would urge you to try and have this trust in the partnership of him and you, and avoid that temptation to just get him to have a little more milk. If he is hungry, he will definitely let you know so don't worry.

The reason you want to stop breastfeeding when you get to the fluttery sucks and move to the top up is that it's important he gets enough milk to keep his blood sugars up and if you allow him to spend too long at the breast he will be expending more energy than he is taking in. I did not appreciate this immediately, and I felt cross at being given a time scale (I was told 10 mins max each side - I believe this to be wrong and unhelpful, but might be useful if you're struggling to differentiate between different "types" of suck). But in fact, it's not hugely important to keep him on the breast as long as possible. Regular stimulation and removal of milk is important, not the length of time you keep him at the breast.

After this top up he was usually very sleepy so I could put him down. If you like at this point, you can express - ~10 minutes each side. You probably won't get very much if any milk from doing this, that's OK, it's not the point of the exercise. If you prefer, you can try expressing about an hour or two after a feed, but honestly, if you're getting him to the breast at least once every 4 hours - that's enough stimulation, prioritise your sleep and meals over expressing. You will also drive yourself crazy trying to keep up with the amount he needs. Easier to let yourself off that hook.

In 4 hours or if he woke up and cried earlier, repeat.

In addition to this - if I knew I had a 4-hour (ish) block where I didn't need to sleep, eat, shower or anything else I would make time to have some skin to skin, both of us under a blanket to keep him warm, I tried to do about an hour a day, I found the mornings were often best. At other times, between feeds I would also hold him as much as I felt like and let him have essentially free access to boob just for the extra stimulation/milk removal for me and extra milk for him. I would let him sleep on me and cluster feed, if he wanted to, and I didn't worry about the fluttery vs "active" sucking or give a top up for these feeds. But once every 4 hours at least I made sure I did a "proper" feed which was what I came to think of the whole rigmarole of changing him, feeding and watching the sucking pattern and doing the top up. I thought of the in-between boob access times as being "bonus" feeds and I didn't worry about noting them on the hospital sheet (we were in for 7 days). Sometimes he'd have a "proper" feed after 2 hours, sometimes 3, sometimes I had to wake him after 4.

After a few days of being at home, I was finding the topping up after each feed to be more cumbersome now I had to think more ahead than just ringing the bell for a nurse, and we knew roughly how much he would take during a day, so we decided to change the top up to a single bottle feed given in the evening which DH tended to do, and other than that one bottle feed, I just fed him as much as he wanted myself and I'd offer after 2-3 hours if he hadn't requested any. I let him stay as long as he liked after swapping for the second boob. I stopped setting alarms to wake up after 4 hours at night, as he was now alert enough to be waking me about that often anyway. I also co-slept by choice which again I was comfortable with after having done so with my first. If I felt like I was having a low supply day, I made sure to put him to the breast every hour on the hour (during the daytime) and things always caught up within 24-48 hours.

As I said, we ended up keeping the bedtime formula feed for a while as it provided quite a good start to a bedtime routine, but after a few months he seemed less keen and so we took that as a cue to stop. Since then he has been exclusively breastfed until the introduction of solids :) It's absolutely doable. My mature milk didn't come in until day 6 or 7, which I think was to do with the separation, and concerned me at the time but I needn't have worried. I also found the emotional hormone bit post-birth was a bit delayed for me, so watch out for that - I got really weepy and down during the second week in particular. But it passed, and we are OK. I'm sure you will be, as well

I’ve often felt that having realistic expectations would help new mums a lot - and I can’t think why we don’t just say what feeding a newborn is like?
I’m currently feeding my fourth to sleep so I’m not an expert by any means but I do have a little experience.
As @TwinMum89 says babies like to be feeding. So when the baby is awake you can probably expect to be feeding it. That will change, in a while, but while they are small their stomachs are so small the take in so little they need access all the time.
Your baby will never grow as fast in its life as it’s doing now, it needs lots of time to take in nutrition to make that happen.
Lots of feeding is no indication of your supply.

I remember my sister exclaiming that she didn’t have time to do anything else and having the lactation consultant kindly suggest that maternity leave is for looking after the baby.

I’m sure you’re doing brilliantly. As you say, it’s about perseverance. In a few weeks you’ll be amazed by how little time you spend feeding.

Oh, poor you and poor him. We had a very similar experience and were readmitted to hospital with 17% weight loss and strict orders to supplement with formula. But I hope i can cheer you up as we went on to breastfeed until DS was almost three and only stopped because I’d had enough.

Firstly, I’d recommend you reach out to anyone who can offer support. In the hospital, there should be breastfeeding counsellors/lactation consultants as well as midwives. Make sure he is checked for tongue tie and get someone to check latch with every feed.

Secondly, do you have milk or is it still colostrum? Make sure you’re eating, drinking and resting enough but you could try hand expressing as well as putting baby to the breast. And lots of skin to skin, obviously.

I put DS to the breast whenever he showed an interest but offered formula as well - you may be able to do this via a cup, spoon or feeding tube, or may need to use a bottle. But think of the formula as making a bridge between the colostrum and the breast milk. I offered the breast first, then the top-up, the latter on paediatrician’s instructions (think it was 70ml every 3 hours and note what he took). The hospital were concerned about dehydration in DS but I received very little support so made a nuisance of myself asking for latch to be checked repeatedly and otherwise just made it up as I went along.

Good luck!

My advice isn't anywhere near as expert as the advice offered above, but when my baby was in hospital and I wasn't able to feed him (older, breast feeding well established) I used boobix lactation biscuits to help maintain my supply as I knew from my first baby that pumping wouldn't keep my supply up as much as I needed.

They worked really well and tasted fine, and a friend who had low supply when her DS was born also found them really helpful.

Breast feed then top up with a bottle x

Thanks everyone for your wonderfully supportive comments. It's really nice to hear from others having had similar experiences and made it work with breastfeeding in spite of having had challenges initially.

I am feeding him formula now just to make sure he doesn't suffer any ill effects from the weight loss. His health comes first. But I would love to not having to be dependent on using it in the future.

Thanks for the extensive and helpful advice, experiences and suggestions. I'll think about how to push breastfeeding whilst topping up with formula until I've built up my supply. Also to maybe get checked if he's tongue tied (although latching and sucking doesn't seem to be an issue, so not sure if that already disproves that theory?).

I take comfort in hearing others have made it work despite initial challenges. Please continue sharing your stories if you have any

Worth getting him checked for tongue tie regardless because it just generally makes feeding more difficult as a rule (eg issues with wind) and the earlier it’s identified, the easier it is to treat. DS was never checked for it despite a number of telltale signs and it was only identified when he was a year old, so am not leaving hospital this time until DC2 has been checked for it!

Personally I think topping up with formula is the issue, but I see the problem and in hospital it's hard to ignore the formula top up.

Baby feeds at 1pm, 10 minutes then you switch sides waking them slightly and they feed for 3 minutes. You then wake them and top them up.
They sleep for 3 hours.

OR

Baby feeds at 1pm, 10 minutes then you switch sides waking them slightly and they feed for 3 minutes.
They sleep for an hour and feed again boosting your supply. They sleep for 90 minutes and feed again. Breastfeeding is supply and demand. The formula is instead of them demanding.

My newborn lost 10% so I think that was on the limit. He however didn't gain for many weeks, but he was a big baby, and I managed to increase my supply. I never expressed or topped up, but I went against advice.

I hadn't been eating brilliantly after birth or drinking enough, that certainly didn't help. You need extra calories, it's not the time to diet.

I agree that topping of with formula is not ideal when you want to establish a bigger milk supply @whatsyaname, but I did cluster feed (every 1-1.5 hours) the whole day before and he was just crying because there wasn't enough milk and even lost more weight on that day). I am now pumping milk at the hospital after each feed to increase Milk supply and here I'm really seeing just how little milk I am in fact producing (like 5ml rather than the 40-60ml he needs per feed), no wonder he's been crying so much when I fed him.

So I'm doing everything I can now to increase my milk supply by pumping, taking supplements, and probably speaking to a breastfeeding councillor and lactation specialist to get their insights to (by the way anyone know the difference between a breastfeeding councillor and lactation specialist?).

I really hope I'll be able to increase supply this way

Its tough, I feel for you. I'm sure I'll suffer again as number 2, due soon. But what you can pump out isn't necessarily what your baby gets. I found it hard to pump hardly anything (later on once supply was well established and baby back on the 91st centile.) I just couldn't get the let down using a pump. I tired using the stimulation setting a bit longer and whacking it up to high. I think a hospital grade pump might of been worth a try, you can hire them.

You might not recognise let down feeling now if it's early days, but baby needs to suck a bit before the milk comes through. That's why they say bottle feeding might put them off as it's instant gratification. I could sometimes get something to pump if baby fed one side and I pumped the other. Some people find looking a baby, holding baby or relaxing music helps with pumping amounts. Or even imagining feeding them. Stress and pressure certainly effect things. Porridge and oat stuff is meant to be good for helping with supply and drinking lots yourself.

I went on to feed DS for 2 years, which I didn't plan, but you will get it established. Good luck

I'd echo what newyear said - don't judge your supply by what you are pumping. When breastfeeding my son would often pull off in distress because of the strength of flow of my milk, but often when pumping I would get just a dribble.

As well as what others have said, keep in mind Pumping is not the same as feeding - no pump is as efficient as a baby at milk removal and many people can’t pump that much but feed a baby just fine. In other words only pumping a few ml does not mean that’s all your baby gets when they feed.

Interesting to read paced feeding @BertieBotts that makes a lot of sense. Wish I had known to try that with my First!

La leche league website and kelly mom have loads of info but top tips to increase your milk were eating oats ( porridge,flapjack) drinking alcohol free beer (like becks blue) Taking supplements like fenugreek (I never tried this one to be honest as it tastes minging) and staying extremely well hydrated - drink loads and loads.

Long feeds and short gaps in between are five for tiny babies - don’t worry if you are feeding every 2 hours or whatever, so long as milk is going in that’s fine. As others have said it is hard work and constant in the early days - if your baby is awake, they probably want to be feeding. Keeping the baby awake long enough for a good feed is the tricky bit!

Good luck and congratulations on your beautiful new baby

As you said yourself, your baby’s health and nutrition come first. Formula milk isn’t poison, it’s life saving if your own supply isn’t enough. The vast majority of my
generation were bottle fed, and we’re the longest lived and healthiest in history!
Being unable to produce enough breast milk is much more common than you’d think, and it shouldn’t be seen as some kind of upsetting failure as a mother.
By all means continue trying if you want to, but don’t use it as a stick to beat yourself with. Simply top up as required with formula and be happy that your baby is well fed and gaining weight.
I’m a doctor, and supplemented both my DDs with formula. They thrived, graduated uni, have IQs over 160 and are v physically fit (Krav Maga, aerial yoga, Munro bagging and skiing among their hobbies!) - I don’t see how exclusive breast feeding would have improved on that!
Focus on getting your baby back up to birth weight rather than fretting over the method of feeding. Good luck, OP.

You need to call a lactation consultant today!

Yes, I forgot to say big thanks to @BertieBotts for sharing your experience from a similar situation. The paced feeding is a good idea, and I'll try not to stress about the low milk supply coming out when I use the milk pump. How long did it take you (and @MyCatScaresDogs) to have a good milk supply for your little ones? I'm just wondering if the formula top up is something I should expect to do for quite a while or maybe not the that long.

Again thanks for all the super helpful advice and insights, it makes me feel a lot better

Have you had a look at the kellymom website? It's American but a fantastic resource for all things breastfeeding & has great advice for anyone struggling with breastfeeding.
I am in now way linked to the website but I used it extensively while learning to & struggling to feed my son

Agree with babdoc. Surely your baby being fed is the main priority? More important than whether you prefer to breast feed? Is it really worth your baby losing so much weight they need to go to hospital? You will just get people on here telling you to carry on persevering with BF even if it's not working. Would you withhold food from a toddler or older child? Formula is not the end of the world.

@converseandjeans I wrote further up that I am of course giving formula now since the health of the baby is absolute first priority and a 18% weight loss (when my midwife informed me) was a real shock. My main concern now is just whether I'll be able to eventually move away from topping up with formula and just breastfeed. So any advice from mom's who struggled in the beginning with breastfeeding is really helpful to hear about.

@Babdoc Thanks for sharing your experience using formula. You're right, I shouldn't see it as the
end of the world if breastfeeding doesn't work out. I just would like to see if I could make it work in spite of the initial challenges.

I think bottom line is to follow all the advice shared in here (also thanks for reminding me of the kellymom and la leche League websites @GrandmaSharksDentures and @adagio I'll spend some more time going through those) and also accept it isn't the end of the world if I can't exclusively breastfeed.

OP, I had to go back into hospital with DS aged 6 days. he'd lost 12% of body weight and was dehydrated. We had to start formula top ups pretty damn fast to get him hydrated. What I then found was that midwives and paeds were pleased with his growth curve while on the top ups and so refused to offer any help reducing or stopping them. HV said top ups were the problem and to stop them cold turkey and 'just feed feed feed'. I was too frightened of dehydrating him again to do that.

He also had a 100% tongue tie which was snipped day 6 after being missed several times. I also never got more than 5ml out of a breast pump.

Ultimately we never managed to drop the top ups, and combi fed for 14 months. Turns out I have insufficient glandular tissue (basically not enough milk ducts) so was doomed from the start in terms of wanting to EBF, although I didn't know it at the time and my mental health really suffered as a consequence. Its a pretty rare condition though, mist people who have a slow start and go on to get their milk going fine in the end.

The kellymom website has the only sensible advice I've ever seen about how to reduce top ups safely.