Breastfeeding, baby losing weight. Help :(

[ImStayingInside]

I have an 8 day old DD. On her day 5 check she had lost 11.6% of her birth weight and by day 7 she had lost 13.5% this resulted in us being sent back to hospital to have her checked over.
At the hospital they did blood tests and confirmed that she is jaundiced - although with levels below those that need treating.
Her latch was checked and corrected slightly, as her bottom lip was tucked in and they were happy with the feeding schedule we had her on.
She has been a sleepy baby since birth and I have generally always had to wake her to feed, which I have been doing every 2 hours around the clock.
In the hospital I was asked to use a pump to gain some insight into my milk supply and I managed 45ml which was quickly devoured from a bottle.
The paediatric consultant who saw her said that as I am producing enough milk for her age I need to switch from breastfeeding to pumping and feed her every 2 hours with a max of 40ml of expressed milk so we can monitor the amount of milk she is having and get her weight up. I was pleased to have a solution and to be allowed home, but the reality is very different.
I am struggling so much to pump for 2 hourly feeds. I don’t always produce the same amount with each pumping session, which meant that by the time I got to this morning’s feed, my pumped supply was short and I ended up just feeding her from my breast.
The pump has also given me very sore nipples, which is eased slightly with lanisoh.
I just don’t know what to do, I was very upset and teary last night, as what I thought seemed like an easy enough solution to her weight loss slipped through my fingers as I was unable to pump enough/stand the pain of pumping to pump anymore.
I have just fed her from the breast today, but I am so worried that she will just continue to lose weight. She is tiny, so really doesn’t have any to spare.
Any tips or ideas would be greatly appreciated, should I just give in and fed her with formula, or even top up her feeds with formula when I can’t get enough pumped?
I just don’t know what to do for the best and it is getting me very upset.

I'd just top up with formula and not stress about it. DD took weeks to latch on and I drove myself demented with pumping round the clock, trying her at breast multiple times a day, etc. I know it's a big mental hurdle but honestly, if she's hungry just feed her. I wish someone had just told me that sooner. We weaned off formula top-ups and she went on to breastfeed till she was 1.

Was she a big baby? Catch down growth is a thing. That's not to say not to follow medical advice - obviously you should, but you could ask the question. Does she look otherwise well and are they happy with her apart from the weight loss?

The doctors advice does not make any sense in terms of the needs of a new lactating mum. The advice should have been to breastfeed or express at least 12 times in 24 hours (to ensure your milk supply is optimal). You have probably had a delayed start to your lactation, due to a sleepy baby. You have probably Kickstarted your lactation now, with all the pumping and the baby is probably stronger and more alert. Which should mean you can go back to exclusively breastfeeding. Monitor the urine output to ensure your baby has six heavy wet nappies every 24 hours. It would be good to get a lactation consultant to review the situation. Ask your midwife for a referral.

Was years ago now, but I had the same problem with DD - she could not gain weight and was v little to start with. I ended up doing a mixture of breast and formula as I couldn't express. I kept going with breast feeding as long as possible but she clearly preferred bottle to me and I ended up stopping by 6 weeks. I did try a support group but I felt too uncomfortable getting my boobs out in front of men so only went once. I really wanted to breastfeed for longer and was gutted to stop but the lack of weight gain meant I had no choice in the end.
At the time, I was so sad, so I totally understand your upset. However, mine is now 16 and ultimately she got fed and grew and that is the most important thing, it's just a bit hard to see that when you are so stressed.
I'm sure posters on here will have lots of ideas; I had great advice when I was in that position which meant I could keep going for the 6 weeks.
Do what you need to do and try not to get upset, finding bf difficult is no reflection on you as a mum. Congratulations on your new baby

Hello OP, congratulations on the birth of your baby girl. So sorry to hear you’re struggling. It’s a hugely overwhelming time without the worry of weight gain etc. I had my baby boy in July and whilst we didn’t face the same issues exactly as you, we did have our own set of struggles related to feeding, and I really didn’t want to move to formula. I tried getting support from midwives and HV’s and hospital staff (my boy was in NICU for a week) but by far the most valuable thing I did was paying for a lactation consultant. She helped me with latching, watched me feed, assessed how happy my baby seemed feeding, gave me a range of positions to try and also gave me great advice on pumping etc. The fact that someone was there to sit and watch me feed/wind my baby for hours (I had to text her just before he was due his next feed and she set off to drive to mine, and she stayed about 3ish hours, watching a couple of feeds in that time) was so valuable. I found her through a recommendation but all accredited ones are listed via the LCGB website. I’ll try and include a link now so you can see one in your area:

lcgb.org/find-an-ibclc/

I think I paid £80, and it covered that session and any follow up support I needed including zoom chats, phone calls and text support.
I also found the National breastfeeding helpline really supportive.

Hoping you find the right support so your daughter can thrive. You’re doing an amazing job.

As PP said, stop overthinking and top up with formula. My baby lost 13% of his birth weight as my milk was slow to come in after a failed induction, an infection, and every drug under the sun. The infant feeding team gave me formula there and then to top him up with. He's six weeks and is almost exclusively breast fed, but I love having the option of formula if I want a longer sleep or to do something for myself. I found expressing such a faff. Don't see giving formula as "giving in" either. You'll find it much less stressful knowing she's putting the weight on and she'll be happier too.

If you are struggling to pump enough then I would give formula top ups when needed. You can still go on to EBF once her weight is up. Don’t stress yourself out! You sound like you’re doing a great job already.

Please be kind to yourself. My youngest lost a similar amount over the same timeframe but instead of sending us to hospital, they sent the infant feeding team out to us every day for a week until things improved (this was during lockdown). Is baby having enough wet/dirty nappies?

If you want to persevere with breastfeeding, I would seek help from the infant feeding team at your hospital rather than the paediatric consultant. The pumping is miserable and unsustainable. Have you had your daughter checked for tongue tie?

My DD is now 1 and I'm really glad I pushed through an awful first few months with breastfeeding as I really enjoy it now and she loves it. That said, there is absolutely nothing wrong with topping up or switching to formula if it's too much. I had to top up my eldest and he started refusing the breast at 7 months - we have the most amazing relationship and bond completely unaffected by the feeding.

So... I would go one of 2 ways: get some proper support for breastfeeding (and stop pumping!) Or top up/switch to formula.

Also if she is jaundiced she probably won't be feeding well as it makes them very tired, but conversely she needs to feed to get rid of the jaundice. That's the trap we fell into and it got worse and we got readmitted and she had to go under blue lights. I'm expecting DC2 later this year and will have no qualms in topping up with formula in those early days.

Lactation consultant is a good shout but very tiny babies often just need time to get the hang of feeding and grow a bit, and if she's hungry then you can give a bit of formula. Poor DD was starving in the hospital and I was trying to pump and feed her and it wasn't until a lovely older midwife said 'Would you like to top her up with formula? Lots of women do!' that I did so and she stopped screaming and she slept. I felt awful she'd been so hungry.

Most of the women in my antenatal group had feeding issues for the first few weeks, and all went on to feed to a year plus in the end, so just do what you need to do for you both and don't stress about it.

(And yes pumping is miserable, I did it for 12 weeks and never again!)

Feed as much as you can yourself, then top up with formula. We give one bottle after 'dinner' - the last feed before bed-, and after the middle of the night feed.
The added bonus is it seems to knock him out for a longer stretch so we get a decent nights sleep even if it's broken.
Just please please don't beat yourself up. Ask yourself, how many toddlers / children or even adults do you meet without thinking 'I wonder if they were exclusively breast fed' ... at the end of the day fed is best

First: congratulations!

As said by a previous poster: has she been checked for tongue tie? A lactation specialist should be able to check this.

I found that I could up my production by eating well, drinking well and sleeping well (the latter will be a problem...). I skipped one pumping session at night to get some extra sleep. Also skin to skin contact improves production.

If I was cold or hungry I couldn't pump as much. That is not to say that I say you have to keep pumping, but more general advice on how to up production. I drank and ate something warm during the night before pumping...

We had a premature sleepy baby and had to use tricks to keep her awake during a feed. Stroking her face, talking and if need be even a quite cold wet towel against her face...

In our case, which is different from yours of course, we had to combi feed. My production remained too low to sustain her.

Wishing you all the best.

I could have written your post when my DD was born two years ago, @ImStayingInside - and the advice I would give myself if I could go back in time is to give the formula top-ups. I stressed myself out - physically and mentally - by trying to pump and breastfeed and frankly it ruined the first few weeks of having my baby. The worry and anxiety really sucked the joy out of being a new mum.

Give some formula but continue to breastfeed (if that's what you want to do) - and put your baby on your breast as much as you can to stimulate your milk production. Take fenugreek supplements, eat plenty of oats/porridge, It isn't the end of the world if your baby has some formula, or even if you decide to switch to formula entirely (which I did at five months, due to having to go on medication - I cried buckets, but looking back, it was no big deal, and I wish I'd done it sooner!)

The ideal is to breastfeed but when it's not working well, or taking time to get there, go with whatever DOES work for the baby and for you. Whatever you decide will be just fine

In terms of the pump being sore, are you using the correct flange size? There is a Facebook group where you can post a pic and they’ll size you up it’s breastpumping, estimator flange sizing and all things related.

Are you on a feeding plan, such as triple feeding. I saw some tips from an IBLBC on Instagram, I’ll relay them below.
-breastfeed baby for as long as you can see active milk transfer, when they start flutter sucking or falling asleep take them off, they’ll be burning calories and not getting much milk. Then if you’ve got someone else hand baby over to them and offer them the top up, then express (ideally at the same time as baby is getting the top up). Typically they say every 3 hours but triple feeding is graft. Try and do every 2 in the day so you can stretch out to every 4 at night, breast and baby need to be fed a minimum of 8 times in 24 hrs.

Does your hosptial have an infant feeding team? Midwives and health visitors have very limited breast feeding training often infant feeding team has an IBLBC who is a breastfeeding expert. They can see if baby is effectively transferring milk or if baby has a tongue tie. Paediatricians also often have poor breastfeeding training.

Try a Hakka on the other boob whilst feeding on the other. It allows you to ditch the pump and catch additional milk

First I would suggest telephoning the national breastfeeding helpline 0300 100 0212 tomorrow morning, it will open at 9.30am.

Secondly, consider whether you have the resources to spend on a lactation consultant. Latch is most likely the problem, they are the best person to help you with this. If you haven't already, look up some advice on latch from a good website like Kellymom or La Leche League.

Overnight tonight, if your baby is waking and willing to feed, I would just breastfeed directly, and take a complete break from the pump.

Nothing terrible will happen with your baby overnight if they are alert / waking and willing to try to latch and feed. They have already had the basic bloods tests. This is not an emergency and your baby will be okay tonight.

Paediatricians are not breastfeeding experts, sadly, and are in general too obsessed with measuring milk volume (which isn't really possible and FYI a low pump volume does not mean a low supply, though inversely a high pump volume is pretty reassuring!) and are too keen to advise pumping, when they have no idea how difficult and stressful it is. DOI, I am a paediatrician myself. Replacing feeding with pumping is generally speaking, bad advice. Additional pumping on top of direct breastfeeding (particularly if you can manage overnight and early morning pumping) can help to bring up supply and get more milk into baby. You should also try to switch breasts, always offering the 2nd breast. If your baby wants to latch, latch them. If they will then additionally take a top up of expressed milk, give it. Then pump, if you can (but don't forget to rest! Pumping after every single feed is torture and unsustainable, usually). Feeding directly is always better if milk transfer is taking place (can you see / hear swallowing, do your breasts feel emptier, is your baby satisfied, even for only a short time, after feeds?). Switching to pumping only is likely to risk reducing your milk supply. Supplementing with formula risks reducing your milk supply but can be a lifesaver to overcome a short term hurdle (for example, if you are stressed beyond belief, need to rest and have an impossibly sleepy baby unwilling to latch then formula over a short period whilst you access some decent breastfeeding support is more than okay. What I would suggest is feed > top up > express, and always use EBM rather than formula if you have it).

Consider ordering some silver nipple shields to soothe/heal the nipple damage you have and some plastic nipple shields now, in case these are needed to make a difference with your baby's latch later on. A passive collection system such as Haaka or Naturebond is really cheap and you may be able to collect some extra milk as you feed your baby, saving time.

Good luck, this stage is really difficult.

Honestly, I'd just too her up with formula and wouldn't give it a second thought.

*top

Honestly stop torturing yourself and give the baby formula it's more important for her to thrive and be healthy and also for your mental health right now

You are me 7 years ago OP. My daughter was a sleepy baby with tongue tie, I just couldn't get her to latch/feed for long enough. The stress of it drove me to tears. In the end my mum came round with some formula and bottle kit- she drained the bottle in one go. Just do both and mix feed, ur baby will be fine. In years to come it wont matter a jot! Xx

Congratulations!

I was in your boat too. 13.6% weight loss and jaundiced. I couldn't find the energy or time to pump enough but a friend bought me a haaka pump and that made all the difference. It's not mechanical- you just stick it on one boob while you feed baby from the other and it catches all your let down. I would get about 30-40 mls each feed without any real extra effort, which allowed easy top ups. I think expressing is a huge ask of a new mum. Good luck!

I can relate to your experience, it's so tough but you're doing great. My little boy lost 11/12% weight and was quite jaundiced, not enough to be hospitalised either. He took a month to get back to birth weight as the midwife explained that the energy he was getting from breastmilk was going straight to getting rid of the jaundice.

I would try and offer feeds as much as possible, also use a haakaa whilst you're feeding to catch the letdown and feed top ups when you can. Keep yourself well hydrated and lots of good foods (and cake lol).

Ps I tried pumping and found it too much alongside feeding on demand, so do what feels best for you.

Hi I was in the same boat a month ago. I was breastfeeding and thought we were doing ok, then one night DD wouldn’t stop feeding. We both got exhausted, and ended up back in hospital. She’d lost 15% both weight. I wasn’t producing enough milk after a long and traumatic labour ending in emergency c section and a lot of blood loss.
They immediately fed her formula, and put us on a formula/breastfeeding/expressing regime. I’d offer breast as ‘free milk’, then give either expressed or formula up to 50ml.
A month on and I’m predominantly giving her formula with some expressed when I can. My volume is still v low -30ml sometimes. But you have to not beat yourself up. At least 60% of my NCT group had to go to formula for one reason or another.

Just an update, we’re on 2 weeks old today and by daughter is almost back to her birth weight at 7lb, she was 7lb 3oz born, so we have been discharged.
I ended up contacting a local breastfeeding support group and my bosom buddy (still feels so weird saying that!) and the breastfeeding support group put me in touch with the feeding team at the hospital who agreed it was unsustainable to exclusively pump every 2 hours and they seemed unsure why the paediatric consultant had even suggested this.
I was put on a new feeding plan of breast every 2 hours and to express at least 4 times a day after a feed and top her up with the expressed breast milk at her next feed.
This has worked and was much less stressful, so I am keeping it up for another few days and then I will start to let her go 2.5 hours at night time and continue to feed on demand during the day - which is a lot! 😂
Thank you so much for all of your comments, I was so down when I made the OP and I am a much more confident and happy mummy today than I was 1 week ago. It really helped to know that I wasn’t the only person who had experienced this.

So glad your local infant feeding team helped - mine were great and by far the most knowledgeable professionals that I encountered when it comes to breastfeeding (compared to doctors, normal midwives etc)