Am I staving my dd by not 'topping up'?

[MardyMaid]

I'm desparately trying to avoid 'having to top up with formula' because of dd slow weight gain (~200-240g a fortnight), going from 2.98kg at birth to 4.06kg at 9.5 weeks, and HV are begining to talk about 'failure to thrive' and 'supplementing with formula' unless the weight gain picks up.

Because of this we've added an extra feed by giving a dreamfeed (with varied success) at 11pm even tho' this seems a bit like madness as dd was sleeping from 8 to around 4-5am and doesn't sleep any longer with it, and sometimes it ends up waking her and she gets quite distressed.

Also, although I'm not happy about it, we've started to top up her pre-bedtime feed with as much EBM I can muster during the day, very depressingly she has had up to 110ml (whuch took a lot of sweat and tears and about 6 sessions with the pump to get) after 50 minutes of 'feeding' on me (well there was certainly some feeding and probably some comfort sucking).

I don't like giving the EBM bottle so regularly but I'm now worried that I'm slowly staving her as she can take so much after feeding and that these bedtime feeds seem to go on forever otherwise. It really upsets me that I can't seem to satisfy her on my own and that she generally settles better after the bottle of EBM, and the difficulty of trying to express a decent amount during the day is really stressing.

Is it just cruel to continue to try and exclusively bf (I really want to), and what could be wrong with my abilty to meet her needs naturally?

its not cruel to exclusively BF. you are giving her what she needs, certainly doesnt sound underwieght. 50mins of feeding seems alot, but everyone/baby is different. if she is sleeping so well, i ertainly wouldnt wake her to feed. its not as though she is losing weight. is there a BF clinic near you - maybe go for some advie, and see if the lath is a prob and she is getting so tired from sucking that she isnt taking enough?

good luck and keep going.

cx

The hours of feeding are "cluster feeding" and they go a long way to building your supply for the future. These sessions can be really tough on you as a new Mum - I cried some evenings with the exhaustion, who knew sitting down could be so tough!

They do however grow out of it eventually. 12 weeks is a bit of a turning point with BF and if you can hang in there it will get easier and she will get better at feeding.

There are loads of threads today about wieght problems and the general advice is to try and persevere as long as lo is happy, sleeping well and is having wet nappies etc.

If your HV is that worried ask for a referal to a Pead, topping up this early could effect your ability to continue to feed. EBM is the better option if you need it. Every few evenings I would give DD EBM after an hour or so of feeding and it helped her sleep a little longer. Also by not doing it every night she did not develop a habit of wanting it.

HTH, pop into another similar thread and chat to the other Mums going through the same, it will make you feel better.

Hi

No of course it's not cruel, it's the best start you can give your DD and you should be proud of yourself.

Don't be disheartened by your DD necking a bottle of EBM straight after a BF. My DS did this too and apparently it is not uncommon. The bottle just pours milk down babies and they will often take it even when not remotely hungry. I wish I had know that 12m ago!

There are several threads like this on the board at the moment (unfortunately) so until someone expert arrives, have a look at them to see what advice has been given.

My ds had only just regained his brithweight at 7 weeks! He was 4.08kg at birth - so to me your dd's weight gain looks great!

Is your dd happy, healthy and alert? If you weren't weghing her, would you be worried?

She's only a FTT baby if there are other things to indicate concern. And if there were, your HV should be referring you to a paediatrician rather than just telling you to top up.

You are doing great.

My ds dropped a lot initially and then barely gained each week (although after the initial drop, he never lost weight - but sometimes gained zero). I also went thorugh the expressing palalver - and actually mananged to express a lot - but "supplementing" with EBM (and for a while, giving every seocnd feed as EBM) didn't change his rate of grwoth - so it showed it was just his natural growth curve.

The breast feeding counsellors (at the manternity hosital - I made sure to avoid HVs ) did refer me to the consultant paediatrician, just to cover themselves, but he took one look at this happy, healthy child and told me to stop the faff of expressing, enjoy my child and that he would eventually start creeping up the growth charts. And he was right.

Thanks for the reassurance.
Yes hertsnessex good advice, she does in fact keep falling asleep during the eveing feeds then wanting more when I move her. We did actually go to a clinic last week which did help my confidence, and was suggested how to improve the latch, which we are working on. Its a bit hard because I have to hold her very close and she doesn't really like it (yet) so I'm now a bit bruised and battered too. Does sound like she's getting more milk with the new latch, but she still takes the EBM after the feeding.

Good to know NineUnlikelyTales that she is not the only one, it certainly is demoralsing to see all that EBM go down, I wonder if it's bad that it's so easy for them to get.

Thanks prettybird, I know I feel a bit silly for worrying when she is gaining some weight, but it's difficult when everyone else seems concerned. Yes re, the nappies and she's always pretty alert (although she is a fussy baby anyway as she's not a great napper so gets somewhat grouchier as the day goes on - but that's babies for you!)

I'll have a look at some other threads as there is normally good advice on here.

There's some good stuff on the kellymom site too and some reassurance that BF babies can often neck down a bottle after BFing but it doesn't mean supply is necessarily low.

BF is so much about confidnece - becuase of MN & kellymom I've neverdoubted my supply despite cluster feeding, night feeding etc etc because I knew it was all normal. If I'd soley been at the mercy of some ill advised HV it could be a different story!

My DD fed for an hour, every few hours for FIVE MONTHS so honestly long feeds are not that unusual. I am very envious that you have such a good sleeper too, she must be a contented little thing.

If I were you I'd just not go to see the HV so often, once a month is okay you know? Otherwise they only get to see snapshot weights and panic rather than realising that babies grow in peaks and troughs. Some babies are naturally lighter too and slower to gain weight. At either end of the weight spectrum the HV give you a hard time (DD is on the 98th percentile - or was last time she was weighed - haven't taken her back since).

Don't worry, you are giving her the very best start in life. Feed her as often as you can, don't worry if you seem to be feeding her all the time, you are getting your milk levels right and she is getting the greatest start you can give her.

how was her birth? could a ranial osteopath help? (just wondered as you mention she doesnt like being close)

Cranial - not ranial!

Interesting point hertsessex, but I'm holding her shoulders not her head and it seems particularly when I have an active let down that she particularly wants to pull away. Having said that we had a rather long labour and she did have a lot of going up and down, getting a very pointy head a 'caput' I think they said, but without success as she was face first, so then attempted forceps (but they couldn't fully reach) so finally an emergency c-section. She does have a rather disturbing habit of rubbing the back of her head when distressed, so maybe the cranial oseto is not such a bad idea.

mardymaid i think go back for more positioning advice, because (dimly because it was all a bit of a blur of tiredness, pain and stress) i do remember that bf counsellor was v insistent re directing and supporting the baby towards the nipple, but not to restrict them in any way.

have you tried rugby ball hold? i found it so much easier.

Mardymaid, it's hard to see what's happening here, as the weight gain seems within normal limits and anyone using the expression 'failure to thrive' with your baby on the figures you have given is certainly misinformed.

Fitting in an extra bf or two is not a bad idea, though the time to do it is obv going to be better if you choose a time when she is not distressed. This would be better than having a fight with ebm, too.

I think you need to see someone again, too.

Thanks fishie and titok

The problem with the latch was that dd was pulling herself off and ending up with not much breast in her mouth, then nursing with much lip smacking and clicking noises. So the idea was to hold her to prevent her pulling herself off, expecting it may take a while for her to get used to it so maybe compromise occassionaly. Now when I stop her pulling off she has taken to grapping handfuls of breast and pulling it out instead, hence the battering! Sometimes I do find we have more luck with the rugby ball hold, but I only seem to manage it with loads of cushions, so not always practical.
I will go back, and maybe try another breastfeeding group. I wish I'd gone sonner actually as the support is lovely.

HV seemed to think weight gain was slow, actually she was worried about the fact we'd crossed a centile line and said if it happened once more, which it would if the rate continued for the next month, it would be called FTT, so I could top up to avoid this. I didn't think the lines were growth curves unless you expected each baby to always stay the same in relation to each other, and for birth weight and length to predict how big your child would be at 5.
However, I did see something from the WHO which said as long as a baby gains 120-240g a week they are getting enough breast milk, so that did get worried as we aren't (quite) making it, and whilst I realise 1 in 100 healthy babies will be off the chart, I didn't like the fact we were heading there, so after the HV visit I was desparate to avoid being forced to use formula and desparate to get the weight up before the next check.

Aaaaargh - another HV that doesn't understand the centiles!

The HV should be looking at the baby, not just at the charts.

THe BF Counsellors I saw (midwive pecialists at the maternity hospital, so excellent) wanted to use my ds as a case study to show that a baby who doesn't follow the growth charts is not necessarily an FTT baby.

You do know you a) don't have to see her and b) don't have to listen to her?

mardy, tiktok may come along and correct me in a little while but to me it sounds like your dd is pulling off because of you could have a strong letdown (or an oversupply, which can be a temporary thing) hence the pulling off and smacking.

have a look at this page from kellymom and see if it applies to you.

hmm kiskidee, don't think it's oversupply as I get so littke when I express, but may be a short sharp let-down. Its sometimes a while comming, particularly in the evening, but then we get maybe 30secs of gulping and pulling away, then nothing for an age and she'll maybe fall asleep.

Still I think it's getting better each time, think it help just to relax myself, so thaks all.

I'm starting to think that if I had been able to have another, then I should make a point of ging to see the HVs, just to show them that there is a range of ways that babies can grow - and that BF can work even when baby doesn't conform to a standardised, smoothed curve.