Thursday, June 26, 2008

Immunizations, plus more

I just got back from getting Gwen's 2-month immunizations. Aside from the obvious fun of watching Gwen scream while the nurses stuck her with four big needles, there is other news as well. I'm not even sure how to process this all so this entry will be more about helping me do that, than sharing coherent conclusions.

While we were waiting for our shots, Norma, the nurse who helped us at the breastfeeding clinic last month, saw us and came to ask how we were doing. I told her I'd been wanting to come see her again to do a pre- and post-feed weigh-in, because we were now supplementing Gwen with a bit of formula, but she'd only gained 7 ounces in 4 weeks. She was stunned, and started asking questions. Here are the facts:
- Gwen feeds all day long, except when she is sleeping or having her diaper changed. She is rarely content to be on her own or entertain herself for more than a minute or two at a time.
- Gwen's latch is good and I can often hear her swallowing (actively feeding).
- I can pump 2-3 ounces of milk in a 15-minute session of double pumping, so I don't think supply is the issue.
- I am on the full dosage of Domperidone *and* Blessed Thistle supplements, and have been since the beginning of May.
- Gwen often repeatedly pulls off the breast after she's been feeding for a while, acting frustrated as if she is not getting any milk, at which point I switch her to the other side.

The nurse who was to give us our shots, Twyla, came in and joined the conversation. She too was stunned by the low weight gain. We weighed Gwen right then and there: she was 4266 grams.

There was a great deal more talk about breastfeeding and supplementing while we went over the "milestone" sheets, during which time, naturally, I was nursing Gwen. Twyla was surprised to see how quickly Gwen demonstated the frustrated "out of milk" behaviour - apparently she should be able to feed actively for 20 minutes before running out. I've never actually timed how long that phase is, though I will be paying attention now.

After the shots, which were horrible - Gwen caught on right away, and as soon as Twyla started wiping the site for the second shot she realized she was going to get stuck again, and boy she was not happy about it - we talked more about her weight and feeding and supplementing and so on. It seems puzzling that I can get a good yield from my pump, yet Gwen is not gaining. It was heavily recommended that we see a doctor to eliminate the possibility of a urinary tract infection or any other reason why Gwen's nutritional intake is being used for purposes other than gaining weight.

The ultimate recommendation from both Norma and Twyla was that we give Gwen a bottle of formula after every feed. That is, I should let her feed for 20 minutes on each side, then if she is still hungry, give her at least 2 ounces of formula, watching her cues to see if she still wants more. I question whether she should instead be put back to the breast at that point, but I guess if the breast is empty that will do her no good. It does seem like she is frustrated or impatient with a slow letdown, whereas the bottle can feed her quickly and leave both of us time to do other things. In the back of my mind I'm thinking of offering breastmilk in the bottle as well, because that's better for her anyway, and if it's an issue of impatience the bottle will eliminate that.

We took the crying Gwen back to the scale, stripped her down again, and weighed her. She was 4278 grams. I'd been feeding her nonstop for almost an hour, and she'd gained only 12 grams (less than half an ounce). Now admittedly, she did dirty a diaper in the meantime, but one would surely hope the gain would be more than that ... right?

So as of today we plunge headlong into the world of supplementing with formula, not to mention seeking medical attention to lay out these facts and see if there are any underlying issues.

I just feel thrown by all of this. I think the problem is that this would normally be the time, in any case, where we switch from midwifery care to The Medical Establishment, and so I knew I would feel a little bit disoriented during that switch. But this issue has me feeling like my barometer is completely askew.

I'm really grateful that Chris was able to be there with me today, not only for the fun of Gwen-wrangling, but to help me take in all this information. Sometimes I just get really emotional and can't process things very well, so it's super helpful to have someone else there to keep hearing what the nurse is saying.


Amberism said...

This is really not helpful, but Claire only gained 6 ounces in 4 weeks and no one seems to have a concern, BUT when I went for her 2 mth shots this week - Tuesday - no other weight had yet to be recorded in her book because I hadn't done it so they didn't think to ask and I didn't tell.

She's still in the 'range' for her age, just below average (15%tile I think, I didn't look too closely) and I feel comfortable with her development so... ~shrug~ Like I said, no help.

BUT I don't feed Claire all day. 40 minutes at a time, max, and then its at least 2-3 hours before we feed again. If after I've fed her from both breasts, and she's still upset, I give her some formula (which often she doesn't drink, just sucks on the nipple) - this is usually in the early evenings.

I see no reason why you can't give her breastmilk INSTEAD of formula from the bottle after a feed. You can still gauge what she's eating, you can see that she's eating, and then can maybe have some insight into the boobage world. So I say, do both, use formula if you don't have any milk pumped, and milk if you have it pumped.

Anonymous said...

I'm certain by now that someone has assessed her suck - but if not, that should be done...stick a finger in her mouth - is there a good strong vacuum there (like she's gonna give a hickey to the end of your finger) and is her tongue down over her gums?

I've had babies fool me in the past - looks like a great latch, swallowing heard etc - output is fine but weight gain is just not there - often because the wee one is missing the vacuum component of BFing...

So, while they are getting milk from your letdown, they are not transferring milk well on their own....

Other flags that I look for when considering this - babe's nursing all the time and mom pumps alot after a feed - if baby has effectively emptied the breast, there shouldn't really be all that much left....

An infection would seem highly unlikely given the fact that she otherwise appears well.....

Give me a call when you're awake (it's only 9am for you now) and we can chat about this if you'd like....and get some closure! :)

Love R


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