Slow to gain wt baby: ?panicky midwife

[mrsbean78]

Hi

My baby son was 4025g (8 14oz) at birth on the 1st of December. At a week old, he was down 3620g (8lbs. He was weighed 36 hours later and had put on 50g (3670g). However, he was found to have dropped down to 3650 (although he was weighed immediately after weeing a huge amount in his nappy).

The other concern was that he wasn't stooling - he hadn't opened his bowels in 5 days by the last weighing. He was having 10 heavy wet nappies a day, though - one for every feed.

The midwife watched me feed and said he was well latched on with a good strong suck. So she was worried about supply. She advised feeding feed two hourly (which I was doing, plus on demand anyway) and to express each breast and feed this in between. I was a bit concerned about this as I didn't really feel there was a major milk supply prob (I've been leaking and engorged as expected) and also I felt we'd all wear ourselves down for no real reason..

So we were sent to the GP who examined him and said he was well hydrated, had good tone/reflexes ("handles beautifully" - like a car ) and bright and alert. The GP also watched him feed and pointed out that he didn't fuss at all at the breast and that she could hear a good strong swallow - she also showed us the muscles he was using to feed and said he was using these efficiently. She examined his oral structure/tummy/anus and said everything was normal. The GP said that breastfeeding was a 'physiologic process' and that there might be peaks and troughs in the early days re: weight gain and that, anyway, because he was a forceps baby it might have been slower as he might not have fed efficiently for the first few days which might have slowed things down. She advised against expressing as she said it was more important to be available to feed on demand given that there was no physical cause for concern and just wait and see what happened over the next few days.

The midwife came back later in the day and she said she felt that he did need 'intervention' and advised I should be syringe feeding after every feed.

I expressed about 2.4 fl oz and fed them over today and yesterday but didn't express at every feed or anything like it - baby just needed me and dh was out at the pub for the baby's head wetting last night.. so I just couldn't manage. Baby has had 3 bowel movements in the last 24 hours. I think it is still a little darker than true milk stools but is more or less mustardly/seedy.

The midwife is coming back today and I don't want them to make a huge fuss if he's lost weight (which I guess he might do if he's now stooling?). I don't think there's any need and I trust the GP, she's a senior partner in our practice and was very moderate and sensible about it all.. Also he is just SO awake and alert and with it, showing no signs at all of distress but not lethargic or anything suggesting weakness..

Also, I was on IV fluids throughout labour and I've read this can artificially increase birthweight?

Any advice on what to say if the midwife panics me again today? I am happy for the m/w to refer me to a lactation consultant but I don't want to be sent off for scans and whatnot and be down at the hospital with my tiny baby open to infection if it's a matter of a few grams and the GP saw no cause for concern?

mrsbean this is doing no good.

Please, go and have a cuppa tea or something, and cuddle your baby, and calm down.

Don't stay on here arguing the toss with a load of internet sprites, it doesn't matter, you are clearly distressed and calming down is more important.

You will get some of the best advice you could ask for on the MN breastfeeding board, and hopefully someday you will be able to see that and be grateful for it.

I wish you and your baby all the best and hope you have a long and successful BF relationship.

If you are so concerned about you baby then put him in your car and take him to paediatric A&E now. I am sure that they will be able to set your mind at rest. You will be seen by a registrar or the on call consultant if it is serious. You will get a follow up appointment for 24 or 48 hours.

"Tiktok has suggested that my child might have something that might mean he can't grow because he is just using calories on surviving.."

No, you asked what concerns might be and tiktok suggested some possibilities.

mrsbean I am gritting my teeth here but I totally understand how worked up you must be so, deep breath....

....You are right re ovbious and benign reasons being the most likely, BUT any HCP or BF advisor worth their salt SHOULD be mentioning the more serious/rare possibilities. It isn't a nice thought but far worse would be if we all just shrugged our shoulders and said oh he'll be fine, and then you didn't go and get him checked.

I am 100% sure that the ORDER in which tiktok listed the possibilities was totally irrevlant. But as a BF advisor I'd say she has a responsiblity to point out the possibilities.

(also note that she is an unpaid, voluntary BF advisor, who only tried to help you!)

Can I go back to Calm down, eat chocolate, feed baby, see proper GP or paed next week?!

I think you sound like you are very tired and stressed, and perhaps have low blood sugar. Some lunch and a rest would be a good idea, now that you have been reassured by your midwife.

I didn't even know she was a BF advisor..

What is a 'proper' GP? Why is my GP not proper?

Thank you MollieO, I might do that.. I have cried more in the last day than in my whole life

I appreciate that you all think I am unhinged and rude but I do think that the way in which that information was presented was appallingly harsh. I am involved in the diagnosis of children and young people with serious conditions and if and when someone asks me the possibilities, I certainly tell them.. but in a much more measured way than I feel they were presented here e.g. 'most of the time x,' but 'in very rare cases y' and then I would advise them, as many people have helpfully done here, to check it out in the real world. I wouldn't just say: 'well it could be A, B or C".

My response was probably not measured - I don't think I am actually very able for that right now.. so apologies for any lack of clarity. I was extremely, extremely angry and upset that the information was presented as it was. However, in the end of the day, I am the one here in absolute floods of tears and distress and my rudeness has, at worst, probably caused a few raised eyebrows.

I see that none of the NHS professionals are assisting you. That is really unfortunate. The only one I had problems with was the HV and that was because she had never come across a child like ds. Everyone else I have dealt with have been absolutely fabulous.

"I hate this NHS pussyfooting about.. I am going to demand today that I am told what the concerns are exactly because I find this veiled 'concern' far more worrying than true information.."

You see, to read that back, it sounds like you want black and white facts. And you asked a question directly to tiktok. She responded to that request.

This is the problem with the Internet, we can't read tone and body language, intention is lost. You can only work with facts and you asked a question, the question was answered. Answering that question itself is a kindliness from tiktok, she works hard to help on here.

It's terrible that you feel sad and demoralised by this discussion. Honestly, nearly all of us have had newborns, we know how it feels. It's terrifying.

But when you look back on this you'll see that it was just a misunderstanding, some wires were very slightly crossed and the rude and uncalled for attacks (that I know were a result of distress, I do understand), will be challenged by people who see a liked and respected poster maligned.

I truly believe people are only trying to help here.

Be kind to yourself. I hope your baby is well.

mrsb this is not RL. It's the internet where everything appears in black and white.

You will find a huge amount of support on here - but you need to be ready to receive it.

Please give the NCT line a call, join a support group or go to your local baby cafe is you have one. Being a new mum is tough. Really tough, but you don't have to go it alone. You sound terribly sorry for yourself - so help yourself.

Everyone wants you to succeed and wants to support you. It does get easier but take the help that's available.

notanun how are you doing? I was thinking about you after your thread the other day. Hope you're ok.

Welcome to life with babies mrsbean! At one point my HV accused me of deliberately starving my baby (he was hovering around the 5lb mark and not getting any bigger). She said that my bfeeding was rubbish. When I said that SCBU wouldn't have let me bring ds home if he wasn't feeding okay she said that they didn't care at all and just liked to pass on the 'problem' to the HV service . Completely ranting but I was so lucky that I could tell her what do with herself safe in the knowledge that I had access to experts.

Some MWs are no better. The senior one in my ward suggested that I could go home 40 mins away (rather than remaining in a very unbusy maternity ward 2 mins from NICU) 4 hours after I had been told ds was unlikely to survive!

He is now a strapping 5 yr old and you would never know what he want through particularly in those first few months.

nrsbean I'll cut you some slack because you are upset and worried.

I did not in any way suggest your baby had a metabolic disorder. You had expressed irritation and worry that people did not tell you what concerns there might be for a baby who did not gain weight.

I responded, explaining I was not in a position to assess your baby, by outlining what some of the concerns would be for a baby who lost weight in the newborn period. This was following up a post in which I suggested your midwife and GP might usefully talk to each other - I explained, clearly enough, that we were in a situation where there was a judgment, and that sensible, informed professionals might judge the needs of a baby differently..so why don't they discuss it, with you there?

I stand by my post.

These are the concerns that are tested for when a baby continues to lose weight. They were not written in any order, or with any idea of scaring you - but if you ask a question, then why complain when people give you the answer? I'm sorry for upsetting you, but there is no way for me to know that when you complained at being irritated at the word 'concerns' used by me and others, because you did not know what was meant, and wanted to know, how on earth could I know what you really meant was 'please don't take my post seriously, I just want to have a rant'.

I did not disparage your GP in any way. I mentioned the fact that one 'concern' for a baby losing weight might be oral anomaly but in your baby's case, this had been checked out by the GP.

Best stay off the internet, I think...don't you? I don't mean that in a nasty way - but it's a suggestion, sincerely meant, because if you become frightened by what you read in answer to your questions, you are better off sticking to real life, truly.

Thanks for the support from other posters, by the way.

JAMM, thank you and bless you. It's kind of you to remember.

How am I doing? I think there's a beautiful pathetic fallacy of my emotional state being truly reflected in the British weather.

I'm about 2 steps away from wailing and gnashing on a moor somewhere. Like a crap Bronte heroine.

It's the lack of sleep you see. I haven't been to bed since I found out. I've confused the dividing line between fantasy and reality.

I'm 'in the system'. We can't tell you how long it will be. Your call is important to us. Please try again later. Merry Christmas.

With respect, I think your anger should be directed at the health care professionals who are concerned, but aren't discussing it with you.

Then again, the possibilities clearly have upset you, so perhaps they made a good call in wanting to wait until absolutely necessary.

When DS was at Children's Hospital and very ill, I would try and be part of the decision making process, but with that, is getting some scary news. He was tested, for instance for leukaemia, so at least I knew what the list looked like, but discussed it all with the various Paediatricians.

(absolutely not suggesting yours has leukaemia)

Could you ask what sorts of tests would be done? How would they be done? Could they be done as an outpatient or only as an inpatient? Our local Children's Hospital has this great facility which is CIU (clinical investigative unit) which is a cross between a ward and outpatients. The specialists all come to the patient, and all the tests there (mostly all)

Poor you. It such a worrying time...

And if you call me 'egocentric' and 'cruel', mrsbean, I reserve the right to be offended and upset by this, too. You are being unfair.

I have shown nothing but kindness and understanding to you, shared information with you as I would with anyone in response to their questions, and given up time to read your posts, think about them, make suggestions and type them, treating you as an adult who wanted an explanation of 'concerns'....explaining that I was not in a position to 'assess'.

You have responded with outraged accusations, and I don't have to like it, or put up with it.

Thank you MollieO, that's so nice and reassuring of you..

I had a lot of problems in the hospital with latch and I am feeling utterly distraught about this lack of weight gain.. I actually didn't have the baby blues when the milk was supposed to come in (I guess maybe my milk didn't come in when it should have) so I wonder if I am having it a bit now..

Tiktok, I'm not going to respond to all of your points. However, I will redirect you to my concerns about how that information was phrased. Given that I "do" diagnosis of serious conditions in RL, I am telling you now that although I now accept totally you didn't mean to scare me, presenting such bald information about conditions incompatible with life as a response to 'what real concerns' there might be if my baby had lost weight today was probably a bit heavy-handed. There are ways, as I said, of phrasing that information e.g. if your baby continues to lose weight and they feel he is failing to thrive, they may want to look at his metabolism to ensure there are no problems and/or rule out any other underlying medical health conditions that might affect his growth.

This is the same information that you gave but honestly, stating that he might have something meaning that he is focusing his calorie intake on survival rather than growth just provoked an immediate, guttural reaction in me. I'm sorry if you feel my response was rude or unfair.. but seeing those words.. Again, because I do work with children with serious and lifelong conditions, I know that these things DO happen to people and their babies which makes me all the more anxious when it even crosses my mind as a possibility..

I don't always become frightened by what I read, but as a new and hormonal mum, I will be honest and say I didn't expect to see mention of conditions that might compromise my baby's survival on this thread - certainly not as the main causes of potential concern. I did just want a pat on the head in this case. The internet is not the right place, of course, but there you go.. I am on another internet forum which I post on regularly and I would have got my pat on the head there, and I should have stuck to it..

I understand from my m/w today that the next step if my baby had lost weight would, actually, be referral to a lactation consultant.

I think your advice about getting the m/w and doctor to talk was fine and very helpful - I have no issues with that at all.

But you didn't ask for a pat on the head, you said you were fed up with pussyfooting around and wanted, nay 'demanded' to know what the concerns were.

And tiktok was very clear in that she wasn't speaking about your child, she was talking in general terms about what weight loss meant in a baby of that age.

I was very forgiving of your anger and kneejerk reaction before but I'm astounded that you haven't the good grace to apologise to tiktok at the very least for the namecalling and accusations. That is very bad form.

"proper" was probably not the best choice of word, I just mean if you don't trust/like your MW then stick with your GP if you're happy with him/her, or find a good paed elsewhere. I found the best strategy for me was to ignore my HV! Too much conflicting advice was too stressful, and again with hindsight I agree with tiktok re getting off the internet!

What is your DS doing right now, do you have an opportunity to relax for a wee while? How do you feel he is doing yourself? I appreciate it becomes very hard to trust your own judgement when HCPs are continually challenging/worrying you.

Tbh mrsbean, you over-reacted (maybe understandably) but you still owe tiktok an apology - especially for starting another thread about this.

If you wanted just a pat on the head, why on earth did you ask for possible concerns to be laid out?

I would second the recommendation to contact the NCT b/feeding support. They were fantastic and actually came to my house to help and see if there was a problem. We also had a b/f clinic at our local cottage hospital - they ran a weekly post natal group that had a b/f counsellor in attendance.

If supply is an issue then you should try domperidone (Motilium) which boosts supply. It was recommended by the NICU nurses because ds was fed with a tube and expressing can affect milk supply. I didn't use it but I know others who did with good results.

Look, I have said I wasn't clear and I was panicky and hormonal and potentially with baby blues.. I have said I reacted in anger because of my panic at the words..

The ironic thing re: "why on earth did you ask for possible concerns to be laid out" was that I was talking about hearing the options from MY health professionals in the way ilovemydogandmrobama suggested.. that little post, which started all the trouble, was me venting frustration that MY health professionals were not having these conversations with me but were just muttering things about 'concern' and 'suspicious'... I wanted THEM to say, look, if he loses x today, then we will do y.. if y doesn't work, then we will look at z.. it wasn't actually directed at Tiktok at all, but I do accept that it was badly worded and unclear.

If you feel I owe Tiktok an apology, ok. I am sorry for being upset and panicky and irrational and using harsh words and being unclear. However, although I will temper the language I used earlier in a state of extreme distress and panic, I will say that I feel it was a bit insensitive to 'lay out' the possible concerns in the way that Tiktok did, beginning with interpreting my post as being directed at her and then laying out only the most extreme concerns in the most extreme way. It seems to me that this was because she felt I'd had a go at her.. and I hadn't, I really was being angry with my own health professionals but I did word it poorly and I apologise for any offence caused by that. After that, I just lost it.. and that was pure, blind panic at what I read. I apologise for that too.

No one thinks it might be a good idea to phrase the potential concerns more delicately? Really???

mrsbean - I'm sorry you are worried about your baby and that it has led you to be dismissive wrt to probably the best internet based bf advice you will find.

I do have to say though that as the parent of a baby who was using all her calories to survive in the early weeks that I wish someone had come along and told me that, in a straightforward way, as tiktok did for you. I don't believe it was harsh. You did state that you found veiled concern more worrying than true information.

Good luck, I hope the next weigh-in relieves you of your worries.

I think no one realised how on edge you were until you kicked off. Tiktok's answer appeared to be a perfectly reasonable one to a reasonable question.

Just read this through after seeing your post on AIBU?

Tiktok answered you in the way that i thought - and it looks like most others on here thought - you wanted. She's been very decent to apologise if she upset you, and other posters have been equally rational and measured in their responses. You are using up an awful lot of time and energy directing your anger at this board.

You keep talking about your extreme distress and panic - well, that's something most of us on here have experienced at some point and people have tried to support you. You keep churning over the same point ie how Tiktok listed the possible concerns and all you're doing is getting in a worse stew. Please, let it lie now.

I can understand your panic my 2nd dd was the same 6lb 15 at birth and 3 weeks later she was 6lb 13oz i fully bf her and my hv insisted i bring her every week to be weighed at one point she gave her 1 more week to gain then she wanted to refer her to check for other problems.

I was beside my self i wanted to buy scales so i could weigh her all the time i was out of control with worry i even thought about switching to formula but didnt i fed her to 1 year and she was fine was just slow to gain weight at 1 year old she was 15.5 pounds and very healthy now at nearly 4 she is on the 50 centile and doing great.

So i know it is worring but the more you panic and become stressed its harder for your body to make the milk your baby needs so take a deep breath and keep positive im sure your baby will be fine xx