Newborn feeding SOS

[Qally]

My baby was born a week ago, and had no interest in suckling at all. I was the only non-transfer in our MLBU so had several midwives dedicate a fair bit of time helping me try to latch him on, but in the end as he constantly fell off, wouldn't gape or root etc., they told me to express and feed him with syringes. One midwife thought he had a tongue-tie, but the paed told her that if that was an issue we should come in at about 6 weeks and they'd consider cutting then.

He was sleepy, made odd whining noises, started to get jaundice and just couldn't feed - fell off every time, except one that left my nipple white after, and was such agony I took the Ponstan for that and not the afterpains. I found a private lactation consultant, who instantly said he had a 100% tongue tie and couldn't possibly feed with that, even from a bottle. Cut was performed on Wednesday night, he now feeds, with only normal newborn/new mum struggles.

The problem is that the midwife came to see him yesterday and said he'd lost 600g from his birthweight (8lb 2), which is over the 10%, and that as he isn't thriving I need to supplement his feeds. My feeling is that he's only been breast-fed properly since Wed. night and it's Sun. am now - that it's just too soon to tell if he needs anything else. I'm obsessionally waking him every 3 hours now (he doesn't seem to want to be fed less than 5 hours apart) as the midwife agreed to give it two days grace. But if he hasn't started to gain by Monday, she is insisting I need to supplement.

I've ordered a Lactaline pump to arrive Mon just in case, so that if I do have to supplement it'll be breast milk, but I'm worried - we had a struggle getting him to work for a nipple because he was used to syringe feeding, albeit only when he was sucking hard on a finger (idea being to keep the link to sucking = food). Please can people advise me on whether combining bottle & breast is doable this small, and if his weight loss is serious, given how recently he's been able to feed? I just know that most of my friends started off bf and then had to switch to ff for various reasons, and I so want to bf.

Sorry this is such an essay - I'm just tearing my hair out - after the struggle with the tie and getting someone to cut it, I thought we were on our way. He feeds, and well once we get it right, and I've stacks of milk.

Oh congratulations on the birth of your little boy.

Sorry it's been a hard start for you.

How is he otherwise? What are his nappies like? Are they yellow/mustardy? Is he producing wet ones regularly? Does he seem alert when awake?

Sorry to hear it has been tough for you and babe. I would trust your instincts. If you feel your baby is healthy and not dehydrated or compromised in any way then stick to what feels right whatever the HV says. Charts are just averages, there are always babies who fall outside the centile curves. Good luck with the breastfeeding.

no advice - just bumping in the hope you get Hunker or someone passing by

For what it is worth, it sounds like they are being cautious after his feeding troubles, but you seem to be doing the right things like wakening him for feeds (even slightly jaundiced babies can be too sleepy) and putting him to the breast often.

Is he having plenty of wet and dirty nappies?

Personally I would keep going with what you are doing, like you say he has only been able to feed since Wed and two days is not a lot of time to put on a lot of weight. If you feel he is getting the hang of it and don't want to give him the bottle then don't, he will soon put on weight if he is feeding well. Listen to what your midwife tells you but remember you know your baby better than she ever will. I would also say if he is happy to sleep for 5 hours then he will be getting plenty milk to satisfy him for that length of time. Try not to worry, wait and see what tomorrow brings when he is weighed. Breast feeding is not easy to begin with but you are doing well, good luck x

I want to say foremost that I am not a breastfeeding expert while there are some women on here who are. I do however have experience of a baby who couldn't feed and lost weight. Ds was born with a bowel disorder and when he first was given food it was via syringe (expressed milk) He was almost 3 weeks old by the time we properly established feeding and had lost a significant amount of weight. I fed very frequently (every 2 hours) and while I did top him up using a syringe it was with breast milk. I expressed after each feed and as he was able to get the milk faster he would start on that then I would put a little on my nipple and he would latch on. Ds did regain the weight on breastmilk alone so it can be done. i wish you all the best and hope that one of the true advisors can better assist you in techniques as although mine worked for my ds they were self designed out of desperation to get ds feeding and gaining weight.

He has lots and lots of wet, but hasn't had a dirty since Wed. night. Midwife wasn't concerned about that, as he is clearly eating enough to soak nappy after nappy. His last nappy was spinach coloured, so mustard should be next I believe!

I'm just a bit frustrated because it was me that got his tie correctly diagnosed and treated, not the healthcare professionals (the lovely hospital midwife picked up on it, but the paed there said it wasn't an issue without even looking at it)and if I'd not done that he'd be in real trouble now. So I wish they'd decide - either poor feeding can wait 6 weeks before addressing, or it can't more than 2 days.

He's very alert, interested in everything and strong now (was the opposite before the cut). His neck/shoulders are unusually strong for such a little guy, apparently, and the jaundice cleared up within a day of bf. The midwife had no concerns until she saw the weights. I'm just torn between following medical advice and following my gut - which is make him feed, feed, feed from the breast, but don't supplement.

Just re-iterating the need to feed regularly if he was even slightly jaundiced and slow to feed. I know that sleeping for 5 hours may seem like he is content, but he may just actually be struggling for energy to waken and cry for a feed.

You are doing the right thing by feeding 2-3 hourly as this will help get the biliruben (sp) through his system and let him lay down some weight rather than using up all his energy reserves between feeds.

All the best.

MWs and HCPs tend to have very knee jerk reactions to babies not being where they 'should be' on the charts and any weight issues that don;t fit their prescribed guidelines. Their instinctive reaction is to say 'supplement' when in an awful lot of cases it really isn't necessary. Considering he's had a week of not really feeding it's hardly surprising he's lost a fair bit.

If I was in your situation, I would stick to my guns and refuse to supplement until you have given the bfing a decent chance to establish - and less than 4 days is no where near long enough. I was pressured to supplement my first 2 dcs due to very slow gain and it meant I didn't bf past 3 weeks and 8 weeks because of the detrimental effect on my supply.

Some women do successfully manage to mixed feed from this stage but it's a tiny minority. I would suspect that your supply will still be very fragile given the tough start you've had and supplementing will be pretty detrimental to it.

SoH makes good points about his nappies, if lots is coming out of the bottom end it's a fairly reliable sign that plenty is going in the top end.

If he has gained when the mw weighs him again (and make sure he is naked and she is using digital scales so it's as accurate as possible), even if it's a samll amount, bearing in mind she's only given you 2 days then you are more than entitled to refuse to supplement.

I would also ask her to give you at least a week before she weighs him again to allow yourself time to get the feeding really well established and get a true picture of how he is doing.

Best of luck and well done for getting this far after an incredibly tough start .

Sounds like you're doing the right things to me. The MW should expect him to have lost weight with the issues you've had. Keep feeding, watch the nappies and get some proper help for latch etc. to check that's all fine.
And write to the paediatrician, as nothing changes if they don't know what happens after they've seen a patient.

Best of luck.

xx

I had a similar problem with my dd not gaining weight, not the tongue tie problem though, he really has only been feedng for a couple of days, it will take longer than that fopr your milk to even come in. My midwife insisted I top up dd1, it caused so many problems I wont go into, you do not have to do what they tell you, they are only advising you, but if you are going to do it your way you probably need to show them that you are commitied, it takes quite a while for breast feeding to establish in the most normal circumstances and your little baby has not had that chance yet.
2 days is not very long between weigh in and if all is well in your eyes then I would ask the midwife to give you longer between weigh ins.
You sound like you are doing a great job, you need to remember he is your baby.
congratualtions.

Qally - what a difficult start and that you have had dodgy info and support.

This is not an issue with 'the charts' - UK standard charts don't actually begin officially until 2 weeks in - the normal physiological weight loss on them is notional. The midwife is right to be concerned at the weight loss, and to stress that your baby needs to show he is gaining weight after his tricky start, but she has no info to go on - without an interim weight between birth and yesterday we have no idea if he is gaining or still losing - and that's the issue. If he is still losing when weighed tomorrow, then it is (I would say) pretty sure he needs to be supplemented but of course with ebm not formula. If he shows he is starting to gain adequately, then we can be pretty sure he is turning the corner.

I agree it's not good that he will sleep 5 hours - this in a baby so young as this can be a sign he is lacking in energy to wake, so it's excellent you are taking the init. to feed more often- but 3 hrly may not be enough. Skin to skin, biological nuturing positions, breast compression - all are imp. now to increase his intake, so he is with you/close to you all the time. You need to aim to use both breasts at least every feeding session (sometimes he will only want one though).

Hope the midwife is weighing accurately and not with spring balance scales too.

A lot of what you say sounds very hopeful - and you sound so motivated and determined which helps

Qally just wanted to let you know just in case you do have to top up your baby, that I was in the same position and am now fully BFing my DD (5 months).

I made sure I offered my breast first and bottle at the end of the feed. Eventually her weight gain picked up (albeit slowly) but I was still so scared of her losing weight again I continued to give her bottles. She started to reject the bottle at about 2 months and now completely refuses it (very annoying!).

Don't give up hope.. you have done brilliantly well so far and its staying motivated that will see you through.

how are you and baby doing now, Qally?