Ped saying supplement what do you think? PLEASE HELP!

[rlandnl]

My baby girl is 2 weeks old today. She's my 2nd baby, I nursed my first for 3.5 years. Around 1 month old we supplemented him with formula for a month or so just a cuople ounces a day, because he needed medicine for seizures, and I couldn't pump andnurse since he was a constant nurser... after that initial bit I was able to pump and nurse and that way he had his med in breast milk

this baby has been a challenging nurser from the start, bad latch, gumming me to the point of bleeding blisters, we got all that fixed by the time she was 1 week old, using nipple shields, She still uses them exclusively, but honestly there are bigger things to worry about as far as I am concerned than her not nursing without them....

today she had a ped appt and he told me that he reccomends that I supplement for at least 48 hours to show that she "can" gain weight, he reccomends formula because we know the caloric content of the liquid, and we can measure how much she's using of the calories or something like that because she will gain weight (in other words pumping and supplementing with my BM isn't as good because we don't know if it's calorie rich enough.... and he wants to "prove there is no malabsorption issues going on". I agreed to the formula, because I don't want them running a crap load of tests on her.

When she nurses she falls asleep every single time. She is a very sleepy nurser and honestly a sleepy baby. She has only gained 3 ounces since leaving the hospital at 2 days old, she was born at 7lb6oz, left the hospital at 6lb13oz, and at 1 week check she was 6lb14.5oz and today at her 2 week check was only 7lb even.... he said he would have expected her to be up to her birth weight at 10 days old.....

I don't know what I am doing wrong, my other child did not have this much trouble gaining weight, by his 2 weeek check (exclusively BF still at that point) he was 7.5 ounces above his birth weight.... what would you do if you were me?

I nurse her on demand, I do hear her swallowing when she hasn't fallen asleep, sometimes she gags even when I let down. I leak through my breast pads (I wear 2 at a time), and when she comes off the breast she has milk dribbleng down her chin, she has a milk mustache and beard (is that from a good supply or the nipple shield I don't know)....

am I not nursing her long enough? I do it till she's too asleep to suck. which can range from 5 minutes to 30 minutes depending. she doesn't act hungry when she delatches....

oh and she has gained in inches, she was born at 19.25inches and now she's 20 and 3/8

any advice? this is very very depressing to me

[lyterae]

I don't have alot of info to help with, I'm sure there are other moms who will have more info. I couldn't read and not send hugs your way though. I would be leary to supplement as I'm sure you are. Can you do feeding tests to see how much she is taking at each feeding?

[rlandnl]

thank you for your post! I havne't done a feeding test, the first time I saw the LC was in the hospital and i didn't have milk yet, the 2nd time I saw a different one when she was 1 week old, we did the nipple shields but we couldn't get her awake enough to really eat (she had just eaten at the peds office anyway)... I don't really have a good way to measre her, I have an OLD baby scale but it's not really that accurate since it told me she was over 7 pounds the other day.... but obviously that's not accurate

[lyterae]

I am a low supply mom, so I'm preparing for not being able to nurse exclusively and to watch for signs of baby not getting enough. Here is some of the information I've collected :

Adequate Milk Criteria
- Baby should regain birthweight by two weeks (I don't know if this is the same if there were problems from the start)
- Should have "seedy" BM diapers, at least 3 per day
- At least 5 very wet diapers per day
- Weight gain should be about 1 oz per day for the first 3 months

----

Now, I know that where I am there are places that I can rent health equipment. Things like a hospital grade pump and a baby scale. I'm planning on renting both so I can pump after feedings to increase my supply and use whatever I pump to supplement with, and to weigh baby daily (and possibly do feeding test weights) to confirm that I'm feeding baby adequately.

If the baby is having enough dirty diapers, I would see if the ped will let you nurse and come in on Friday even for a weight check. Stay skin to skin and wake her up every two hours to nurse. If she won't wake to nurse I would pump, just to make sure your supply stays up. I've never used nipple shields, so again this might not be completely accurate for your situation.

[SubliminalDarkness]

I'll disagree with the last poster.... Not all babies regain birth weight by 2 weeks, especially if there was a rough start to nursing. My DS2 didn't regain birth weight until a few days over 3 weeks old. And the pediatrician was absolutely fine with that because he was gaining, his diaper output was fine, and he was responsive and behaving normally for a baby that age.

I also think it's incorrect to think all babies will gain an ounce a day. That would mean all three month old babies should be about 5 1/2 pounds over their birth weight, and that simply doesn't hold true for all babies and is an unrealistic standard.

I also had low supply, and was on high alert for the need to supplement(I had a breast reduction, flat/inverted nipples, DS2 had bubble palate, macroglossia, and tongue-tie). But we took other things besides weight into consideration, mostly diaper output and development. He WAS gaining, just slowly.

[Ruthla]

Did you have any IV fluids during labor? Those fluids can make the baby "bloated" at birth, artificially inflating the birth weight. Perhaps your baby "should have" only weighed 6 lbs 13oz at birth and was back to her "birth weight" by the time she left the hospital and has gained a few oz since then.

If you do need to supplement for a little while, make sure you do so in a way that avoids nipple confusion. An SNS or finger-feeder makes a lot more sense than a standard baby bottle, since she's not well established at nursing yet.

[rhiOrion]

Originally Posted by rlandnl

thank you for your post! I havne't done a feeding test, the first time I saw the LC was in the hospital and i didn't have milk yet, the 2nd time I saw a different one when she was 1 week old, we did the nipple shields but we couldn't get her awake enough to really eat (she had just eaten at the peds office anyway)... I don't really have a good way to measre her, I have an OLD baby scale but it's not really that accurate since it told me she was over 7 pounds the other day.... but obviously that's not accurate

Just because it doesn't match the doctor's scales doesn't mean it's useless for weighing before a feed and after. The difference is what matters.

Also, I can get a BIG variation on DD depending on when she last ate, how much, when she last pooped, when she last peed, etc. I'm talking several ounces. So I wouldn't discount that weight you got if it wasn't much over 7 pounds.

[rlandnl]

Thnks guys! I read them all quickly between nursing sides so I will have a better reply later but I did want to say, yes I had lots of IV fluids (GBS+ and had 3 doses of the ABX) plus another bag or 2 with my epidural....

Also she has about 10 diaper changes a day, and there is poop in every single diaper... not always a lot but something... she has a couple big ones a day

also the scale is pretty hard to read, it's from probably the 60's maybe the 70's and it's a old dial scale it's hard to get her to lay on it, and when she does I am conviced she's gonna roll off...

[lyterae]

Originally Posted by SubliminalDarkness

I'll disagree with the last poster.... Not all babies regain birth weight by 2 weeks, especially if there was a rough start to nursing. My DS2 didn't regain birth weight until a few days over 3 weeks old. And the pediatrician was absolutely fine with that because he was gaining, his diaper output was fine, and he was responsive and behaving normally for a baby that age.

I also think it's incorrect to think all babies will gain an ounce a day. That would mean all three month old babies should be about 5 1/2 pounds over their birth weight, and that simply doesn't hold true for all babies and is an unrealistic standard.
.

I wasn"t trying to say this was the gold standard, just in the books I have read it is recomended that babies regain birthweight by 2 weeks and that they gain about 6oz a week until 3 months.

[Pepper44]

It's hard to say for sure since this is just over the internet, so you should obviously follow your instincts first, but I would not supplement. It sounds like you have plenty of milk based on her diaper output.

Are her poops mustard colored? Do you think she's getting enough of the fatty hindmilk? If you have oversupply or just a lot of milk maybe she is only getting the watery foremilk and not enough calories. I had that problem with my first DD. If that could be the issue try block nursing! Also find an LC with specialized accurate breastfeeding scales so you can weigh her before and after eating and find out exactly how much she's taking in.

I would also consider finding a different doctor, one that has knowledge about breastmilk.

You can call an LLL leader for more advice, and it will be free. The LLL has helped me SO much with my breastfeeding relationships.

[rlandnl]

she just nursed 20 mins each side, I didn't hear a lot of swallowing but DS is home so things are louder here.... however while hubby was burping her after she spit up all over him... herself, his shirt his pants, really if she wasn't getting enough would she be doing that????

ugh this is so hard I feel like such a failure

[SubliminalDarkness]

Originally Posted by rlandnl

she just nursed 20 mins each side, I didn't hear a lot of swallowing but DS is home so things are louder here.... however while hubby was burping her after she spit up all over him... herself, his shirt his pants, really if she wasn't getting enough would she be doing that????

ugh this is so hard I feel like such a failure

You shouldn't feel like a failure! IMO, the person at fault here is your pediatrician, for making such a statement based only on an arbitrary number. There are very few absolutes with children, and growth is certainly not one of them.
From what you've said, I absolutely would not supplement. I truly see no reason to, at all. She's growing, she's eating, you're producing milk, her output is great..... What is there to gain by supplementing?

[crystal_buffaloe]

You are not a failure, and with the info you've given us (her diapers and her behavior), I would not supplement -- and if you feel you have to, for goodnessake, please use pumped breastmilk (and hopefully via SNS).

I would be VERY suspicious of a doctor saying to supplement with forumla versus supplementing with pumped breastmilk "because we know how many calories are in formula." UGH! BLAH! BAH HUMBUG! Breastmilk is more calorically dense than formula. Breastmilk is better than formula!

Get thee to a BFing friendly ped and an LC!

[Devaskyla]

I agree to try block feeding. Also, if you're using nipple shields, you really need to be doing compressions while nursing.

I've used nipple shields with 3 babies now. My oldest never did wean off them & we did have some supply issues early on. My other 2 eventually weaned off them & never had any major issues because I used the compressions very time.

[AislinCarys]

You can check if she's swallowing by putting your finger on her neck, below ear/chin. You should be able to feel it. Much easier than hearing it at this early stage.

Check out drjacknewman.com

There's a lot there about low supply/gaining issues, and plenty on getting sleepy babies to feed!

My DD was fairly sleepy, and always on the breast, lost weight and we found that she wasn't swallowing much. And by then, at least, I had low supply.

I wouldn't give formula, but I would contact a good LC.

[ewe+lamb]

Can you go to a LLL Meeting near you, you have lots of support over the internet but you need lots of support around you as well; to surround yourself with women who want to/do/have breastfe(e)d to give yourself the best opportunity possible to continue - maybe find a new ped who will work with you to continue breastfeeding too - just talk to the other mothers.

LLL have also just brought out the new 8th edition of the Womanly Art of Breastfeeding, it's a fantastic inspriational wonderful book which will give you all the information and support you need to continue doing what you KNOW is right for your baby.

Block nursing and compressions, getting a really good latch are all imperative too, you can try this too www.biologicalnurturing.com, also keep resting - difficult with a toddler I know but do try to get some rest and if possible - don't know if you already do this but you could co-sleep - babies can take up to 60 per cent of their daily input during the night - could be worth a shot.

Keep posting and hope you manage to work things out.

[rlandnl]

Thank you everyone!

this is all so new to me, I didn't have any trouble with my son, so I feel totalyl at a loss here. I nursed him for 3.5 years and it went wonderfully, his weight gain was perfect too.

It's funny about the compressions I do that naturally, I always did with my son, and I do with her too, I have no idea why.

I will look more into the block feeding as well, I did that with my son without knowing what it was, mainly because my left breast was producing more, and my left nipple is better. And I had been doing that with her but then when this whole weight gain thing came up and we saw the LC at her 1 week check up, I started alternating... right now, I am doing 20 min one side, 20 min on the other side every time I nurse.

The one thing I am still having trouble with is letting her sleep at night. I am so tired waking up is hard for me, so like last night she slept from 11:30-4:00 before she woke up. I *know* I should have woken her up but I didn't because I didn't wake up. Hubby is gone 14-15 hours a day, and he does what he can, but most of everything falls on me, so I am so tired. Do you think I should set an alarm and wake her up every 3 hours or something? or will she wake up when she's hungry?

I will be seeing a new LC early next week, it's the soonest I can get there since its an hour away and my son has school, and the weekend is coming soon (they are only there M-F)

I am going to look into LLL I was planning on it anyway since I went to a couple meetings when my son was almost 2 it was a nice support system when no one else I knew was nursing their toddlers....

Oh and we do cosleep, we have the crib sidecarred but she doesn't like to even sleep there, she only wants to sleep between hubby and I, usually pressed up against one of us. She is a very clingy baby, usually only napping if we are holding her.

Thank you all for the support. It's hard to believe that I had no problems with DS and this time, I feel like everything is going wrong. I hope that tomorrow she has gained some weight. I am also working on getting a hospital grade pump from WIC so that I can use BM to supplement. I have supplemented her with 1 SNS filled with 2oz of formula, and 1 bottle with 2oz of formula, but I think she was getting too much food actually because she spit up so much. But I can't wait to get the pump and stop with the formula. I really really didn't want to do it, but all I could think as I was nursing her was what the doctor said to me "I think she's hungry". That killed me as a mother to think that I am starving my child.

Let's hope that tomorrow she has gained at least 2 ounces and they will leave me alone.

[SubliminalDarkness]

Yes, that is one thing..... Babies should be nursing every 2-3 hours 'round the clock until they've regained birth weight. Once they've regained birth weight, assuming there are not weight gain problems, you can let the baby begin to nurse on demand only overnight.

[rlandnl]

Originally Posted by SubliminalDarkness

Yes, that is one thing..... Babies should be nursing every 2-3 hours 'round the clock until they've regained birth weight. Once they've regained birth weight, assuming there are not weight gain problems, you can let the baby begin to nurse on demand only overnight.

I was afraid of that. I don't mind waking her during the day, but I am surviving on so little sleep right now that I don't know how I can possibly function on less. A nap during the day is next to impossible, like otday had I laid down I would have had to get right back up because 7 y/o DS (with autism) had to come home from school on his 2nd day because he couldn't handle being there anymore...

Here is what her schedule for the past (almost) 24 hours looks like....

3:05 pm full diaper pee and poop
3:15- 3:35 nurse R
3:40-4 Nurse L - burped LOTS of spit up
4:00 small poop diaper
4:15-4:50 2 ounces formula via SNS on my finger
TOTAL FEED TIME 75 minutes
4:55pm big poop diaper
slept till 7:20 woke up with formula all over face- spit up (total sleep time 2:20min approx)
7:45pm big pee little poop diaper
7:50-8:15pm nurse L sleeping after (NO SHIELD!)
8:20- 8:40 nurse R @ 7 min delatched tried to burp- no burp, sleepy seemed full but her to nurse to the 20 minute mark after a diaper change at 17 minute mark.
8:40 big poop big pee diaper
9:35-9:45 nurse R
10:15pm little poop and pee diaper
10:30-11pm 2 ounces formula bottle via daddy
1am woke up didn't want to nurse just wanted to be moved closer to daddy and mama since she was put in the side carred crib at 11pm while we laid down together and fell asleep....
4am woke up diaper little poop and big pee
4:12-4:32 nurse L sleepy after 12 min, kept going till 20 min mark
4:36-4:56 nurse R lazy at 6 min, delatched at 10 min, relatched made it to 20 min, fast sleep will supplement at next feeding?
5:15am woke up again diaper pee
5:25am started to feed 2 oz formula in bottle ate 1/2 ounce and fell asleep
7:35am woke her up to bring DS to school
7:35 big pee diaper
8:25am pee and poop diaper, pooped through to her clothes
8:30am nurse L 20 mins face covered in milk, running down her chin and everything
8:55 nurse R 20 mins
no supplement she was sleeping
it's now 11:30am she's still sleeping, I had to pack her up into her carseat and go get DS at school, and she still didn't wake... I don't know when I should count from for her last time she ate? from when she finished? when she started?

So far in almost 24 hours - nursed 4 times on left* 20 mins each, 5 times on Right* 20mins each, 4.5 ounces of formula, 8 pees and 8 poops

Does that look right to you?? I do know there is the 5 hour gap from 11pm-4am, that doens't happen every night, and I will see about setting an alarm so that I wake her... I have to wake her every 2 hours? 3 hours? 4 hours? God I don't know how I am going to do this, because each feeding takes 40-75 mins depending on if I am supplementing that feed, plus diaper change times, she's up for approx 2 hours every time she eats at night (even before she was getting supplemented that's how long she is up), we go to bed at 11 and get up at 6:30am (well I do) so that means I wake her at 1 go back to bed at 3, get her up at 5 and am up for the rest of the day since I have to get up within the 2 hour time frame anyway... plus it takes me a bit to unwind and get back to sleep... often I have to take her out of the bedroom to nurse her since DH works 12+ hour days and has an hour commute each way, so I am wide awake and it takes time to get back to sleep. honestly I think it would just be easier to not sleep at all... because at least then I would be running on adreniline for a while rather than feeling sick (that's how I feel when I only get sleep an hour at a time...)

sorry this is so long, I am just thinking through it all in my head... I really wish DH could work less and not have to go in so early because he could get DS ready for school instead of me having to do it, DS is not independent at all in that regard, and I have to bring him and pick him up.

[pumpkinhead]

Originally Posted by rlandnl

she just nursed 20 mins each side, I didn't hear a lot of swallowing but DS is home so things are louder here.... however while hubby was burping her after she spit up all over him... herself, his shirt his pants, really if she wasn't getting enough would she be doing that????

ugh this is so hard I feel like such a failure

You are not a failure. Not at all!

I'm not an expert, but it doesn't sound like she needs supplementation at this point based on what you describe. The only thing that I would suggest is to do some breast compressions at the end of a feed so she's getting lots of hind milk. Don't automatically switch her to the other side when she starts slowing down.

I would want her weighed before and after a feed to see how much she's actually taking in. IS the an LC you can see? A local LLL who could weigh her? Could you rent a scale for a few days?

Are her poops really liquidy and/or green and frothy?