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. 💔

OP also I felt EXACTLY like you about bf and I were to have another baby I’d bottle feed from the off now. Sod all that cluster feeding and sore nipples!

Absolutely no shame in it and you’re actually putting your baby first in many cases by choosing it ( not all the gumpf about breast is best - can you tell I’m angry about this slogan!!)

Aw OP that sounds really hard. You’ve had loads of great advice already but I just wanted to say that your baby being hungry 30 mins after a feed does not mean you didn’t do a “good job” with the previous feed.

Their tummy is so little at the start for some babies they can literally need to feed that often (every 20/30 mins) at some points in the day. All of my babies cluster fed at points. It won’t last forever but can be very draining at the time obviously. If baby looks hungry, she probably is regardless of when the last feed was sometimes, so always worth trying a feed just in case imo, and that will be good for supply too. Hope you feel better really soon

@handmademitlove it was a midwife who checked after DD was born and last night it was the nurse (or maybe she is a midwife(?) on the ward I'm on now).

Feeling a bit panicked and overwhelmed with the replies and like every decision I make is massively high stakes. Not sure what's best and really feeling fragile without my DH to support me.

I went to an incredible talk the other day about donor breast milk. It’s amazing! The donors go through strict testing, and the milk is treated so it allows you to keep providing breast milk. It’s a charity so all free!! Also some of the women who said they had used it said that they only needed a couple of bottles to tide them over until their milk came in. I wish I had known about it before as it would have changed a very stressful first week when my now 7 month old DD was born.

It’s a minor choice between bf and bottle. Go with your instinct. Seems like the biggest thing in the world but it’s really not. I sat there weeping with a hv suggesting I give up bf!!

Have you got nipple cream / balm for your nipples?
If not, get some.

Slather it in on after every feed - let your nipples air dry.

Feeling a bit panicked and overwhelmed with the replies and like every decision I make is massively high stakes. Not sure what's best and really feeling fragile without my DH to support me.

remember whatever you decide will be ok for you and baby, it will be ok

Just to quickly say, sorry I referred to your dd as a boy in my post. I was thinking about my son so much and typed too quickly!

Has your baby been properly checked for tongue tie? Ask multiple people to check her. My baby had it and it was missed initially.

You can do this.

Establishing bf is like turning on a machine. You have to keep it fuelled (you must eat and drink, loads, as much and whatever you fancy) and you have to keep it turned on.

Your baby will probably feed almost constantly for the first few weeks. I could never differentiate between one feed and the next, it was just all one big feed. Get your bra off, get back to bed or on the sofa with your baby and just snuggle each other basically night and day. You need the smells of each other to stimulate things both ways. Supply and demand. You can do this.

I had a similar experience but never quite broke the top up dependency so combi fed for 6 months. I know others who have managed to get back on EBF and others not at all.

I beat myself up about the combi feeding it at the time and was so upset. They are now 9 and 7, strong as anything, and it feels like a distant memory until I read a thread like this.

So I just wanted to say I can see how much you want the best for your baby. And whatever happens with feeding you are a great mum! This is a really hard period and will pass. Sending love

My LO lost 10% by day 5 and was exclusively breast fed. We were also daily attending the hospital each day due to concerns about jaundice . I had the midwives and drs watch me feed and check latch, tongue tie etc so many times. I was devastated LO was losing weight so quickly and felt it was entirely my fault and my failure . Was constantly told all was well , latch good , milk supply seemed good.

Was recommended to top up after each breast feed (I could either pump and bottle feed some breast milk or formula) . We took that advice and did a mixture of pumped milk and formula for top ups and LO slowly started to gain and eventually got back to birth weight. They dropped the top up feeds naturally within 6-8 weeks as they were gaining satisfaction from the breast feeds as my supply regulated and we got the hang of everything. The top up feeds also allowed by partner to take a couple of feeds if I needed him to so I could nap, shower etc which in turn gave me that moment to take a deep breath and refocus and ultimately saved my breast feeding journey (I am sure without the top ups I would have given in by week 2/3 and been exclusively FF)

no matter what choice you make with feeding , you will get through this and settle into your own routine with what works best for you and LO. you are not failing everybody’s journey is different. I personally feel that being able to say that you are struggling and need a break or help is the very best thing you could have done. It takes strength to ask for help. By getting up and trying and making the hard choices about these things for you and LO you are succeeding.

congratulations on your baby’s birth. You will both be ok. You will both be rocking it in time.

Untrained long time breastfeeder here. You are doing brilliantly and you're sounding knackered and overwhelmed. My health visitor swore by chocolate and eating three meals a day and snacks between to keep your energy levels up. I've never been so hungry or thirsty ever and was drinking pints. And eating loads overnight. Second all above info.

Keep baby close, lots of skin to skin, snuggles and lots of feeds to up your supply and be aware of cluster feeding it's entirely normal. Like I said I'm not trained but from what I've picked up keeping baby close helps increase your oxytocin levels for bonding and wellbeing. And regular feeds ups your supply. If top ups are required you may be able to pump for these instead of formula.

The staff and hospital are not supporting you with breastfeeding. As others said contact the La Leche League, you may also have a local branch on Facebook. Ive used my local one they were great. There is also a Facebook breastfeeding and lactation support UK group with trained admin and you can post for help. Breastfeeding and Lactation Support UK. Were you given a list of phone numbers for breastfeeding support on your discharge home? Beginning Breastfeeding LLL

My friend has had tongue tie checked for at hospital and been told all fine but then still ongoing issues so she paid privately and it was a tongue tie. I had issues with a shallow latch and was told to look at the flipple technique.

You've got this and sending love and hugs.

Firstly - it will be fine! Having to make decisions about stuff you know little about is overwhelming. And everyone you speak to will likely have a different opinion. Very few decisions you make will have any long term serious effect. So don't worry too much about getting it wrong or right.

Some questions to help perhaps:

What do you want from all this? Obviously the best for baby, but do you want someone to tell just you what to do? Or do you want to understand what options you have so you can make a decision? Both are absolutely fine options!

Ask staff if there is an infant feeding team you can speak to.

Ask staff what their plan for you both is - what are they worried about? What are the next steps?

Are the feeds going okay when they happen? Or are you worried about frequency? Little and often is normal at this stage. You can't overfeed them when breastfeeding! Their stomachs are tiny at this age so they can only take a little at a time.

Meanwhile, just keep feeding. Feeding can be a little uncomfortable at first as it is a new sensation, but if it is hurting, things may need a little adjustment. There is a lot of information available on different things to try to improve baby's latch.

I also had a very similar experience, you don't realise the emotional rollercoaster breastfeeding can be!

I followed the advice & used nipple shields and top ups, then transitioned to EBF. Still feeding now at 16 months. I had access to a great support group via my health visitor and would recommend seeing if there's anything similar, it really helped to be with other mums who were struggling with similar issues.

Simply because they are not breastfeeding experts, or even particularly knowledge on the subject.

It's also much easier for them to give formula.

Please don't panic, it will be ok. It is so overwhelming, especially with first baby.

In summary, you need:

• A lactation consultant
• A browse through through the la leche website
• a tongue tie specialist

It is ok to top up with formula if it's going to take the stress away, but don't increase the volume. Just give tiny amounts like 30-60ml as you can stretch their stomachs.

Keep on with the nipple shields of that works.

I had terrible problems with latch, cracked, bleeding nipples but as baby got a bit bigger it resolved on its own. By 2 weeks we were ok.

You're doing great.

The only thing I'd add to the great advice you've already had on the thread is to look into other ways of holding your baby when feeding. For me, whilst DC2 was always happy in the traditional hold, in the early days DC1 always fed better when held more like a rugby ball (beside my body rather than across it). I'm not sure how recommended that was, but it was what worked for us.

I feel you so much. I had a very similar experience, except 11% weight loss and jaundice thrown in. I was admitted, and had such contradictory advice from medical professionals and no one doing anything except rush in and out that in my overwhelmed frustration I stood in the hospital and shouted "will no one just take the time to help me?!"

Do you want to breastfeed? That is the first step for you. How much do you want to invest your time in this? At the time my answer was yes. (Looking back, 9 years later, I question how important this actually should have been but I understand at the point you are in how important this feels).

You've had some excellent advice on this thread regarding where to seek support - La Leche and lactation consultants. Re tongue tie- if you can afford it you could consider private. A consultation cost me £250, was same day and for me was hugely worth it.

Good luck. However it works out you have not failed - please don't think that. You are looking after and loving your child in the best way possible and they will thrive no matter how you feed them

Aw op you sound like such a lovely mum, firstly you are doing brilliantly the first few days are exhausting and overwhelming so please give yourself a break you are not failing at anything you are trying to do the best by your baby girl. Secondly you will hear all sorts of typical phrases such as breast is best, breast feeding is easy blah blah blah but honestly it isn't always easy straight away you and your baby are still getting to know each other, they feed pretty much constantly in the first few weeks with cluster feeding it is overwhelming and exhausting I remember saying to my mum that I felt I permanently had my dd on my boob! You have had some amazing advice re lactation specialist I think that would be great for you to help with your bf journey. And finally and this is really important if you do want/decide to use top ups. THAT IS MORE THAN OK. Fed is best and you need to do what is best for your baby but also for you. These feelings of overwhelm won't last for ever I promise you will figure it all out and it will be ok.Take care of yourself and remember your are doing amazingly mumma your dd is lucky to have you. X

Hi OP, the first few days/weeks are really hard and I don't think I've ever felt as tired or overwhelmed. I was kept in hospital for a week, initially to help support feeding then my son developed jaundice and needed phototherapy. During that time, he was struggling to latch or was in neonatal so I couldn't feed him. The hospital supplied a pump to help me express and he was fed my milk when I couldn't feed him or when he couldn't latch. He was never fed formula and I don't recall the hospital ever suggesting it. I think advice is that you shouldn't pump for the first few weeks because it can result in oversupply but it helped me establish enough of a supply to feed my son and the hospital supported that.

The hospital nurses/midwives weren't great at helping me to establish breastfeeding and we struggled to get anywhere with latch etc. Once we were home, the infant feeding team (Scotland - not sure if England has an equivalent if that's where you are) visited me several times to help with latch, positioning etc. and they were more helpful showing me different ways to lie and hold baby. It took about 5/6 weeks to fully establish breastfeeding and until then I continued to express and give top ups by bottle. He really struggled to feed properly and would need top ups constantly. I actually got to the point I'd offer a bottle of expressed milk first because offering the breast was too stressful. I'd cry most days (often most of the day) because I felt like I couldn't satisfy him without a bottle top up but he was just so tiny (premature) and a little lazy from the jaundice that it took a while to get the hang of it. One day something just clicked and I didn't need to express and top up again - it literally happened overnight. My son is now 8 months, exclusively breastfed and will reject a bottle. Hopefully that gives you the reassurance that this is definitely not the end of your breastfeeding journey.

Also, just to add I was advised to try nipple shields but it didn't help my son. He appeared to latch but he was latching to the shield and trying to feed from that, rather than the breast which, as a first time mum, I didn't pick up on. It looked like he was feeding but he'd be there for ages, get tired, would fall asleep then wake up starving because he hadn't fed enough to start. Once I removed the shield, feeding was easier. Everyone's experience is different so hopefully you can access feeding support to help get you established.

Hi OP,

There are lots of more experienced posters here than me, but I just wanted to share I am going though a slightly similar experience with my 3 week old baby.

We were kept in hospital for a while due to weight loss as she wasn’t latching well. Various midwives in the hospital tried to get her latching with no success and in retrospect I think it is true what posters here are saying that midwives in hospital don’t necessarily have breastfeeding expertise.

After discharge my community midwife referred me to an infant feeding specialist midwife and I would advise you to see if the same is available in your area as she has been so supportive and knowledgeable in terms of positioning, and diagnosed that my baby has a tongue tie which we are now looking into getting treated. As others have said, you should definitely ask about tongue tie for your baby as damaged nipples can be a sign of that.

Baby is now able to breastfeed to some extent thanks to the support I’ve received, but not enough to get all her nutrition from that so I am also topping her up with expressed milk and some formula. I was reluctant to use formula at first, but quite simply it has been essential in order to get her weight moving in the right direction without making myself ill (at first I was attempting to express all her top up feeds and I was getting so exhausted it was really affecting my wellbeing). So please don’t feel bad about adding some formula to your baby’s feeding plan.

Hoping that in time once the tongue tie is fixed we will be able to switch to fully feeding directly from the breast, but in the meantime we have a combo solution which works for now

Wishing you all the best because breastfeeding is honestly the hardest thing I’ve ever done in my life and I hope you find a solution you’re happy with xxx

OP the key thing to remember is that whatever happens with bf your DD will be ok.

BF / FF both are fine. I know it feels like a huge issue at the moment but this will pass.

If you want to BF then keep offering and call a lactation consultant. If you don’t then FF is perfectly good.

But remember - it will all be ok either way!

So sorry OP, this happened to me with my first Dd a generation ago

I succumbed and added a bottle but it did mess up my supply and gave me problems with engorged breasts.

I thought she was feeding but she was sleeping

I think the links given are a good idea

What about NCT?

For context, I'm a GP and have fed each of my three children for between two and three years. OP, you're doing brilliantly. You haven't failed your daughter, and you are providing enough for her - 8% weight loss is perfectly normal and doesn't imply there's anything wrong. In fact, nothing you've described (including the trace of swallowed blood in her vomit) sounds abnormal or overly worrying.

Bring her home, get into bed and just feed all day. Anytime she wakes up, feed her. This will increase your supply more effectively than pumping or anything else. Contact LLL for support. This intense early stage will be over before you know it, I promise.