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Hi mamas,<br><br>
A quick background: I'm a postpartum doula who's helping out a friend. She just had her second baby two days ago via cesarean section. Her first experience with breastfeeding was quite challenging - her son lost more than 10% of his birth weight (also born via c-section and was a large baby at 10lbs 14oz), had some latch issues and was supplemented with bottles from the get-go. She was virtually traumatized by the experience and gave up on pumping and nursing after six weeks.<br><br>
I met her a few months ago and agreed to help her out. Her husband is skeptical of her breastfeeding again and her in-laws, who live next door, are strong opposed to the idea. Her support system is very limited and coupled with the lack of confidence in herself from the previous experience, she's left feeling very worried and vulnerable.<br><br>
Anyway, here is the current situation. The baby is about 36 hours old and has apparently lost 8.5% of her birth weight (originally 7lbs 5oz). The nurse is already threatening supplementation if she gets to 10%. The baby's latch and positioning requires a bit of work but I've helped her get a good latch and can hear some swallowing, no clicking... The baby is sleepy, but easily roused with undressing. Overall I think she's on the road to becoming a breastfeeding champ with only a slight learning curve for mom.<br><br>
Re: the baby's weight loss: She's had several meconium stools already and still has some fluid in her upper respiratory that she's been bringing up. I think a great deal of her weight loss is linked to these things. Also, mom's milk isn't "in" yet, although she's making a good amount of colostrum. I've told her that this is normal and have recommended keeping the baby on her, skin to skin, as much as possible over the next few hours, nursing frequently (with good latch and positioning, which we've been working on.) I'm hoping that by tomorrow her milk will be more abundant.<br><br>
Her concern is that if they want to give the baby a bottle they'll perpetuate the latch and supply issues in the long run. They want her to pump, but she has very sensitive skin and ended up bruised and blistered from the hospital pumps the last time. I hope to help her hand-express <i>if necessary</i> and cup or finger feed. I'm hoping we don't get anywhere near that, though.<br><br>
I think the biggest hurdle here is her confidence level. Secondly, the sooner she's home from the hospital and more relaxed, the better.<br><br>
Any experience, suggestions are welcome. Anything I can say to this mom that could help her stay strong? I know she wants to breastfeed more than anything... She just has to get through the first few days.
 

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You've said it--she just needs to keep going for the first couple of days.<br><br>
There are better ways to evaluate dehydration than just weight checks. Also, if the baby is two days old, the mom's milk could arrive with a vengence tomorrow.<br><br>
There's one other thing; I personally think that a lot more is made of nipple confusion than the reality. Maybe for some babies who's suck reflex is compromised, nipple confusion is a huge issue. For my babies though, when they were hungry, they weren't that picky. Even if this baby gets a bottle or two of formula, the mom shouldn't give up! It will take a couple of weeks to get nursing down in a secure way--two or three bottles won't change that much. She can do this.
 

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My baby basically didn't eat for the first three days, she lost about 10% of birthweight, wasn't peeing or pooping much after the initial meconium. Then at about a week she figured out how to actually nurse, took a while to gain the weight back, and all was well.
 

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Something else to keep in mind about "if the baby needs supplementation"- it doesn't have to come from a bottle!!! Babies sometimes do need supplementation, but they never "need" bottles! Even one or two bottles can interfere with a baby learning how to latch on (doesn't always happen, but it can) and this kind of damage is much more likely to happen with newborns than older babies.<br><br>
If the baby does need a little formula (or they decide to give it even if it's not an absolute necessity) I'd encourage them to use an oral syringe (generally designed for giving meds to babies) rather than a bottle. Finger feeders are even easier to use, but that requires specialized equipment that they may not have access to. Every drugstore and baby store sells the oral "medicine" syringes.<br><br>
Also, if they do use formula, remind them that they don't need to use a whole bottleful at one feeding. They can give the baby an ounce or so between nursing sessions, and discontinue the formula as soon as her milk increases in volume.
 
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