not gaining enough

[tinaduck]

Went to the Dr. today and my LO only gained 2.5 oz in 16 days. She was 6.10 at birth and lost to 6.5 before leaving the hospital. She is 7 weeks and my ped wants to try to supplement 2 or 3 bottles a day and continue BFing other times. I am terrified to do this but, mu hubby is extremely concerned and I don't see any way around it. I am taking fenugreek and pumping like crazy. I had my tubes tied and this is my last chance to BF. I want her to be healthy also. I need advice.

[Aleida]

I may be wrong- but aren't the growth charts at the doctors offices based on formula-fed babies, who, to my understanding, are generally overfed (as many moms feel they must empty the pre-filled bottle as opposed to deciding for themselves when they have had enough in one feeding).

She has gained weight, she has re-gained her birth weight, so this is great! But, if you are concerned (and it is such a hard decision) to use formula, could it just be done via a Supplementary Nursing System (SNS)? Maybe a lactation consultant would be available to help more? I used it and my daughter still was BF and stimulating my breast when she nursed, but also got some formula during a BF session.

Another option (maybe?) is to take a few days and just nurse, nurse, nurse. Put your feet up (get help from hubby or another source if you can) and just keep nourished, hydrated, and rested. That may be enough to increase the milk supply and she may gain weight w/o having to supplement. Fenugreek is good, pumping is good, so you are doing a great job all around!

Hang in there!

PS- these are just suggestions from when my daughter was not gaining enough and I was (like you ) quite opposed to supplementing with formula.

[Becca75]

How much does she weigh now? How is her output (wet and dirty diapers)? Has she been sick recently? Has she been weighed consistantly on the same scale? Did she get longer beween visits? While weight is an indicator of whether or not she's getting enough, it's not the only indicator. There could be a problem with the amount she's taking in, but it could also be that she was in a period of growing lengthwise instead of gaining weight, or she could have had a small illness, or she could have just been weighed on two scales that were calibrated differently. Health can't be determined just by weight.

I agree with the PP that having a few days of laying around doing nothing but nursing couldn't hurt anything. If you supply is low it will definitely help, and if not it will just give you some rest!

[StillSingingMom]

We can't really offer reasonable suggestions without a little more info.

First, how much does your baby weigh right now?

How are you doing postpartum? There are some issues that can affect milk supply. Are you still bleeding? If so, you need to go see your OB. Has your baby's latch been evaluated by a lactation consultant? Have you done some pre- and post- feeding weights on a medical grade baby scale? We need to look at the mechanics of milk transfer to see if you are producing enough milk, if baby's suck is strong, and if the latch is adequate.

I would go see an LC before starting supplementation, assuming that baby's weight is within a normal range. How many wet diapers do you see a day? What does your nursing pattern look like?

Honestly, it's not unusual for a baby to lose around ten percent of her weight after birth. That's perfectly normal. I'm assuming that your baby was born at 6.1 and lost to 6.05 (not 6.5, since that would actually be a weight gain.) That looks like a normal range to me.

I'd want to see her pattern of gain since then before going to supplementing three times a day. And if there's an issue with milk transfer, it's very possible that fixing that would be much easier than trying to keep your supply up while simultaneously formula feeding.

Go see an LC. The hospital or birth center where you delivered may have one on staff that is available to help; you could also ask baby's pedi for a referral, or we can try and find one in your area.

[tinaduck]

Sorry she weighs 7lbs 6.5 oz. 16 days ago she weighed 7 lbs 4 oz. She is wetting pelanty but, not pooping alot. She went 4 days without pooping this last time and before that it was every 2 days. The pedi said that was fine. She hasn't been sick. I have been put on antibiotics this is twice for my tubal. PP I am fine no bleeding my check up was fine. This is my fourth and they were all slow gainers and I am so freaking frustrated. My hubby is on my case and he has every right to worry about the well being of our child. My pedi is BFing right now and is urging that I not give up BFing but, supplementing isn't going to help my production. Every time I supplemented before it ended my BFing experience.

[StillSingingMom]

My hubby is on my case and he has every right to worry about the well being of our child.

Well, of course he does. But it is good for your baby for him to be supportive of the breastfeeding relationship, too.

My pedi is BFing right now and is urging that I not give up BFing but, supplementing isn't going to help my production. Every time I supplemented before it ended my BFing experience.


Well, yeah... Nothing kills supply like supplementation! Are you losing weight? Rapid weight loss can impact supply, too. (Sorry if I'm filling your ears with things you already know- but in case you don't, I'm trying to be helpful.)

I agree with PP that if you have to supplement, the SNS is the way to do it.

Is there an LC available to help you?

[Nipple_nectar]

I am glad you know that using formula will only hurt your supply and sabotage the BFing relationship. Do you have access to a lactation consultant? I would recommend getting baby weighed in just a diaper before a feeding and after a feeding to confirm any potential milk transfer issues.

Tell your DH ( dear husband) that he needs to trust the bewbie! Your baby may need some help, you can do breast compression to help her empty the breast quicker: www.kellymom.com/newman/15breast_compression.html

There are many ways that you can help a slow gainer, an LC would be able to work with you one on one and get you to success quicker:) Is she sleepy or is she a good eater? Are you able to nurse her a minimum of 10-12 times in a 24 hour period?

Hang in there, nursin momma, we can help you:)

[Amy_G_]

a

[Amy_G_]

ok, so that was a very helpful 1 letter post of mine, wasn't it?
;)

If your babe had not been weighed in between birth and now, the weight gain is an average of 1.8 ounces a week. Normal is 4-5 ounces a week.

That is a HUGE red flag that baby is not just growing slowly, but is barely gaining.

I would start by making an appointment with an LC TOMORROW.
Ask for a weigh in before and after a feed to see how many ounces baby is taking in.
I would discuss the best ways to supplement and evaluate your supply. Honestly getting your baby closer to being on target with growth if this is a supply issue, will be more important to your breastfeeding. If baby is small and not getting enough they will have a wean and ineffective suck and your supply will suffer even more.
When you pump are you able to get anything?
what kind of pump are you using?
have you had sore nipples?
How long does baby go between feedings?
How long do feedings last?
how many wet diapers a day?
when did poopy diapers go to less frequency?
were you separated from baby due to your tubes being tied, and what's this about the antibiotics, if you are fighting an infection, your system may be "thinking" in terms of survival, rather than in terms of make more milk.

[tinaduck]

ok, so that was a very helpful 1 letter post of mine, wasn't it?
;)

If your babe had not been weighed in between birth and now, the weight gain is an average of 1.8 ounces a week. Normal is 4-5 ounces a week.

That is a HUGE red flag that baby is not just growing slowly, but is barely gaining.

I would start by making an appointment with an LC TOMORROW.
Ask for a weigh in before and after a feed to see how many ounces baby is taking in.
I would discuss the best ways to supplement and evaluate your supply. Honestly getting your baby closer to being on target with growth if this is a supply issue, will be more important to your breastfeeding. If baby is small and not getting enough they will have a wean and ineffective suck and your supply will suffer even more.
When you pump are you able to get anything?
what kind of pump are you using?
have you had sore nipples?
How long does baby go between feedings?
How long do feedings last?
how many wet diapers a day?
when did poopy diapers go to less frequency?
were you separated from baby due to your tubes being tied, and what's this about the antibiotics, if you are fighting an infection, your system may be "thinking" in terms of survival, rather than in terms of make more milk.


She gets 10 feedings a day eats every 2 hours for an hour. My nipples have been fine no pain. 8-9 wet diapers a day. I have gotten infected where my tubal was so my body may have been fighting the infection instead of making milk. She seems content and even only oes 3 hours at night without eating. I have already screwed up the latch letting her daddy give her a bottle of pumped milk. I have a medala pump it is a double or single I acn get 2 ounces a pumping secission and that is more than I ever got before. I am pretty beaten though I have 3 oither children and have went far above anything I have ever done before when nursing. I want a healthy child..

[Amy_G_]

eating for an hour every 2 hours seems a warning sign to me that baby is not effectively nursing. some babies do tend to take a while to eat, but usually the amount of time gets shorter as they get older, not staying at the point to take 1 hour.

Have you been to an LC at all?

I would seriously get an LC in on this.
I would get a weight check before and after a feeding to see how many ounces baby is taking in. I will venture to guess that it's a smaller than normal amount.
work with the LC and pediatrician to figure an amount of supplementation needed each day to reach a certain amount each feeding.
I would take that supplementation amount and feed it at the breast with a supplemental nursing system--so baby nurses at the breast and gets your milk, plus what is in the SNS bottle. If the SNS is too awkward, I would consider nursing for your normal amount of time or slightly less, and then give any supplement thru a breastfeeding friendly supplementation device such as a cup feeding, finger feeding, etc.

After a feeding, I would pump for at least 5 minutes after the milk stops flowing--but not to the point of pain. Any milk pumped would be used for supplementation at the next feeding, to replace the formula you are most likely using. Being sure to empty the breast and ask for more milk would help establish a stronger milk supply.

If you do not see any difference in supply within 3 days, speak with the LC about other galatagogues you may want to use besides fenugeek--I would recommend Kerry's herbals online for a good source for a tincture which works better than pills.

Do you feed on one side per feeding, or do you switch back and forth? do you use breast compressions during a feeding?
do you hear sucking and swallowing during the feeding.

My first instinct is that there is a supply issue going on--indicated by long nursing sessions and low weight gain. Maybe you have a kind of mellow baby, who is content no matter what she gets as long as she's able to nurse as much as she wants to satisfy her need to suck. OR there is something wrong with her latch, to the point that she is unable to take in enough milk at a feeding to grow at her potential. Usually it would show with a poor latch = painful nipples, but sometimes the latch is off but not to the point of pain to mother. Often the two items go hand in hand and one causes the other to get worse.

You really need an LC to check this situation out. be sure they are an IBCLC, and if one doesn't help, get another opinion.

[KerryS]

I agree with Amy wholeheartedly. The weight gain your baby is having indicates that your baby is not getting enough to eat. Also, nursing for an hour at a time for every feeding suggests that baby is not nursing effectively or not getting enough milk to satisfy her (yes, it's fine and normal for babies to comfort suck and "hang out" at the breast, but every feeding should not take an hour).

My recommendation is to find an IBCLC in person who can work with you. Based only on what you've said, it does sound like supplementation is appropriate for your baby, but it does NOT have to be the end of breastfeeding! My third child was FTT and I dealt with low milk production due to a number of factors, and I had to supplement from 2 to 6 months of age in order for him to get what he needed, but as he got bigger and stronger, he was able to increase my milk supply, and we're still nursing strong at 18 months.

It's all a matter of giving the supplement appropriately. Supplements can be given at the breast, using a lactation aid http://www.kellymom.com/newman/05lactation_aid.html

You should also be doing breast compression while nursing to keep the milk flowing and give baby more of the fatty hindmilk. This is a good way to increase milk supply http://www.kellymom.com/newman/15breast_compression.html

When supplementing, you can pump after feedings for 10 minutes to give additional stimulation to your breasts. Although, this is less important if you're religiously doing breast compression with every feeding.

Finally, just because you may need to supplement does NOT mean your baby has to have formula. Other than the first week of supplementation, my baby received only breastmilk for supplement and when I was at work. I received donor breastmilk through private mother to mother donation (see the link in my sigline).

Good luck and hang in there. Even if you do have to supplement, that does NOT mean you failed at breastfeeding, or that your breastfeeding relationship is over. I and my baby are a testament to that.

[tinaduck]

Thanks guys I have a appointment with LC tomorrow and I am willilng to do what I have to go. I have the supplement system and it seems to be doing fine maybe the LC can tell me what is going on after seeing a latch or weighing before and after.

[Amy_G_]

thanks for the words of wisdom Kerry. I appreciate your input.
Tina, let us know how the LC visit goes tomorrow.

[Amy_G_]

Oh and Tina, Kerry is a IBCLC who has been there, done that with a similar situation to yours, so I asked her to please stop in to answer your questions. Hope it gives you some hope.

[KerryS]

using formula will only hurt your supply and sabotage the BFing relationship.

NN, I love you, but I really take exception to this statement. Yes, using formula CAN hurt supply and sabotage the breastfeeding relationship, but that is not an across the board accurate statement. There are situations where the use of supplement can HELP the breastfeeding relationship. If the baby is very slow to gain and the mom has low supply, chances are they don't have a lot of energy and have a weak suck and tire easily at the breast. Supplementation, at that point, will help the baby to gain weight, gain energy and be able to nurse better, more effectively, and for longer periods. This, in turn, will HELP mom's milk supply.

My situation is a classic example of that - I resisted supplementation until he was 2 months old. If I'd known then what I know now, I would have started supplementing much sooner. It wasn't until I started supplementation and he started having appropriate weight gain that he began nursing more effectively. He gained weight, was stronger and more alert, thus was able to nurse better and increase my milk supply.

Generally, what you said is good advice, but I'm really nervous about absolute statements. I also am really nervous when people say "trust the bewbie." In cases where the baby has very slow, inappropriate weight gain, "trust the bewbie" can actually be a dangerous thing to say. To me, it's saying to ignore the scale and just nurse your baby. If baby isn't gaining weight, then clearly there is a problem that needs to be addressed and fixed.

[Amy_G_]

I think at one time I was much more of an only breastmilk supporter --but I don't think I ever viewed formula as being pure evil like some people may. Of course that may be because I know breastfeeding moms that have used, gasp, formula and breastfed their babies from day one, as doing 100% breastmilk did not work for that baby/mom/family.

Sometimes formula can help SAVE a breastfeeding relationship by allowing the focus to switch to ensuring the baby is healthy and gaining weight, so then you can fix any latch issues, as well as focus on monitoring and fixing mom's supply if needed without the freak out that there is NOT enough milk for baby right now.

Of course formula must be used judiciously, with much thought about how to give it, how much to give and the timing of feeds. Because you give formula for a short time, does not mean that breastfeeding has failed. It is a tool like a pacifier or super absorbent diapers, or even a crib--a tool that can be useful, harmful or just not fit what the baby/mom team needs. Can't throw them out the window completely.

Weight gain is a place where formula may be the answer--or private milk donation if that can be arranged. Ensuring baby gets fed enough to grow and thrive should be primary goal.

I try to always pull up the baby weight gain calculator at kellymom on threads like these where weight gain seems low.
http://www.kellymom.com/babyconcerns/growth/weight-gain-calculator.html
and
http://www.kellymom.com/babyconcerns/growth/weight-gain-calculator.html

0-4 months might be anywhere from 4-8.5 ounces a week gain and be ok. average is 5-7.

when weight gain is less than half of that 4, there is a problem that needs much more than just keep breastfeeding, that some babies are just slow gainers, and such. If baby had gained 4 ounces a week, the 7 weeker starting at 6 lb 10 oz would weigh about a pound more. A pound seems like so little, but in a small infant, it can be huge.

[tinaduck]

NN, I love you, but I really take exception to this statement. Yes, using formula CAN hurt supply and sabotage the breastfeeding relationship, but that is not an across the board accurate statement. There are situations where the use of supplement can HELP the breastfeeding relationship. If the baby is very slow to gain and the mom has low supply, chances are they don't have a lot of energy and have a weak suck and tire easily at the breast. Supplementation, at that point, will help the baby to gain weight, gain energy and be able to nurse better, more effectively, and for longer periods. This, in turn, will HELP mom's milk supply.

My situation is a classic example of that - I resisted supplementation until he was 2 months old. If I'd known then what I know now, I would have started supplementing much sooner. It wasn't until I started supplementation and he started having appropriate weight gain that he began nursing more effectively. He gained weight, was stronger and more alert, thus was able to nurse better and increase my milk supply.

Generally, what you said is good advice, but I'm really nervous about absolute statements. I also am really nervous when people say "trust the bewbie." In cases where the baby has very slow, inappropriate weight gain, "trust the bewbie" can actually be a dangerous thing to say. To me, it's saying to ignore the scale and just nurse your baby. If baby isn't gaining weight, then clearly there is a problem that needs to be addressed and fixed.


Yeah I think you are defnitly on to something. She already is doing much better at Bfing. I thought she was doing worse but, she just got lazy on her latch. She is getting more satisfied and at one weigh in she gained .5 oz after feeding. After working on getting her to drop the jaw she got 4 oz. You guys are great I defnitly needed the rest. I defnitly needed to get rid of the infection. I defnitly needed a LC and support. I found all of those on here! Thanks again to everyone. I feel so much better about not losing this experience I had almost give up. Keep on giving the hope.

[Amy_G_]

So glad you are seeing such improvement so fast!
Keep up the good work, and know that your baby will throw some other kind of curve ball at you in regards to breastfeeding (or just life in general), and you can get thru it. The next curveball will be the 3 month growth spurt where you'll think you've "lost your milk" cause she'll want to nurse non-stop and not seem happy. If you fix latch, weight and supply now, you won't need to worry about that one, just nurse thru it.

[tinaduck]

Last question for now is how long do I pump for at one sitting? I am still trying to get up enough milk for our trip to the beach. I have tried nursing with her in the seat and it doesn't work so well.

[Amy_G_]

pump until the milk stops flowing, or for 5-10 minutes longer if you want to up the supply.
or until you get bored/tired if that takes too much time. I don't know how well you let down for the pump, or anything. It does vary per woman.

[Nipple_nectar]

NN, I love you, but I really take exception to this statement. Yes, using formula CAN hurt supply and sabotage the breastfeeding relationship, but that is not an across the board accurate statement. There are situations where the use of supplement can HELP the breastfeeding relationship. If the baby is very slow to gain and the mom has low supply, chances are they don't have a lot of energy and have a weak suck and tire easily at the breast. Supplementation, at that point, will help the baby to gain weight, gain energy and be able to nurse better, more effectively, and for longer periods. This, in turn, will HELP mom's milk supply.

My situation is a classic example of that - I resisted supplementation until he was 2 months old. If I'd known then what I know now, I would have started supplementing much sooner. It wasn't until I started supplementation and he started having appropriate weight gain that he began nursing more effectively. He gained weight, was stronger and more alert, thus was able to nurse better and increase my milk supply.

Generally, what you said is good advice, but I'm really nervous about absolute statements. I also am really nervous when people say "trust the bewbie." In cases where the baby has very slow, inappropriate weight gain, "trust the bewbie" can actually be a dangerous thing to say. To me, it's saying to ignore the scale and just nurse your baby. If baby isn't gaining weight, then clearly there is a problem that needs to be addressed and fixed.

My "trust the bewbie" mantra has been here for a long time, it is best suited for new moms who are having trouble trusting themselves and believing that they are, most likely, indeed capable of 100% nourishing their babies. That statement was directed at her DH, he needs to trust that mom is making the right choices and be more supportive of her.

That is also why my main piece of advice was to be seen by a professional, I would never just willy nilly say ignore all those flags and hope everything works out, I always say get some feedback from a professional in person, not depending solely on some internet persona.

I appreciate your professionalism here and if I am wrong about some things, I don't mind being corrected, that is the difference between you, the licensed professional and me, the homemaker.

It's really just my two cents.

I think your situation was a rare one and I agree wholeheartedly, that supplementation can be coupled with an excellent BFing relationship, especially when the mom is a seasoned professional like yourself. My advice was for the many new readers who unknowingly take advice from uneducated people, sometimes DRs, and without being prepared for it, lose the fragile supply they have worked so hard to keep.

I feel bad for moms like Tina, working so hard to make it work, depending on sometimes faulty advice that gets them nowhere quick. Being surrounded by unsupportive people will only bring about your demise even quicker. There are so many moms who have given up, exhausted and mentally beaten, being set up sometimes only hours after baby's birth, by a thoughtful nurse who thinks formula is the answer. I wish I could do more to help the many new moms that come here looking for some guidance.

Absolute statements? I wouldn't call any of my opinion an absolute statement, just an opinion, really.

So, I am here to help and any time you have the time to contribute is an absolute bonus, peace out.