Need advice! 6 day old baby losing weight - mw advice is to top up with formula, help am worried about my lo losing weight. Long post sorry!

[rosieposey]

I had my son last Friday and although i havent breastfed before or i have but its always gone a bit wrong ( he is my 4th ) i really wanted to try this time. I have a nice large age gap between him and my others (12 years) so am able to concentrate completely on him and hopefully get this breastfeeding thing nailed this time.

The midwife weighed him on day 4 in the evening and said that he had lost just over the 10 percent of weight that he was allowed and she said she' usually send him back to the hospital for tests but that she would come back and weigh him the next day but in in order for him to put weight on i would need to top up with formula.

I am an insulin dependent diabetic in pregnancy and it was touch and go whether he was going to end up in scbu anyway ( they were testing his bm's every three hours just before feeds ) and i was advised to formula feed him to get up his blood sugars initally as colostrum would have sent him crashing and straight to scbu ( doctors and mw's advice ) as it was the formula only just put him above the 2.6 that he was allowed to be but it was always my intention that when we got home i would feed him BM as soon as it came in.

He seems to latch on fine but falls asleep almost straight away with the effort of sucking so i started to express every feed for him so i could see what he was getting ( i was expressing up to 80 ml and he takes between 60 and 70 per feed ) so i thought he would put on weight fine and was shocked by the midwife telling me that he had lost just over the 10 percent. She told me to do formula top ups but tbh i just panicked and put him straight on formula in order to get him to gain weight and avoid going back to the hospital. I have been expressing every three hours still so that i can put him back on BM as soon as he gains enough weight but mentioned this on my ante natal thread and someone said i should post on here for advice. Am new to BFing and was expressing to make sure that he got BM that i thought he needed. I do still put him to the breast a couple of times a day for the two mins that he lasts before falling asleep because i dont want him to forget but as he was weighed yesterday and had put on the appropriate amount for one day it seems that the formula only route is working in terms of him putting on weight.

Sorry if this isinfo overload but thought id give the background to his feeding right from birth as is probably relevant. I would like to breastfeed exclusively but cant get him to stay awake for more than 3 mins so am having to express and i would like to know when i should stop ff and go back to bm even if it is expressed?

Oh should also mention that he has been quite jaundiced since day 2/3 and wonder if that has anything to do with losing weight on BM?

Rosie, I hope you´re reading what Tiktok is saying, that there doesn´t seem ANY REASON for concern! Why why why do so many health professionals force women into giving formula when they do NOT want to formula feed? I just don´t get it. The midwife seems to be insiunuating that formula is better for the baby when it is definitely NOT!

You are doing brilliantly with the expressing, your baby has plenty of milk, work towards bf only!

Why this obsession with weighing? IME babies suddenly put on a lot of weight then less so. Weighing every few days just seems to stress the mother and is completely unhelpful. Better be aware of signs of an ILL babý than pay attention to the scales. Maybe Tiktok could advise on warning signs of a poorly baby..?

I'm always wary about doing anything but raise questions about advice given by HCPs, even it seems puzzling advice, sachertorte, and I am not saying there is no reason for concern, just as (like you say) there doesn't seem to be any...but rosie's baby has faced health and feeding issues in the early days, and the midwife is there, and is the expert on the spot, so there may be other stuff going on. There's a limit to how far a talk board can go....so there may be a reason for the concern, but if there is, it's not obvious, and more to the point, it's not clear to rosie

At the very least, the midwife should be explaining why snacking is to be avoided, and why the baby has to feed every four hours - very few newborns, breast or formula or ebm fed, feed as infrequently as this.

I have no idea - from what i can gather it seems to be that maybe she thinks that he isnt gaining because of Milo getting fewer calories from bm - like i said i have no idea just transmitting the advice given. I am pretty sure that i could make up the bm that he needs i just dont understand when i made it clear to her that i am expressing a high volume of bm that she wants me on a 50/50 ratio.

When i was waiting to have my c section i also had a chat with the midwife who was looking after me and she said 'im not supposed to say this but if you want your babys blood sugars to stabilise quickly then i would start off on formula' which is what i did. It seems to me that its a given amongst health professionals that formula makes babies gain weight/ have stable blood sugars and i am worried that even if i give him the same amount in terms of volume of bm that the midwife is advocating in the 50/50 formula bm ratio that he will still not gain weight or will struggle to.

rosie - it's perfectly acceptable for you to call the midwife and ask her to explain all this stuff to you...you can say you are upset and a bit confused and puzzled.

Thats what i thought - i thought that feeding every two and a half to three hours was pretty normal for a newborn but the midwife said he is a big baby and should be taking anything up to 120mls AND going every 4 hours between feeds. She said she isnt worried about his general health and that he seems to be doing fine its just the weight gain thing that they all seem to be obsessing about. As far as i can see he is in fine fettle and is much more alert than he has been in recent days as i think the jaundice is improving

rosie, in that case, you deserve a second opinion. None of what she says makes sense, if she is happy about his health.

Its never the same one either - i have seen 5 different ones now since i have been home - i will give them a call i think and ask if i can just give him more like they want me to but ALL bm instead of topping up with the formula. Maybe she wasnt listening and thinks im not expressing enough but i know that i am thanks to tiktoks advice about expressing 8 times a day - i have loads now it seems and i want to give it to my lo.

You can call between 9 and 9.45 in the morning to speak to community midwives at my local hospital so will do so tomorrow morning.

rosie, good plan.

Thanks once again for the advice

Mistlethrush i should be waaaay more chilled being as he is my 4th but its like starting all over again with the 12 year age gap. I know all babies are different and gain weight differently. I seem to remember my DD1 always being at the lowest centile and the health vistor was always worring but she is a strapping 16 year old now.

You should call your local SCBU for some pro per neonatal advice,(comm Midwives are not always op to date with these things i'm afraid) although please ut your mind at ease. The current guidelines allow for BF babies to loose 13% of their original BW. 10% is for Formula fed babies...so please don't panic. Sounds like you are doing just fine. Good luck x

????? upagumtree - where are these guidelines that differentiate like this? Are you sure about this? I would be very concrened about any baby who lost 13 per cent off birthweight - current research would put 10 per cent at the very outside of normal. Of course it does not mean babies should have formula - but it does mean the bf needs checking so it can be fixed.

Rosie - how big is he? Ds certainly never went 4hrs between a feed. Quite often it was only 2.5 - normally 3 though, but then only once we'd got a routine going - and you're still early days for that.

It does sound strange making him wait longer but giving him larger feeds - I would have thought more often with slightly smaller feeds would be more likely to get more into him overall...

Hope you get some good advice - it would be good to just have a single person that you are dealing with to start with!

It's not really about 'size' , though, is it, mistlethrush? It's normal newborn behaviour to feed more frequently than every four hours because feeding (however it's done) is about contact, comfort, reassurance, love, cuddling...it's not about the milk

I get very twitchy when I hear about HCPs who say what newborns 'should' be doing with regard to amounts and timings....this is where the midwifery advice received by rosie is so questionable.

Really tiktok? Well he is now only at 10 percent under his birthweight but last week was 11. I have just expressed 120 ml exactly ready for his next feed. Tbh there isnt much hope of getting that into him, i think the most he has ever taken in one feed is 90 - 100 ml i just dont think he likes great big feeds and waiting ages for the next one.

Mistlethrush he was 8lb 12 ozs when he was born and now weighs 8lb 2 oz last week his weight dropped to 7lb 13 oz which was what pushed him just over the 10 percent 'allowed' to 11 percent and made me worry. Until i speak to someone tomorrow i am going to try and give him as much ebm as poss - its unlikely that he will take more than 60 - 70 ml in one feed and continue to feed him on that 3 hourly ish basis then i will call the community midwives office tomorrow but i wont get to speak to either of the 5 that have vistited me since last Sunday im sure. Just want to clarify what the midwifes advice is and why its given and also why its not ok to solely give ebm to him too.

No - I agree Tiktok - the point I was making that ds was large - and still was needing more often (and probably smaller) feeds - 4 hrs seems an awfully long time to go, particularly if you are trying to encourage weight gain.

Rosie - the only thing I might be able to help a little with was that we found the best way to keep ds awake for a little longer for feeds when he was a bit sleepy was by tickling his feet - otherwise he sometimes went off before having a good feed then woke up hungry half an hour or an hour later - during the day this was fine but not so appreciated at night time!

Tiktok...Have had a look in my files. Can't find reference but when i'm back at work i'll try and find it for you. Our unit operates on the basis of the 13% weight loss for Breastfeeders and 10% for formula fed babies due to the composition of Breastmilk being lighter and natural and not fortified with all sorts of crap. Like I say when I track down the reference i'll get it to you.

Will try the feet tickling thing mistlethrush - midwife also advised that when feeding to strip him down to his vest so as to make him more alert. He is quite alert at night at the moment though and seems to be awake through a couple of his feeds, he just doesnt seem that keen on taking large amounts like she is suggesting thats all,

upagumtree, would be interested in this, thanks.

I think anything proposing a 13 per cent 'rule' for bf babies is not evidence based, though, and I would be very concerned about a policy that seemed to be based on guesswork

Here's a couple of up to date refs for you (though there are many in a similar vein)

pediatrics.aappublications.org/cgi/content/full/112/3/607
www.ncbi.nlm.nih.gov/pubmed/14602693

While initial weight loss (up to day 3-4) is slightly greater for bf babies, I don't think you will find evidence anywhere for a 13 per cent guideline - but happy to be enlightened

also, upagumtree, breastmilk may be 'lighter' ie digested more quickly, but the calorie count is about the same....I don't understand about formula being 'fortified'. The reason why ff babies tend to lose rather less weight at first is prob because of maternity units suggesting unphysiologically large volumes of it!

Tiktok i think thats where midwives are getting their wires crossed perhaps in terms of advocating formula as being more 'weighty' and more likely to make babies gain weight. I didnt actually know that formula and bm are the same calorie wise either!

rosie - breastmilk does differ in calorie value depending on how full the breast is (fuller breast = less fatty milk = fewer calories) but it averages out to be more or less the same as formula....in fact this table shows breastmilk has rather more calories in it:

www.kellymom.com/nutrition/milk/change-milkfat.html

www.smahcp.co.uk/productcomposition/ shows that one brand has 67 kcals per 100 mls, compared to the kellymopm table showing an 'average' of 75 kcal per 100 mls for breastmilk.

rosie am no expert on breastfeeding but having exclusively breastfed two large and hungry babies I do think the advice of your MW sounds quite odd.
All the weighing, discussion about amounts and ratios and talk of going for 4 hours without a feed must be very stressful. The 4 hour thing sounds very out of date, this is how babies were supposed to be fed when I was born, 38 years ago!

How about just trying to relax a bit with your baby, lots of skin to skin, feeding him on demand (with breastmilk/EBM and not formula) and trying not to worry about pleasing the MWs.

Quite a few MWs are not that well trained about breastfeeding so their advice often varies and is not always accurate.

I always used MN or Kellymom for advice, though appreciate you need RL support too, but IMO your MW is not giving you this.

I was just wondering about that tiktok, bf babies just get little bits of colostrum in the early days, but bottle fed babies seem to get quantities of ff from the start? is colostrum supercalorific or is there a calorie difference there?

Not sure about calories in colostrum, madmouse, but it's a known feature of early formula feeding that babies get given large volumes of formula - far greater than the equivalent volume of colostrum...