Big newborn with feeding problems

[Johanne]

I spoke to Samuel's Mum about this on the chat last night, so I am repeating myself a bit, but anyway. I'm here looking for support rather than "answers" at the moment. My DS2 was born on Thursday, so he's now 5 days old. His birthweight was 10 lbs 7 ozs. My milk came in yesterday. On Sunday morning, when he was 3 days old I rang the postnatal ward because he had spent the previous night very fractious and sucking his fists and i thought he wasn't getting enough milk. I breastfed my DS1 for 13 months with no bottle feeding at all so i have some experience and things just didn't seem right. However, the midwife told me that he's probably be fine when my milk came in and he was a big baby so he could handle it. He slept all day Sunday which i wasn't really concerned about, we just laughed because my DS1 never slept. Anyway, the community midwife came to visit yesterday and weighed him and he has lost 1 lb 4 ozs in weight which they are unhappy with. I was told he needed to put weight on my Wednesday (tomorrow) or they need to come up with a plan to supplement with bottles. he needs to be fed every 3 to 4 hours, wake to feed.

I tried to implement this yesterday last night and today, yesterday afternoon went okay but in the night apart from one really big feed he would wake every 2 and a half hours (which is fine) but only suck for 5 minutes and couldn't be woken trying all the tricks. Well, he'd wake after 20 mins of trying and then do 5 mins again or just refuse to open his mouth. After another a big feed at breakfast he was unable to wake and feed at 11 so after an hour of trying i rang and spoke to another midwife in the community midwfe team who looked after us when my DS1 was born. She agreed that there was a problem as DS2 is not really producing wet nappies or stools like you'd expect either and advised that we give him a bottle of formula to try and see if that gives he more energy for a breastfeed later. She says she has no doubts that I am a breastfeeder but at the minute it is a vicious circle, rather like someone who doesn't eat because they are ill and then doesn't have the energy to eat and get better. We are not swapping over to bottle feeding, at the minute it is more like giving him medicine to make him "better" (my analogy). I am not worried about my milk supply exactly because at the minute my DS is doing a wonderful job of letting that dwindle by himself and hopefully the formula will give him the strength to start breastfeeding properly.

So he's drank 2 ozs, we'll just have to see how it goes.

Jo

[N Lou]

Firstly Johanne, Congrats on your new baby!!!

I thought all babies lost a bit of weight in the first 2 weeks. My midwifes wouldn't weigh ds when they came out as they didn't want to worry me.  Anyway, with a birth weight like that (Wow!) i don't think he'll starve anytime soon!

Secondly, we had the same feeding probs with ds and had to use a few bottles of formula to 'kickstart' our feeding routine and it worked just fine and we (eventually) went on to breastfeed like a dream.
Hope it works for you too and you'll soon both be settled in to a routine!!

Let us know how it goes.

[Johanne]

Yes they all do lose some weight - he's just lost more than they are happy with. I think there is something like a percentage of birthweight that they use as a guide.

Johanne

[Samuel's mum]

Hi Johanne
Great to see you here too.
My LLL book says 5-7% weight loss is very normal. Then it says 'While a weight loss of 10 % is considered acceptable to some medical professionals, it is usually a sign that a mother needs additional help...' Delayed 'milk production' is a reason in about 1/4 of cases.

She says she has no doubts that I am a breastfeeder

It's great that she said this. It's a good way to look at it. Whatever happens - even if you have to supplement a fair bit initially as a worse case scenario - it doesn't mean you won't be up and running with bf very soon.

I was advised by my midwife that if I wasn't getting the 'stimulation' from Sam's feeding it would delay milk production and possible cause supply problems in the future (The first few weeks are very important to establish long term supply levels because of prolactin hormone production). I would talk to someone about pumping (not giving it to him but just to stimulate your supply) if you haven't already.

 

We are not swapping over to bottle feeding, at the minute it is more like giving him medicine to make him "better" (my analogy).

Great way to look at it.

HUGS.

[Harvey and Theos Mam]

They allow for 10% of the birth weight.

Harvey had jaundice and that was a vicious circle for a couple of days where he needed to feed, to keep the jaundice at bay, but the jaundice was making him too sleepy so then he had no energy to eat. We gave expressed milk but he was a few days old at this time. I did give him formula a couple of times and never had a problem with my milk supply as i have a very good supply.

Good luck with your feeding.

[Johanne]

My DH tired to give him another bottlefeed an hour or so after the last one as he had only taken 2 oz initially and the midwife had wanted him to have 3-4 ozs. He did take 1 and a half ozs but again it took my DH 20 mins to wake him up and he had to be really coaxed into feeding and constantly struggled to keep him awake. So, at least i know it's not me, but on the other side he's struggling   with bottle feeds too which is not good because his energy has to come from somewhere We will see what the midwife has to say tomorrow when he is weighed again. I am not blaming myself, I can't control when my milk comes in or what size he was. This is a solveable problem, we will sort it - it just breaks my heart at the minute to see him refusing feeds when he's so new and so needs to be feeding. I have never seen a baby that is so hard to wake :S The really stupid thing is I have loads of milk in there at the moment and just hand expressed a load into the bath because i'm getting lumpy and uncomfortable. I'm going to try a breastfeed at 8pm-ish and see how that goes (3 hours after the second bottlefeed).

[faithandme]

My son was 9 lbs 5 oz. when born and I had a similar situation.  He breastfed well in the hospital, then my milk came in.  After about 5 days of him being very sleepy,not eating well, and losing over a pound, I visited the lactation nurse.  She told me that I was very engorged, even though I was pumping to help with that, and that due to the engorgement my son could not "latch on" properly.  She said that every time he would try to nurse the pressure in my breast would push him back and he would give up.   This is my second child and my daughter had not trouble latching on, despite engorgement, and ate voraciously. 

My salvation was a nipple shield.  A nipple shield covers the nipple and reaches the back of the baby's throat so they can latch on.  Some babies need it until they stop breastfeeding and some only until the mother's breast is no longer engorged. We're still using it and he is 6 weeks old and about 12 lbs now!

[Samuel's mum]

I know - I don't seem to be leaving you alone!!!

You could try getting some in with a syringe as that takes him not effort at all (I used one for the first couple of days).
Do keep hand expressing or pumping. It's really important you stimulate your supply or it will simply go away again. If your breasts are not receiving the 'make milk' message, production will shut down. One more thing to think about - sorry!!!

Have you heard of SNS? It's a way to supplement while still stimulating your supply:
http://www.medela.co.uk/UK/en/breastfeeding/products/nursing.php
If you phone a helpline they could talk you through the benefits of using one.

Good Luck for tomorrow. You are certainly right you have no reason to blame yourself - of course not.

[Johanne]

Just to update you, Alex had gained 3 and a half oz on Wednesday and a further 1 and a half oz by Friday. I try not to let him go longer than 3 hours between feeds during the day and on Thursday night he slept through from 11pm to 6.15am (when i woke him for a feed) after 3ozs of formula. Last night he slept from 8pm - 6.00 am following a breast feed, though he had been feeding all day and awake between feeds so I think he may be on a growth spurt. Does anyone know if you adjust milestones for overdue babies? Alex is two weeks overdue and now a week old, so could he be going through the growth spurt that generally happens at 3 weeks old?

Today Alex has fed well a couplel of times but also had a couple of "snacks" and is napping a fair bit - I hope he isn't suffering from lack of energy again because he's missed out on the night feeds, but the midwife wasn't unhappy with him sleeping through at night and if he was hungry surely he would have worken up and I would have fed him?

The midwife is coming back on Wednesday to weigh him again anyway. I'm not sure if they will keep coming back until he has regained his birth weight. The health visitor is coming on Wednesday also, so it may be that his care is handed over to her at that point.

The only real issue now is that Alex is not opening his bowels at all regularly. Although he had meconium poos and a couple of dark brown poos for a few days after he was born he hasn't had a poo since Monday and certainly no light brown breastfeeding type ones. The midwife has told us to give him a little cooled boiled water each day and masseg around his anus when we do a nappy change to try and get things moving. She isn't too worried though as he had the earlier poos and there are no other symptoms - he is eating and sleeping and his stomach is not distended or hard. She thinks he is just absorbing all the nutrients in his breast feed and hasn't had enough formula for it to go through his system yet - but when he does finally poo it will be a whopper! 

Jo

[Southernbelle]

Johanne,
My Son did the same thing.  He was 8lbs 10oz at birth and was very sleepy. He didn't stimulate my supply well and we ended up having loads of problems.  I wish I had pumped early on with him being so sleepy.
Has he been tested for jaundice?  DD had it pretty bad at the begining and she had lots of trouble waking enough to nurse.  With her the LC had me offer her about ten sucks of formula and then quickly onto the breast.  This actually worked a fair bit because she realized she was hungry and would nurse for a few mins after the formula rush. Sometimes I had to repeat the process a few times during the nursing.  I tried SNS too but it was difficult for me to get the hang  of without DH to help me get it set up.    Both my babies had a hard time with poops.  It usually at this age means they are not getting enough.  I used to get so excited when DS would poop becuase it signaled that he was eating better!  If I were you I wouldn't let him go longer than 4 hours at night until you get the nursing going well. 8-6am seems like a very long time for a baby who may not be getting enough calories during the day.   At one month, DS was doing better and my ped told me it was ok to let him sleep until he wanted to wake at night, but before then she was concerned about his weight and my milk supply problems. 
Hang in there. I know how frustrating it can be.  Especially if you had no problems with your other baby.  My friends who had great aggressive nursers could not understand how much I had to go thru to get both my babies healthy and eating.

[Southernbelle]

Have you tried going on the LLL site message boards.  They are excellent, minus the constant push to cosleep.  You may get some good help from a leader on the site! 

[Johanne]

The night before the first night he slept through he had been up all night sucking and then in the day he had hardly slept either but had fed well - 20 mins each breast every 3 hours or less, so I put the first night of not waking down to having had good feeds and being darn tired. I was darn tired too! He fed a lot yesterday too but wanted to either bf or be cuddled / fall asleep on people so didn't get a lot of good quality sleep, so last nights long stretch was due to tiredness and catching up I think. Today he has fed fairly well and is napping a lot after feeds but I am not letting him go longer than 3 hours between feeds and sometimes he wants more after 1 or 2 hours, so I am fairly sure that now he is getting enough during the day. i would rather bf all day than be up at night! i don't know how the fact that he is napping a lot today will affect things tonight - i will have to wait and see.

[clh]

How are things now?  I just found this thread & wanted to respond...  My 8 lb, 10 oz ds lost over 10%, too, which didn't make the doctors happy.  We supplemented a bit in the hospital before my milk came in, but stopped that after going home.  I tell you that to tell you that it took about 3 weeks for my ds to reach his birth weight again.  He was gaining the whole time (which satisfied my doctor), but it just took a while to make it back to that original weight.  Hang in there!

[Shdef]

If he is 10 pound, the loss of 1 pound is normal... In my hospital they said 10%...

But because the pounds and ounces are sooooo ridiculous and medieval that I can't calculate it in my head...


Okay... 10 pound 7 oz is 4.9 kg...
1 pound 4 oz is 0.6 kg....

So it is a wee bit more weight loss than 10% so they were right with suggesting the bottles... But that is very common with very big babies. Things will settle

[Johanne]

At the minute he is having mainly 3 hourly breast feeds during the day with one bottle in the evening and then more breastfeeds if he wants them. He seems really contented, naps between feeds and sleeps for fairly long stretches from 9pm onwards. last night he woke for a feed at 4am and then woke again at 8.45am (by which time hubby and DS1 were on their way to school!  ). So far he has gained about 5 oz, so he is gaining weight but slowly.

We were a bit concerned because he didn't have a BM from Monday to Saturday - but the midwife checked him over and wasn't too worried as he wasn't having any other problems and his tummy wasn't hard or anything like that. She figured he was absorbing the breastmilk and wasn't having enough formula to go through him. Still she suggested he have a little cooled boiled water every day and massage his anus at each nappy change and that seemed to do the trick.

So at the moment things are soldiering along nicely. The bottles mean that i can spend more time with DS1 if I need to (eg. i took him to his swimming lesson on Friday which I hadn't really been up to towards the end of the PG), so the cloud has had a silver lining. He didn't need the bottle - he slept the entire time I was gone but it's good that it can be used if necessary.