Firstly, sorry in advance for the essay - there's a lot going on!
My baby is nearly six weeks old, and I have been trying to breastfeed. Unfortunately, he was not (is not?) gaining weight as he should be and I'm not sure what to do. (I should mention I'm not in the UK, so some services and protocols are a bit different here.)
He was born at 3.66 kg but within 24 hours had gone down to 3.47 kg. As I had IV fluids, I understand this can sometimes artificially inflate the birthweight so the weight at 24 hours should be used, but this isn't what the HCPs we've seen have used...
At 3 days he was down to 3.27 kg (10.8% down on the actual birthweight, but 5.9% down on the weight at 24 hours). The nurse was concerned about this, so he was weighed another couple of times over the next few days. By 7 days he was at 3.38 kg and seemed to be gaining so we were told he didn't need to be weighed again but I could come back for a peace of mind check between 2 and 4 weeks.
He then stopped pooing for 10 days(!) - the last poo he had before this was still meconium/transitional. After about 5 days, I got concerned and tried to call the clinic but no one ever got back to me and then eventually he started pooing and was producing lots of wet and dirty diapers. However, for my own peace of mind, I booked him in for a weigh-in at four weeks.
I should say that through this entire period, I was exclusively breastfeeding, but it was really not going well. He was feeding around the clock - maybe sleeping for an hour at a time at night, but mostly awake and at the breast. We couldn't put him down, and when he wasn't at the breast he would just scream. I now think he wasn't really getting a lot of milk (as I don't think he was swallowing the vast majority of the time), but at the time thought that's just what babies do. Feeding was absolute agony for me, frequently leaving me in tears, on top of the pain from recovering from my difficult delivery. It was all just too much for me, so against my better judgment we started giving him a dummy - it meant that I could sleep for a few hours while my husband gave him the dummy. It was not great but it was manageable.
We took him to be weighed at 4 weeks, and he had gained 10 g since the previous weigh-in at 7 days. I was shocked - he had been eating so much, and producing lots of diapers. This also meant he was still not at his birthweight, or even at the 24 hour weight. We were advised keep him awake and focused on feeding for 30 mins at a time and to supplement with 25 mls ideally of EBM after every feed. For a variety of reasons I couldn't pump that much, so we supplemented with formula, using a supplementer at the breast.
He was like a different kid - suddenly sleeping for hours at a time, finally seeming satisfied after a feed, seeming to grow more lively and healthier looking. I can't tell you how guilty I felt for essentially starving him for his whole first month.
We took him back the next week (after stopping using the dummy), and he had gained about 150g, putting him below the birthweight but above the 24 hour weight. We were told this wasn't enough and to supplement as much as he wanted after every feed. I was told to make pumping more of a priority, even if it meant letting my husband feed him with the supplementer and his little finger, so that I would have time to pump. That night he took 90 mls of formula after a feed - again, clearly starving.
Over the next two or three days, he would sometimes take no formula after a feed and sometimes not be satisfied after 90 mls. However, it seemed to me that the more formula we gave him, the more he wanted and I was really concerned about the impact on my milk supply. I did A LOT of reading into techniques for increasing supply and started switch feeding with compressions. This had no impact on his intake of formula.
He really likes to comfort nurse, so I wasn't sure if maybe he was just taking in all this formula as a by-product of wanting to suck all the time. I also got some baby scales for home, and saw that he had gained 350 g in four days. I thought I could try to start reducing the amount of formula I give him, and started trying to give him 40 mls or so after every feed but he very quickly went back to square one. CONSTANT nursing/screaming/refusing to sleep. I'm giving him between 40 and 70 mls every two hours now, on top of him nursing constantly in between, and it still doesn't seem to be enough for him. When he's not at the breast, he's rooting, sucking his hands and/or screaming. It feels like my breasts don't get enough of a break to fill back up again between his feeds (which are non-stop), as he only actively drinks for the first minute or two and otherwise is comfort sucking. After a few minutes, he seems to get frustrated and starts pulling, bobbing, grunting and eventually wailing. I'm getting no sleep, and my husband is at his wits' end as he can't help us.
I don't know what the problem is and don't know what to do. Is my milk supply too low to sustain him? If so, how can I increase it? (I've taken a few "nursing holidays" over the last week and think it's increased a bit but clearly not enough.) I'm really worried about this as I think he was not eating enough the first few weeks and am concerned it has already had an (irrevocable?) impact on my supply.
Or is the problem with him getting enough milk out of the breast? We've been working a lot on his latch, and I think it's much better, but again, clearly not enough. Or is this normal 6 week growth spurt behaviour? If so, should I stop/cut down on the formula, even though he seems so miserable without it?
I know I need medical advice given the weight gain angle, but I think the medical advice will be to supplement more and I'm really worried about the impact on my (already low?) supply. As you might be able to tell, I'm also prone to catastrophising and could probably use some perspective...