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Thread: Low Birth Weight - worried breast feeding may fail

  1. #1

    Default Low Birth Weight - worried breast feeding may fail

    Hi,

    My 2nd daughter was born 3 weeks ago at 38 weeks she weighed 4lb 15oz which was big surprise (due to pre-eclampsia - diagnosed around week 36). On top of that I was due to be induced at 38weeks (because of the PE) but when they examined me to start the process the found no head in my pelvis and we discovered she was breech so ended up with a c-section (had planned home birth so obviously very upset).

    My daughter was given to me skin to skin within half hour after the birth and I got her latched on beautifully. I carried on trying to feed her for the next few days but sometimes she would latch well other times she wouldn't and she was extremely sleepy - had to be woken for all feeds.

    On weigh in she lost 16.5% of her birth weight which was very upsetting (she has no reserves). She had bloods taken which were ok but we were told to breast feed every 3 hours (maximum 15 mins) and express and top her up by cup with 42 ml of ebm.

    Tried this, cup feeding ended up disaster, daughter fought the cup and more ebm got spilt than eaten! All in all very stressful. Following weigh in she lost again so in dispair we tried the ebm by bottle. This worked well and her weight started to rise. So we did 3 hourly feeds with ebm by bottle top ups.

    She is now 2oz off birth weight and so we tried demand feeding but with top ups if a feed didn't seem sufficient. She started getting breast adverse and so I am keen to dump the top ups but cannot afford for her to lose weight. Her suck seems to have diminished and she is very fussy on the breast, gets upset after 3 sucks, fists clenched, pulling away. Then occasionally often evening (after day of top ups) she will manage a latch beautifully.

    I just don't know what to do, there is no way I could stop supplementing her ATM as her feeding is so unreliable but I feel we're on the slope to failure as she seems to want the breast less and less.

    After feeding my previous daughter for 13 months I am struggling so much with this. I so want to feed her but am not sure how to get her back to breast successfully whilst ensuring her weight does not drop. It is so upsetting to see her fight feeding like she does while showing obvious signs of hunger and as much as I loath giving her the bottle I have to say my relief knowing she's not hungry is immense.

    Not sure it is practical to keep expressing long term and not feeling confident that I can resolve the bottle to breast issue. Need advice, encouragement - is this normal with low birth weight babies, do I hang in there and hope or do I need to move on? Most of all I want to enjoy my new daughter but at the moment feel like I am not as I am so stressed trying to get feeding established, keeping my milk up and I have no time at all for much else which is detrimental to my other daughter.

    Is formula the answer? Is weight gain the higher priority over the benefits of breast feeding? Anyone had any experiences of overcoming these challenges?

    Thanks xx

  2. #2
    Join Date
    May 2006
    Posts
    20,626

    Default Re: Low Birth Weight - worried breast feeding may fail

    Welcome to the forum and congratulations on the new baby!

    First of all, how are YOU feeling? Pre-E and a c-section are a lot to recover from, especially after you'd planned a homebirth.

    Very small, premature, or early term babies are often sleepy and have trouble staying awake to nurse. I think you did right to start using the bottle- with such a tiny baby, who, as you said, has no reserves, you need to prioritize getting baby growing over the ideal "rules" of breastfeeding. That does NOT mean you must move to formula or feel like you're in a situation where breastfeeding success is opposed to weight gain. Just that you get the baby growing and nursing WHILE you work to get breastfeeding going smoothly.

    Has anyone suggested using an at-the-breast supplemental feeder? Medela makes one (Supplemental Nursing System) and there's another one called the Lact-Aid which a lot of moms seem to like better. Now that baby is close to birth weight, I think you might be safe to ditch the bottles and supplement baby at the breast.

    Another technique that may be helpful to you and baby would be something called "finish at the breast". You nurse, offer a top-up, and then put the baby back to the breast, so that she nurses herself to sleep, learning to associate the breast with relaxation, satiation, and pleasure.

    When feeding the baby by bottle, you can try making the experience as much like breastfeeding as possible by:
    - Cuddling baby close to your bare chest when bottlefeeding her
    - Tickling her lip with the bottle until she opens WIDE (don't let her learn sloppy latch habits by slipping a bottle into a half-open mouth)
    - Using a slow-flow nipple
    - Pausing the feeding after every ounce or so, to get baby used to the ebb-and-flow pace of breastfeeding
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3

    Default Re: Low Birth Weight - worried breast feeding may fail

    I agree with mommal. If supplementing is needed, try bottle first then finish at the breast, and/or try an lactation aid for supplements.

    How often are you pumping and what kind of a pump? In the early weeks you are trying to build milk supply as well as pump enough to feed baby. So a hosp. grade rented pump would be the best pump. The rule of thumb is to pump for every time a supplement is given or baby does not feed well, but basically pump as much as you can, do not pump INSTEAD of nursing. I hope you are no longer doing that feed every 3 hours thing.

    Is formula the answer?
    temporary supplements with formula MAY be the answer. A baby who is too small or weak to suckle effectively needs to be supplemented, either wiht breast milk or formula or both, if mom cannot pump enough breastmilk. The key is to protect your milk supply at the same time, by pumping and nursing lots, and protect breastfeeding by giving supplements in as breastfeeding supportive a way as possible. To do the latter, number one would be to use a lactation aid, (see http://www.nbci.ca/index.php?option=...tion&Itemid=17 and here there is a video of a baby using an aid: http://www.nbci.ca/index.php?option=...id=6&Itemid=13
    number 2 would be cup feeding or using paced bottle feeding techniques, adjusted as needed in order that a small, sleepy baby gets enough. http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Is weight gain the higher priority over the benefits of breast feeding?
    See answer above, supplementing in order that baby gains weight as NEEDED and supporting breastfeeding in teh long term can happen together. But it's important to understand how much weight gain would be normal and needed for health reasons, rather than pushing a weight gain rate that holds a small baby to an unnatural standard for growth.

    Are you getting any hands on assistance from you hcp, or anyone? A lactation consultant?

  4. #4

    Default Re: Low Birth Weight - worried breast feeding may fail

    I have little support, midwives are due to discharge me tomorrow and have offered little extra advice, to be honest I have felt they just want the weight gain to happen so they can tick their box and move on. I asked about a referral to a lactation consultant but was told they didn't think we were at that stage? I am in the UK and despite the NHS pushing the benefits of breast feeding I haven't found the support to be there backing this up.

    The problem with start and finish at the breast is that I can barely get my daughter to latch on at all now, she pushes back, cries, fusses, kicks her legs and clenches her fist - I have tried various positions and it seems to make little difference.

    I am at verge of giving up, today I bought formula with a very heavy heart. I am still pumping every 3 hours, it is exhausting and demoralising and is having a big adverse effect on our family, all our time seems to be focused on feeding. My husband is back to work next week so I will need to resume "normal" chores/school drop offs etc. I just don't think we'll be able to continue and I honestly can't see that my daughter will end up back on the breast.

    Honestly I feel a failure, I feel my body failed her with the pre-eclampsia and robbed her of the chance to gain extra weight inside me and now I am failing again as I haven't managed to establish the feeding - I know so far she's only had my milk but it isn't the same as breast feeding properly.

  5. #5
    Join Date
    Mar 2006
    Posts
    10,440

    Default Re: Low Birth Weight - worried breast feeding may fail

    I exclusively pump with four little boys around me. You can do it! But better if baby will nurse


    http://kellymom.com/bf/concerns/child/back-to-breast/

    I hesitate to suggest a nipple shield, especially fr a baby with weight gain issues, but it might help her latch on.

    I would suggest an SNS as well.
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  6. #6

    Default Re: Low Birth Weight - worried breast feeding may fail

    they didn't think we were at that stage?
    Jeepers. Are they aware you are ready to give up and formual feed? I would say you are well past the point an IBCLC should have been consulted. How does it work, do you have to be referred to an LC by your midwife? Are there private practice (fee for service) LC's there? What about your local LLL-have you contacted them? Your local LLL is a free resource that may really help.

    But, whatever is, is. Don't let your health care situation stop you from doing what you want to do. Many times moms simply have to figure this all out on their own. Remember the most important things: A baby learns to nurse by nursing & protecting your milk production relies on milk being extracted from the breasts frequently, by baby or a pump or both. This is a very difficult time, but things may feel better once you are home. Get as much help with everything else as you can. I forget-do you have a hospital grade rental pump for at home?

    If pumping every three hours works for you, fine. But a baby would be cluster feeding so no reason to not cluster pump (pump when it works for you) if that works better for you. If baby is not nursing at all, the idea is to aim for 10 pumping sessions a 24 hour day or as close to that as you can. See pumping log: http://www.llli.org/docs/00000000000...umpigchart.pdf

    If you are not already doing so, offer to nurse as much as you can, no need to wait for baby to cue, but of course also nurse at the earliest subtle cues. Let baby nurse as long as baby will or at least as long as you can get baby to more or less actively suckle. The advice to nurse every three hours for 15 minutes was very problematic advice, in my opinion, and along with the bottles, possibly led to the problems at the breast you are seeing now. Luckily, this is reversable.

    Link Susan posted above has really great ideas for encouraging baby back to the breast. I also suggest laid back/biological nurturing as a great way to gently encourage a baby to latch and nurse.

    Laid back: http://www.llli.org/docs/00000000000...astfeeding.pdf and http://www.biologicalnurturing.com/video/bn3clip.html

    feeding cues: http://www.llli.org/docs/00000000000...eding_cues.pdf

    You are not failing anyone. I would say you are being failed by your health care providers /system, so go ahead and get angry about that if it helps you, I was able to breastfeed my oldest despite great difficulies because I got so mad at my clueless pediatrician I basically breastfed out of spite. But do not get down on yourself. You did not give yourslef per-eclampsia! You did not cause the c-section! You have done amazing to provide your own milk to your baby so far, all while recovering from major surgery yourslef. BTW, after c-sections (I had two) it is important that your pain be managed properly but also be aware that narcotic pain killers can be very mood altering-depressing, in short.

    And what is proper breastfeeding? it's whatever you say it is. To your baby, you are not just proper but perfect in every way no matter what happens.
    Last edited by @llli*lllmeg; July 4th, 2012 at 02:24 PM.

  7. #7
    Join Date
    May 2012
    Posts
    48

    Default Re: Low Birth Weight - worried breast feeding may fail

    Hi,

    I have had two 38 week babies and a full term DD. 38 week small babies are soooooo sleepy. We have had similar problems. My son was 38 weeks and needed to supplement with the bottle and got bottle preference and only able to nurse him to 4 months. I am currently BFing my 2 month old who was also a 38 week 5lb 15 oz baby. It was such a struggle to keep her awake to feed. A few tricks I picked up:

    I REALLY recommend an SNS. (They sell them on Amazon BTW.) It helps keep them awake to eat and stimulates your milk supply. I was scared to use it at first but It is so easy. She ate faster with it too. I used a Tube and Syringe provided by my IBCLC. I wish I would have used it with my son.

    One thing that took me a long time to realize was not to swaddle my baby anymore. I never saw hunger cues while she was swaddled because she was so cozy.

    My two month old is doing well now so hang in there momma, it is possible.

  8. #8

    Default Re: Low Birth Weight - worried breast feeding may fail

    Thanks for the replies. I managed to find a private Lactation Consultant and she came out yesterday.

    It seems we have a few issues:

    Small sleepy baby
    Small mouth - large nipples!
    Baby not opening mouth wide enough
    Tongue going up (as result of bottles)

    So obviously we need to make sure she is fed be it on the breast or by another means.

    While she was here she managed to help me to get my daughter latched on and although it took quite a lot of persistence she did seem to take a feed. That was very encouraging and helped me go back to basics and check for correct latch.

    We tried again on each feed later on and managed to get her on twice for a short period after a placating bottle! I felt a bit demoralised after that but have to keep reminding myself this won't be solved overnight and will take time.

    Remembering that she is having breast milk helps me with this, yes obviously I want her feeding directly from me but she is getting the benefit of breast milk and that is the main thing.

    The sns isn't likely to work until I can consistently get her to nurse I think? Because she fights and won't latch it wouldn't be possible to use an sns from what I can see? The lactation consultant didn't suggest it (I wonder now should I have asked) - have I misunderstood, if they are just playing at nipple and not properly latched would an sns work?

    I have also looked into the "calma" teat by medela, looks like tongue has to be down to use do possibly may be worth getting? Not sure, afraid to introduce anything new.

    Need to keep trying to get her to latch and maintain a positive relationship with the breast for her. Hopefully as she gets stronger and bigger it will get easier, there is still hope I think.

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