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feeling the pressure to suppliment after a c-section

1155 Views 23 Replies 20 Participants Last post by  wombat

My wife is a little frustrated since it seems like our entire birth plan has gone out the window. I guess there is only so much that supportive midwives and doulas can do. My wife ended up getting an epidural, pit, and a c-section... all things that we REALLY wanted to avoid!

Our beautiful baby daughter has now lost 10% of her birth weight (6.5 lbs, down from 7.4) after 48 hours, and of course the nurses are suggesting supplimenting by formula. Our pediatrician is being supportive and understands all thre reasons to stay away from formula, but she had mentioned ealier that 10% weight loss is approaching her tolerance limit.
The midwives say that after a c-section, it takes around four days for the milk to come in.

We're getting colostrum by the drop, and trying to pump to help the milk come in. Our daughter is only latching on for about 5 minutes every two hours. Lots of diaper action (hence the weight loss), and (obviously) some jaundice. First baby for my wife.

Any suggestions??? What amount of weight loss should we tolerate?
What should do as we approach that limit? Any suggestions as to what we might suppliment with?

We tried asking the pediatrician about supplimenting with pedialyte, but she wasn't really receptive to that.
There aren't any milk banks or milk sharing programs nearby.

Not supplimenting with formula is the LAST VESTIGE of our birth plan, so it's really psychologically tough for us. We don't want to give in to the pressure and suppliment with formula.


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Some thoughts...

I was put through the same thing (c-section instead of waterbirth etc..) and I REFUSED their nasty fake milk even though my babe lost an entire pound. He was the same weight as yours! He gained back his birth weight in a couple of weeks and is now 24#s and 13 months old. No harm done!

I did say "fine" to the glucose water when they wouldn't back off. We used a syringe with a thin tube slid in next to my nipple. He hated it! My milk came in on day five. I think leaving the hospital helped immensely!

Is the babe rooming in and sleeping next to or with your wife? Instant access is vital. She should be topless with the babe on her chest as much as possible so baby can root and latch at will. I had my sister bring a breast-feeding pillow to me so that I could nurse him without hurting myself.

If you are getting truly worried, are there any friends of yours that could pump for the baby, or even come and nurse her?

If you do end up with a supplement, use a syringe or cup, because a bottle will majorly *bleep* things up even more!

Finally, insist that the doctor spell out exactly what the concerns are and the medical evidence against losing more than 10% of birthweight.

ETA... Oh yeah, the Iv and drugs we c-section mamas get can cause an infelted birthweight too. Make sure you question the docs about that. I found that pressuring them for statistics and real data will sometimes get the ones who have an agenda to back off!
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I basically had the same experience. I was all ready for a birth all natural but baby had other plans as she was breech. I had a csection, baby was jaundice and by the second day, baby's jaundice got worse and i was told that i needed to give her formula in order to get rid of the jaundice. being a first time mom and weak and weepy from the surgery, i gave in and had them give her a bottle since i didn't know at the time how common jaundice really is. this then started with difficulty with latching on and i struggled for a solid 2 weeks. my milk didn't come in until day 6 and i was FrEAKING out until then. this long rant is basically saying that if i ddid it over again, i would in no way give a bottle again. as frsutarting as it is, let your wife nurse as much as she can, it'll all work out and baby will gain weight sending you lots and lots of positive vibes your way....
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hugs to you and your wife. here is a great website about breastfeeding after a csection:
(this website caters to plus sized moms, but as it says, it has great information for moms of all sizes).
I am not sure what weight loss is acceptable in babies (actually I just googled it and one source said between 5 and 10% - so you are still within the normal range). I know that they pumped me full of fluids for my c-section and I question my DD's birth weight (and a lot of wet diapers I think shows how much fluid actually got to the baby). She came out 9lbs 8.5oz and left the hospital at 9lbs. Her lowest weight was 8lbs 14oz. She hadn't gained back her birth weight by two weeks, and the ped told us to supplement because of this - and we supplemented for two weeks. I also had additional problems with tongue tie so my milk never got properly established. I ended up seeing a doctor who was an IBCLC who gave me a prescription for domperidone to help my milk supply. We got back to exclusive breastfeeding and are still bfing at six months post partum. I would ignore the nurses and ask to see an LC or call LLLI for help - make sure her latch is good. If you do supplement, use an SNS or some other non-bottle method to supplement. Perhaps your wife could try pumping in between feeds to get her milk in faster? I guess ask a LC about that. I was very upset about the c-section (and am currently experiencing PPD and PTSD because of it) and being able to breastfeed helped heal some of the hurt. It sounds like you are a great partner (like my DH!) and are very supportive of your wife, that will help ensure her success with breastfeeding.
Good luck.
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Both of my sons lost about a pound and I never supplemented them and they are fine and large! It is normal to lose weight. My milk didn't come in until day 5 with my 1st son and it was fine and he nursed like a champ. My 2nd son took weeks to figure out nursing effectively and he is also fine and big! Just keep putting them off and nursing the baby and when you get home it will be fine. Starting formula supplements causes a lot of problems. Babies whose moms got IV fluids come out heavier than they would have been b/c they got extra fluids, too, so don't worry.
After my cesarean, my dd's nursing sessions were super short - usually 5 minutes and only taking one side. I always felt like she wasn't eating enough, but it turned out that she was just a very efficient nurser. She kept her 5 minute/1 side pattern for the first several months of her life.

It only took my milk 36 hours to come in, so please keep in mind that it may not be 4 days for your wife as well. Lots of diaper action seems like a good thing to me.

I wouldn't worry yet, honestly. Stand your ground and advocate for your wife. I imagine she's in a bit of pain and emotionally shaken up - she may not be able to stand up for herself and her baby right now.

Good luck and I hope everything goes well for your family.
Here's another current thread about this issue, hopefully you'll find it reassuring:
Do you know anyone who's breastfeeding currently that you would trust to nurse your babe for a session or two to appease the docs? If so, keep it short, you don't want baby tanking up and not stimulating mama's milk!
I had a c-section also and from what I remember my milk came in 3 days later.

I was VERY surprised my hospital did NOT push formula because by that point Holden had lost about 10% of his birth weight. I think since he was having plenty of wet diapers, they weren't worried. Plus I had told them no formula, and they had a big sign on his isolet saying so. This was a very pro-breastfeeding hospital so that could be why too.

I came home on a Saturday (my milk came in a little bit the night before) and by Monday Holden had gained half a pound!! The lactation consultant was amazed and so was I! Once my milk came in he was just fine.

I wouldn't give up just yet, do they have lactation consultants at the hospital?

Try to get that baby to nurse as much as you can and hang in there!

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Get a lactation consultants, LLL (La Leche League) leaders, or knowledgeable, supportive, pro-bf friends/acquaintances by your wife's bedside right now.

Learning to bf can be difficult, and it is especially hard if you have medical "experts" standing there saying you are HARMING your child by not supplementing. Surely "they" know more than you, right??? Well, let me say that I got HORRIBLE advice about bf'ing from my doctor and some other folks at the hospital.

My son was jaundiced and received phototherapy shortly after he was born. I was told that they HAD to supplement him. I refused. They kept insisting. DH said okay. I still said I didn't want them to but allowed it ONLY if I were able to nurse him first before any supplementation and a syringe be used instead of a bottle. So the first time they gave him the syringe with formula he took like 3 cc's and wouldn't take anymore. I was so proud of him!!! They never tried to supplement him again.

I also had a c-section and my milk actually came in on the second day. I was SO relieved. Your wife's milk could come in today. I would definitely give it more time. You've gotten some great suggestions here. I think the wet diapers are a really good sign and as long as those continue, I wouldn't worry too much.

Sorry the birth didn't go like you wanted. But congratulations on your wee one! Things will definitely get easier day by day and before long this will be a memory.
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they don't know what is normal for a breastfed baby because they take care of so many formula fed babies. they are operating from a knowledge base in a different subject- your infant right now is the way nature intended- they put on weight in the last few weeks of pregnancy because it is a biological fact that the milk won't be in for a few days.

as far as the jaundice, SUNLIGHT was meant to help with that, but kind of hard when you're stuck inside a hospital!

I would continue to refuse the supplement, and like a previous poster mentioned, ask for some medical information, like some reports or papers or references in a peer-reviewed study supporting their allegation that losing more than 10% body weight is dangerous and requires formula supplementation. they won't be able to give it to you because it doesn't exist.

IF you are forced to give formula, do it with a syringe at the breast, and give SMALL amounts. NO bottles as that could permanently destroy the breastfeeding relationship. when you get home, as long as baby is having 6 wet diapers per day, toss the formula and just bf. as far as pumping, save those drops of colostrum so that if you do supplement you can mix them w/ the formula. pump for 20 minutes at a time, 10 minutes isn't usually enough to get a good letdown in the beginning.

keep in mind formula supplementation is the #1 reason bf'ing is ruined. do whatever you can to avoid it. go home as soon as she feels good enough, tell the pediatrician you'll come into the office every day if they try to say you can't go home yet. when you get home bring the baby into sunshine as much as possible to counteract the jaundice. good luck. congrats on your new baby. getting through these first few weeks is difficult! but you can do it.
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I'm the wife of PrairieDad who had the problems with this issue. I'll post an update here now about what is happening, and clarify what happenred before.

Our baby was born at 7lbs 3oz. My birth experience will be posted in the april due date clubs, so you can see how frustrating it was, and how absolutely exhausted we were by the end of it. It was a necessary c-section in the end due to really bad malpositioning (and yes, I tried everything!), so that's where we stood. I should also mention here that I have PCOS (although it is mild), which can also affect supply/milk coming in issues. I'm also sure that the difficulty with the birth had something to do with it- it was violently terrible at times- and my complete and utter exhaustion, coupled with the fact that we had terrible roommates in our non-private recovery rooms (ugh), all had something to do with it.

At the time of my husband's post, literally all we were doing was nursing and using my breastpump (ameda purely yours) all night long. I had already seen two lactation consultants, who verified the latch was good. I just had no supply.

The ped was worried initally due to a) weight loss and b) high bilirubin level. I know these are common in breastfed babies, and she knows that too. She's very pro-breastfeeding, and we talked about it. She agreed to give us one more night to feed, feed, feed, and see what happened, although it went completely against her personal guidelines.

What happened was our daughter became much more ill. At this point, she was basically nonresponsive. This was an extremely upsetting time- it is still upsetting me greatly, and is difficult to post about. We were doing EVERYTHING to just get her to latch on for only one second or two. A 20 minute pumping session yielded less than 1 mL of colustrum from both breasts together. We still fed that to her, but it was.. just breaking my heart. Her mouth was so dry she could hardly latch on- I had to wet my nipple or finger just to get it in there. Her lips were chapped, her fontanels were looking shrunken, and it was very obvious she was not well. This makes me literally cry just typing it right now.

The next morning (after a run in with a BITCH of a nurse who said in a scolding tone "do you know she is running a TEMPERATURE? Do you know she lost more weight last night?!" We said, "no, and yes, and so what is her temp? Oh, you don't know? What were her lab results? Oh, don't know that either? " We then saw the ped, who was annoyed that the nurse who basically eavesdropped on her conversation said those things. She totally pooh-poohed the temperature, but said she had lost even more weight since they last weighed her and was obviously dehydrated. Her bili level was over 15. There really was no question at this point to suppliment, mostly becuase her behavior made it nearly impossible to eat. This was one of the hardest decisions we had to make. We started supplimenting yesterday morning.

So we are supplimenting at least .5oz up to 1oz of formula every two hours. The plan suggested by my ped goes like this: 1) breastfeed ALL YOU CAN. 2) pump for at least 10-20 minutes to build the supply. 3) suppliment with formula using manual syringe feedings. This means, basically, this is ALL WE DO. The lactation consultants at the hospital actually don't like the supplimental nursing systems, as the baby can actually learn to latch on to the tube. We recognized this when she tried to latch on to the syringe, so we can put it in an area of her mouth where it isn't possible, etc.

So today we had to go back into the clinic to have a bili level drawn and have her weight checked. She is back up over 4oz. She still has a high bili level, and might be admitted to the hospital after another checkup tomorrow if it's still high (15.4). However, sometime last night after probably 5 suppliment feedings... she just WOKE UP. She is a different baby. She's no longer dehydrated. She will open her eyes. She latches on to me over and over (we're still working on her STAYING latched on), and has nursed better than she ever has. She also eats at least a full oz of formula every time. I also pump every other feeding, and I'm getting more each time, and it looks like my milk will start in soon! I only have to suppliment until my milk comes in. She has not lost her latch.

SO, I think this story shows that sometimes supplimentation IS NECESSARY!! However, you can do it in a way as to not only preserve the health of your child, but preserve the breastfeeding relationship. The breastpump is absolutely essential, as are the constant attempts to breastfeed as encouraged by our ped. I hope that in a few days this will no longer be an issue, but really really hope the jaundice gets better! I have to realize that I did not hurt my baby due to some sort of "pride" in our birth plan- we were just so destroyed by that point, and we so wanted every chance to avoid her ever, ever touching formula.

Thanks so much for all your comments and suggestions about this issue, we both really appreciate it.
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Glad to hear she's doing better!!
I came here today to see if you had an update.

I hope your milk comes in soon. Glad to hear that your supplementing hasn't hurt your bf'ing relationship, keep up the good work mama!
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The c-section should not affect when her milk comes in. 3-7 days is perfectly normal for milk to come in.
She should be fine at 10% loss. I'd personally want to wait a bit longer.

Perhaps do some pumping to help stimulate the milk.

Also contact a Certified Lactation Consultant and see what she suggests.

I really admire your devotion to your babe. It sounds like you're handling your difficult situation beautifully. I hope you and your daughter are feeling much better very soon.
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Congrats on your new baby!!

This underlies what I've said before- sometimes supplementation is necessary, but bottles never are!! It's unfortunate that you don't have access to donor milk to use in lieu of the fake milk- but all in all, this is certainly a time when supplementation is appropriate!!
no one in their right mind would argue against feeding a baby who is becoming moderately jaundiced and dehydrated. my baby was lethargic and non-responsive for her first couple weeks of life, mildly jaundiced, couldn't nurse due to cleft palate. because of NICU restrictions she was formula fed until my milk came in, which was against my wishes, but by the third day I would have wanted her to have the formula anyways.
if baby still isn't nursing, make sure you pump 8x per day, 20 min each time, the pump isn't as good at establishing a supply as a baby is but it can certainly be done! hopefully she'll develop into a champ nurser soon!
Congratulations, mama. Your devotion and commitment to your daughter is an inspiration. I wish you the best of luck and I hope that you are able to put all this behind you another mama who had a hard, difficult birth experience that was very different from what we had dreamed of and planned for, I send you hugs.
if you don't know already, try to get some vitamin e oil on your nipples after all those pumping and latchings on and off. it will help you to be less sore and ensure that the bf relationship stays good!

glad to hear that everything is moving in the right direction. i also had a birth that was the opposite of what i wanted in the end, but have a beautiful son and am very thankful. keep up the love and committment. that's the most important thing!
With the dehydration it sounds like supplementing was the correct thing to do in this case. And, just because you are having to supplement now, doesn't mean you always will. I had to supplement for a while and haven't had to give any formula for 4 months now (DD is 6 months). Sounds like you are working really hard to do what is best for your babe, keep it up!
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