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Old 12-31-2012, 04:14 PM   #1
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Help! I can't make a decision regarding supplimenting

I had a baby girl, 8 lbs and 15 oz, on December 19th. Out of my four, she was the heaviest by 1 1/4 pounds, and a week later than my next latest. At the after-birth checkup (she was 5 days old) she had lost a lot of weight I don't remember the exact amount now, but it was about 11 ounces. They've had me coming in for weight checks ever since. I have yet to see our actual pediatrician because of the holidays/her off-days.

At 8 days she had lost a full pound. The nurse told me to suppliment with formula, but I refused, and concentrated on increasing my milk supply, because I was very dehydrated.

At 10 days, she had gained 2 ounces - now she was exactly 8 pounds. We saw a doctor subbing from a different practice, who told me what we were doing was great, and to keep doing it.

Today, at 12 days, she only gained .5 ounces (So she's at 8 lbs, 1/2 oz.) The nurse practitioner told me that she would really suggest supplimenting with formula at this point, since I'm making a large enough quantity of milk and she's still not gaining. She wants me to give her a 1/2 ounce or an ounce after I finish each nursing.

I'm torn. I really don't want to supplement, especially not with formula. Every single major world health/medical organization I've found suggests using your own milk first and then moving on to other things if that can't work. Not to mention the possible milk production problems.

I'm "watching the baby, not the scale" and she's perfect. Hydrated, alert, hitting milestones, active, acting satisfied, etc. If I didn't have a scale, I wouldn't worry at all.

Other pertinent information: I feed on demand, so about every 1 1/2 hours to 3 hours, depending (she cluster feeds.) I make sure she empties one breast and then we move to the other, and she usually gets to the point on that one that I see hind milk coming out. She is having the proper amount of wet and dirty diapers.

Oh, and at the doctor's office today, after the appt, I breastfed DD in our patient room, and then asked to weigh her on the scale again. She weighed 8 lbs, 3 ounces, so she got 2.5 ounces of milk (by weight - water oz by weight vs volume is similar, so I assume the same with bm?) I had actually nursed her right before the doctor came in for several minutes, so I'm sure she took in more than that.
~~~~~~~~~~~~~~~~~

But then I worry that maybe she's not getting something she needs - this is really, really slow weight gain. There's no way she'll be up to birth weight in the next two days, or anywhere close to it. Is it possible for breastmilk to not be nutritious enough? I am sooo hesitant to supplement with formula, but at this point, would doing it for a couple days really be that big of a deal?

I guess I'm looking for people to tell me what they would do in my situation, if their baby was gaining weight so slowly. Would you continue to nurse as much as possible and hope for the best, or would you supplement? I worry that we won't find the solution (if there's a medical issue) if we don't at least try formula, but then again, if there's a medical issue, wouldn't it show in other symptoms by now, like listlessness or other things indicating she wasn't getting nutrition?

I'm so confused!

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Old 12-31-2012, 04:59 PM   #2
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Re: Help! I can't make a decision regarding supplimenting

Can you use a supplemental nurser? (So it doesn't effect your nursing or give you supply issues?)
You can make them easy with a butterfly (this is a type of needle) and a screw on syringe. Ask your doctor for them as every office has these. (You remove the needle from the butterfly and discard. You just want the plastic tubing. and put formula in the syringe. Hook the (tubing from the butterfly) to the syringe. tape the tube to your breast 3to 4 inches from the nipple so the end of the tube is long enough it will fit in the baby's mouth when BFing. As you BF, gently squeeze on the syringe giving 1/4 oz or less at a time.
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Old 12-31-2012, 05:18 PM   #3
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IF I was you -
I wouldnt suppliment yet. I would drink more water and nurse more often until 3 weeks. Then see how much weight was gained by then.

also, did you have iv fluids during labor? I dont have a link but there was a study done that showed if you had a lot of iv fluids during labor it would inflate the babys birth weight. so the baby would have water weight and would lose more weight then average.
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Old 12-31-2012, 05:25 PM   #4
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Re: Help! I can't make a decision regarding supplimenting

If I was in your situation, I would give it another week without formula, and see if her weight gain improves. Yes, I would be concerned about the slow gain, but she's only 2 weeks old. She may have had extra fluid on board and is balancing out. Since she's fine on all other accounts, I don't see the harm in waiting a bit longer before supplementing. Good luck!
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Old 12-31-2012, 05:38 PM   #5
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I would not supplement yet. I would, only *if* the baby would be unhappy and or not having enough wet /dirty diapers.
((Hugs)) mama. Those first few weeks Can be rough. But don't let your pediatrics office/nurse scare you.
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Old 12-31-2012, 05:44 PM   #6
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Re: Help! I can't make a decision regarding supplimenting

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Originally Posted by vmomma View Post
If I was in your situation, I would give it another week without formula, and see if her weight gain improves. Yes, I would be concerned about the slow gain, but she's only 2 weeks old. She may have had extra fluid on board and is balancing out. Since she's fine on all other accounts, I don't see the harm in waiting a bit longer before supplementing. Good luck!
I love that this is coming from an RN (did I read that right?) It's especially reassuring, hearing it from a mom AND a baby medical expert. I think my biggest fear is that I'm harming her by withholding formula, that somehow she is starving, but your post made me realize that if that was true, I'd likely be seeing it - have a sickly baby on my hand, not the alert, content (mostly!), satisfied little thing I have.

Thank you all, ladies. I'm feeling a bit better, though I don't like confrontation very much, so I have a feeling Wednesday's check in might be hard when they ask if I used formula. My husband said, "if it doesn't feel right, then there might be a reason. When they ask, just tell them - you don't have anything against formula, but it just didn't feel right to do it." I told him that when I think about giving her formula, my muscles tighten and I feel very "on guard" - definitely my instinct kicking in, but I can't figure out exactly what it is that is bothering me. I am more concerned with Abby's health than whether I breastfeed or not, so it's not about principles...
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Old 12-31-2012, 05:44 PM   #7
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Re: Help! I can't make a decision regarding supplimenting

Just some advice from a momma that also had a LARGE baby. My little guy lost a pound in the hospital and as a first time mom I was SO scared! I know better now, but I don't regret supplementing with formula. I did exactly what your ped recommended. Nursed and then supplemented 1/2 oz at each feeding. He got up to 12 pounds by his 1 month. At that point, I could have gone back to just BFing easily and did until I weaned him at 4 months because I had to go back to work. Would do it differently now that I stay at home full time, but just letting you know that you could do this and then go back to EBF if you want to. I hope this helps! Whatever you think is best, is definitely best I just wanted to give you the other side of the coin.
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Old 12-31-2012, 05:48 PM   #8
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Re: Help! I can't make a decision regarding supplimenting

We were kinda in this boat with DD- she was born at 9# 3oz, and by day 5 had lost 15 ounces, despite my milk coming in at 24 hours, and her nursing around the clock (with audible swallowing).

They wanted me to supplement in the hospital, but I refused unless it was with my milk.

She was slow to gain as well, and we did wt checks- until she finally regained her birth weight at close to 4 weeks old- her pedi suspects her true birth weight was inflated by the extra fluids I was drinking just prior to delivery (low amniotic fluid) as well as fluids during my c/s- she has never had formula to this day- and once she got past the slow start, she gained well- and is now a hefty 24 pounds at 9.5 months!

So, personally, I would not give formula just yet- you are doing the right thing by watching the baby and not the numbers.

Also keep in mind- the 1 pound of weight loss is probably not accurate- unless she is being weighed on the same scale as when she was delivered!
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Old 12-31-2012, 09:01 PM   #9
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Re: Help! I can't make a decision regarding supplimenting

I wouldn't supplement with formula unless there was a valid reason why I couldn't just pump some milk and bottle feed the pumped milk. If weight gain is still an issue at the next weight check, contact an IBCLC as a "second opinion.
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Old 12-31-2012, 09:38 PM   #10
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Re: Help! I can't make a decision regarding supplimenting

This is going to sound like a strange question, but when you were in labor, were you on IV fluids?

From what my midwifes were telling me when I had DD2, it's not unusual for babies who's moms were on IV fluids to have an excessively inflated birth weight, and then lose a lot in the first day-ish of life. So if that's the case, I wouldn't worry about the weight loss, or about her hitting her birthweight right away. It's something they're seeing more and more of late, and they're currently doing some studies on it, but it seems like with babies who's moms had a lot of fluids during labor their 24 hour weight is probably more accurate than a weight taken directly after birth.

So if we can discard that, I wouldn't worry. Baby *is* gaining, just not really quickly, and all other signs point to a healthy baby. Unless she stops gaining or starts losing, I'd just keep on keeping on, KWIM? Both my LOs were slow starters with weight gain, but then took off. Yours can too.

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