breast feeding, slow weight gain PLEASE HELP

[Sella]

Breast feeding dd3, never did very well with other 2 - 3weeks with first and 4 months with 2nd. This time she was weighed at 5 days and lost 3oz weighed again at 9 days lost another 3oz weighed again today, day 17 and has gained 1oz!
I'd really hoped it would be more than that as she has lots of wet nappies and 2 days ago did her 1st fully yellow poo (a massive 1 too!)
Midwife is talking about expressing after feeding and possibly topping up, but I really don't want to go down that route. With dd2 she was slow to gain and I expressed after every feed, got little or nothing off and tied myself in knots, it did nothing for my milk supply and at 4months I admitted defeat and went on bottle.
Am I panicking too early, should I give it another week before I make a decision, midwife says my attatchment is good and she feeds all day then goes about 4 hours at night. Please help I really need some advice...

I had exactly the same experience with DS1 (third DC) and was given the same advice. I said I wasn't happy with formula top-ups as that would surely affect my supply which had never been brilliant with the first two. After speaking to a different midwife I was put on domperidone for two weeks which seemed to do the trick. I did try expressing as well but never got much and it was difficult to find the time with two other DCs. DS1 is now 4 months and chubby! Is there a different midwife or HV you could speak to? Hope you get some help. No doubt a bf expert will be along soon with some proper advice!

I've got lots of questions for you.

First, are there any health issues I should know about? How was her delivery?

Second, how often is she pooing now? Every day? More than once a day? A poo "counts" if it's as big as a 50p piece ... When did she stop making meconium?

Third, how does she seem? Is she happy, unhappy? Is she alert (for a tiny baby)? Sleepy? Miserable? How much does she sleep?

Fourth, how often are you feeding her? Are you offering both sides? How long does she feed for? How do the feeds generally end? (Does she come off? Happy? Unhappy? Does she fall asleep? Do you take her off?) Do feeds hurt? How are your nipples?

Fifth, is she feeding much at night? Where does she sleep? Does she sleep much in the daytime?

Sixth, what weight was she born at? Were all these weighings done naked, with electronic scales?

It's worth noting that we don't know what happened between day 9 and day 17. Maybe she lost even more weight, and then gained it back quickly.

Expressing after every feed can help to boost your supply. Expressing isn't a good indication of how much milk there is, though, because no pump is as effective at extracting milk as a baby is - millions of years of evolution beats some blokes in a lab, every time!

I know your midwife has looked at the attachment, but frankly, many midwives are not great at that - if you are willing to say where you live, I can have a dig for bf groups where you can go see someone who specialises in breastfeeding, who can double check your latch, and give you great support. (free!)

Alternatively, if you look at your nipple after a feed, that can give you an idea how good her latch is - your nipple should look pretty much the same as it did, going in. If it is at all smushed or crushed or different-shaped, then there is room for improvement in the latch.

I think you're doing just brilliantly... if she has wet nappies and seems healthy to you etc., I woudn't personally worry.

I wouldn't let go of the ebf with so little reason - feeding formula will only reduce your supply... if she needs more, she will generate more milk, if you give her access to the breast.

IME, some MW are too quick to reach for bottles.

Do you mean she is up 1 oz on her birth weight - or down 5 oz? Either way, I tend to think that if there was real concern the MW woudl be more than just suggeting things...

If yu're really worried, and feel the need to do something, you could always have a day in bed with chocs and mag and baby to boost your supply... but really woulnd't be worried.

great post NQC

Yep - on the button, NQC

Sella - if all that is a concern here is your baby's intake, and no health problems, then making sure she feeds effectively on both breasts and often day and night should be the first thing to address.

ok - so many questions to answer!

1. she had a natural delivery and has no health issues

2.she's pooing about every other day, but they are massive poos when she finally gets round to doing one, up the back and through her clothes - sometimes through several blankets as well! They started changing colour around day 3-4 but her 1st proper yellow one was 2 days ago. 3.she seems happy to me, her basic routine is to feed a lot in the day, especially in the morning, with a bit of a sleep mid afternoon, then a big feed around 6ish then every 3-5 hours through the night. In the day sometimes it feels like I don't communicate much with her because she feeds so much or sleeps, but when she does open her eyes she is nice and alert. She loves being talked to but generally not being put down - although a couple of times a day she will sit in her chair. 4.Feeding varies greatly eg 12.30am this morning, 3am ish, 6.30am, then between 9.30 and 12pm she was on and off because she kept falling asleep but if I took her off she would cry and root, last feed around 1pm then she's slept all afternoon, will wake her up soon for another feed then prob get 1 more in before she has a good sleep tonight. Quite often she will fall asleep on the breast but sometimes she will feed really effectively. Since last thurs I've been trying to take her off and wake her back up again but that is when feeds merge into eachother because she nods off again. If she cries most of the time I will put her back on again until she is happy (like 1pm today). Sometimes I get to the point where I think its prob wind now not hunger! My left nipple is a bit sore, there is a crevice around the bottom of it, right one is fine. Generally, they hurt for 30 secs then are fine, although sometimes the left will hurt for longer, I know this is prob poor attatchment and I'm working on it! 5.She feeds around 2-3 times in the night-depending on what you call the night. She won't go in the moses basket yet so its either bouncy chair or with me. In the day she tends to have 1 big sleep either in the chair or the pram. 6.She was 7lb9 at birth 7lb6 on day 6 and 7lb3 on day 9 then 7lb4 today - day 17. Thanks for all advice, I have list of bfeeding groups, just haven't dragged myself to any yet!

DidMcD what is Domperidone, I've never heard of it?

Sorry about the long post - would be grateful for some more responses! I'm trying to stay positive, drink lots of water and rest, and if I didn't weigh her I would say there was nothing wrong! Really want to make it work this time, but being told by midwife that by 3rd child some women just don't have enough energy/milk really depressed me. It seems that no matter how much I want it my children just don't want to breastfeed. I'm desperate to do everything I can to make it work this time. In terms of expressing I did that last time after EVERY feed, but don't feel like it increased my milk supply, think basically dd2 just couldn't be arsed with it and much preferred to have milk poured down her neck in the end.

Anyway, better go she's waking up, will check posts later...

Sella - you still need to say if you are offering both breasts and how she was weighed (ie accurately enough).

The weights - if correct - are unusual, but not diagnostic of themselves.

To be honest, it's still not clear what's happening - you'd be helped by seeing someone. A baby sleeping instead of feeding well is cause for concern, but maybe she is not doing that...hard to tell.

hi, domperidone is a drug that has the side effect of increasing milk production. My GP prescribed it because all other reasons eg poor latch etc etc had been eliminated. I noticed an immediate effect which was maintained when I stopped taking it.
We may have been fine without it, I'll never know but I think it gave us the start we needed. I struggled to keep up with bf my first two DC but it's much easier this time. I don't properly understand the science, sorry!

Yes, please do try to go see someone. Latch is tricky, and having an expert (not a midwife!) look at you both sounds wise.

Domperidone might not be a bad idea, but this doesn't necessarily sound like your supply is the problem - more likely bad latch.

Domperidone is an anti-nauseant drug which has a side-effect of increasing lactation. It's pretty safe, not a serious drug, but it does need to be prescribed, and this use is unofficial. (My borough's BF people have a standard letter to GPs that say 'I saw your patient, please prescribe her domperidone' which I bet helps.)

Sleeping with you (assuming you and your partner don't smoke, and don't drink much) is the best thing for her. Much as you'll be hungrier if you are next to a chip shop, being next to you will make your DD want milk.

right! yes i'm offering both breasts, she seems to feed slightly better off the left one (which is the one with more pain!) but more often she will have times of the day where she feeds better rather than sides.
Her weights were done on electronic scales, the first weight loss(7lb6) and todays +1oz were definately done on the same set of scales, the 2nd weight loss (7lb3) may have been different scales, don't know if it would have made a difference but 1 midwife put scales on the carpet and another on the table - this makes for a different reading on my bathroom scales!
I will try and get to a bfeeding group tomorrow and ask about domperidone. Thanks for not chastising me about bed sharing NQC your about the only 1 who hasn't! I don't smoke or drink and my partner is not allowed in the bed if she's there because he is a very heavy sleeper. The only thing that concerned me about it is if she is so cosy that she is sleeping longer than if she was in a moses basket?
Can you tell I'm going round and round in circles - I promised myself I wouldn't do this this time!...

Have to go now, but weights with the scales on a carpet are not accurate.

Whatever....she's still not at birthweight on day 17, which is a spur to seek change, which is what you are doing. Good to see someone at the group - they need to see a whole feed and to ask you how typical it is.

It's totally ok and understandable for you to be stressed.

Bedsharing is totally fine, under current advice, as long as, as you say, nobody smokes or drinks. I think she's more likely to wake up and be tempted, if she's in bed with you, as you smell like milk, iyswim.

Hi Sella,

Do go and see an expert if you can - My DD didn't regain birthweight for several weeks even though everyone (2 midwives/2 HVs) had told me her latch was fine. Saw a BF counsellor at a support group who adjusted my position, and by the following week she'd gained 5oz and continued to gain steadily ever since.

I did have to express after several feeds a day for a few weeks to up my supply as I think it had dipped due to her ineffective feeding. I also took Fenugreek to help increase my supply.

She's 18 wks now and all is going brilliantly.

I noted the comment from your MW about 3rd time mums not managing BF due to milk/energy- my GP spouted that clap-trap to me too about DD ("It's much harder 2nd time round so don't worry about it - you've managed to BF one, so that's something..." WTF!)which really pissed me off, and made me even more determined to prove her wrong!

Fingers crossed you get the help you need - you're doing a wonderful job xx

so the health visitor has just left, she has called the breast feeding support woman - to tell her my baby has significant weight loss! I'm sorry it's 5oz for god's sake!
spoke to support woman on phone and she wants me to express all day and night. i'm really reluctant to do it after last time but i suppose i don't know till i try so will give it a go. sending husband out to get some fenugreek tried that last time time.
does anyone think i should try and get some domperidone yet - will it be difficult to get or am i panicking too early! bit difficult not to to be honest when have just been told if her feeding isn't good over weekend to go to a&e!

Sella, sorry things are still difficult for you

Your HV's phrasing might not be great but a baby 5 oz below birthweight at day 17 is showing 'significant' weight loss and she was right to refer you to a bf support specialist.

No one on this talkboard can really say anything that helps much in terms of what you should do - the HV has seen your baby and should be in a better position to guauge what needs to be done. I don't think advice to 'go to A&E' if the feeding 'isn't good' is specific enough, though - no wonder you are not sure what to do.

What did the bf support person say? She may well be justified in saying to express often, inc at night (she can't literally mean 'all day and night') because she may have assessed this as being a situation that can be retrieved, but only with some intense 'therapy' ie expressing. It's good you are prepared to have a go.

Can't comment on the dom - ask the HV or the bf person about this.

I think something should have been done when your baby appeared to have lost more weight between day 5 and 9 - that might have made things less crucial now.

Hope things get better for you.

You can get Domperidone over the counter - in the form of Motilium (if they fuss, tell them it's fior your husband's IBS ). Bloody expensive though, at £4 for 10 tabs - and you need 4 a day, 8 if you follow dosage on kellymom not the packet.

we have a very slow gaining ds3. he was born very small at 4lbs and although he regained his birth weight quite quickly, from then it's been a struggle and he is below the chart. A VERY sleepy feeder in the beginning. I would have to wake him up to feed, give him about 10ml or so of expressed milk just so he had the energy to feed, then top up with expressed milk after. If you find she falls asleep straight away you could try the 10mls of expressed just as a livener. The top ups and expressing hopefully won't be for very long, just until the feeding is established and she starts gaining regularly. Another thing we did was call la leche league, who put us in contact with a lactation consultant (think that's what she was called!) she came over to the house and watched him feed and gave us lots of good advice and encouragement. Hopefully there will be something like that in your area. We're still co-sleeping as he feeds a lot through the night. I hope you can get some good advice and it works out for you. I'm really glad we stuck at it though, it did get a lot easier and his feeding is so much better (and no more expressing