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 is recommended. While this sounds good in theory, when trying to preserve breastfeeding, adding bottles and/or supplements can be devastating to your milk production. Many young babies have trouble going back and forth between breast and bottle, sometimes developing flow or artificial nipple preference, and mom often feels rejected if baby fusses at or refuses the breast.
Often mother is not taught how to pump properly to empty her breasts, which negatively impacts her future milk supply. When baby is at breast and mother doesn't observe active suckling, then offers the recommended formula or milk supplement, she may think her baby is 'drinking' while at her breast. Instead, what may be happening is this baby, who cannot effectively breastfeed, is pacifying, waiting patiently at the breast until he's given a milk supplement by the easy-to-use-bottle! The soft bottle 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". This is a misunderstood situation. Newborns are hardwired to do a very few essential things: They naturally suck (breastfeed), grow, and breathe. When 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 gestational age or preterm. These babies most often have immature sucking skills.
Large for 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 such as 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 being given magnesium to stop a preterm labor, 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 (IBCLC) in private practice who can come see you at home. Serious breastfeeding problems seldom resolve only with time. Without 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 taking very little from your breast, or even nothing at all, 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 jaw movement. This jaw movement is so strong that you will see the ears, and sometimes forehead, visibly move with each suck and baby's jaw will drop down & pause for a second. You may hear the Suck, Suck, Caw sound. The Caw sound is your baby swallowing a mouth full of milk. Dr. Jack Newman has wonderful videos on YouTube and his website showing the difference between nibbling and actively drinking milk.
After the baby has latched, try deep breast compressions as soon as baby's suckle slows. You gently squeeze your breast about 1/2 inch to 1 inch behind the areola, the dark part of your breast. Hold that squeeze until your baby starts to suck and swallow rhymically, 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.
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