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!

MrsK: were these the same scales? Thought the HV was coming to house with same scales but you say she was weighed at GPs? A 40g difference is hard to grasp the significance of - it's too small for most scales to be accurate about, and a 2 day gap between weighings is normally too short.

Was she weighed naked? Had she just weed or poo'd?

Yes, 4 oz of formula at each feed is a lot. Yes, it would virtually swamp bf.

You have only been doing your new regime of skin to skin and extra feeding since the weekend (am I right?) and weighing this morning is too soon to see an effect, IMO.

Yes, four hrly feeds in those early days have meant a slow start.

You can't ignore what the doc is saying, but you can get a second or third opinion - and also ask them to reconsider their advice. You could ask them if a once-a-day top up of EBM would be ok; you could ask them to weigh her again in a week, which would give you more time to feed, feed, and feed and do all the things you have only been doing since Monday to increase her intake.

Your baby is healthy. I don't see the panic, to be honest - weight is only one way of assessing health. She may be slow to gain, and still ok. I do think you need to get some medical/HV backing for not topping up, though.

Hi tiktok...see this is why I am confused...I think my baby may have acid reflux, certainly showing many of the signs, (hates being on her back, doesn't sleep during the day, incredibly distressed unless asleep or feeding, feeding for hours at a time during day and evening) and the below is from a leaflet on acid reflux...it says to completely empty the breast no matter how long it takes. HV coming later today to weigh her, just hope to goodness she has gained something.

Your breastmilk changes in composition throughout a feeding. Early in the feeding your baby
receives your foremilk. Foremilk looks much like skim milk, it is thin and watery and may have a
bluish tinge to it. It is very thirst quenching, high in volume but low in calories and fat. Later in
the feeding your baby receives your hindmilk. It resembles whole cream, low in volume but high
in calories and fat.
In a two to two and a half hour period try feeding your baby from only one breast no matter how
many times he wants to feed. This will help ensure that he has totally emptied your breast and
gotten the right amount of hind milk. This will help provide him with the same number of
calories that he was getting with a smaller volume of food in his tummy and he may need to
feed less often.

willowstar - what can I say? The leaflet you are quoting simplifies the situation and misleads.

The breast will not 'totally empty' doing what they say. Yes, feeding on the same breast within a two to two and a half hour period will increase the amount of creamy milk a baby gets, probably.

But there is no such thing as 'the right amount of hindmilk' and no way of ascertaining how much hindmilk a baby gets.

If a baby has acid reflux - properly diagnosed by someone who knows what they are talking about and not by someone who has simply latched on to it because they don't know what else to suggest - then I can see the suggestion to deliberately feed on one side within a 2-2.5 hour period may help.

Fat content of the milk is related to the volume of milk in the breast. This can correlate with the frequency of feeding, but its not the length of time on the breast that's important, really...see kellymom for good explanations.

thanks tiktok, have to say I am clutching at straws just trying to work out why she is so distraught so much of the time and why she feeds and feeds and feeds and feeds...the only times she isn't like this is during the night and in the mornings, but from now ish (midday) onwards she is enormously unsettled and upset and seems to want to feed continually until about 11:30 at night, I am finding it exhausting and my nipples are getting sore! going to speak to my local NCT BF councillor today so hopefully that will help :-)

tiktok they were the same scales - HV invited herself along to appointment with GP. She was weighed naked and she had just done a big poo & wee - which they saw as I had to clean her up before putting her on the scales!

I've been doing once a day top up of ebm most days since weekend and we're still at this point so doubt they'd go for that. I asked for a couple more days doing what I've been doing but was told "we need to deal with this now" got the impression they thought I was starving her.

Asked if supplementing now would mean supplementing longer term but didn't really get a straight answer - am scared that there'll be no support to help me get back to exclusive BF once I take this route (as I'm feeling quite pressured to do so).

How do I up/maintain my supply now? I know feeding her is best for doing this but surely if I'm tanking her up with formula she'll want to feed less?

MrsK - I think you'll be helped by speaking to someone you trust in real life. Your HV and GP have 'form' in giving you advice you feel you have little confidence in, so this is important. Is there a bf-friendly paed you can see as an outpatient? You can ask round locally for this. You did not get a straight answer to your Q about supplementing longer term, I suspect, because they did not know how to answer you.

Sometimes, babies who are under-fed conserve calories by not feeding well or strongly at the breast. This cycle is broken by judicious use of formula which gives the baby more energy to feed better at the breast - there is no way this board, or me, can assess whether your baby falls into this category or not. The formula is temporary and is not usually anything like 4 oz per feed - yes, this will tank her up and she will feed less. But 'some formula' is not the same as 4 oz per feed.

There are options - SNS (google it - look at the Medela website), EBM, donor milk...hope you find someone in real life who can talk them through.

Thanks TikTok. I know I need more "RL" advice & will try to get...

I'd always thought my Doc was BF friendly...I guess only if you don't have any problems! and the HV runs 1 and attends another of the BF support groups in the area FGS!

The BFC who I saw yesterday also runs another drop in clinic about 20 miles away tomorrow so I'll get to that once DS is in nursery and see what she thinks. Can a BFC (she works for NHS) overrule the guidance of GP? Domn't really understand how these things work - have always just done what i'm told by 'professionals'

MrsK: sometimes, even bf-friendly HCPs don't have enough knowledge to recognise and resolve problems.

Your HV sounds under-qualified to actually run a bf support group, from what you have said she has told you

Bfcs can be under-trained, too....I would trust any bfc who was fully trained by one of the vol orgs, but some people calling themselves bfcs are not. If she has a clinical qual. as well as being a bfc, then she could be fine for you. It is not a question of one person 'over-ruling' another - this is your judgement about whose advice you trust. Sorry! Good idea to see the bfc again, I agree.

Just to clarify: a bfc trained by one of the vol orgs is still not able to make a clinical assessment of a baby's health....she can recognise normal and abnormal, and have an excellent idea of how to fix bf that's less than great, but she cannot say 'you must give formula' as this is a clinical intervention.

Just to say I have sympathy with your situation.DD is 10 weeks now but we went through a similar scenario.Only dropped down to a minimum of 3.2 from 3.45kgs .

I had both visiting MW and HV staring at my chest; speaking to me like a cretin eg 'are you eating etc'; remember sitting in a corner of the room in tears trying to express 5ml afetr a feed.

Ditto the constant feeding which obliterates opportunity to express. I chucked expressing and just put her on all the time; stopped clock watching/ trying to keep teack of when she last fed.

Ditto feeling like a failure&denying my firstborn child.

Ditto fed up with conflicting advice and loosing all confidence.In the end I phoned BFC nearly in tears and said magic words:I' m thinking of quitting BF. An appointment appeared, latching confirmed as fine...vague sense of calm.

Ditto families response eg both parents still pushing for ff.

I lost all perspective and became obsessed with the weigh in. Even though a big stool woulld account for 20gms or whatever.

Would I do it differently? As discussed previously bf isn' t for everyone. I do think the health profession is so focussed on bf that there is no support when a mom could do with taking a break (don' t shoot me!) but if you are completely miserable you can' t produce milk.Or enough support to keep you going.

BTW: As for conflicting advice. They wanted me to feed every 3 hours; express after each feed; EBF immediately. ALSO advised to relax(!), get fresh air and have long baths. You do the math...IMPOSSIBLE!

At 10 weeks I' m still hanging in there.But new issues (don' t want to cross post), and hardly feel like the height of womanhood.

Hang in there.It will get better. Get 'proper' advice and foolow a single management plan that you are comfortable with, you trust and you feel is achievable.

Good luck.

Sorry so long winded.

Thanks hermomminess your post has made me cry (again for about the millionth time today) but has also given me a bit of hope and another burst of "actually, I can do this" energy.

I've been told to feed 2 hrly, then express and feed the formula...where do thse people think th hours in the day come from! Is a good job my toddler goes to nursery (for more hours a day than i'd like at the moment, but hopefully this'll get sorted soon)

I veer wildly between "I'm determined to fix this" to "maybe we should just switch to formula and save all this time & heartache"

Oh I'm getting all the "are you eating?" crap om everyone too ...I am, but usually at the expense of something else (5 mins rest/an expressing session etc)

Hi MrsKitty, no advice from here, just wanted to send you some positive thoughts. It sounds like you are doing a great job. Isn't it annoying that there is no specific 'super kellymom-reading BF counsellor in each county. It annoys me that we get such a range of differing advice from all the different midwives/health visitors. I would have happily gone private and thrown any money at the problems I had with my dd (2 years ago!) but had no-one I could turn to, just an endless round of BF cafes and baby clinics. terrible times.
I'll be thinking of you
xx

It's been ages, but I really just wanted to update this thread to let those who offered advice know how things went, and also so that anyone who may come across this thread via a search with similar problems can see what happened. (Been meaning to update for ages, but, time flies and all that!)

Good News...Still BF at 3mths and don't anticipate stopping anytime soon .

Went to see infant feeding specialist (who's also ex-NCT bf counsellor) who agreed that advice from GP re: amount of formula top ups was ridiculous. Gave DD a few days with one small top up of formula, coupled with expressing after several feeds a day for a few minutes over 3 or so weeks, and also slightly adjusted my positioning for feeding.

It seems my supply dropped a bit due to the infrequent early feedings, which the expressing rectified (is there in abundance now) and also the BFC?s theory was that my original position was allowing baby to access milk, but perhaps not effectively enough to stimulate enough hind milk.

DD has consistently gained 5-7oz a week ever since and is quite happily following the 25 centile in her red book.

Very happy and thanks again for all the support & advice I received.

sorry havent read all this but i feel for you. the feeding from one breast is what i do anyway but i am like a bloomin cow.... i hear someone elses baby crying and i squirt..... which can have its down sides too!a friend expresses after a feed and either freezes it or chucks it just to make her body think she needs to produce more??!! I agree the clock is no good..... just stresses you out. My ds was 10lb 11oz at birth and feeds for 10 mins, has a nappy change (good tip for waking them up) then goes back to same breast for another 10 mins ..... i say 10 mins but it could be more or less cos i really dont watch the clock!he was weighed at day 14 and was 11lb 13 ozs so i think it is working!