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. 💔

Thanks again for the further replies - I've had a much better day today! A midwife visited me at home and was so lovely and helped me so much. She weighed my DD and she's now lost 6.6% of her birth weight so she's on the way back up thankfully (though I know the formula will have had an impact on this obviously). She showed me different feeding positions and DD has managed to have some much longer feeds since which is reassuring. She said she thinks DD has a slight tongue tie which has been causing her to not be able to maintain a latch (which would explain why her feeds have been shorter and why she needs them more frequently and is generally frustrated/fussy when feeding). She told me to contact a particular local lactation consultant for a proper assessment so I've booked one in for next week. I'm feeling a lot better and a midwife is going to come round on Thursday too to re-weigh DD and check on me. The midwife reassured me that they are not worried about DD's weight at all, they're mainly doing it for my reassurance and wanting to check I am doing okay.

I'm feeling a lot better and more hopeful for the days ahead. ❤️

My baby was born small (2.7kg) and lost 9% of his birth weight. I came under immense pressure to supplement with formula but I resisted.

If your milk only came in on day 4 and your baby is 5 days old then it's far too early to judge.

Your milk supply works on a demand and supply feedback loop, so the more your baby is at the breast, the more milk you will produce. Supplementing with formula in the early days can prevent you from establishing your supply because your baby will also be drinking formula and so will breastfeed less than they otherwise would.

I would give it another week, making a real effort to breastfeed at least every 3 hours or more often if your baby is hungry, and see if her weight stabilises. I found it helpful to start a feed using a nipple shield until the flow was well established (when it was painful, not otherwise) and then take the shield off for direct contact between his mouth and my nipple.

Delighted to see your update, OP! Sounds like you're doing brilliantly.

Such a great update! You have survived your first parenting hurdle. Wishing you all the best!

I am glad you have now got some supportive HCPs to look after you!

Thank you for the update and verypleasedyouare finally getting decent help. Keep going, you will get there!

Wonderful!

Just as an update, things haven't been plain sailing since my last update unfortunately. Since our hospital admission, Dad's weight loss (from her birth weight) went down to 6.6%, then back up to 7.2%, and yesterday she was weighed again and had also lost a further 20g. I feel like I am constantly failing her and am really struggling mentally. I don't know how I can be good enough for her and it breaks my heart to think that she is getting smaller by the day 💔

I am trying so hard with her feeding, but it's difficult when the support has been from different midwives each time (I feel like they all have their own opinions and it's confusing trying to work out how best to improve our situation). We are feeding lots but unfortunately her latch is still a problem (am trying various techniques to deepen it but sometimes DD gets upset when I keep having to take her off so I end up settling for not the deepest latch - I know this isn't great but it's so hard when it's the early hours and she's crying at me). Our appointment with the lactation consultant next Thursday feels a very long time away.

I think I am going to start expressing so I can have a back up of milk in the fridge for times when we are struggling, but I am so overwhelmed with everything right now that I can't work out what things I need to express the milk and feed DD (I already have a second hand double electric breast pump (it's this one by Lansinoh https://www.amazon.co.uk/Lansinoh-Breast-Electric-Breastfeeding-Breastpump/dp/B00J7JTGX2), but I can't work out what I need to store the milk in and how to sterilise everything etc. It all feels so overwhelming and I'm scared of doing things wrong and things not being clean enough. If anyone has any advice/links to things I would need that would be greatly appreciated.

Also, I have been referred to the perinatal mental health team who are going to see me at the end of next week.

I feel so heartbroken that I can't be enough for my DD. I have struggled with anxiety and depression in the past, and although before pregnancy I was feeling in a better place with my mental health, I certainly felt anxious at various points during my pregnancy and doubted my abilities to be a mum. I just feel so sad and defeated. At times in my pregnancy I would have thoughts that my baby deserved a better mum than me and that they would be better off with anyone else as their mum and now I'm discovering that is the truth and I was right to doubt myself. 💔

@Polkadotfloral I’m sorry you’re having such a rough time. Is there a local breastfeeding group you can get to? Or a private lactation consultant who can come see you ASAP? The NHS is absolutely shocking when it comes to breastfeeding support and the long and short of it is you are doing nothing wrong and there is nothing wrong with you, the system is letting you down.

I had similar troubles and it was going private and ignoring all NHS advice re breastfeeding that did the trick.

Can you post a rough indication of where you are and we might be able to help find a support group? Otherwise could you post on a local Facebook group asking about one?

Please please don't think you're not enough for your daughter, you are everything she needs and all that she wants.
I haven't rtft so sure I will be repeating but what helped for us was rugby hold with both of us totally naked from the waist up - not great for getting out and about so we hibernated.
Re the pump and sterilising I have a similar looking one and I take the tube out of the back that connects it to the unit then wash and sterilise all the parts separately, basically whatever will come apart!
Sending you love OP it's a bloody minefield xx

Ooooh, it gives me such rage on your behalf OP. I'm so sorry you've had such crap support. I haven't RTFT but have you found your local BF group/cafe? If you can't find it easily from social media then call your children's centre and they should be able to point you in the right direction. Mine was a lifesaver. Almost all of us turned up on our first week, cried, had tea and biscuits thrust in our faces and had the best support and advice.

@Polkadotfloralfirst and foremost, huge congratulations on the arrival of your DD! Babies are the most wonderful and exhausting things ever and parenting is harder the adjustment is huge.

Well done for persevering with breastfeeding through the challenges you've faced so far - that makes you a brilliant mother already to keep on trying, you're putting baby first and you haven't given up on what you want to achieve for you both. There is no better mother than you for your DD.

I second all of the advice to find support within the community and from breastfeeding groups. Have you spoken to the Infant Feeding Team? Try them first. My local children's centre runs a breastfeeding support cafe you can just turn up at and they'll help, no appointment needed. Mine runs twice a week, is there something like that near you? Then there is also an NCT bumps babies and breastfeeding support group near me on a different day, again you don't need to be an NCT member or on their antenatal course to reach out for support. There are others by the other charities mentioned above too.

If you can't find the help you need soon enough in the community, try online. Search for Breastfeeding Peer Support in your local area. There is a wonderfully supportive Facebook group called 'Breastfeeding and Lactation Support UK' which is run by lactation consultants and trained breastfeeding support, they're very responsive and helpful too. 'Feeding Younger Babies and Beyond' is another supportive group.

When DD does latch and feed, you can gently massage and squeeze your breast to encourage a letdown.

Store your expressed milk in storage bags like these shop.medela.co.uk/products/collecting/breast-milk-storage-bags/ Boots do them and own brand ones are fine too. Label the bag first then put the milk in, gently squeeze out excess air then freeze.

I love my UV steriliser but they are a bit pricey.

The big Milton cold sterilisation box is as good as anything!

I use the Medela storage bottles as it's far more practical to freeze in small portions.

https://shop.medela.co.uk/products/collecting/bottles/

@Polkadotfloral you are the best mother for your daughter. No one else can fill your shoes. It is you she wants and needs. You are all she has ever known, her home, her very own mummy.

I’m glad that you are going to get support from perinatal mental health.

You are doing fantastically, your daughter is lucky to have a mum so concerned to do the very best for her.

Please access breastfeeding support from one of the charities today by phoning them to talk to someone today.

Try this number

http://www.nationalbreastfeedinghelpline.org.uk/

I should add that UV sterilisation is not recommended by the NHS.

The recommended forms are

Milton or other sterilising tablets

Steam sterilisation

Boiling water sterilisation

You are doing an amazing job for your daughter. Right now the only person being let down is you by a lack of support.
My DD had a tongue tie and the early days of breastfeeding were painful and sometimes it was just impossible to get her to latch. I know exactly what you mean about settling for a shallow latch. I couldn't stand the thought of relatching her and it was always painful prising her off. My midwife brought round some little cups that had a spout that we used to feed her sometimes. They might be helpful for you.
She had a tongue tie division when she was two weeks old and we are still breastfeeding now at four months so things can absolutely get better if you receive the right support. Equally if you think that bottle feeding would be best for you all then your baby will thrive too.
We did cold water sterilising. Big Milton bucket with a lid put cold water and a Milton tablet in and your pump, bottles etc are good to go in twenty minutes (wash first in hot soapy water). The solution is good for twenty four hours so is an easy thing for your husband to set up each morning.
I second contacting your infant feeding team. Have you tried googling infant feeding team plus the name of your town or county?

Hello, just an update - my DD was weighed yesterday (when she was 10 days old) and unfortunately she has now lost 9.1% of her birth weight.

The midwives have told us to feed her at least every 3 hours (which feels like not much as I was previously feeding her much more regularly (especially in the night) as she was showing cues for feeding) and to follow up with a 30ml top up of either expressed milk or formula. We've been mainly using formula for the top ups as I've been struggling a lot mentally and trying to pump has been adding to my anxiety (though I have now managed to express about 70mls so we are going to use this on the next few feeds).

I can't bring myself to feed her the bottles directly as it's breaking my heart that I can't get her to latch and feed from me anymore. She is technically latching, but she seems almost like a different baby in her temperament - I have to wake her for every feed (which is only once every 3 hours) as she's just constantly sleeping. When I'm trying to feed her she's so lethargic (despite trying hard to keep her alert by stripping her off to her nappy, changing her nappy and doing skin to skin cuddles before attempting to feed) and I can see she's finding it hard to latch and maintain suction. I don't know if it's the formula that's made her so sleepy but I'm just so panicked about this whole situation, to the point where I know my anxiousness around her is probably also impacting her ability to feed from me.

I don't know how she is going to put the weight on if this continues. I'm scared for her weigh in with the midwives tomorrow. I've got a call booked from the infant feeding team on Monday and am going to see the perinatal mental health team on Monday too. We've got an appointment with a lactation consultant on Thursday but it seems so far away. I'm so frightened and not sure how to make things better. 💔

Tell a lactation consultant how desperate you are for immediate help or contact your local breastfeeding support charities, their volunteers are excellent and can usually help almost immediately.

It's ok to give her formula as top ups and that takes the pressure off you to pump.
Feeding at least every 3 hours means that's the maximum amount of time between beginning one feed and beginning the next. Feed as much as baby wants but don't let it go longer than that.

You were given bad advice in the hospital but it will all sort itself out.
The fore milk/hind milk idea is no longer viewed as "gospel" . Let baby feed as much as she wants and switch boobs if you want/need to.

Ask your husband or mum to find a number for a La Leche League/ breastfeeding peer/Lactation consultant you can contact TODAY. Maybe a post on a local Facebook group or a local what's app group?

Baby will be ok. My little boy was underweight until 5 weeks. then I supplement him with formula until about 6 month (gradually tapering off) and he breastfed til age 3½. So giving formula is not the end of your breastfeeding journey

Last message, sorry!

I just had an idea - why not post here on Mumsnet in AIBU for the most traffic saying "help to find emergency breastfeeding consultant today in X place"
Someone will put you on to someone

You are doing all you can, baby will be ok. And everything can be fixed one way or another.

Even if she only had formula between now and Thursday you could still get back to breastfeeding.

I would definitely contact the LC to see if they can fit you in sooner x

Hi OP I haven't got much time to reply but wanted to quickly say if she is suddenly more lethargic that is not normal and probably warrants a GP visit rather than midwives. Might be nothing to do with weight or bottles. My baby was lethargic suddenly around this age and turned out she had an infection. I don't want to worry you, she's probably absolutely fine, but just something to be aware of.

Your experience is so like what happened to me with my first. It was so awful. I have never felt so anxious or like such a failure. I put so much pressure on myself to EBF. A&E strongly advised topping up with formula and I did so with a heavy heart. Every formula top up made me panic I would completely dry up. I actually think I sought help from too many different places as each had their own idea of the position that would work, or the hazards of using a bottle. My head was spinning with supplementary feeding systems, hospital grade pumps and the like. My daughter also had a tongue tie and it really did make a difference to have it cut. Things also improved as her mouth got bigger and she could naturally take more of the nipple. I wish someone had said to me that it really is possible to get back off the formula. Once your child's TT is sorted the high likelihood is that her latch will improve and then you can gently and slowly reduce the formula if you want to. Use the formula as and when you need to. It is a medicine that was developed for just this purpose. You will be able to reduce it again, i promise. I fed my daughter until 18 months, perfectly successfully and you absolutely will be able to do the same.