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. 💔

No specific advice OP just that I remember being in your position and feeling completely overwhelmed, sleep deprived and emotional about the situation. Constantly getting conflicting advice and not knowing what to do for the best. Both mine dropped 8% by day 5 (think this is pretty average drop) and both ended up exclusively BF long term. In a few weeks time you will feel a whole lot more confident about it all - you are doing great! (Even if you don’t feel it in the moment!) x

It sounds like everyone was just trying to do their best with a panicky stressed first time mum, they could see you needed some rest and support so I don’t think what they did was wrong. However if you really want to breastfeed (if you think you can cope mentally) then you just need to go home, stay in bed and get on with it. You need to accept baby’s feed very frequently and focus on nothing but rest and the feeding, no visitors except maybe mum/best friend for short moral support visits etc, DH bringing you meals and taking care of the house. Get midwife/infant feeding advisor/lactation consultant in to help with positioning and attachment, sort out any tongue tie etc. Download a decent breastfeeding book on your kindle too as that would have told you about babies swallowing blood from cracked nipples without you having to rush off to A&E. Gook luck x

The nurse putting your baby back on the same side is a very strong indication she is not qualified to help you with breastfeeding. The foremilk/hindmilk stuff is years out of date. Feeding repeatedly from the same breast is actually a way to REDUCE supply - this is called block nursing. Switching sides is a technique to help if supply is low - this is called switch nursing. https://breastfeeding.support/forget-about-foremilk-and-hindmilk/

Reading between the lines, it sounds like breastfeeding is going well. You have milk, your daughter can latch and feed, she hasn't lost >10% bodyweight. What's the reason for nipple shields? These, and formula top-ups, risk reducing your supply and derailing breastfeeding for you. If you top up, expressed breastmilk should be first choice, but if your baby is latching well, then you don't need to pump and top up. Hospitals love it when you do because then they know what the baby has had in ml - try to resist the pressure! Just feed lots.

If you stay in hospital, please ask to see the infant feeding team (unfortunately, they usually work office hours IME). Not midwives or paediatric nurses, who mostly don't have enough knowledge of breastfeeding beyond basic positioning. I wasn't allowed to see the infant feeding team because I was on NICU with my baby, and was told the nurses there were all qualified for breastfeeding support. In actual fact, they were disastrous and nearly derailed breastfeeding completely for us. When I did finally see the infant feeding team, they were horrified! If you can't see the infant feeding team, or don't want to wait, you could pay privately for a lactation consultant.

Most babies feed long and often in the early days. Gradually the feeding time goes right down (2-3 minutes now with my 9 month old) but the feeds stay frequent (every 80-90 minutes in the daytime until weaning for us; never heard of any breastfed baby doing the mythical 3 hours! But much longer at night after the early days).

Good luck and please don't let these people derail you. You need family/friends to support with nappy changes/holding the sleeping baby/household chores, so you can feed the baby, feed yourself, and rest.

Also, look up some videos on how to tell the baby is getting milk - what their jaw looks like when they're swallowing etc.
And try to enjoy these precious early days if you can, despite the exhaustion - they're over very quickly! My son fed for hours upon hours a day and I spent the whole time worried about supply and tongue tie and so on. I wish I'd enjoyed sitting on the sofa watching TV and holding my tiny baby. After the first 3 months, the feed is over before you've found the TV remote.

It's perfectly ok to just feed when your baby wants to. Hospitals are obsessed with schedules for some reason. As long as your baby is happy and you feel ok to carry on, then I wouldn't give top ups personally. Save the top ups for if/when you're in need of a break. If your baby is not getting enough, you will know about it!

Doctors and midwives often miss tongue ties. You need to see a qualified tongue tie practioner. We had a similar experience to you and it eventually turned out my son was tongue tied. Once that was sorted things improved massively.

The problem with formula top ups is that you need to be putting baby to the boob every few hours to tell your body to up the supply.

Based on my experience I'd get home ASAP and get seen by a tongue tie practitioner and IBCLC. They'll soon sort you out.

It's really hard.

You need to sleep and eat more to get your supply up - formula in the meantime won't do anmy harm. But try and feed or pump at least once in middle of the night as this helps supply - it's better to drop and early morning or evening feed than the middle of the night one.

Can you ask hospital to give you a breast pump to encourage your supply and also so you can feed baby your own milk?

Have you had her checked for tongue tie? This caused me to have bleeding nipples

Agree with a lot of the posts.

Go home. You breastfeed, hand the baby over to DH when done and go to sleep. And repeat. Sometimes shower etc instead of sleeping. Oh and eat! One handed with a very lightweight IKEA plate balanced on the baby while they feed for max efficiency.

See a lactation consultant to check positions etc.

Try to not catastrophise - babies are very adaptable and little you do right now apart from stopping completely is irreversible. Either method of feeding is fine, it's what's right for your family. I've breastfeed 3, for 4.5 years but on an individual level there's not a big impact.

Breastfeeding is toe curling painful and really really hard in the early days, but pays off after about three months.

Hi there I am a registered midwife with interest in infant feeding. I am genuinely appalled by the hospital advice you have been given so far. Are they actually in the UK? If yes, they practice in a very outdated fashipn. Firstly weight check on day 4 is meaningless. Weight should be checked on day 5. I am almost 100% certain that your baby's weight loss would have been less than 8% on day 5. Secondly even 10% weight loss on day 5 is not a clinical reason to introduce formula as babies begin to catch up once milk comes in on day 3 or 4. Thirdly the correct treatment for sore nipples is help with positioning and attachment, not nipple shields. Nipple shields interfere with milk supply in the long term. Also babies should never be separated from mums unless in truly exceptional circumstances. Mums' milk hormones are highest at night. Feeding baby formula all night long without so much as telling you to pump (and providing the pump) is appalling. Also, the midwife should be giving you evidence based advice, not telling you what worked for her 2 children. I have been a volunteer in a breastfeeding support group for 3 years before I trained as a midwife. If you really want to breastfeed long term you need to seek help with positioning and attachment. Someone has sent you a video, it's an excellent start. Also you need to start pumping to stimulate your milk supply, it can drop of very quickly. Don't judge what your baby would get from the breast by the amount you pump. Baby would always extract more milk than the most expensive pump. So lots of skin to skin, deeper latch (watch the video), unlimited access to the breast, be prepared to feed all night (normal baby behaviour) and pump between feeds. Regarding the tongue tie - if you have seen your baby sticking the tongue out at least once- your baby doesn't have tongue tie. Even if does it won't necessarily need to be corrected, many babies adapt beautifully. Try to go and see your local breastfeeding support group at the earliest opportunity. Try not to panic too much, it's very early days and nothing irreversible has happened. I hope it helps

Further to the earlier post 70ml of formula for day 4 baby is excessive- they should be having 40-60 ml, depending on weight. I would try to get an early discharge tomorrow morning

Apologies, I just realised your baby is day 5. 70 ml for day 5 is acceptable. 8% weight loss on day 5 is also very much acceptable, especially since your milk only started coming yesterday

With both my babies I topped up with formula after feeds for the first couple of weeks.
It saved my sanity with my first born after having had next to no sleep for the first week because he just wasn’t getting enough milk from me (his nappies were dry). I remember crying my eyes out the first time as, despite having fed him for an hour directly beforehand, he demolished the bottle and I felt such a failure.
with my second child I topped up from the beginning and it made such a difference for those early weeks.
In both cases I then EBF them for over a year.
Maybe it meant my supply took longer to establish but I believe it was probably the difference between me giving up completely.

I was also readmitted with my baby who lost less % thank yours but he was also jaundiced and was very sleepy.

I was put on a feeding plan and it was to first try the breast, if that didn't work then to use expressed breast milk and top up with formula. The target was 60ml per feed and I managed to express 10mls to start which took an hour or more to pump. And I had to feed him every two hours. So I too got no sleep trying to ensure my baby got my milk.

I look back and wonder why I did this to myself. I needed sleep. You need sleep.

Carry on with breastfeeds first but if your baby is still hungry then please do top up with formula.
I went on to bf fully for 18 months and then with baby number 2 I am 2yrs on and still going strong.

So please do persevere with breastfeeding but dont worry about the formula on the initial stages either!

You're doing a fab job and congratulations!!

Also, I saw a lactation specialist who gave me a top of before a feed to place my fingers at the outer edge of areola and push in. Use both hands to the whole areola is being pushed on and hold there for 30secs to a minute.

Then put baby on. Your breast should feel softer.

My breasts were incredibly hard and full and my baby just couldn't get a could grasp on it but I found that worked well and another thing was to express off a bit and relieve the pressure in breast and put baby on.

Inverse pressure is the method.

I really feel for you. I got myself in a complete state over my second dc's weight and it left me questioning everything (despite successfully breastfeeding my first). My second had lost 11% by day 5 and they wanted me to top up with formula, but like you, I was worried that might be counterproductive to my supply which I could tell was just coming in. They gave me 24 hours and said to feed every 2 hours, it was exhausting, but my lo gained in that 24 hours and continued to gain thereafter. We continued on the 2 hour feeding schedule for a bit longer and then I was able to leave her sleep longer at night, but keep at every 2 hours during the day. So we did manage without top ups, but it was an exhausting couple of weeks getting things back on track.

There isn't a right or wrong, you have to do what you feel is best. Good luck!

Thanks so much to everyone who has replied. Just as an update, the treatment I received turned out to be absolutely awful. I'd been told after I arrived (and tearfully agreed to let them formula feed my baby overnight) they she would be brought back to me at 8am this morning and they would assist me with feeding her. It got to 8am and no-one had come to see me. Because I'd been feeling so anxious, I didn't want to make a fuss so I waited but at 8:30 I just couldn't do it anymore so I went to find DD.

As I approached the nurse (it was a different nurse to before as the shift had just changed over) she gleefully told me that they had just fed DD 70mls of formula. I got very upset at this point and was told that I would need to wait until 11am to feed her myself and they would help me with positioning etc. My DH and MIL arrived and were horrified about this. I just felt too upset and blindsided to let them know how heartbroken I was but my DH felt so appalled that he actually went back downstairs to the birthing centre to speak to one of the midwives there to seek advice about what was happening and ask if she felt this was necessary. She was also appalled and said she would come upstairs to speak to the sister in charge as she said this was completely wrong. She did come up and speak with the sister, and the sister then came and spoke to me and basically said there was a miscommunication when the shift changed and how she was sorry it happened but she couldn't turn back time. I was then again told to wait until 11am to feed DD, and that they would support me when I did.

I asked if I could use a pump as my breasts were so sore and engorged as I hadn't fed DD since just before midnight the previous evening. They said I couldn't as I should pump after the feed at 11am. Again, because I was feeling so anxious, I felt I needed to follow their advice so I waited. At 11am we did manage a feed, though it was difficult as the ward was so hot at DD kept getting flustered and frustrated and wouldn't latch. She did eventually feed but it was difficult on such engorged breasts and painful for me. They then did allow me to pump, and I managed to get 130mls in under 30 mins! I was amazed that I had managed to get so much but was so angry considering the comments I'd received about my supply the previous night.

They were very resistant to us leaving, but my DH helped me make a case for us and we told them that we would prefer to seek support in the community. The doctor came round and thankfully agreed to let us be discharged (the nurses were clearly unhappy with this) and so we went home. I have been managing to feed DD since (still struggling with her matching and then coming off/getting frustrated and fussing at the breast) but unfortunately my confidence has been further shaken and now I am feeling so worried about her getting enough from me. We have also been feeding her some of the milk I pumped using syringes.

I thankfully have an electric breast pump at home (a colleague gave me her old one (it is a closed system so I think it is okay to use hygiene wise)) so am trying to learn how to use it and have some sterilising bags coming in the post tomorrow so that we can sterilise the bottles and machine parts (though I need to learn which parts need to be sterilised etc as I'm not sure about this). I'm hoping maybe I can start pumping after each feed to build up a stock of milk I can give to DD to give my nipples a break and help establish my supply.

Currently holding a sleeping DD who last fed at 12:30ish so will look to wake her for another feed soon (feeling so paranoid that I'm not giving her enough). Someone from my community midwife team is going to come and see us tomorrow and re-weigh DD and I am going to ask them for help with my positioning as I'm still having so much trouble getting DD on (and getting her to stay on).

Going to try and find some local breastfeeding support groups and hopefully things will get better if I keep asking for help. Also I will contact the infant feeding team at the hospital who should hopefully also be able to help me (to be honest, I'm not sure why I wasn't sent in their direction in the first instance!). Still feeling pretty fragile and anxious but am glad I am not stuck on that ward anymore.

Hi OP. Really sorry to hear the hospital were unable to provide support but hopefully you can now relax and get that in the community now you're home. If your nipples are sore, I found the silver cups were great. Just express a little bit of milk in to them and pop them in your bra between feeds. It really helped me heal when I was sore and cracked in the beginning.

I could only feed dd lying down for the first few weeks. (I would always fall asleep!) I would just put her next to me and she’d be quite happy that way.

Hi there, I am so glad that you are off that ward now. When you feeling less fragile you might consider putting in a complaint. You might want to send one copy to the infant feeding team to keep them in the loop. The other copy to PALS who oversee complaints for the entire hospital. PALS might be more effective in instigating change. It the first time ever I suggest someone makes a complaint against my midwifery colleagues (unless you were on paediatric ward- in any case nurses should have known better) . What has happened reterally made my blood boil. The practice you suffered is out of date by over 30 years. Surely the ward ought to learn something new by now. No other woman should go through the same. I do appreciate you might just want to forget about the whole experience. As for your current struggles this is what I would suggest based on my 3 years experience in the breastfeeding support group 1. You have amazing milk supply if you managed to pump 130 ml in one go. Remember baby will always take more from the breast. 2. Fussiness on the breast, cluster feeding in the evenings and feeding all night long in the early weeks is normal baby behaviour not an indication of your low milk supply. 3 You need to rest as much as possible during the day you will be on a night duty all night in the early weeks. 4. You baby is taking sufficient quantity of breast milk if they generate 6 heavy wet nappies and at least 2 poos in 24 hours (maybe start counting them down). 5. The poo should be changing to yellow now if it hasn't changed already. Exclusively breastfed babies stop pooing every day by about 2 months- it's normal. 6. Look up Global health media breastfeeding videos- it's a collection of short videos on what to do about nipple pain, different breastfeeding positions etc. 7. Try to go and see an infant feeding specialist in a local infant feeding group to work on positioning and attachment. 8. 8% weight loss is still within normal parameters for an exclusively breastfeed baby. Their weight will be checked tomorrow, I am sure the % will have come down. I can tell your confidence has been badly shaken. A few formula top ups hasn't done irreversible damage to your milk supply. Try to relax now. It's best not to introduce bottles till 6 weeks. It's so much easier for a baby to drink from a bottle, they go lazy on the breast. I have seen it many times over - a topped up infant will put on a convincing show they a suckling on the breast. In the meantime, mum has to keep increasing the volume of tops up. I am sure the exceptions are possible. However haven't seen them in the infant feeding group. And all my mixed feeding friends gave up breastfeeding by 3 months. It's very hard work to keep pumping in between looking after the baby, preparing feeds, sterilising equipment etc. I suggest you wait until your baby's weight gets checked over today for your peace of mind. Then try to аvoid any top ups with either breast milk or formula. Lots of skin to skin and unlimited access to the breast should suffice.

Phew I'm so glad you're out, I have been thinking about you.

Keep baby close and keep feeding on demand and seek expert help!!

Be prepared for the infant feeding team to be about as useful as a chocolate tea pot - much like the rest of the 'help' you've received.

I found the silver nipple covers to be the best for nipple recovery in between feeds.

I'm really glad you're home and far away from the hospital's 'help'. They can be very toxic places at times.

Hi OP, glad you got home. As above, the advice you were given at hospital is very out of date.
Babies are designed to loose a little bit of weight after birth. They should regain the birth weight by 2-3 weeks.
Babies breastfeed for many reasons, hunger thirst, comfort, to calm down, to get to sleep....the list goes on! This is really normal newborn behavior.
The nurse who told you to feed from one side to drain your breast is wrong. The care and support you received as sounds awful. Maybe think about complaining to PALS when you are back on your feet.
Offer both breasts, feed frequently, keep your breasts stimulated frequently. Hand express or pump if they are engorged. Keep baby in skin to skin as much as you can, it really is beneficial and allows you to rest too. Have a look at breast compressions if baby is sleepy on the breast, it can help get more milk into baby and reduce the need for top.ups.
Can you get your partner to have a look to see if there is a local breastfeeding support group in your area.
Keep going, they first few weeks are tough 🤩

OP also really concentrating on positioning can help.
Make sure baby is super close so her chest is as close as it can be, arms not tucked in between you. Try and imagine she's got glue on her chin, and you need to stick her chin to the breast far enough away from the nipple so that the nipple is pointing up her nose. When she roots up at opens her mouth quickly bring her on from behind her shoulders. Make sure you aren't holding the back of her head, even a finger or thumb up the back of the neck can restrict their head and it needs to be able to tilt back. Support the nape of her neck and across her shoulders.
As mentioned the global health media videos are good, LMJ infant feeding support on Facebook has some excellent videos too.

As I am short in time, just a few remarks (sorry).
You mention that your nipples turn into a lipstick shape. It may be the latch, it may be a tongue tie. I am not in the UK, but we had about 5 professionals missing a tongue tie. The IBCLC certified lactation consultant only needed some information and a few minutes to look in our DD mouth to have an answer. Maybe see if one is available?

As other people said: cluster feeding is normal! Try to get sleep, drink something before/directly after every feed. Eat enough. Make sure you feel comfortable, also warm enough...

You can use cushions to support your baby so you have a hand free and can position the two of you correctly for a feed. Make sure you sit comfortably. In the beginning I found this very difficult.

There are many feedings positions, the most used one may not be the easiest for the two of you.

I used a hakaa to relieve some of the engorgement whilst feeding. And 130 ml is really good! Don't loose hope!

Oh and nothing wrong if one breast is empty to offer a second one. It is just that they want you to provide hind milk to your baby...

We had feeding issues, but still feeding! Getting the proper support is what made this possible. Wishing you luck. Enjoy your little one.