In a message dated 9/4/0 2:57:24 PM, [log in to unmask] writes:

<< My 3 week old has been gaining slowly and I have been under an enormous
amount of pressure from my Health Visitor to supplement him with formula.
I, of course, want to do what is best for my baby and not compromise his
health in any way...but I don't feel comfortable with the advice of the HV
and I am really stressed and upset.  I should mention she did the same
thing when I had my daughter 2 1/2 years ago (pushed formula because of
slow weight gain).>>

Carolyn,
I agree w/ Barabara's comments about slow gaining babies--I believe it is
hard on them and I doubt that it is physiologically normal for healthy
full-term babies to lose weight after birth. So, I can understand a scenario
in which the HV might be concerned. OTOH, I believe it is irresponsible to
recommend (or certainly "push") artificial milk at any bf dyad without
exhausting all possibilities for exclusive bf. IMO, any HCP who is concerned
about bf should either have the skills to facilitate successful bf or refer
to someone who does. So, while we can give you suggestions, I would repost
with the heading--"Need LC in Britain", so that you may speak with someone
directly who knows your medical system, etc and perhaps even can see you in
person. My suggestions, however, are below.

<<My son is not yet back up to his birth weight.  He weighed 6lb 12oz at
birth, and is today (21 days) at 6lb 8oz.  His lowest weight was 6lb 1oz at
11 days of age.  The HV wants to come out and weigh him constantly (average
3 times a week) although I have managed to put her off a couple of times.
Weighing him so frequently puts an enormous amount of pressure and stress
on me, and I feel it does not give us a chance to put some significant
weight on.  The last time she weighed him was 4 days ago, and when she came
today he had put on 2 1/2 oz.  He is having plenty of wet nappies, several
yellow seedy stools, and is becoming more alert (he was VERY sleepy at the
breast for some time...was jaundiced and had thrush) and active. >>

While jaundice is a normal physiological process in mammals, it has become
problematic in Western cultures where births are medicalized (making for
sleepy babies) and many mothers have difficulty establishing bf. So, when
juandice is problematic, that is usually a red flag to me that baby is nbot
getting enough to eat at the breast. Has your thrush been resolved well? If
not, this can underly slow weight gain. How were you treated and are you free
of symptoms now? Was the baby treated, as is proper protocol?

<< I also feel he is more vigorous at the breast. >>

Every bone in my body wonders if you are latching this baby on
correctly--deep latch with no pain, no breaking of suction (no clicking,
dimpling of cheeks), lips flanged, tongue cupped beneath breast. I have
worked with mothers who have nursed multiple babies all latched on
incorrectly. Because the problems self-corrected over time or were not
severe, the mothers never realized it until third babies or subsequent
babies. I am guessing you have not received good assesment of your baby at
the breast?

<< However, the HV is concerned
because he is below percentile on the growth chart...and thinks he should
catch up ASAP.  She would not leave today until I agreed to supplement him,
which is against my wishes.  She has advised me to stop pumping (using a
hospital grade double pump) and only nurse him every 3 hours ("to allow
your breasts to fill up") and to supplement him with 4oz. of formula after
EVERY breast feed.  I feel if I do this, he will be so full he will not go
back on the breast for ages and will thus compromise my milk
supply...although the health visitor insists the opposite will happen (says
he will become hungrier and nurse more frequently).>>

Since the HV's basic bf info as you report it is highly flawed, I would be
concerned about following advice from her. Again, I suggest finding an LC or
other bf specialist (I know there are some other good organizations in
Britain represented on this list). If my baby truly needed supplements, of
course I would pump my breasts. Her suggestion to stop pumping is somewhat
like saying artificial milk is the preferred supplement. I think you know
that 4oz of artificial milk will assure your baby will never desire to go to
breast and will signal your breasts to stop making milk. What you did not say
was when you pump (before or after feeding), for how long, if you are
double-pumping, how often you pump and most importantly, how much milk you
pump? Are your breasts full at the beginning of a feed and soft afterwards?
Do you leak or see spraying or have other signs of let-down? While not all
mothers experience these signs, it can be informational if you do. Do you
observe your baby gulping at the breast? Is he primarily sleepy or is he
alert? Are you using breast compression or aware of how to do so to be
assured baby is truly finishing the first breast before switching to the
second? "You say he has several bm"s, but does he consistently have 3-5 or
more per 24 hours or is he squeaking by w/ the minimum? Perhaps he is getting
a good supply of foremilk but inadequate hindmilk. I explain this as someome
sitting down to every meal and drinking a glass of juice while leaving the
food on the plate. You will be satisfied for a short time, but not for long
*and* the cook will eventually stop bothering to put any food on your plate.
In other words, if you don't ensure he takes adequate hindmilk, he will not
gain well, but will be well-hydrated and even alert, but may appear scrawney
and fussy and gassy and hungry often. He will likely fall asleep at the
breast fairly quickly and his poopy diapers will decrease over time, as will
your milk supply. A good deep latch and breast compression almost always
solves this problem and many others.

<<  I should mention that
she agrees that he is well hydrated and she feels he is healthy, just that
he looks a "little scrawny" and is gaining slowly.  She is coming back to
weigh him tomorrow and she wants him to have put on an additional 4 oz (in
just 24 hours...I feel this is unreasonable!).  She also says she cannot
force me to supplement, but insinuates if I don't I will be starving my
baby (which he shows no signs of) and he will eventually quit feeding at
all and shut down.  She also said if he continues to gain slowly she will
have to recommend us for hospital referral, and the hospital will then feed
him the way they see fit to put weight on quickly.  I have given him
expressed breast milk by cup (I have an SNS but feel very awkward using
it...baby gets upset and won't latch on well....I don't mind the cup
feeding, even though time consuming) but she feels it would be perfectly OK
to supplement by bottle at this point, although she didn't force the
issue.>>

I do not see any reason to give this baby a bottle or artificial milk based
on the information you have provided. I will admit, however, that I hold a
very extreme position on the introduction of any artificial milk into the gut
of a newborn. I believe it is extremely dangerous and should only be done when
 absolutely necessary.

Finally, I would suggest using some additional means of increasing milk
production, assuming it is low. I would tend to think it is likely to be low
if your baby has been sleepy and nursing poorly, unless you have managed w/
the pump to bring in a good supply. You can try using a tea steeped from any
combination of fennel and fenugreek seeds (crushed first), blessed thistle,
red raspberry, hops, nettles or goats rue. Be sure to include the blessed
thistle, but like the hops it is very bitter, so you may want to be sure to
include the fennel for flavor. You can also try the homeopathic remedy
luctusa virosa.

Jennifer Tow, IBCLC, CT, USA

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