Newborn losing weight- trying to figure out what's happening - Mothering Forums

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#1 of 15 Old 08-11-2013, 11:24 PM - Thread Starter
 
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This is long but I am trying to be as concise as possible.

 

My sister, L, had her first baby, A, ten days ago and they are having some problems with breastfeeding. She was 8lb6oz at birth (08/02), 08/03 she was 7lbs12oz, 08/06 she was 7lbs3oz and 08/09 she was 7lbs2oz.

 

L has one inverted nipple and A didn't latch very well on that side, L didn't try very hard to get her to take that breast. A also has a fractured clavicle from birth that seems to bother her when we try to put her on the side with the inverted nipple. So she was feeding only on the left breast and her nipple became very sore. The nurses in the hospital were not very helpful, kept asking her to give formula, and the one LC the hospital employs was apparently on vacation. So, L got really discouraged but she is very committed to nursing.

 

Once we came home from the hospital, nursing seemed to be going okay. A was feeding every 2-4 hours but she was very sleepy and somewhat jaundiced. She would sleep 4-5 hours at night, she was really hard to wake up. L did not really want to wake up to nurse at night because she was exhausted. We tried pumping the right breast (the one with the inverted nipple) a few times and syringe feeding, but we only got an ounce or two each time so L didn't really want to bother.

 

We went to well baby check on 08/06 and the ped was concerned about A's weight loss so we saw an IBCLC on 08/08. The LC didn't seem too concerned. She told L to use a nipple shield on the painful nipple (L was seriously wincing in pain when A latched) and not to bother trying to nurse on the inverted side. She said we should pump that side and give A milk with a finger feeder. So we did that but L still didn't really want to pump, baby was still sleepy.

 

At the weight check with the ped 08/09, A was still losing and the ped gave L a lecture that freaked her out and made her feel suuuuper guilty. She told us to give 2oz of milk after every nursing session, whether BM or formula and be sure to put A to breast every 2 hours on schedule.

 

Well, L can't pump enough milk to give 2 oz after every feeding and A won't take that much anyway. We could give her maybe 1oz after feedings (mostly BM but some formula) and even that was a huge struggle to get her to take it.

 

So, I have L taking fenugreek and blessed thistle, lactation cookies and tons of food and water. A has been wanting to nurse pretty much constantly and we are pumping as much as possible, though she doesn't really come off the breast long enough to take any expressed milk. We got her to take the inverted side finally today with the nipple shield; the other nipple is still really hurting.

 

We go for another weight check tomorrow, so hopefully it's working. Issues that remain, though: (1) A has plenty of wet diapers but only maybe 1 dirty every day or day and a half. It is dark, kind of greenish with some yellow; and (2) I'm concerned we are creating latch problems by using the nipple shield.

 

So basically.... ADVICE PLEASE! :)

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#2 of 15 Old 08-12-2013, 12:06 AM
 
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Is there another lactation consultant in your area that she can see? There's got to be somebody who can give better advice than not nursing on the inverted side and using a nipple shield to treat discomfort.

 

At this point, I would expect baby to have a poopy diaper at least every day, hopefully several a day. The poop should be yellow and seedy, like mustard mixed into cottage cheese.

 

diaper photo of breastfed baby

 

http://www.breastfeedingmaterials.com/view-breastfed-baby-stool


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#3 of 15 Old 08-12-2013, 12:34 AM - Thread Starter
 
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There is one other IBCLC in the area ( the one from the hospital who was on vacation). She told us to go to the one we saw, who is through WIC. I thought that was weird advice too. We could try again with herr, maybe. There is an LLL meeting tomorrow morning, so maybe some help there. Her poops don't look like any of those so I don't know.

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#4 of 15 Old 08-12-2013, 02:50 AM
 
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I would definitely go to the LLL meeting.

Does the inverted nipple protrude at all when she uses the pump? I'm wondering if you could try pumping a bit first and then attaching the baby to the inverted side.

Wanting to feed all the time is good I think, it will help with milk supply as long as she is attached properly.

How many days has she been using the nipple shield? It can create problems with mill transfer. I found it useful for a few days to help my nipples heal a bit but my babe did lose weight in those days. I would suggest she try again without the shield - maybe tomorrow at the LLL meeting with someone giving her attachment advice. It will probably still hurt a bit but be bearable. That was my experience.

It would be great if she would feed more overnight. 1am-5am are when prolactin levels are at their highest so feeding then is great for supply. Can she feed her every 2hrs overnight and then get someone else to look after the baby so she can have a sleep during the day?

Also staying in bed with lots of skin to skin contact and feeding can be good for supply as well. If they could both stay in bed, shirts off and just feed, feed, feed for 48 hrs that might help.

At LLL tomorrow I would specifically ask for help with attachment on the inverted side (try a different hold if the clavicle is still painful) and coming off the nipple shield on the other side.

Also it may be that she just doesn't want to breastfeeding that much. You mentioned 3 relatively simple things which she didn't want to do. That may be her way of telling you that she has done all she is prepared to do in these circumstances.

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#5 of 15 Old 08-12-2013, 05:44 AM
 
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That's a lot of weight loss for a baby.

 

In this situation, honestly, I would offer some formula.  I'd even offer it first - it may be that the baby is having trouble getting milk out of the breast, or pain from the fractured clavicle, and by the time she gets to the post-feeding milk in a bottle, she's just too exhausted.  I also worry about the jaundice.  If she's not eating enough, she won't be processing the bilirubin out of her system, and the jaundice could be getting worse.

 

I think the nipple shield is the least of your problems right now.  If it helps, use it.

 

I hope that A wanting to feed all the time is a sign that things are turning around, and that she's getting milk and gaining weight.

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#6 of 15 Old 08-12-2013, 07:43 AM
 
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I too would offer some formula. If her supply issues resolve, he can wean off of supplements then.

But in the mean time, a super lethargic baby losing that much weight needs to EAT.

Playtex's Vent Aire slow-flow wide nipple bottles are the most like real nipples I've ever seen. Babies latch on just like at the boob.

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#7 of 15 Old 08-12-2013, 08:19 AM - Thread Starter
 
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I haven't posted much on mdc before and I can't seem to get the quote function to work the way I want it to, so please bear with me.

Quote:

Originally Posted by katelove View Post

I would definitely go to the LLL meeting.

Does the inverted nipple protrude at all when she uses the pump? I'm wondering if you could try pumping a bit first and then attaching the baby to the inverted side.
It protrudes a little when she pumps but baby will only latch for a few seconds, then she pulls off and screams.


Wanting to feed all the time is good I think, it will help with milk supply as long as she is attached properly.
How many days has she been using the nipple shield? It can create problems with mill transfer. I found it useful for a few days to help my nipples heal a bit but my babe did lose weight in those days. I would suggest she try again without the shield - maybe tomorrow at the LLL meeting with someone giving her attachment advice. It will probably still hurt a bit but be bearable. That was my experience.
She's been using it since 08/08. It seems like baby is getting milk, every time she pulls off there's milk in the shield and L's breasts seem to be soft after she feeds. She is still wincing when baby latches even with the nipple shield so I don't know. I didn't know if her latch was right without it but IBCLC said it was.


It would be great if she would feed more overnight. 1am-5am are when prolactin levels are at their highest so feeding then is great for supply. Can she feed her every 2hrs overnight and then get someone else to look after the baby so she can have a sleep during the day?
She is feeding more at night now but not as much as during the day. I didn't know that about prolactin, how interesting. I can take care of baby during the day but she just wants boob all the time the past two days.


Also staying in bed with lots of skin to skin contact and feeding can be good for supply as well. If they could both stay in bed, shirts off and just feed, feed, feed for 48 hrs that might help.
They are doing this already.


At LLL tomorrow I would specifically ask for help with attachment on the inverted side (try a different hold if the clavicle is still painful) and coming off the nipple shield on the other side.

Also it may be that she just doesn't want to breastfeeding that much. You mentioned 3 relatively simple things which she didn't want to do. That may be her way of telling you that she has done all she is prepared to do in these circumstances.
I have asked her a few times about this but it seems like she just didn't realize breastfeeding might be hard? I don't know, she seems willing to do everything now.
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#8 of 15 Old 08-12-2013, 08:25 AM - Thread Starter
 
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Quote:
Originally Posted by MeepyCat View Post

That's a lot of weight loss for a baby.

 

In this situation, honestly, I would offer some formula.  I'd even offer it first - it may be that the baby is having trouble getting milk out of the breast, or pain from the fractured clavicle, and by the time she gets to the post-feeding milk in a bottle, she's just too exhausted.  I also worry about the jaundice.  If she's not eating enough, she won't be processing the bilirubin out of her system, and the jaundice could be getting worse.

 

I think the nipple shield is the least of your problems right now.  If it helps, use it.

 

I hope that A wanting to feed all the time is a sign that things are turning around, and that she's getting milk and gaining weight.


We have been offering the formula/ expressed breastmilk but she won't really take it. I think L's heart will break if we offer it first. Of course we will if we have to, but hopefully her weight is up when we go to the ped today. Jaundice is definitely getting better, or at least it looks like it.

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#9 of 15 Old 08-12-2013, 09:18 AM
 
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I hope it is up! It sounds like you have been makings huge effort.
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#10 of 15 Old 08-12-2013, 03:29 PM
 
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Originally Posted by aimeem View Post


 I think L's heart will break if we offer it first. 

 

This is no doubt true, but a necessary sadness possibly. I have supply issues and the first time my LO took gleefully to a bottle full of donor milk in the hospital from a nurse, I cried in my husbands arms for an hour. Then we tried to not do supplements after that and ended up with a baby who would could nurse seemingly peacefully, then begin wailing again if she didn't just sleep for 6 hours instead getting frightfully lethargic.

 

The next time I gave her a bottle, and saw her chug it immediately and suddenly look livelier and happier, I cried again. I still get a little sad everytime I see her take to anything but my bare chest. 


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#11 of 15 Old 08-12-2013, 04:51 PM - Thread Starter
 
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So, news is that baby is up 1 oz since Friday and she also grew half an inch longer. The ped is okay with this gain and we have another weight check on Wednesday. We saw a different ped today and she thinks that we are on the right track with finally getting A to take both breasts. So I guess we are going to see the other IBCLC tomorrow and see what she thinks.
 

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#12 of 15 Old 08-12-2013, 06:20 PM
 
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Best wishes, I applaud your effort ( all of you!) .
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#13 of 15 Old 08-12-2013, 06:39 PM
 
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My experience with pain and nipple shields: my DD nursed a couple of times after birth and then started screaming and pulling away at every nursing session. She also lost quite a bit of weight in the first few days. I pumped constantly and DH fed her colostrum with a syringe for almost a week. It was completely exhausting. But it got us through and kept up my supply.

My IBCLC also prescribed a shield for slightly inverted nipples, but it was the wrong size. I measured my own nipples and learned they were two sizes. So I went to Babies r Us and got the correct sizes. It made a big difference--still painful but not as horrible as before.

The nipple shield was the only thing that got DD to eat, and it didn't negatively affect my supply. In fact, the local LLL Leader said that the new style doesn't ruin supply like the old style did.

I had wincing, crying pain with latch for a ridiculously long time. DD's latch was checked by a very knowledgeable IBCLC and I tried all LLL suggestions. Nursing finally stopped being excruciating around 3.5-4 months, believe it or not. We used the shields that whole time. Once DD's mouth was a little bigger (around 4 months), I tried getting her latched for a few seconds, taking off the shield, and putting her back. For us, I only had to do it a couple of times and we never used the shields again.

Is it possible that the breast pump is hurting your sister a lot? It hurt me at the beginning, so I had to start at the lightest setting and slowly work up to get more milk out. The hospital LC acted like I was a wimp for complaining about the pump. Maybe your sister ran into this too? Just a thought. And the pump attachments (the cone thing that attaches to the breast) come in different sizes, too! I had no idea, but when I got the correct size, the pump hurt less and was more efficient.

For supply issues, the mothers milk tea didn't help me at all. But eating oatmeal made a noticeable difference. I eat it for breakfast daily to keep up my supply (DD is 10 months now). Quaker soft oatmeal cookies were heavenly little snacks for me. She could try some of those!

It sounds like your sister is dealing with a lot of conflicting emotions right now. She's in love with her new baby but is in excruciating pain and is maybe feeling like a borderline failure (especially if her baby ends up needing formula). When it was me and my baby having issues with nursing, I needed endless encouragement and genuine reminders that I was doing everything I could, was an awesome mom, wasn't at all a failure, etc., etc.

I hope this helps! Nursing doesn't hurt now and I'm so glad I stuck with it.
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#14 of 15 Old 08-13-2013, 08:30 AM - Thread Starter
 
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Thanks for sharing your experience, it sounds like a lot of what my sister is going through.

 

She does have 2 different sized nipples, but I can't find the smaller size nipple shield anywhere. I tried target, toys r us and motherhood maternity. I guess I need to just order on amazon. We got a larger flange for the pump for one side and that helped a lot. The pump does hurt her, although it doesn't seem to hurt her as much as nursing. She has a medela harmony from the hospital, ameda purely yours from our insurance (for free!) and a hygeia double electric from WIC and they all seem to work about the same for her. We do start super slow/ low suction and work up to more intense pumping so she can tolerate it. I have also been wondering if baby's mouth is just too small to get a good latch and might be better when she grows bigger.

 

She hates the mother's milk tea and hates oatmeal but she has been eating a ton of lactation cookies that I made her.

 

Yes, she is pretty overwhelmed right now. She is young and has a lot of conflict/ stress in her life in general, feeling like a failure for getting epidural and then all of this on top of everything is a lot for her. I came from another state to take care of her for a few weeks and I'm trying to do everything for her so she can just stay in bed with baby. Her boyfriend is not very supportive of breastfeeding, cosleeping, etc that is important to her so that makes it harder for her too... hopefully things are on the upswing. She nursed in public for the first time today and it went really well. She seems to be in better spirits now that baby gained at least a little.

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#15 of 15 Old 08-13-2013, 12:04 PM
 
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You're welcome! That's wonderful news that her baby is gaining weight! I hope your sister can try to let it sink in that her baby is gaining weight (and also not losing weight!!) purely from her own milk! She's keeping her baby alive! That's amazing!

I'm glad the different sized flanges helped and am hopeful you can get the correct sized nipple shield quickly online. Again, for me, it helped but it didn't stop the pain completely.

Other pain relief techniques:
-- LOTS of ibuprofen (gel caps, specifically), literally like 800 mg every 4-5 hours;
-- the freezer chilled ice packs that you put in your bra between nursing sessions;
-- lots of lanolin after every nursing session (sometimes before helped me too);
-- turn baby to a different position. This was the one thing that helped me the most! I thought DD had to nurse in one of the three positions I had learned, but it's not true! I tried sitting her bum on my thigh (or on a pillow on my thigh) and bringing her to me sort of sitting up facing me. It made a big difference. We still nurse that way. Or I recline on a bunch of pillows with pillows under my elbows and lay DD on top of me--she nurses and then falls right to sleep. (Wish I had tried this early on. I would have gotten a lot more sleep.) The times I've tried the traditional positions recently hurt a lot. It must be something about DD's mouth shape.

I'm sorry to hear her boyfriend isn't very supportive. My DH's encouragement really helped when I was in so much pain. Maybe it would help to remind him of how much formula costs and that breastfeeding is (mostly) free. Also, is it an option for her (or you) to say something like "Look, this is important to me so I'm going to do it no matter what. However, it would be a lot easier with your support and encouragement." I've had to remind DH of that before.

My DH wasn't excited about cosleeping but it helped sell him by proving that DD cries less when sleeping by me. So we're all happier and getting more sleep. And DH was honestly scared not so much of cosleeping now, but he didn't want to be bed sharing with DD when she was a lot older. But neither did I. So I kept reassuring him that it wasn't forever. That helped him be more supportive and less anxious.

Regarding the epidural, I had one too and I REALLY wanted a natural delivery. But after many hours of really difficult labor, it was what I needed. Your sister did the best she could and was rewarded with a perfect, healthy baby! That's really all that matters. Once this nursing pain is dealt with, I hope she can relax a bit and enjoy cloud 9. The truth is that breastfeeding and childbirth are really hard, and they ARE harder for some women, but they're still totally worth it. It really won't always hurt so much. She just has to hang on until it gets a little easier. And something else: if she decides that formula is best for her and her child, there are NO hard feelings. It's her job as Mom to weigh the options and pick the one that's best for her and to trust that choice.

You and your sister sound like troopers for getting through a tough birth and for not giving up on nursing when you have so many obstacles against you. I applaud you both!

(Sorry, I'm long winded.)
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