Lisa sent me a text 2 days after we had last spoken and implemented the plan to help increase Sophie’s milk intake:

Lisa:

“Feeding is going well thanks. The expressing is still challenging with timing. Sophie seems more content but a lot more spewy… hoping that’s OK?

We still get screaming in the lead up to pooing, 1 hour after her feeds, but, overall she is doing much better. Thank you!

– Lisa

P.S. I started writing this text yesterday and only just finished now… sorry”

Katie:

“I’m not surprised it has taken you so long to reply to me; I’ve given you a huge task!

Well done! You’re doing a fab job! The vomiting is not a concern if she is otherwise well and its milk coloured. It’s a really normal occurrence.

I’m glad Sophie is a little more settled. The poo situation will improve. A lot of bubs are still unsettled right before. Keep going, but, rest when you can… even if it’s just for 20 mins, lying in a quiet room.

-Katie”

A Few Thoughts from Katie

I knew that Sophie was going to be weighed in two days’ time at the Maternal Child Health Nurse Clinic, so, I was happy to continue the plan. After all, there were improvements rather than no change or worsening of the situation.

If Lisa had been concerned that Sophie wasn’t getting better, we would have altered the feeding plan to suit.

As is often typical in life, things don’t always go according to plan! Lisa phoned me for help on my last day in Melbourne for 2 weeks. I was going overseas!

I was actually on my way to the airport whilst we had this conversation! The timing couldn’t have been worse as all I wanted to do was go and see Lisa and Sophie in person.

Our diaries had clashed over the last few days so I had been unable to visit or meet with Lisa and Sophie earlier. It definitely wasn’t ideal; normally a lactation consultant will meet with you in person when you need support.

So things were tricky and Lisa’s phone call made me worry a little as I would be out of communication with her for 48 hours as I was flying to Europe.

Our Phone Call

Lisa went to the Maternal Child Health Nurse (MCHN) today to weigh Sophie. She had gained 44g making her current weight 3040g at 3 weeks and 3 days of age. She was still not back at her birth weight.

Lisa explained to me that Sophie’s:

  • Wet nappies were much heavier now.
  • Poos had more yellow solids on top of nappy and were less watery. Sophie was having at least two per day.
  • Sophie was cueing for breastfeeds between 8-10 times every 24 hours, but was taking about 60 minutes or longer at the breast.
  • Sophie was refusing almost all of her expressed breast milk top up feeds after the breastfeeds. Lisa had tried her with the Calma and traditional teats but with no luck. All Sophie had taken was the very occasional 20mls of expressed breast milk.
  • Sophie was still vomiting amounts which looked like her whole feed.
  • But Sophie was much more content now and was having less pain when she did a poo.

Because Sophie was not gaining weight as well as expected, the MCHN had advised Lisa to take Sophie back to see the Paediatrician.

This is standard protocol from a MCHN or lactation consultant if a baby has not regained to their birth weight by 3 weeks of age. The research shows us that 97% of babies have regained by this age and it is important to rule out other causes, like illness, before assuming it is just a feeding issue.

Lisa phoned me and told me she had an appointment in 4 days to see the paediatrician and asked what she could do. We talked for a long time on the phone and I sent the plan through in email so that Lisa didn’t have to try and memorise everything we’d discussed!

Lisa was concerned that maybe Sophie did actually have a lactose allergy. We discussed how it was not likely as Sophie’s poo’s had greatly improved and were not green or watery. There was also no blood mixed up in the poo.

The other good point, which we would be unlikely to see with a baby who had an intolerance or an allergy, is that Sophie does now settle much better after feeds. It would be more likely that a baby would still be very upset and unsettled if there was an ongoing intolerance or allergy.

The other positive was that Sophie had actually gained weight. It was a small amount and definitely less than expected and needed. At the same time, it indicated even more than it was unlikely there was a lactose intolerance or allergy.

The expected daily weight gain is about 25g -30g each day for babies in the first 3-4 months. But I was pleased Sophie was going to be investigated again by the paediatrician so the vomiting could be expertly investigated and hopefully ruled out.

With all vomiting, it is important that a baby is otherwise healthy and meeting their milestones in weight and growth, etc. When they start to lose weight or gain very slowly and are vomiting frequently a medical professional should always be consulted for a check-up.

Sophie was improving… but it was too slowly. We definitely weren’t at the point where we could relax yet. This is why it is always a good idea to combine lactation problems with a medical review for issues like these.

Lisa had explained to me that it appeared like Sophie was actually falling asleep on breast and therefore not taking all she needed. This made me think that perhaps Sophie was getting tired at the breast as the feeds were going on for so long. If this was the case, we needed to make feeds much more efficient for them both.

So What Were the Positives and not So Positives?

Lisa and I discussed these and devised a plan which Lisa felt she could do.

Positives:

  • Sophie had gained weight, even if not by as much as expected in 5 days.

Issues to work on:

  • Still below birth weight after 3 weeks
  • Slow weight gain
  • Vomiting possibly an issue
  • Taking over an hour at every feed
  • Sleepy at the breast
  • Not taking her top up extra feeds

So, here’s what I wrote to Lisa…

Katie:

“Hi Lisa,

In this email you’ll find the plan we discussed on the phone:

  • Breastfeed 8 times every 24 hours
  • Switch feed
  • Use breast compression
  • Max 30 – 40 minutes total time at each Breastfeed
  • Top up with 30-40ml or more expressed breast milk after feeds
  • Express 8 times every 24 hours (when possible) including at least one of those to be a night time expression

Switch feeding: feed on the breast until Sophie becomes sleepy or you hear only very minimal swallows. Then ‘switch’ Sophie to other breast.

Once Sophie becomes tired on this breast ‘switch’ her back to the other breast. Repeat twice or thrice on each breast, until Sophie satisfied or you reach 30 – 40 minutes max. I have capped feeds times to 30-40 minutes because it is essential that Sophie is not too sleepy to take her top up feed. And it’s essential you have time to cope with breastfeeding, topping up with expressed breast milk, double pumping and ensuring you get enough rest!

Note: Switch feeding can help when a baby gets really sleepy at the breast, stays there for long periods of time, only sucks and swallows a few times instead of regular sucking and swallowing, and is not gaining weight well enough. The ‘switch’ helps baby to stir and wake up. The other breast will have a let-down of milk waiting for baby to drink and this means baby will more likely stay awake whilst the milk flows. As the flow of milk slows, a baby who is not having enough calories may get sleepy. Switching baby to the other side can keep baby awake and it encourages them to drink more milk. It’s a temporary solution that lactations consultants may advise for babies who are struggling with gaining weight and are sleepy at the breast.

Breast compression: compress your breast gently with your whole hand during sucking. Release your hand off the breast during Sophie’s pauses. When Sophie starts sucking again compress your breast again, but always ensure that your hand is placed in a different position on breast, so you don’t cause any milk duct blockage.

Breast compression helps encourage the flow of milk and should help to keep Sophie sucking and swallowing milk.

Try the laid back breast feeding style to get Sophie to have deep attachment.

Keep in touch and get lots of rest. This will get better. You’re doing such a good job. Stay strong!

-Katie”

A Few Thoughts from Lisa

Going back to the MCHN to have Sophie weighed (every second day, while still not at birth weight), I was feeling hopeful that Sophie would have gained enough weight to hit birth weight or at least adequate weight for the time frame.

I felt that she had been at the breast frequently and she had been much more settled than before. Yes breastfeeds were taking forever, but, I didn’t mind that as much as the screaming.

Hearing that she had only gained 44g was so disheartening and really put me into a “what do I do now?” “Is this hopeless?” mentality.

I completely understand how it can all become too much for a new mum and how the switch to formula can become an option.

I considered this more than once but also remained hopeful that Sophie and I would find our breastfeeding rhythm soon. I truly believe lactation consultants are worth their weight in gold. They help you through the myriad of issues that can come with breastfeeding.

Sophie was not taking the expressed bottle feeds and, due to her refusal, I became a little slack with the expressing. This was not helpful in either getting Sophie to gain weight or keeping my supply up.

The MCHN had suggested a return trip to the paediatrician as Sophie was now well behind the timeframe they would like for her to be back to birth weight and my appointment was not for four days. I needed interim support.

Katie once again calmed me down and gave me a clear and easy to follow plan. She also supported me in going back to see the paediatrician.

We had a new determination to get Sophie to take the bottle to help top her up. Having given time frames for each stage of the feeding process made it not feel like I would have to be at it all day long.

While my hubby is very supportive of breastfeeding and all I was doing. Having Katie to talk it all through with was another level. She is someone who understands the feeding process and how taxing it can be and was a really big crutch to get through this rough patch.

How would you describe your own breastfeeding journey? Did your baby have any trouble putting on weight? Please join the conversation here or on our Medela Australia Facebook page.

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