Need help keeping 9day old awake during feeding

[Nicole915]

My daughter is 9 days old. Her birth weight was 9lbs 13.5oz. Her current weight is 8lbs 12oz. Her weight didn't increase enough (stayed the same from wed to friday) so the ped wants us feeding every 2 hours for 15 min each side. I have a SNS that I can supplement with, but would like to stick with just breast milk.

When we were feeding on demand, she wanted to be fed every 3 hours, with a 4 or 5 hour break at night. My milk is in, but since this is my first time I can't identify how much she is getting. She has about 6 wet diapers per day. She has not had a bowel mvt since thursday, and then it was still the dark tar stuff.


Questions:

How can I keep her awake for these feedings? She tends to drift off after about 10 min. I have tried stroking her, bouncing her, talking to her, bright rooms, playing with her feet and a cool washcloth.

[ewe+lamb]

OK, your little one needs to put on weight and you need to keep her awake, here are some things that come to mind, I would highly recommend breast compression to you, see www.drjacknewman.com, click on videos and then look for the breast compression, a baby with a slow weight gain needs to nurse more often I'd try every 1-1.5 hours for the moment so that you can boost her energy, sleeping takes alot less energy than nursing hence the situation you find yourself in. For the SNS you don't have to supplement with Formula you can pump your own milk and use that - that is what LLL recommends first, so you could try that - keep your baby close to you, make sure that she nurses every 2-3 hours at night as well, maybe have a little nursing vacation in bed so that you can build up your milk supply and get some rest at the same time and make sure that you are eating well maybe dh or your mom or just someone who can come in and help for a while until you establish your milk supply. Go over the position of baby at the breast as well, there is www.biologicalnurturing.com run by a LLL Leader and IBCLC which is great and also keep in mind, keep baby tight in, ear shoulder and hip in a straight line, point your nipple at nose so that baby opens wide wide wide her mouth, look at the lips that should be open like a book (turned out), check that she can stick her tongue out so that it comes over the bottom gums and you can see a little at the side when nursing. Hoping that some of this helps - post again if you need more information or clarification or just some support.

[PatioGardener]

Sounds like you have a sleeply one! It is so important to get them to transfer enough breastmilk to get over that sleepy hump, put on that weight and get rid of the meconium poops.

A couple of questions: 1) Did you have IV fluids in labour? If so, for how long? This could artificially inflate baby's birthweight.
2) Are you pumping after feeds?

In this situation I would try a couple of things to get baby to feed.

-a good LC to check latch and milk transfer.

-breast compressions during the feed. This can get the milk flowing and stimulate baby to drink more often. For a video that shows how to compress the breast see www.drjacknewman.com There are also good vidoes there of baby swallowing - so you can check milk transfer.

-switch feeding. When baby starts to stop swallowing, and breast compressions don't stimulate it, try to go to the other breast. This will stimulate a let down and hopefully baby's interest in feeding too. You can then switch back to breast #1 when baby stops swallowing, and feed up to "6 breasts" in one feed!

-Pump after each feed to continue to stimulate supply.

ETA Slow to post - I see Ewe+Lamb has given much of the same advice!

[Heba]

Fab advice already from the wise ladies here. You could also try lots of skin-to-skin (as suggested, keep her close to you - s2s will help stimulate her).

Good luck, and please let us know how you are getting on!

[Llyra]

I'll be honest with you-- in your position, I'd consider using the SNS with pumped milk for a few days to a week. Once she regains her birthweight and establishes a steady weight gain, you should see a marked improvement in her ability to transfer milk, but I think it's very important in the meantime to get the milk into her. If breast compressions and naked feeding and the other wonderful suggestions you've gotten don't seem to help, I would give in and go for the SNS. I went through this with both my twins. I think the major danger is that the ineffective nursing they do when they're sleepy affects your supply, which means even when they do nurse, they're getting less and less, and in turn therefore are more groggy and uninterested in nursing.

A few days of nursing with the SNS, then pumping afterwards and putting that milk back into the SNS the next time, might be just the thing.

And I disgree with your ped. I don't think every two hours is enough. I would be feeding at least every 60 to 90 minutes during waking hours, for as long as you can keep baby awake and swallowing, until you see a steady rate of weight gain past birthweight.

Once my twins were about a half pound over birthweight, we were able to go back to demand feeding without any problems, because they actually started waking and demanding!

[Nicole915]

Thank you all for the tips! We've been doing lots and lots of skin time, and that does help. The suggestion to swap breasts is brilliant, thank you so much. We think that is really making a difference.

I had a "Lactation Consultant" come to the house today... the quotes are intended. She walked in the door with formula and bottles in her bag. I could not have been more horrified. Needless to say, we asked her to leave. She was a referal from a friend of a friend, but really left us with more doubts than we began with.

We're up to 9lbs 1.5oz today, so a gain of ~4oz over the weekend. She's done with the tar like stool, its now brown and soft. Our plan is to stay at two hours, and give pumped milk via the SNS. Does that sound viable? The ped suggested 15ml of breastmilk or formula via the sns per feeding.

I'm having a lot of doubts, my confidence is pretty much shot, and I know so much of that is just exhaustion. We feed for 40 min, then by the time we get her burped (she's having lots of gas) and settled in, we have about an hour to rest before starting all over again. If we go to every 60 min like Llyra suggests, that will mean we get 10 min breaks. I just can't imagine how I can do that around the clock. Even now I can tell the baby is just exhausted. When she got to sleep in the car and the doctor's office without being woken to feed, she was so alert and refreshed.

Is 20 min on each side per feeding reasonable? If she's still swallowing a lot, I obviously let her go as long as she'd like.

Sorry if this reply isn't as articulate or concise as it could be, I'm a bit frazzled. Thanks to all of you for your kind wisdom.

[PatioGardener]

First of all... CONGRATULATIONS! 4 oz over the weekend is awesome! 'Typical' growth is 1 oz/day - so you guys are doing great!

I think your plan for nursing every 2 hours, with 15 mL breastmilk by SNS at each feed is completely reasonable - but Mama, watch the baby and not so much the clock during a feed. Watch those swallows - if baby falls asleep quickly then you have the tricks now to keep going! You may want to save the supplementary milk until breast #2 (or #3!) so baby feeds longer and gets that 'boost' at the end. I wouldn't be wedded to the 20 min per breast schedule - watch baby and see what she needs.

And watch for pees and poops. You want 6 heavy wet diapers a day and 3-4 poopy ones (which will now transition to yellow, which is normal.)

And remember that you are going to get to the point when baby is nursing well and has gained back birth weight and is able to go longer than 2 hours per feed if she chooses (she may go 3-4 hours at night even!). That should happen pretty soon (in 1-2 weeks) and you guys will be able to relax a bit then! You can get there, Mama! You can do this! You are doing this!

For now, sleep when you can and if anyone asks what they can do to help - be honest and say "food and laundry would be so great!"

ETA: I would avoid formula if at all possible. It is digested slower than breastmilk and therefore baby won't feed as often. Are you able to pump 15 mL of breastmilk after a feed? If so, just re-feed that.

[Llyra]

Wow, that sounds like progress! That brown stool is the transition stool. It should change to yellow or orangey-yellow soon, like the PP mentioned.

And I agree-- don't time feeds. Let baby stay on as long as baby wants to. It does wind up being three full-time jobs for a little while, but it's not forever. Have you attempted side-lying nursing yet, at night? That can make all the difference in the world, because once baby latches and is suckling, you can go back to sleep. Then baby just nurses back to sleep, and you don't have to stay awake until baby is finished.

I highly recommend giving it a try, as soon as you feel ready, if you're not already. It saved us, here. It can be challenging at first-- I used to sleep with the light on, in the first two weeks with the twins, because I couldn't get them latched in the dark. But it doesn't take long before it becomes easier, for most mamas. Some mamas never do master it, but I think that if you can do it, it's the easiest way.

I would stay away with the formula as long as you can, unless baby starts losing weight or stops gaining again for a period of time. It's a downward spiral supply-wise, and it makes baby feel artificially full, which makes baby nurse less frequently, and that's not what you're aiming for.

I would think that you could probably aim to wean from the SNS as soon as baby is a half pound over birthweight, unless there are other signs at that point that baby is still having trouble.

[CalaRei]

My babes were *very* sleepy when we brought them home, and it was a big struggle to keep them awake, even for their bottle feeds/supplementing. We would get them up, change diapers even if unnecessary, strip them down, sometimes even rub them gently with a damp rag. And then during the feeding we'd talk to them, rub their hands or feet, stroke their chins, etc.

Things will get so so so much better once your LO starts waking and telling you she's hungry.