EBF 5 day old has lost 8%, being told to give top ups - is this a good idea?

[Polkadotfloral]

Hello, I'm wondering if anyone has had a similar experience. I am a first time mum to my 5 day old DD and am hoping to EBF.

My milk started to come in yesterday (when DD was 4 days old). Yesterday afternoon DD threw up a little after breastfeeding and there was blood in it. I called 111 for advice and they told us to take her to the emergency paediatric department at our local hospital. They did various tests and it came back that the blood in her vomit was from me. I have been struggling with my latch (getting the 'lipstick' appearance to my nipples after feeds) and have been experiencing some pain. I hadn't noticed but there were some tiny scabs on my nipples (but no blood on my breast pads) which is why I hadn't thought that the blood was from me. After a long time in the emergency department, they decided it would be best for me to be admitted for some support with my feeding. I was very tearful and feel awful that my tiny DD has been ingesting my blood.

So I finally got to the ward at just before midnight and once I'd settled and they'd gotten me something to eat (hadn't had a meal since lunch time) we tried feeding with nipple shields and we did get DD on and she fed for around 5 mins. We tried again on the same breast and she fed for another 5 mins. The nurse said it's best to feed just from one side per feed to allow the baby to fully empty the breast so that it encourages your body to replenish that larger amount per breast. She said she thought my supply looked great and that it looked like I'd managed to give DD a full feed in just those 10 mins.

We got her in the cot for bed and then about 30 mins later she stirred so I changed her nappy as it was wet and then the nurse said it looked like she needed another feed. I felt so overwhelmed at that point that I just started crying again as I'd been awake for nearly 24 hours and thought I'd done a good job at the last feed (as the nurse had said it looked like DD had done a full feed and my supply looked great). She said they could have DD overnight and give her some formula to tide DD over and even though I feel so awful about it I agreed as I just didn't know how I was going to manage to keep going given how exhausted and upset I was.

I've spoken to the nurse this morning who let me know that DD had a 70ml feed at 2am and a 47ml feed at 5am. She said she thinks the problem is that even though my supply looks good, it's not yet at the level DD is needing as DD's seeming really hungry (I have no idea what the amounts mean to be honest). She's said when it's time for her next feed at 8am we'll have another go with the nipple shield on the other side and then offer DD some formula to top it up. She said it will be better for my supply in the longer term to top up for a few weeks.

I just feel pretty crap about it to be honest. I don't know why my supply isn't there and after being told it looks great etc it just feels so demoralising. I never wanted to give her formula and I have no idea about how to prepare bottles or anything.

Just feel bad about the whole thing and worried I'm not going to be able to breastfeed long term if I give her formula after each feed (how will my body know I need to be producing the extra if I'm not pumping/feeding?).

In terms of DD's weight, she's lost 8% since birth (so not a shockingly huge amount). Can I seek advice from someone else or do I just have to go along with this? I can't see how going down this route will allow me to EBF in the future. Would it be possible for me to continue with EBF (with support for getting the latch right to reduce my pain) and for DD to get enough from me, or am I now just destined to not produce what she needs?

I feel like such a failure about all of this and think I will burst into tears when I see DD again at 8am. 💔

You need a lactation consultant not a nurse/midwife, can you request to see a hospital one?

Try le leche

@Garman Thank you, I will ask if this is possible

You need a lactation consultant as the hospital are going to derail your breastfeeding.

You are doing a great job.

Leave hospital and find a breastfeeding cafe or support group if you can't afford a consultant.

Do you have any support at home? Someone who can take you?

You are doing a great job, you are just tired.

https://www.laleche.org.uk/ here is the link for le leche

a d their phone number for help

Poor you it really sounds like you’ve been through the ringer. Firstly I would say one of the most important things is to also look after yourself. Getting sleep and enough calories will help your body produce milk for your little one.

The bf on one side is because the foremilk which comes first is really a thirst quencher. The hind milk is full of good fats and nutrition baby needs. It would be a good idea to pump from the other side whilst you feed your baby (or directly after) to stimulate supply. You can then use the pumped milk as top ups whilst you get some rest.

I think 10% weight loss is the marker for being sent back to hospital so not terribly far off it. My first dc lost nearly 12% Midwife recommended breast pump, breastfeeding tea helps to increase supply. Formula top ups for a few weeks but then went back to ebf.

@luckbealadytonight the nurse said she did it with her two children and was able to EBF long term - why would the hospital be looking to derail me BF (genuine question, I don't know why they would suggest this if it wasn't a good idea even though my gut is telling me not to do it).

I have my husband at home who can help me, he's on leave until the new year.

Second speaking to La Leche.

they will be able to advise you properly. I would be concerned that if they are giving formula that should be coming from your breast, it will affect supply.

Try and get some rest and do as much skin to skin as possible. Has tongue tie been checked properly too? That is one of the biggest barriers to getting a proper latch.

The pain, cracked, bleeding and lipstick shaped nipples indicate that your baby is not latched deeply enough. If you think that position and attachment are good then it might be that your baby has a tongue tie.

8% weight loss is fine and should not require top ups.

Nipple shields are probably not the answer in the situation you describe and could cause potentially more challenges with breastfeeding rather than they solve in this particular scenario.

Taking your baby away from you and giving formula is bad practice and would not meet baby friendly guidelines. You were admitted for breastfeeding support and it sounds like you didn’t get any instead you have intervention which is the opposite of breastfeeding support.

To be honest I don’t understand the rationale for admitting you. You could have outpatient breastfeeding support but it sounds like your local hospital is not very good at breastfeeding support?

You could get some support from whatever breastfeeding charities you have locally.

La Leche League
Families and Babies
NCT
BfN
ABM

These videos are good and will give you some ideas to try before you get skilled help from one of the charities above.

https://globalhealthmedia.org/videos/what-to-do-about-nipple-pain/

https://globalhealthmedia.org/videos/attaching-your-baby-at-the-breast/

Seek advice from a specialist. Midwives rarely have anything other than basic breastfeeding training. A few of the things your midwife has mentioned suggests she has not had any recent training!

The best thing you can do is feed, feed and feed some more. And rest whenever you can. Supply is based on demand. Has your baby been properly checked for tongue tie?

La leche league have lots of useful info that may help you he more confident in what you are experiencing. Although an American site, kellymom has some great info on feeding.

Do you have help from the other parent or friends? Look after you - eat, drink plenty and rest where possible. Snuggle up in bed or on the sofa and just concentrate on feeding and resting - everything else can wait!

The one thing I wish I knew before I had a baby is how often they feed.
I was led to believe that a baby fed every 2-3hours.
This is at a minimum, but in those early days it's can be every 20mins. It is exhausting, but it does pass.

Your baby is cluster feeding, the best way to up your supply is bring the baby to your breast often and lots of skin to skin.

But I'd ask the hospital to check for tongue tie and have a good look for a posterior one. The hospital should have tongue toe specialists - just to be sure!

I echo the advice to call la leche.

But Lucy Webber is a lactation consultant on instagram who has loads of helpful advice -

instagram.com/lucywebberfeedingsupport_ibclc?igshid=MmVlMjlkMTBhMg==

Do some research around best positions - for a good deep latch.

I had to start top ups around 8 weeks old and it sadly ended our feeding journey - earlier than we would have liked!

Good luck!

The formula occasionally will do no harm, but if you want to try to continue EBF, then the best advice I can give is to make your DD's mouth as wide as possible before she latches on. Really wide, it makes SUCH a difference, the pain is gone. The community midwives would physically pull her lower jaw down just before she latched and oh my god the relief was indescribable. Do that.

Sorry it's so tough OP. They do often need to feed pretty much constantly when your milk comes in to encourage your supply to establish. Definitely call LLL for advice and support. IMO the more you feed the better and if the only way you can do that is with nipple shields that's fine as a short term thing. Hope it improves soon. The weight loss is not concerning and now the milk has come in the weight loss most likely will be OK.

They took a quick look at DD when she was born and again yesterday night and said it doesn't look like she has a tongue tie (is there a more in depth check they can do?)

I think I was admitted because I was so tearful and worried last night. I feel so unsure as this is all new to me and I feel like such a failure for not being able to provide enough for DD. I don't know how things will get better with my nipples and if they don't improve then how can I continue? I feel so helpless and alone and am scared if I don't just follow their advice I'm not going to be able to get any further help from them.

Feeling panicked and scared and like every decision I make now is going to have a massive knock on effect.

This is similar to my experience. Had a traumatic birth with DS1, very little sleep and we were both re-admitted at 4 days old as he had bad jaundice that was getting worse and had lost 11%.

We were seen by the hospital feeding nurse and effectively told the same thing as you have. Feed from one side and formula top ups and put on a schedule to do this every 2 hours.

We followed this advice and it worked. After getting a little more sleep one night as my husband took DS1 while I slept in the spare room I felt better. After a few weeks the jaundice had gone and my son was gaining weight. I also went to our local feeding support groups and lactation consultants and DS1 was diagnosed with a tongue tie. Once that was resolved things got a lot better as feeding became easier.

I stopped the formula top-ups after about a month and it didn’t affect me EBF for the rest of his first year. He didn’t miss them, didn’t prefer a bottle and was happy with EBF.

I agree with a PP I needed to feed my baby honestly constantly in the first two weeks or so. Then still for hours per day after that. Was tough but I avoided formula that way and it boosted my supply. I think avoiding formula top ups as much as possible is best. Especially given that her weight loss is normal for an EBF baby. Are you making sure baby's mouth is WIDE open when she latches on? Touch their nose with your nipple and then when it opens really wide shove whole nipple in.

Hello OP congratulations on your beautiful baby.

I hope you will find what I have to say helpful, but I will preface by saying, I am not qualified, and encourage you to try and seek support from a lactation consultant.

I will also say that, when you are in hospital, the nurses and doctors will try and find the quickest ‘medical’ solution to a problem. Quite understandably! So, in this instance it will be giving top ups to the baby. So, that will be the angle they will come from in the first instance.

Ok, I have 4 children. I’m still breastfeeding the youngest (16 months), I’ve exclusively breastfed all of them, for quite a while each.

My experience is:

Nipples: ok I know ideally the nipple shouldn’t be lipstick etc, but each of my children has done this at the start while we got used to each other. It’s not ideal, but it was functional, and did right itself.

Take your bra off and let air at your nipples. They will be sore. Try and get multi-mam nipple compresses to aid recovery of the small scabs.

I know everyone says it shouldn’t hurt, but, having a sensitive part of your body repeatedly sucked on for hours at a time, will hurt. Until your body adapts.

Oh also, their mouth should look like a little fish while feeding (lips out not tucked in, if that makes sense)? I used to just gently use my little finger to bring their lips out of they weren’t.

There’s a lot of advice about latch and doing things ‘right’, I never really managed all that perfectly, but I got the baby on, and we managed to jumble along ok between us!

Supply

Breastfeeding is demand and supply. The more you keep your baby on the boob, the better the whole thing will function.

It’s hard with your first baby, as it’s overwhelming and boring, and honestly, baffling that something so small could want food again!!

Stick with it!! Your milk is in, you are doing brilliantly.

keep her on the boob all day, as much as you can. The fewer top ups the better really, as that affects the demand/supply equation. (But I can’t give medical advice so, you know, do what is right for you!)

For what it’s worth, my eldest lost similar weight, I was beside myself and worried non stop for months…. He’s now 9 and wonderful!

You are doing a brilliant job!

Congratulations! Slightly random, but eat loads of houmous. It's excellent for breast milk. And be kind to yourself, you're doing amazingly well and it will work out.

Is your hospital BFI Accredited as none of that sounds good practice.

Firstly good support with P&A should be tried before nipple shields, as while they have their place they can also hinder things as well. They can impede milk transfer and milk production as the nipple is not directly stimulated.

They should not have separated you and baby, and Def should not have given formula without encouraging you to express so that your supply could be encouraged. I know the sleep deprivation is a killer and as a hcp this seems like a supportive thing to do but it potentially could really upset bf being established l

You should offer from both breasts at feeds, switching between breasts is sometimes helpful for a baby as it encourages multiple let downs. Both switch feeding (frequently swapping breasts during a feed) or block feeding (feeding from one breast only for X amount of time) should only be done under directions from a feeding specialist as they can cause other issues. Feeding from one boob and then offering the other is fine!

8% loss on day 5 is fine if baby is otherwise clinically well. Really first line for top ups should be ebm as expressing post feed will encourage your supply. Also if your milk only came in on day 4 then it may take a little longer for baby to start gaining.

Ask to be referred to your maternity infant feeding specialist, ours are ibclc lactation consultants so you wouldn't need to pay. We have both hospital and community based ones. Peer support can be helpful too.

I’m so sorry that you are having such a hard time @Polkadotfloral you are doing brilliantly and the early days with a new baby are exhausting not to mention that hormones are all over the place when the milk comes in.

Only tongue tie practitioners can assess for tongue tie accurately, it requires hearing a feeding history and doing a thorough oral examination, it is more than just having a look.

In some areas you can access tongue tie practitioners on the NHS but not in others.

These websites might help but please find out what local breastfeeding support groups you have locally and access the help they offer.

https://www.tongue-tie.org.uk/

https://lcgb.org/

@Polkadotfloral - couldn’t read and run as I went through a very similar experience with my eldest son. He’s now 16, but I remember all too well how stressful the early days were. Please take a deep breath and acknowledge how challenging sleep deprivation is, and remember you have just brought a new person into the world. You are doing brilliantly.

Absolutely yes to the advice on here to get help with feeding from a consultant - particularly the latch. For me, my son lost 10 percent of his weight within a week. He was a big baby (over 9lbs), and in my case, though I intended to do EBF, despite trying my best (I saw consultants, took fenugreek, tried to pump etc), in the end I did top up with high quality formula, as my supply just didn’t seem quite enough to sustain him. I can’t say this enough - if you need/want/have to do that - this is TOTALLY FINE.

I remember having ridiculous feelings of ‘guilt’ after having all the ‘ breast is best’ advice. But remember, he is STILL getting all that benefit from you, if you need to top up to sustain him, that benefit doesn’t change.

I get it - the early days are so overwhelming. Mine barely slept and it makes you so emotionally fragile. But trust me, it will all be ok. If it helps reassure at all - that same baby is now 6 foot tall, just got 10 x A*s in his GCSEs and is doing A-levels. This is not a stealth brag, but just intended to show you that topping up with formula was all ok).

Best of luck with however it goes and whatever you decide and can manage re feeding. You’ve got this xx

This happened to me. The reason may not be the same for you but I’ll share so you have it in mind.

DD threw up blood (terrifying ) and we were admitted for a few days and they said it was from me. With hindsight, I now know it wasn’t - her stomach was bleeding as she had a severe dairy allergy.

it took me another 3 months to give up bf and put her on special milk. I felt awful too as I think we are completely indoctrinated by ‘breast is best’.

Breast is not best. Best is what works for you and your baby. It is not best if they are losing weight. It is not best if it is so hard it is making you stressed. There is nothing wrong with bottle feeding and you are not letting your child down. You will look back in years to come and wonder why the hell you sweated the change!!

If you use formula just be prepared for a reaction if there is a dairy allergy there - mine came out in hives. Or digestive discomfort (colic). Worth a test if you get anything like this and you would have to pay for speed. Have some antihistamine in the house.

Who checked for tongue tie? Most midwives are again not trained for this - ask if there is a lactation consultant at the hospital that you can see. Many tongue ties are missed in regular checks - I have referred people back to the hospital many times where they have been missed.

You sound very worried - if you can, phone one of the breastfeeding helplines.
Perhaps ask the midwives if there is any need for you to remain in hospital or if there is community support available for this. You will sleep and eat much better at home usually!

Having a new baby is very stressful - constantly worrying about whether you are doing the right thing is exhausting. If baby is producing wet nappies they are getting milk in. If you offer feeds every time they start to get unsettled, your supply will respond. It is very early days and losing 8% is within normal range.

both my children were admitted for weight loss and both went on to extended bf. In fact I still haven’t weaned the second and she’s 3!

you shoul have a feeding plan. A one off night with more formula won’t have any effect. First time a nurse looked after my baby all night and didn’t wake me it was clear I needed some sleep Don’t worry about crying. I spent the entire time both times crying. In fact I cried so much the second time they kept the baby and sent me back to maternity for a day as I needed some sleep. I had long hard labours both times.

The feeding plan.
Should be calculated to your baby and the weight it needs to gain. The feeding plan with my first was bf on demand but I have to breast feed every 3 hours even if that meant waking the baby. After one of the 3 hour feeds I had to give 30 ml of formula. This was to top up the bf not to replace it. We kept this up for a few weeks and then my supply had increase. The weight loss stopped within a day and then slow gains.

My second wasn’t on a feeding plan as she lost weight due to cmpa so it was an elimination diet as I had plenty of milk.

Thereshould be a bf advisor on your hospital and the hospital grade pumps are great, they should be able to get you one of those to help. You can also cup feed. Hospital have the special little cups but someone will probably have to go to special baby care to get one
unmumsnetty hugs