My 10-week old is gaining weight more slowly than than the curves on the WHO growth chart - from his birth weight on the 25th centile, he has just dropped below the 0.4th centile line.*We're trying everything under the sun to improve his gain -*more frequent feeding, deep latch techniques, breast compressions, expressed milk top-ups after feeds, fenugreek, switch feeding to keep him awake if he dozes off, nursing vacation to increase supply, etc. but to little avail. The thing is, the current programme of expressing for top-ups alongside full-time feeding is killing me... Between feeding him on demand every 1-2.5 hrs during the day at 30-40 mins each time, and trying to find opportunities to express enough to make up 120ml (4oz) for top-ups (given in small amount over the day after feeds), I can barely leave the house without missing a window to fit in a pumping session. He feeds every 2-3.5 hrs at night, so that's 10-12 times per 24 hrs, but I don't pump at night so I can sleep. I can't keep it up indefinitely but don't know what to do...
He was born at 3.24kg (7lb 2), dropped to 3.0kg (6lb 10 - a 7.4% drop) at 5 days, took 3 weeks to regain birth weight, and currently weighs 4.0kg (8lb 11) at 10 weeks. He had tongue tie that was snipped at 3 weeks, then a nasty bout of thrush that was painful for us both, so for the first 5-6 weeks there was a potentially good reason why his weight gain was slow at an average of just over 100g (3.5oz) per week*.*Unfortunately, it hasn't accelerated much since then.
Week 7, I started taking fenugreek and expressing 50ml EBM per day for top-ups (delivered in small amounts over the day at the end of feeds), and had a breastfeeding counsellor observe a feed and help me latch him more deeply: at weekly weigh-in he had put on 120g. The health visitor suggested supplementing with formula since breastfeeding "wasn't working out" - I refused, with support of local bf counsellors. Week 8, I continued with 50ml EBM per day except for a couple of days where we stayed in bed for nothing but feeding and skin-to-skin: he put on 150g that week but hit the 0.4th centile line, which made the health visitor insist more firmly that I supplement with formula (again I refused, as it didn't make sense to me, or the bf counsellor I asked, to force formula when EBM was available). Week 9, I doubled EBM top-ups to 120ml per day: he put on only 100g...!* I have found a different health visitor who is more supportive of breastfeeding and is no longer putting me under pressure every week, but has referred us to a paediatrician with an appointment in 2 weeks' time.
Why is the increase in EBM top-ups not increasing his weight gain? It's like he's dropping his intake from the breast as the intake from EBM increases, so he's still taking in the same (or even fewer) calories overall. Is it possible that pumping after feeds means he has to work harder to get the same amount of milk on the next feed, so he ends up taking in less from the breast than if I wasn't pumping? Or is it possible for top-ups not to work because the baby is self-regulating intake to suit appetite (even if it means maintaining slow weight gain)?
Is it worth me maintaining this gruelling programme of expressing milk if it makes no difference? I had a phone conversation with a lactation*consultant a few days ago, who*thought I was doing everything right but suggested*that 120ml (4oz) per day is not much of a top-up. I thought it was pretty good going, as it takes me about 4 sessions to make it up: I get 20-50ml (0.7-1.8oz) per pumping session, as I can't leave it too long after he finishes feeding to express or I'll still be pumping when he wants to feed again. She also thought that 20-50ml was a poor yield from a double pump and hence a cause for concern, but the kellymom site says 0.5-2oz is normal yield per pumping session for a mother who is breastfeeding full-time. Who is right here? Because I don't know how I can increase the amount I give him in EBM top-ups when I'm struggling to manage 120ml.
Is his weight gain a cause for concern or not? There doesn't seem to be much agreement on when it's time to worry. He is otherwise fine - alert and active and meeting his milestones, producing 6-7 wet nappies per day and a big yellow poop every 1-3 days, his length and head circumference are tracking the 25th centile, and the doctor was happy with him at his 8-week checkup. So I'm not sure whether there's really a problem or not... The LLL info and a local bf counsellor says 4oz per week is normal, albeit at the lower end, but that doesn't keep pace with the weight charts at all.
Sorry for length of post. I've been in tears so many times over the last few weeks and have asked for help so many times from different quarters, but don't know what to do to sort the good advice from bad. All I want is to be able to breastfeed my baby normally - no pumps and bottles - so he is healthy and happy but I don't even know if that's possible any more