Please help - hospital pushing ff onto new mother

[FrankCross]

Apologies for typos (on phone)

A bit of background; dsis gave birth at 11:55pm on Boxing Day, baby latched on in the first hour of life and fed well whilst in hospital. They were discharged at lunchtime the following day.

During the first night at home dsis kept baby to the breast for most of the evening but he started to become a little dry (sunken front fontanelle). The emergency midwives advised a formla top-up and to speak to mw doing visit next day.

Dsis then suffered a PPH and was taken back into hospital by ambulance the following day before the mw arrived (28th). Managed to get baby into hospital too where feeding went well in the day and then screamed blue murder all evening despite spending literally hours at the breast. Hospital mw topped up withformula. Baby awake and rooting for milk again within half hour of feed though mw advised he'd need waking after fourhours(!)

Baby had been happily sleeping for three hour sstretches, so we changed tactic yesterday and tried to put him yo the breast after an hour in the hope of keeping him hydrated and encouraging dsis milk to come in. Again, baby not satisfied and only placated by milk so was topped with formula.

Had got mw to agree to show dsis how to use electric breast pump so that she couldexpress whilst topping up but due to them being "very busy on the ward" they hadn't gotten round to it by the time I left last night.

During the night (with diff mw on) dsis has been told not to express and formula is going from a top up after time at the breast to the main feed.

Had asked for paed to check baby to rule out any medical cause (Tongue tie, any other reason for getting dry) but this has not been done yet.

Pro ff mw is now wanting to discharge dsis as feeding is "established"(!!) and I've been unable to get in touch with the hispital's lactation consultant.

Does anyone have tips/ideas/sources of help that they can recommend?

Dsis wants to bf and has done brilliantly to come this far despite being actively pushed in the other direction. Mw are calling baby's health into question if she continues to bf and are repeatIng the "hungry baby needs formula" line.

If dsis is unable to bf then fair play, but it seems to me that the only thing standing in her way is lack of resources which is appalling.

(baby has been having wet nappies, latch looks correct, baby can be seen swallowing whilst on)

any help most appreciated

babies feed like demons in the first 2 weeks - DD was permanenlty attached to me

it is usual - the more they are on the breast the better

has her milk come in??? DD didn't sleep at all until mine did on days 3/4/5

is there a medical reason why formula top ups are needed????

tsc, I don't think there's been any argument that formula probably was/may well have been the best thing to do for the baby at the point at which he was dehydrated. The question is whether FC's sister is getting any real help in attempting to reestablish breastfeeding and build up a supply. The "hungry baby needs formula" line she's currently being spun is bollocks and separate from the probably valid "dehydrated baby needs formula" line short term measure.

Ruby - milk not I. Yet, hospital advising top ups as shrunken fontanelle is sign of dehydration.

Thesecondcoming - I am happy to support dsis in any decision she makes and I am sure that she knows this. She is expressing a wish to bf and I want to support her in that.

This really has nothing to do with the ff vs bf debate, I'm just trying to get help fir my sister who is not getting the help to be able to feed her baby how she wants.

This sounds like poor postnatal care, sorry

If the baby looked dehydrated (on day 2? very unusual, and very difficult to diagnose, as fontanelles look sunken anyway, and there are far easier signs than this...though on day 2 dehydration would be very unusual, as I say), then hand expression of colostrum would protect things and not interfere with bf.

Babies need to be kept close to mum, and unsettledness does not necessarily mean 'I am hungry' but 'I need to be next to my mum'...this baby will have been separated when your sis was treated for her PPH (scary...) even if the baby was admitted too. There will be all sorts of disturbances and tension in the house, and the baby is best comforted by being at or close to the breast - all the time if poss.

Forget 3 hrly feeds, forget hourly feeds even - forget the clock! A newborn of this age - he's only 5-6 days - thrives best with lots and lots of 'visits' to the breast, at least both breasts, and it seems very early for the midwives to be giving up on bf

Obv, he needs to have his hydration levels maintained, but this is done most effectively at the breast. Expressing this early on might help, but it can interfere with what we want to happen which is more bf!

No one here or anywhere else should suggest your sis ignores the midwives. Instead, she needs to discuss her situation with whichever one she feels understands the situation best, and work out a plan. If the baby needs formula for the moment, then your sis can discuss how much and when, and how to keep it to an absolute minimum so bf is not compromised.

Hope things get better. Would be a good idea to weigh the baby and to check the other signs bf is going well....soft yellow poos, for example.

If she's had a pph what is her iron level now? If its low it can affect milk supply. Has she needed a blood transfusion?

The thing is, her baby is still only 4 days - it is day 4 now (my calculation of 5-6 days was wrong). Her milk may not even have come in yet, and the PPH and the hospital admission and all the upset, and the use of formula, can easily delay it.

It should be reasonably easy to protect the milk supply and get her and her baby off to a good start from now on...even if formula is used for a time until she returns to full bf.

But she does need midwifery support, I think.

Thank you tiktok.

Baby is now four days old and he's still in the hospital with dsis. Last night the mw took baby from dsis to ff despite her protests and wouldn't entertain the idea of putting him to the breast first. Dsis has not been informed how much formula he took, has not been allowed to ff him (mw insisted on doing it elsewhere) and now baby isn't keen to latch.
Dsis is also struggling with being exhausted and has low iron etc. Baby is "technically" not a patient and so has not been checked by anyone since birth. Similarly, the mw advised yesterday that they won't weigh him until day five in the community.

The mw were going to show dsis how to hand express at lunchtime yesterday and still have not done so. Will push for this today.

This sounds pretty poor stuff, FrankCross. Your sis may be feeling very unassertive and just unable to insist on the information (about amount of formula and so on) she wants.

I can imagine that an exhausted mother with a baby who is fussing and crying might seem like she needs to be 'rescued' by the hospital midwife who took the baby, meaning well. The fact she was not 'allowed' to ff him makes me think the midwife was probably trying hard to help her and to let her rest.

She really does need someone expert overseeing this care - there must be a midwife in charge of infant feeding, or else her named midwife can be involved and sat down and asked lots of questions and asked for support and a plan to restore bf.

Aggghh that makes me so cross on her behalf. The baby is her baby, they should not be bullying her into doing something against her wishes. I really can't see why m/w wouldn't put baby to the breast first and at the end of the day it should not be her decision.

Sometimes where I work if we have concerns about the weight gain of a baby (normally a transitional care premmie) then we may advise not to push b/f in the early days as they can burn more calories through trying to feed than the actual feed. But it doesn't sound like this is the case here at all.

As for taking baby away to formula feed, thats bad.

I'm a m/w and if I'm cup feeding a baby formula then I'll do it at the bedside so mum can see what I'm doing.

Thank you both, I'm so pleased that someone undrstands as I'm starting to feel like I'm banging my head against a brick wall with the staff here.

Iron count was 9 something(?) so she's on iron and was advised yesterday that she may need to undergo d&c if things don't improve.

I know that dsis is exhausted, she gets different advice from the different mw, and when I'm not here to help voice her concerns (ie overnight when visiting is over) she feels like she's being bulldozed.

I spoke to her very lovely community midwife this morning who was going to call the ward and speak to the head mw to make sure that we're getting the message through loud and clear, and hopefully get dsis some support.

Today's mw is apparently coming to check both dsis and baby soon so will ascertain exactly what has happened in the night with regards to feeding, and what they advise moving forwards.

Baby last had a bowel movement the night before last (was meconium) if that's significant?

Thanks also to DavidTenant who articulated what i was trying to say in my op

Good news that the comm. midwife is getting involved.
Yes, it may be significant that the baby has gone 36 hours without pooing - needs to be mentioned to the comm. midwife.