gaining enough weight??? What to do???

[@llli*elliesmom82412]

I'm a little frustrated because of our 1 month check up yesterday. 10 days ago my DD weighed in at 5 lbs. 3oz. We have to go in for frequent weight checks because I was induced at 37 weeks 2 days because she was growth restricted in utero and only weighed 4 lbs. 12 oz at birth. I have EBF for the first month, with the exception of one day where I supplemented because she wasn't peeing. Yesterday, she weighed 5 lbs. 9.5 oz, which is a 6.5 oz gain in 10 days. That's almost 2/3 oz a day which is what I was told was normal. The doc wants me to supplement four times a days with either EBM or formula. I really don't want to do formula but I am not able to pump enough to supplement and keep up with feedings because she feeds so often. I'm just extremely frustrated and don't know what to do. What is normal weight gain? If she's gaining and have enough output do I really need to supplement? It almost makes me want to give up.
The doc mentioned feeding and pumping after four times a day but I worry about oversupply then??? And that just takes more time than I have right now. I just don't know what to do?

[@llli*djs.mom]

That is in the range of normal but a little on the low side which probably is worrisome only because of her low birth weight. You definitely want to supplement with your own milk! Because doing so will interfere with you ques much less. How often are you putting her to the breast? Because it should be at least 10-12times in a 24hout period. IF you aren't feeding her that often you could begin by increasing your daily feeds. If you are already feeding that often consider pumping one breast while you feed off the other. That way it won't be anymore time spent then you are already spending feeding.
DO NOT GIVE UP! There is nothing in your post that suggests that you are struggling or doing anything wrong. So DO NOT move to formula feeding that you know is NOT as healthy for your child just because your doctor discouraged you. You are making her perfect food. Breastfeeding IS overwhelming in the beginning. It is for everyone. It is a ton of time spent in one spot everyday feeding while your supply regulates and quite frankly it takes longer than 4 weeks. So at this point you should wrap your mind around the goal of getting up in the morning and feeding your baby. All day. Every day. For 2 more weeks at least. That's it. Plan for that. Accept that and the time will pass much more quickly and easily. Set up a nursing station. A place where you will happily be. With phones, remotes, laptops, books, magazines and movies. I got up to pee, change diapers and get more food. For about 6 weeks. Before I left the house. And you know what? You never get this time again. This time to sit and hold your newborn. Where you get to know each other and find your nursing groove. It's time well invested. You will NEVER be sorry that you invested this time in the overall health and well being of your child. Even if it seems completely tedious, isolating and overwhelming at this point. I swear.
Also if you ere going to pump just ONCE a day on it's own, I recommend 1st thing in the am when you get up to pee. Most women have the highest yield in the AM. Stick with it. And Stay focused. You are doing fine.

[@llli*lllmeg]

edit- i did not see pp before i posted, sorry for any repetitive info...

My understanding is that, very generally, a gain of an ounce a day starting at around day 5 or so is 'normal.' (Prior to that, babies often lose weight or weight gain is stagnant.) Of course some babies take a little more time to build up to that good of a gain.

But some babies gain more or less rapidly and it's perfectly fine. And some sources suggest anything over a half ounce a day is OK. Your baby is little and gained very slowly in the first two-3 weeks it sounds like? Plus there were growth concerns in utero, which is likely why your doctor is being so cautious. Whether weight gain right now is really an issue that requires supplementation depends on several factors.

I have a couple of suggestions- 1) talk to you doctor more in depth. Explain that while of course you will do anything needed for your baby’s health, you are committed to breastfeeding and believe that breastmilk is best for baby and is all a baby normally needs. The AAP would agree with that, btw.

2-Ask your doctor what weight gain he or she would like to see at this point. Ask what he thinks the problem is-does he suspect you have low milk supply? That baby cannot transfer milk well? That there may be an underlying medical condition slowing weight gain, what?

Since breastmilk has the same or more calories than formula, IF a baby cannot gain as needed at the breast, that means either baby is not getting enough breastmilk or there is something else wrong and it has nothing to do with what or how much baby is eating.

So if you can you might want to see an IBCLC to have breastfeeding assessed and to do a before and after nursing weight check to get an idea of what milk transfer is happening at the breast. Just remember these only tell you what happened at the one nursing session. A one month old would normally be transferring about 2 ounces at a nursing session, but of course this varies throughout the day.

Do you have pain when nursing? And how often does baby nurse? At this age it would normally be a minimum of 10-12 times a 24 hour day. And any longer sleep stretches-more than 4 hours say-should probably be avoided while weight gain is an issue.

And always, always, make sure weight checks are done very carefully with baby naked or in a dry diaper on the same scale every time!

[@llli*elliesmom82412]

I did tell my doctor how important breast feeding is to me and that is when she recommended supplementing with breast milk but I just am not able to keep up with the pumping and the nursing. I typically pump one side while she feeds from the other because she definitely has a preference and I feel like one side produces more??? The doctor mentioned both a supply and a transfer problem because she said pumping would increase my supply and that giving her .5-1 oz in a bottle after 20 min of feeding at the breast would help me know exactly how much she is getting.
I am not sure if this is any indication but I have had to be away from her three times now and each time I have left enough EBM for her to have the equivalent of 1.5 oz for every hour that I am gone. I leave several bottles with 2 oz each in them. She will take the 2 oz in one feeding and be content, and will eat every 2-3 hrs. Normally, she feeds every 2-3 hrs throughout the day with 1 four hour stretch at night.
I never have any pain, nor have I ever had any pain, with nursing. I did see a lactation consultant while still in the hospital after she was born and she said that the latch looked good and she was actively nursing without falling asleep.
I have taken an additional four weeks off from work to try to make sure breast feeding is well established before going back to work. We have found a wonderful baby sitter who has cared for three little girls whose mother breast fed them for 12 mths. Thanks for your help!

[@llli*lllmeg]

The doctor mentioned both a supply and a transfer problem because she said pumping would increase my supply and that giving her .5-1 oz in a bottle after 20 min of feeding at the breast would help me know exactly how much she is getting.

OK this is why it would be great if you could see an ibclc now so breastfeeding can be assessed. That you saw one in the hospital is great but now things are different, as there was no reason to think there would be a weight gain issue then. Plus with nursing things may change rapidly & dramatically in the early weeks.

Supplementing after nursing is potentially problematic, as a baby will often take whatever is in a bottle no matter how full they are. Babies love to suckle, will suckle what is placed in their mouths, and cannot stop the flow of milk from the bottle nipple once they start. Hence you often hear of a baby 'chugging' a bottle after nursing-this means nothing.

Instead, when supplementing is needed for the breastfed infant, it is typically recommended that baby is given a small amount- like the suggested 1/2 ounce to an ounce prior to nursing and then being allowed/encouraged to 'finish at the breast.'

Yes pumping will increase milk production if you have low production. It will also increase milk production in a mother with normal milk production or even over production. But as you have found, having to pump-especially on top of frequent nursing-gets very, very wearing on moms and can lead to early cessation of nursing as the grind becomes to much and the family moves to formula instead. This is why it is important to be pretty sure that low milk production really is the issue or part of the issue when recommending pumping.

I am not sure if this is any indication but I have had to be away from her three times now and each time I have left enough EBM for her to have the equivalent of 1.5 oz for every hour that I am gone. I leave several bottles with 2 oz each in them. She will take the 2 oz in one feeding and be content, and will eat every 2-3 hrs.

So if I have this right-with the bottles you have provided the typically suggested 1.5 oz per hour and that has been about what baby eats? So if that indicates anything (and I am not sure it does) it indicates normalcy.

Normally, she feeds every 2-3 hrs throughout the day with 1 four hour stretch at night.

A baby nursing every two hours with one four hour stretch would be nursing 10 or 11 times in 24 hours. A baby nursing every 3 hours with one four hour stretch would be nursing 6 or 7 times. 10 is good, although it would be fine if it were more, 6 is not usually nearly enough for a one month old.

But most babies when allowed to cue feed do not nurse in hourly patterns at this age. They may nurse 2 times or more every hour for part of the day-such as during a fussy evening-and then take a longer sleep stretch, then nurse every 1.5 hours for a time, then go 3 hours-etc etc. This is called cluster feeding and it is a typical pattern at this age. That is one reason I suggest thinking in terms of how many times in 24 hours baby nurses rather than how much every such and such hours. The other reason is that, if you find you would like to try to add more sessions, I think it is easier to consider offering the breast, for example, two additional times a day, than suddenly thinking "I have to nurse this baby every two hours." The “every two hours” thing just sounds exhausting and impossible. It defeats moms right off. And it is not even how most babies nurse.

If your baby is able to transfer 2-3 ounces per session, then adding just two more nursing sessions would mean 4-6 more ounces into baby a day. So you can see how just nursing a little more often can potentially make a big difference. AND nursing more often increases milk supply, just like pumping does.