You have been eagerly awaiting the birth of your new baby. The nursery is ready. You and your partner have taken childbirth and breastfeeding classes. You may even have a doula but your baby's birth didn't go as planned. You are told he isn't getting enough so it's time to supplement. So why is your newborn losing weight? You did all the basics such as immediate skin to skin contact after birth and your baby latched immediately but despite nursing for really long stretches of time, your baby is not gaining well. You may be struggling with this problems for days or the first few weeks.

The first thing a mother is told when her baby isn't nursing well is to supplement with formula using a bottle after every feeding. Some times donor breast milk. This sounds good in theory but if you are trying to preserve breastfeeding, adding bottles and/or supplements can be devastating. Many young babies cannot go back and forth between breast and bottle. They may develop flow and nipple preference and mom often feels rejected if baby fusses at the breast.

If the mother is not taught how to pump and properly empty her breasts. The times baby is breastfeeding right before taking the recommended formula, mom may think that her baby is drinking her breastmilk. Instead, what may be happening is this baby, who cannot effectively breastfeed, is pacifying patiently at the breast until he's given milk by the easy-to-use-bottle! The soft nipple using gravity flow simply pours into baby's mouth without his needing to use much effort. A lot of mothers will say "my baby is a lazy-nurser", or "she sleeps at the breast and then wakes up when I give her a bottle". Newborns are hardwired to do a very few essential things: They naturally suck (breastfeed), grow, and breathe. If one of these three things are not happening. Something is wrong.

Many mothers are told to Triple Feed: breastfeed, pump and bottle feed. Triple feeding is often used by care providers who don't truly understand lactation. Triple feeding causes early cessation of breastfeeding. It is unsustainable for most women to keep up this grueling schedule of feeding and pumping around the clock with little sleep for days, weeks or on occasion, months. Triple feeding routines should always be monitored by your lactation consultant to ensure breast milk intake increases daily, or weekly for infants with poor milk transfer and low or slow weight gain.

Often the most basic question has gone unanswered. Why did this baby fail to breastfeed? If several weeks have passed, why is this baby still unable or unwilling to breastfeed?

Reasons babies fail to breastfeed:

• Small for their gestational age or born preterm. These babies often have immature sucking skills.

• Large for their gestational age or born to a mother with gestational diabetes. These babies will often have low blood sugar after birth and need more calories. They will nurse sluggishly or not at all.

• Birth injuries like vacuum extraction, forceps delivery or cesarean birth, where this infant was pulled through a tight space with stress on their head/neck. These babies can be sore and in pain. They may find it difficult to nurse in traditional breastfeeding positions guided by their mother.

• Infants who need oxygen: Breathing has to take priority over eating every time.

• A long difficult labor: Babies are just exhausted and simply need time to recover.

• Delayed milk supply: Maternal health issues or birth complications, such as excessive blood loss, preeclampsia, embolism or cardiomyopathy.

What can you do as a mother? Ask for the lactation consultant at the hospital immediately --- don't wait. If one is not available in the hospital or they were not able to help you, call a board certified lactation consultant in private practice who can come see you at home. Serious breastfeeding problems seldom resolve only with time. Without some professional intervention, challenges are likely to become harder to overcome and may continue to be a struggle for a mother.

What you can do on your own:

Start pumping immediately. Many women spend days or weeks breastfeeding baby first, then given 2 to 3 ounces of formula afterwards. If your child is not taking anything out of your breast, or only a very small amount of milk, you will continue to have low milk production. Breastfeeding works by Supply and Demand. Your breasts only make milk when milk is first removed. Your body doesn't recognize the amount of supplement your baby takes by bottle, and therefore assumes the amount of breastmilk being removed is enough for this baby!

Directly after birth, hand expressing into a spoon or small cup is the best way to get out colostrum. A lot of women will try pumping and believe there is nothing there because colostrum will either leave a fine mist in the breast flange or come out in tiny drops. Colostrum is really thick and your baby's first natural inoculation against bacteria and viruses. It is worth the effort to hand express it out.

Use alternative feeding methods. Newborns don't have to be bottle fed. There are: Cup feeding, Finger feeding, Supplemental nursing systems, and At the the breast supplementing. Be vocal, ask for an alternative feeding system and guidance for use..

For babies with newborn jaundice or sleepy babies, be proactive and 'feed your baby first' with enough food that they are alert and looking around, then offer the breast. To ensure success, massage your breast first to stimulate milk flow and encourage a letdown. You are successful when milk is leaking from the nipple.

For all babies who are not breast feeding well. Undress your baby before feedings and do lots of skin to skin contact. Massage your baby and talk to them. Try baby-wearing, this is known to stimulate natural breastfeeding cues for your newborn.

Paced bottle feed near the breast while holding baby.. By slowing down bottle feeding and using skin to skin contact at the breast, it can be easy to coax a sleepy baby to the breast. Switch sides every feeding to mimic breastfeeding.

Try gentle body work. Cranial Sacral Therapy or chiropractic adjustments for infants can help get things back in line after vacuum extraction, C-section, or a long labor. It is also helpful for one-sided breast aversion, a baby who is refusing the same breast every feeding.

Know the difference between active nursing and nibbling. Identifying the difference is critical. When your baby is actively nursing, his jaw goes up and down with wide movement. This jaw movement is so strong that you will see the ears, and sometimes forehead, visibly move with each suck. You may hear the Suck, Suck, Caw sound. The Caw sound is your baby swallowing a mouth full of milk. Dr. Jack Newman has wonder videos on YouTube and his website showing the difference between nibbling and actively drinking milk.

After the baby has latched, try deep breast compressions. You gently squeeze your breast about 1/2 inch to 1 inch behind the areola, the dark part of your breast. Hold until your baby starts to suck and swallow then release. Repeat until your baby stops drinking milk on one side then move baby to the other breast and repeat.

A wise old saying is 'watch the baby - don't watch the clock'. Exactly! But watch baby actively drinking milk not sleeping at the breast. 'You can be successful' after a bumpy start, getting help quickly is the key.

Click on links for helpful videos:

Dr. Jack Newman - Baby 28 Hours Old Assisted Latching

Dr. Jack Newman-Really Good Drinking

Dr. Jack Newman- Nibbling

Breast Compressions