Doc wants me to supplement... help!

[hfidanzo]

Hi there, I posted a few months ago about my fears of trying to breastfeed again, after two failed attempts. There was so much encouragement and great advice, here - I thought I'd peak in again with another question and see what my options are...

I've finally had my beautiful son, 9 pounds 3 ounces at birth.
Last weigh in at the hospital was 8 pounds 8 ounces.
Two days after discharge at the doctor's office was 8 pounds 11 ounces.
Today... almost two weeks after birth, he is at 8 pounds 6 ounces.

The doctor said she's very concerned, and that he should be atleast back at birth weight by now. I've worked through so much already, having seen a lactation consultant, and using tricks like the nipple sheild and the gel packs for all of the pain, that has finally begun to subside... and now this --- I feel like such a failure.

Doctor wants me to supplement. Which I'm completely against, for two reasons:
1.) The recent scare with formula and melamine, I can't knowingly put that in my sons' body, regardless of how much or little is present.
2.) This would be a huge mental setback on my endeavor of breastfeeding. It's a slippery slope, and I can easily see myself just going over to all formula if I start a little now.

What can I do? Has anyone else here run into this?

Thanks so much!!!
~Holly

[ColleenF30]

Docs seem to have a bad habit of not giving enough time for a breastfed baby to gain. Can you increase his feedings mama? I went to every 90 minutes when my doc tried to froce me to supplument.

[jodyvo]

nurse nurse nurse. Just keep nursing that baby as much as he will take. He will get there just give him a couple weeks

[trylyn5]

How old is baby now? Have you weighed before and after each feeding to see how much he's getting? How many wets/poops per day? How long is he sleeping at a time? This may be a case where you can't let sleeping babies lie. I had wake dd up to eat. She still rarely demands food at 9 months so I'm a clock watcher. You might also try pumping right after he eats to help stimulate supply and to possibly have ebm to supplement wit if it does come to that. Drink LOTS of water and eat oatmeal or things woth whole oats in them. I'm talking like a gallon of water until this gets resolved.

Above all though, remember that the most important thing is to feed your baby. I've been there and I cried every time I had to use formula but if he needs it, that's what's best. We overcame our low supply at 10 weeks. Our issues were unusual but don't give up. You are NOT a failure even if you have to supplement the whole time.

[Lumatiza]

All great advice. I would say though that it's not the end of the world if you give your baby one bottle a day just to make sure. It can actually be pumped breast milk, if you can get enough so that it's still your supply. It might be useful to see how much the baby drinks during this one bottle session. If he gulps down 8 ounces then he's probably not getting enough and you can try breastfeeding him and pumping for a few days while you get your supply up. In addition, I found it really helpful to get my daughter used to a bottle early on so that I could leave her later on to go to work or run errands etc. I actually started mixing breastmilk and formula at three months because wasn't able to get enough pumping. Then at six months when she started solids and I had more time she went back to exclusively breastfeeding and we're still going strong at 14 months. My point is that not all is lost if you have to make adjustments here and there. The important thing is not to stress out and work with the experts to find a solution that you're comfortable with.

[Nipple_nectar]

All great advice. I would say though that it's not the end of the world if you give your baby one bottle a day just to make sure.Actually, there is a serious threat here of nipple confusion. It is not recommended under any circumstances, to use an artificial nipple with a breastfeeding newborn. If you need to supplement, make sure you are choosing a BFing friendly alternative. www.kellymom.com/bf/pumping/alternative-feeding.html www.breastfeeding.com/all_about/all_about_confusion.html

It can actually be pumped breast milk, if you can get enough so that it's still your supply. It might be useful to see how much the baby drinks during this one bottle session. If he gulps down 8 ounces then he's probably not getting enough and you can try breastfeeding him and pumping for a few days while you get your supply up.All newborns have an insatiable need to suck. Offering a bottle is not a reliable indicator of true hunger because babies actually have a reflex that involves the tongue and when you place anything on the tongue, they automatically suck as long as you allow them. A breastfed baby can easily gulp 8 oz. but this is not an indicator of true hunger, just demonstrative of an ability to suck.

In addition, I found it really helpful to get my daughter used to a bottle early on so that I could leave her later on to go to work or run errands etc. I actually started mixing breastmilk and formula at three months because wasn't able to get enough pumping. Then at six months when she started solids and I had more time she went back to exclusively breastfeeding and we're still going strong at 14 months. My point is that not all is lost if you have to make adjustments here and there. The important thing is not to stress out and work with the experts to find a solution that you're comfortable with.

You mentioned a nipple shield. I strongly urge you to stop it's use as it can interfere with effective milk transfer and is associated with poor weight gain. If you are not using it~ yay! Just give your baby time to catch up.

It is not necessarily true that all babies are at their birth weight by two weeks. Some babies take a little longer and there are many things you can do to maximize weight gain. For instance, doing breast compression ( www.kellymom.com/newman/15breast_compression.html ) will help baby empty the breast at each session.

Tell me what your sessions are like: are you offering both breasts? How long at each breast? How often is baby nursing? Trylyn is right, I would wake baby during the day after two hours and offer the breast. I wouldn't let baby sleep more than three overnight.

You can pump after each session to increase your milk supply but I am not convinced you even have a supply problem. If you are seeing a minimum of six wet diapers in a 24 hour period, you are doing fine.

Is your baby sleepy or difficult to wake for a feeding? That can be a problem in the early weeks: www.kellymom.com/bf/normal/newborn-nursing.html )

If you want to, pump for a minimum of twenty minutes after each session on both breasts and then offer any expressed breastmilk with a finger feeder.

http://www.kellymom.com/babyconcerns/growth/weight-gain_increase.html

[hfidanzo]

A lot of what many of you have said resonates with my gut feelings so far. Even before waking up this Thanksgiving Day, I began to pump right after feedings... I'm only getting an ounce of milk after feeding the little guy, but hopefully - this will increase production. And you're right.... I wasn't taking good care of myself, so I'm making sure that I eat, (easy to forget with three little ones, while I homeschool, cook, and clean all day after a C-section), making sure I drink lots of water, which I wasn't doing, and actually taking that prenatel vitamin that I set out every morning and let sit there for days thinking that I'll take it when I have time to pour myself some water.

While I disagree strongly with Nipple_nectar, I truly appreciate the different views on the board. The nipple sheild, I do have to say, is my saving grace, it's cut down on my pain by atleast 90%. Which is what kept me from breastfeeding my other two daughters.

Any other advice that anyone can think of - I am extremely greatful for. And I wish you all the most blessed Thanksgiving Day with your little ones!
~Holly

[Psyche]

Here's some more info on nipple shields.

http://www.llli.org/llleaderweb/LV/LVJunJul00p39.html

http://www.kellymom.com/bf/concerns/baby/wean-shield.html

The general opinion is that nipple shields are a short term fix, and they can be associated with poor weight gain.

[Nipple_nectar]

They are great articles Psyche, thank you:) Hfldanzo, no need to strongly disagree with me, I am just sharing research with you, not my opinion. You can take it or leave it.

As for the shield, I used one, so I understand the neccesity and the despair that drives you to it, I'm sorry you are having trouble. The truth is you need to treat the cause of the soreness.

In the meantime, there are safer alternatives to treat your nipple trauma that won't interfere with building your supply, baby's weight gain or create nipple confusion. It is your choice whether you would like to consider the shield the source of your problems.

We, as a community, will try and support you and your choices, our biggest goal is to give you the evidence to make your own informed decision.

Research evaluating the rubber and latex designs revealed reduced milk transfers of 58 percent and 22 percent respectively. Often, with use of the thick rubber shields, including artificial bottle teats placed over the breast, infants are not able to compress the maternal milk sinuses, which can lead to long-term milk production problems and increased nipple soreness and damage.

[madelsmama]

I strongly agree with Nipple Nectar.

A baby's ability to gulp down any huge amount of liquid from a bottle after eating has little to nothing to do with whether s/he is getting enough milk from the breast. A more accurate way to determine baby's true intake is to go (again) to the LC and do the before and after weights.

Talk more about the latch pain and what the LC has said about the latch. The nipple shield results in lower milk supply over time as does a latch that results in not emptying the breast well.

Hang in there--let's figure this out!

[KerryS]

Research has shown that a *properly fitted and used* nipple shield is not associated with decreased milk production, and it actually is associated with GREATER milk intake for babies who have a weak latch. Please make sure that you're using the nipple shield correctly and that it's properly fitting (it needs to fit like a GLOVE against your nipple). I didn't read closely to see WHY you're using a nipple shield, but if it's due to painful nipples, you also need to address why it's hurting to nurse and fix that problem. It's most likely due to an improper latch, which can interfere with milk transfer. When using a nipple shield, you also need to have regular weight checks and follow ups with a lactation consultant.

I haven't read all the responses, but I would say that supplementation is appropriate for a baby who is continuing to lose weight at two weeks old. In addition to supplementation, you need to make sure your breasts are being adequately drained by using breast compression during feedings, and pumping for an additional 10-15 minutes after all feedings. This will help boost your supply, and you will be able to turn around and supplement your baby with your pumped milk, rather than formula.

I would recommend, if possible, that you give supplementation through a tube at the breast, rather than a bottle or finger. That way, it eliminates the possibility of developing nipple preference, and it provides additional stimulation of the breasts. The tube and supplement should not be introduced until the end of the feeding, after you've drained both breasts and used breast compression.

[KerryS]

It is not necessarily true that all babies are at their birth weight by two weeks. Some babies take a little longer...

I just want to address this. If breastfeeding is going well, a baby *should* regain birthweight by 7-10 days postpartum. A baby who does NOT regain birthweight by this time is at risk and interventions need to be made - it's a yellow flag that breastfeeding may not be going well. A baby who is still LOSING at 2 weeks pp is a red flag that lactation is not going the way it should, and interventions need to be made. Supplementation while addressing and fixing the underlying problem is recommended.

Whenever I see a baby who has not regained birthweight by 10-14 days, it concerns me, and it indicates some sort of problem or issue with breastfeeding that needs to be addressed ASAP.

[KerryS]

Research evaluating the rubber and latex designs revealed reduced milk transfers of 58 percent and 22 percent respectively

The thing is, though, that the rubber and latex designs are no longer being used. Nipple shields are now almost exclusively made from silicone.

[Nipple_nectar]

As always, I defer to Kerry, as she does know best:)

[ima062002]

Holly - you need to find out what is happening, whether this is an issue that lies with you (i.e. low supply) or with your baby (latch etc.) - or both. The LC should weigh your baby before and after a nursing session to see how much milk transfers.

There are hidden hindrances to a good supply for instance thyroid issues (see here for more info: http://www.breastfeed-essentials.com/hindrances.html) which should be ruled out as well.

So I disagree with your doc on the supplementing BEFORE establishing what is going on but you'll need to see the LC asap. Only after we know what is going on can there be a strategy advised, which may or may not include supplementing with formula.

At around 2 weeks ppt your baby should be close to his birth weight although some babies may take longer especially if mom had lost of IV fluid during the birth and the baby's weight inflated because of it.

[KerryS]

So I disagree with your doc on the supplementing BEFORE establishing what is going on but you'll need to see the LC asap.

IMO, she needs to do both simultaneously. If baby is still losing weight at 2 weeks postpartum, then this is, IMO, an emergency situation and the baby needs more nutrition than what he's been getting. At the same time, she needs to find out WHY baby is not getting enough to eat and working on preserving her milk supply by pumping after feedings and working with an LC to determine if the problem is with milk production, milk transfer, or a combination of both. But the first rule is FEED THE BABY, and a baby who is still losing weight at 2 weeks postpartum needs to be supplemented.

Supplementation does not have to be formula. If you're able to pump any milk after feedings, you can supplement with that.

People seem to be ignoring a very important point. This is not just a "slow gaining baby" - this baby is ACTIVELY LOSING WEIGHT. This should NOT be happening 2 weeks after birth!

[hfidanzo]

Thanks so much, everyone. I've been actively pumping after each feeding, and have been able to gather an ounce to an ounce and a half after each session, so 99% of the time, I'm able to supplement with the pumped breastmilk... this has worked out really well so far. We've had to supplement with formula twice, and once --- he wouldn't take it, (it was the first time, and he seemed very upset at the taste or smell, I don't know -- but it gave us a small chuckle, since his dad and I really didn't want to go that route anyhow.)

We're certainly not above knowing that if formula is what's going to help him, then that's what we have to do.

My LC is the one who started me on the nipple sheild and showed me how to put it on - and I'm convinced that the pain is due mostly to a poor latch, as I can tell the difference when I am successful in getting a nice wide mouth to feed into. It's getting him to do it consistantly that is the problem, I don't know any tricks.... I have an appointment with another LC this upcoming Friday, but can already see in little Joey's face that he's gaining a bit.

Is it common for a new baby to eat less during the midnight feedings, or does that just mean I need to work harder to keep him engaged to eat more?

Thanks again Mama's!
~Holly

[Earthmama]

You're doing great. I'm glad you're seeing an improvement. I wish you the best possible outcome to all this.

Your baby is lucky to have such a determined mama!

[Nipple_nectar]

It is possible that baby is more sleepy for overnight feedings and I would just follow his cues, regarding the length of the session. Doing breast compression ( www.kellymom.com/newman/15breast_compression.html ) will help him empty the breast quicker.

For superior pain management, you might want to consider using the silverette for long term success. Pure silver cups that you place on your nipples between feedings, will heal nipple trauma quickly and eliminate soreness without the use of creams or concoctions. You can read more about them here: www.breastfeedingheaven.com

Don't be surprised as your baby develops a more effective latch, you will see a decrease in the amount of milk expressed after each feeding. To practice the all important latch, watch the good latch versus bad latch tutorial at www.drjacknewman.com

Don't hesitate to remove him and start over if it doesn't feel or look right, gently inserting your pinky in the corner of his mouth will break the seal and minimize injury to your nipples. Are you using Lansinoh lanolin between feedings? This will also help with soreness. You can also use it before and after each pumping session.

You can also use www.soothies.com for immediate pain relief.

[KerryS]

I agree with NN. I would add that if you can correct the latch, you will likely not need any assistance with sore nipples. Also, a proper latch will help him to get more milk.