Formula top ups - should I still wake to bf?

[Aberforthsgoat]

Started a new thread for this, previously had one about breast feeding struggles.

DS is two weeks old and not up to his birth weight yet. He was weighed Thursday and had put on 75g and was still 155g off birth weight, had been exclusively bf.

Over the last week he’s been seriously cluster feeding at night and taking less during the day as he’s sleepy during the day and wide awake at night.
Last few nights he was seriously unsettled between night feeds and just wanted to be on the boob the whole time.

Today we got weighed again and he hasn’t gained since Thursday and was showing slight dehydration signs so they recommended 30ml of formula after every daytime breast feed which I’ve done.

He’s just had a feed (bf) and gone straight down to sleep... which is unusual at this time as this is usually when the cluster feeding starts.
I’m wondering if he’s just been hungry this whole time and the cluster feeding has just been him not getting enough initially.
But now I’m also wondering - if he continues to sleep through do I wake him every three hours to bf as is my instinct? 120mls of formula isn’t enough to sustain him completely, even with the daytime bf as well, and I don’t want my supply to go down as I’m hoping he will hVe gained in the next week and I can phase out the top ups as the health visitor has suggested.

Just a little confused as to what to do for best. I’m also considering expressing from tomorrow as my boobs are now huge and uncomfortable, and He hasn’t been feeding as long on the breast since he’s had the top ups.

Apologies if this is long and rambling I’m very tired and stressed about his lack of weight gain as he was born at 37+3 and is tiny anyway - was 2.6kg at birth, went down to 2.4 and is now back up to 2.54 but can’t afford to lose much obviously.

I would wake him. First though, see if he will feed asleep. Try to latch him and see, if you stroke his face, ear to mouth, as you try to latch it can stimulate the sucking reflex in the wee one.

If he's still not up to weight, the cluster feeding is to encourage your milk production. Now his tummy is full, he'll sleep, as all the feeding was to make more milk; but he still needs to try and drink some of that extra milk he's been encouraging too.

Thank you @herja I’ve set an alarm for an hour’s time, and will try that.
I desperately want him to gain weight which is why I’m trying the formula but I don’t want to ruin my bf supply at the same time, and obviously don’t want him to eat less overnight

Wake for scheduled feedings.

Also, if they have you topping up with formula, you need to be pumping. Your supply will only meet demand with use.

Thanks @purpleartichoke they didn’t tell me that. I have an electric pump I will sterilise and start tomorrow. How often should I be pumping? Sorry I am new to all of this

Thanks for the tip about sleep feeding @Herja he just fed for 15 minutes while asleep so I’ll
Continue with that two to three hourly

That's fantastic! If he's happy to dream feed, you can fit extra feeds into day time naps too. I fed my first almost constantly for the first two weeks to get my supply, and his weight, up.

Thank you! It hadn’t occurred to me, I don’t know why, so now I’ll do that with the formula supplement and hopefully he will gain a nice chunk in the next week.
It really worried me when he hadn’t gained but because he’s been up all night he hasn’t been feeding much during the day, and I think this is where I’ve fallen down. So now I can pop him on while he naps :) I think it could be a game changer.

Sounds like you've had a good result at last! Bless his heart, feeding is difficult sometimes in the early stages (I had similar problems with mine), but it doesn't last and you're doing everything right.

You said, "we got weighed ", which made me laugh - you were weighed as well as your baby? Not criticising, just having a small chuckle. The royal 'we' is not unusual so I'm told.

Hahaha thankfully I did not get weighed @bluerussian I think I’d be stressed about that for the opposite reason! 😁

My little one spent some time on a ventilator at birth so i couldn't bf initially, once I could I had to bf baby, pump for 20 minutes then give a formula top-up (which turned to expressed breast milk top-Up once my supply was beginning to establish). Kept this up for a week to get my supply going and for baby to stop dropping weight. Your midwife/lactation specialist should be able to advise you on this!
The cluster feeding will get your supply up, and the hours between 2-5am are the most important time for increasing your supply (I think) so I would bf through the night - if you can dream feed that would be amazing! It's really tough to begin with but once your supply gets going it does get easier!

Thank you @RumRumRum I’m definitely going to unpack the pump tomorrow and give it a go.
I will try to do as you suggest with the bf/pumping/formula

I was just so gutted he hadn’t gained although I suppose a three day period isn’t huge and he is much more settled now so I think he has been hungry

Currently doing my second dream feed of the night so hoping he continues to do this as it will be so much easier - as soon as he slightly stirred I popped him on and it seemed to work

He also doesn’t seem to be working as hard to feed now judging by his breathing so I think he was probably struggling to get as much as he needed before

I would double check this with your midwife first though as you can overstimulate supply too (it's a fine balance!)
Sounds good that baby has had another dream feed! Hopefully things are moving in the right direction for you.

Will do, didn’t realise that! There’s so much to this feeding lark isn’t there?

Thank you, mumsnet has been so helpful in these lonely early morning hours

Hmm he just did quite a big forceful vomit after the latest dream feed. He never usually did this with bf, I wonder if it’s his stomach adjusting to the additional formula?
Although not sure how he’s going to benefit from it if he’s not feeding as much in the night and then vomiting it up 😫 this is so stressful.

Hopefully it will be a one off as he’s not unsettled, although he did spit up after both formula feeds earlier.

I’m really starting to worry he has some kind of digestion issue

This is very common. Did you manage to burp him after each feed despite him being asleep?

No I didn’t :( I will do though. Midwife said bf babies don’t need to be burped but As I’m mix feeding now I should.
It was after he had a few little coughs in the cot which worried me so I picked him up and sort of winded him on his back and then he was sick so it might have been me!

I’m very tired and just worrying about everything now

Breastfed babies still need to be winded, that’s really misleading advice.

Formula is a lot thicker & heavier on the stomach so that could be why he’s being sick.

Look at the Hakka pump on amazon, you use it in the breast not feeding & it catches let down.
There’s a growth spurt around now so cluster feeding tends to pick up for him to get his order in for the next day.

I made sure to wind him after the next feed and he only did a tiny spit up after and went off to sleep quite contentedly

I’ve been given such contradictory advice around feeding since I left the hospital

He’s still spitting up after every feed now even bf which he wasn’t before I added formula - do you think I need to mention this to the health visitors Incase it means he doesn’t gain weight again?

Have a look at a supplemental feeding system if you want to continue breastfeeding. They stimulate bm production whilst ensuring baby still gets enough nutrition. Then once baby is back up to birthweight you can slowly decrease the amount of formula and continue with breast.

This is the one I used: www.medela.co.uk/breastfeeding/products/feeding/supplemental-nursing-system

I would definitely mention that to your midwife @OP, I'm sure it will be fine though. BF babies definitely do need winding; I was told they don't too, I don't know why they say that, because I found it to be far from the case!

Had he been sick at all before this much OP? I can remember DS didn't vomit at all until a week old. It was in my hair at a large, outdoor family party in the middle of summer... lovely. After that he was quite a bit for a few weeks. I think that my milk came in with a vengeance and he was still feeding with the same force as he had been before, once he calmed down a bit more, the puking did too. Do mention it though, to put your mind at ease.

He wasn’t sick much before, I spoke to the health visitor today and she said it sounds like possetting and only to worry if it’s more than half an egg cup full which I don’t think it is, it’s mainly just spit up.

We had a better night last night and now we have been topping up with formula he seems to be hungrier as he’s asking for the breast more during the day

well he's been guzzling formula today, as well as bf but not for as long. I've also managed to express 90ml so i think my supply is ok, which is making me wonder why on earth he hasn't put on weight. Hopefully with expressing top ups as well he will get a decent amount, just incase he's got a weak suck or something as he's so small, and I've been told his latch looks good so it can't be that (unless midwives are mistaken of course).

The fact that he was three weeks early doesn't seem to have been taken into consideration in regards to his weight, I don't know if it should have done.

I just really hope he has gained by our next weigh in this week, and the week after. I'm so nervous about it already. I keep thinking maybe he has an underlying issue or something :(

Three weeks is considered full term, so no, it's correct it wasn't taken into account. However in the first 2 weeks of life you're looking at weight loss (up to 10% OK) and regain. Once birth weight is regained or at 2 weeks old, you start with the centile charts. If they are looking at centile charts before 2 weeks of age this is not current best practice.

Health visitors and midwives are not necessarily experts in breastfeeding - if you feel that you might not be getting the full picture, I would seek advice from somebody who is. The list I wrote on your other thread should help you find somebody who is local to you.

This is an interesting read about "The latch looks good". Unfortunately the videos are long gone,the link to more videos works though.

www.analyticalarmadillo.co.uk/2010/09/effective-breastfeeding-its-not-all.html