BF 16 day old still not gaining weight. Advice / solutions to enable me to continue BF please?

[MrsKitty]

This'll be a long one...Bear with me...Any advise greatly appreciated.

DD 16 days old. Weighed 4025g (8lb 13.5oz) at birth, down to 3700g on day 5 and 3600g (7lb 15oz) on day 9. Weighed again on day 14 and was 3660g (8.1) but HV said this wasn't enough - she came back today (day 16) and there's been no change. Don't know what else I can do!

Milk came in on day 4 and had issues with engorgement/swollen nipple (here) which had again returned over the last couple of days (I think it's my pump causing it so I've ordered a new one and am valiantly trying to hand express now)

HV & GP told me on Fri to express & top up with EBM(40-60ml) after every feed which I tried to do over wkend but she was feeding mostly every 2 hrs which left no time for expressing and the top ups I offered (every other rather than every feed) were refused most of the time (although of course when HV was here today she guzzled it down)
HV also suggested I take Fenugreek to increase supply which I've been taking since Friday. She's been feeding 2-3 hrly in the day since wednesday but going 5-6 hrs ovrnight - was refusing to wake any sooner - friday night I set my alarm for 4 hrs but it took nearly an hour & half to get her to even entertain feeding. Last night though she woke herself more regularly.

I wondered If I had the beginnings of Mastitis on friday night as one breast had a creeping redness / heat to it but regular feeding on that side seems to have gotten rid of that -it is the same side with the swollen nipple though?

Have seen x2 BF specialists in the last fortnight at BF groups both of whom have said my latch looks fine. Will go again tomorrow for more advice.

DD has had an awful cold since wk 1 (Thanks MIL) which hasn't helped matters.

I have to go back to GP on wednesday & I sense If she's not gained by then we'll be encouraged to FF. I'd much rather get to the bottom of the problem & fix it rather than give up - I fed DS exclusively for 6mths and then on until he was 13mth so I'd really like to be able to do the same.

DH supportive (although worried) but not much support from other friends & family (conversation with best friend -
BF "How's DD?"
ME "Not bad, having some feeding probs she's not gained weight yet"
BF "You going to put her on the bottle now then?")

Don't know what else I can do - are there any other causes I should be wondering about?

Apologies for huge War&Peace length post, but figured more info = more to base suggestions on...please help!

Hi MrsKitty - so sorry to hear you are having this problem - one of my DTs lost some weight when we first came home from hospital and it really sent me into a tailspin - there's not much more emotionally challenging (especially when sleep deprived) than thinking you're not giving your dc enough to eat.

My DTs are breastfed too - one thing that helped with the smaller one was to split the feed into 2 parts. He would feed and fall asleep, and I would assume he'd had enough and put him to sleep in his cot. the bf consultant suggested changing his nappy / winding him when he fell asleep to wake him up, and then feeding him again (same breast) to make sure he gets the hindmilk. That is the fattier part, apparently, and helps them to feel full / put on weight.

Don't know if your dc is a sleepy feeder, but this really made a difference to us.

Hope that is of some use...

OK....I agree, this is a situation, from what you say, that deserves a bit of concern. I am assuming you dd has been weighed accurately ie naked on good quality digital scales, preferably the same ones.

I don't think your care has been brilliant, to be honest - day 9's weight should have rung bells. Babies normally stop losing weight from about day 4-5. They may not start piling it on, but they should stop losing.

What about poos and wees?

2-3 hourly in the day and 5-6 hourly at night - I'm thinking that adds up to 7-8 times in 24 hours? Prob not often enough, so is there any way at all you can bump this up? You need to be feeding at least both breasts every time - just doing this, and feeding 3 x sides or 4 if you are not already doing it will help massively.

It's not supply I would be concerned with, to be honest, but the baby's intake. You can be making gallons - it really doesn't matter if the baby is not getting it, and on this cursory read, this is something that can be addressed.

Lots of skin to skin, lots of responding quickly when she squeaks, and feeding the baby is more important than expressing, unless it's clear she is not removing the milk effectively and this does not seem to be an issue.

What do you think?

TikTok I was hoping you'd be here - you always seem to give such good advice.

I've been doing as much skin to skin as poss since Friday (was before too but have made more of a conscious effort since then)

I also felt that actually feeding was more important than expressing which is why I didn't stress too much about expressing over wkend as I felt feeding her "whenever she squeaked" as you put it would be more effective, however now that she's remained static I don't know if that was the right thing to have done.

I think she's removing milk effectively -she has regular bouts of the pause & swallow motion and at times I can literally hear milk pouring down her throat. - This is the same for both breasts-both the OK one and the sore one. (too painful to express from left side but get relief when she feeds so must be removing?)

Poo's & wee's - Id say at least 5 wee nappies per day and 2-4 poos (have been bright yellow since day 4, although wet poo rather than creamy consistency- MW said this was fine?)

Quantity of feeds - I'm trying to ensure 8-10 in 24 hrs now, have been since saturday. She always falls asleep on one side so I wake her and switch sides (sometimes straight away,sometimes 10-20 mins later) and do try to switch feed several times if she agrees!

Re:scales consistency - up to day 5 was on Mw scales, day 9 onwards was HV scales-She was concerned on day 9 and sent me to GP but GP just said top up and I'll see you again nextt week (weds) HV is going to come too on weds to weigh again on same scales.

HV suggested alternating feeds with one BF an one EBM bottle "so we cann see what she's taking" but I'm a little unsure of this - for one thing I have limited success with expressing and for another she's only 2 weeks old - don;t want to add nipple confusion to my list of woes unnecessarily!

Also, meant to add - I was gestational diabetic - would this have any bearing on things?

ziggysmum well done on feeding twins! think we met on a thread earlier in the week - glad the sandwich technique worked out for you!

MrsK - gestatioal diabetes may make a baby's birthweight higher than it would be otherwise. I'm not aware it would impact on bf.

You have had such a lot of advice....the HV's idea to alternate bf with ebm makes no sense to me, sorry. You don't need to know feed by feed what she's taking, anyway. And what if you do know - so she takes Xml ebm, what then? She may take more, or less, at the direct bfs.

Talk about it with your HV - ask her what she thinks about feeding more often and feeding her on more 'sides' each time to increase her intake.

Your baby sounds fine and healthy but yes, I do think it's a good idea to make sure she gets lots of opportunities to feed.

I had a similar problem with my DS. It took him a long time to regain his birth weight. I wish i had sort more help than I did.

Brief list of things that should help...

Make sure you are getting enough rest and eating well - it's the best thing for milk production. (nuts and dried fruit snacks really helped me.)

Try to completely drain the 1st side before you swap sides. The fatty hind milk is the best bit for weight gain the fore milk is a thirst quencher.

Don't make her to warm and cozy while feeding - she'll nod off too easily. With my DS I played with his feet, talked to him and changed him if he was really sleepy.

NCT have a dedicated phoneline to help Mums with breastfeeding probs... NCT breastfeeding helpline on 0300 330 0771, open 8am to 10pm, every day.

Hope some/any of this helps.

Should also have said he's now a strong healthy 5yr old.

Your DD will be also - this bit is hard - don't be hard on yourself.

Nicalala - totally agree about the need for more help for mothers.

Rest and eating well will make no more than a very marginal diff, if that, to milk production. Trying to drain the first side is not v. helpful - switching sides when the baby indicates he needs to is better for intake and production. It is impossile to completely drain a breast anyway

Well this whole "top up" malarky as suggested by HV & GP has been completely unhelpful... As I mentioned earlier DD took the lot when HV was here (about 40ml) but now I'v been trying to wake her for a feed since 230 (2 hrs after last one) but she just takes a few comfort sucks then goes off back to sleep!

Thanks for all advice - Food & rest is all the MW/GP/HV have been asking about too - I appreciate that they might help me cope better but I know they're not going to improve DDs efficiency or my milk -one of which would appear to be the problem...

HV actually said today "but you can't go on feeding her every 2 hrs it's not sustainable - your breasts won't ever get a chance to fill up" I thought well if I don't, how am I ever going too reach the 8-12 feeds in 24 hrs you told me was recommended?! She's been very attentive but am getting so many mixed messages from various angles!

I've been trying to stay calm / focussed on this and keep it together but the more it goes on the more i wonder what the hell else I can do...TBH I just want to cry at the moment.

DD has now woken and is feeding BTW but a damn sight later than I would have hoped.

MrsK - your HV has given herself away, with that comment about breasts needing to fill up.

She may be helped by reading this:

www.kellymom.com/bf/supply/milkproduction.html

It sounds as if you are better informed than the people whose job it is to support you

tiktok I know - I think that's why i'm so bloody upset - none of the 'pofessionals' have been able to tell me anything I don't already know or have told me stuff that I know's not relevant! I was a regular on Kellymom when BFing DS and made it my business to find out everything I could about it - fat lot of good being so bloody informed is doing me now though - hate not being able to fix it/find an answer!

Sorry, I can't add much but I wonder if the diabetes is of relevance. If it wasn't perfectly controlled then your DD may have been bigger than she was meant to be at birth, and is now experiencing 'catch-down' growth.
This is something that would only be obvious with hindsight, though, as she will find her centile and grow along it.

My sympathies to you- my DS took ages to regain his birthweight- no HCPs seemed to care much (!) but I do look back and wonder if I was doing the right thing by refusing to even consider formula. He seems alright now though .

MrsK - I think you will be ok. It's certainly the case that babies of mothers with GD may be a tad heavier than they'd otherwise be and you might then expect (as Faintly says) some catch-down. I think it's worth monitoring your baby's weight, and taking action to ensure he has plenty of chances to feed, but honestly....it is not worth tying yourself in knots about it, as he has not continued to lose, he has in fact gained (a little), and all his other signs are good.

I can't see any justification for the slightly panicked suggestions to use ebm, esp when expressing is not easy or productive for you.

Just continue doing what you are doing - as long as his weight is going upwards, there seem no grounds to worry unduly. Especially not by someone who think breasts have to have certain gaps in order to 'fill up'....

faintly yes, I wondered that too re: diabetes, but have had a quick look & not been able to find any research to support it.

I just found this thread when I came on to post almost the exact same post. My daughter is 14 days old and is not gaining the weight she lost. I have the same problems with her falling asleep quite quickly and have some success with stimulating her, usually after 10 to 15 minutes...I sometimes have to take her outside in the cold to get her to wake up again! I am feeding almost constantly from about 11am until 11pm, but she does sleep for 4 hours and 3 hours during the night and for a couple of hours in the morning.

I too was told to express but I can hardly get a drop out of me after she has fed, so not sure what to do about that.

My main confusion is that I don't know when I should be switching breasts. She generally feeds for 30 mins (with stimulation) then I jiggler her around and wake her again and feed for for as long as she wants (usually 20-30 mins) on the same breast so she can get the fatty stuff, as advised by HV, but midwife said I should switch breasts after 30 mins. Just don't know what to do so carry on with same breast most of the time unless she is still chewing her own arm after 1hr in which case I switch. I am finding all the conflicting advice hugely confusing.

Anyway, you are not alone and it seems neither am i :-)

willowstar - can you give precise info about weights?

How many times do you feed her?

Deliberate, one sided feeding is not a good thing for a new baby, generally speaking....your HV is quite wrong about this. We do not need to worry about timings and foremilk and hindmilk, still less engineer the bf.

Breastfeeding, generally speaking, is best stimulated by offering both sides often - this means not looking at the clock, but looking at the baby. So when your baby tells you by his behaviour that he has had what he wants off side one, switch him to side 2.

I am an NCT bfc, and getting very tired of HCPs who tell mothers to only feed from one side to 'get the hindmilk' - it is a misunderstanding of the research and if I could find out who is telling whole armies of them to tell mothers to only feed on one side 'to get the hindmilk' I would happily strangle them!

Some mothers can do this, and their supply is still brilliant, their babies thrive and no problem. A few mothers find their supply does not build up and their intake dwindles.

Routinely, offer both sides per feed. It does not matter if the baby routinely takes both - but he needs the chance to do so.

Hope this helps!

Hey willowstar sorry you're having problems too...it's not easy to be rational and objective in these early days is it? And the mass of conflicting info you receive from every person you see (different MWs, Hvs, GP etc) is very frustrating.

Saw BFC today who told me I was right - avoid top ups - and certainly not after every feed as the HV suggested, but perhaps one in the evening of the milk collected through the day. Re: expressing after feeds she said only getting 10ml or so was fine, suggesting that baby had fed well.

She watched me feed on both sides (first time anyone's bothered) and was happy with latches (left side a little off due to swelling but still ok) and happy with transference of milk (swallowing/jaw motion etc) also happy with number/colour of daily poos/wees.

Got to go back to GP tomorrow for reweigh...

In my head I feel she's healthy, feeding regularly (more so now) and feeding effectively - she was born heavy but she has a tiny frame (she's not scrawny- just little) compared to my son who had a similar birthweight - I just don't think she's meant to be a 91st prcentile baby (what she was born on) . I hope GP agrees with me and gives us a bit more time to try to gain back some weight rather than immediately jumping on the FF 'solution'.

tiktok, how would I know if baby wants to switch sides? Like I say I can usually keep her going for 30 mins or so then she kind of doses off but as soon as I move her she wakes up screaming and i put her back on again for 20 mins or so only for her usually to cry again and i have to leave for for half an hour then start agagin.

Maybe I should switch when she seems to have had enough around 30 mins?

As for the weight...she was 3.4kg at birth, down to 3.1 at 5 days, up to 3.2 at 7 days, back down to 3.1 at 10 days and she will be getting weighed again tomorrow.

I am just so confused by the conflicting advice because this feels like a really big deal at the moment to me and I feel like the responsibility is huge. I will try to switch her after 30 minutes...not getting very far with keeping her on just the one for hours at a time so it is worth a go. thank you.

tiktok just noticed we x-posted yesterday - only just seen your reply. Thanks for vote of confidence - feel far more sure of myself today and happy that i'm doing the right thing... fingers crossed for a gain tomorrow.

willowstar - it's horrible to be confused and befuddled, when diff. people tell you diff. stuff

A baby who feeds for 30 mins and then dozes and then perks up and wants some more...yes, put her on the other side at that point. But watch her behaviour rather than the clock. When you feel sure by looking at her and the way she is sucking and swallowing that she is definitely doing more dosing than feeding on that side, switch her.

She needs to feed often, day and night, and this will increase the volume of milk you make and the volume of milk she takes in. If your HV is still talking about one side only, then discuss with her the info at www.kellymom.com which has a good explanation of how bf works.

The loss of 100g between day 7 and day 10 is not good, but it could be different scales, or operator error. You'd be looking for no further weight loss tomorrow at the least. Is she pooing lots (at least 2-3 soft yellow poos in a day?).

Hope all is well tomorrow, MrsK!

Hi tiktok...same midwife, same scales :-( Again, the whole how many poos a day thing is confusing me too. she has 2 a day ish, but a couple of days has had none. I mentioned this to the HV and she said not to worry, some babies go a week without pooing, yet other people suggest it is really important?

I know you say not to go by the clock...but she usually gets drowsy by 10-15 minutes into her feed. At this point i usually take her off, wind her, talk to her, take her outside, whatever, and keep her going for the next 15 minutes or so. I can't stop thinking about the hindmilk thing as it has beee drummed into me...surely i shouldn't switch her after only 15 minutes? I was led to believe that would mean she only got the 'sugary' milk, not the good fatty stuff???

Your HV is not sharing good info with you, willowstar The majority of new babies have 2-3 or more poos a day, and this is a good sign of intake. Many older babies don't poo for a week, but this should always be checked out with a younger baby.

In a young baby who is gaining weight well, lack of poo is unusual but not worrying. In a young baby, lack of poo is a sign to weigh the baby and if necessary to increase intake by making sure feeding is effective and frequent.

The clock is not a good guide of anything - any more than I can tell how much you have eaten by timing you! If your baby is drowsy 10-15 mins into the feed, then you can swap with confidence. You do not need to keep jiggling her through another 15 mins on that side. 10-15 mins is perfectly respectable and probably bang on the middle of average time for the first side!

To say 10-15 mins is not enough, because she 'only' gets the sugary milk, is a dead give-away - whoever says this does not understand enough about how bf works, sorry.

You can give any of the bf helplines a call and they can talk you through all this and give you more confidence.

What you have been doing so far - feeding on one side only and not swapping - has not worked for you. Your baby has lost weight. It is fine to try something else

She lost weight. Was 3.66 on monday, 3.62 at GPs this morning.

GP & HV insist now that I top up with formula - said I have to offer 4oz after every BF - surely this is way too much - it's practically a whole feed isn't it? I'm so upset and just can't think rationally about this. GP said she looked healthy and was too healthy to refer for failure to thrive (whatever that would entail?)but that formula was a must "at this point".

Don't know what to do. Have enough EBM to offer one top up of that vice formula but then that's it - not confident I can express enough to match the amount they want me to give in formula.

Do I not have enough milk? is that the problem? what can I do to increase it?

Is it because she was only feeding around 6 times in 24 hrs when she was first born? no one at the hospital said it was a problem & nor did the community midwife - it was only when my brain kicked back in after the shock of childbirth that I realised this had not been enough & I should have been waking her more regularly. I feel quite let down at the lack of support in the early days (I suspect because I was perceived to be confident having previously fed my DS) and I feel so shit now -like i've let my DD down in the most fundamental way.