On baby weight and breastfeeding preemies

26 Aug

We have been dealing with a weight issue pretty much since we found out we were pregnant.

At the beginning, our first couple of ultrasounds yielded healthy heartbeats, but the fetuses were not large or developed enough to be measured for growth. As we neared the halfway mark, though, our ultrasounds indicated the babies were underweight – only in the 12th or 13th percentile for growth.

Now, here we are, 2 1/2 weeks into life with twins, and the pediatrician is telling us the girls are underweight and not catching up fast enough.

First, some hard numbers:

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Anna

  • Birth weight: 5 lbs, 2 oz
  • Discharge weight: 4 lbs, 10 oz
  • First visit weight (11 days old): 4 lbs, 5 oz

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Elise

  • Birth weight: 4 lbs, 11 oz
  • Discharge weight: 4 lbs, 3.5 oz
  • First visit weight (11 days old): 4 lbs, 1 oz

And now, some color:

We knew the girls were small, but we were thrilled when they were born at about 5 lbs and at 37 weeks; our chances of being able to bring them home immediately without complications were excellent. We also knew that the girls would lose weight, but then gain it back within about 2 weeks.

Well, when we went to the pediatrician (the girls were 11 days old), they weighed in at their lowest (see above). The pediatrician, who is not our regular doctor, and who has terrible bedside manner and is painfully socially awkward, said, plainly, “That’s not good.”

We felt punched in the gut.

He asked us some questions about how the girls were eating, peeing and pooping – all indicators of healthy babies – and we gave all the right answers.

He had us go to the birthing center at the hospital for a breastfeeding consultation, and after meeting with the much more chill, much more caring nurse/lactation consultant, we came up with a slightly more aggressive feeding plan.

Basically, we have to:

  • Feed the girls every 2-3 hours
  • Have them at the breast for at least 10 min.
  • Supplement them with 5-10 mL of pumped milk every time

I also have to pump for 10 minutes after every feeding.

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We were doing most of that, but we weren’t entirely diligent about it. We definitely were good about feeding them every 3 hours, even setting an alarm for the middle of the night, but we weren’t always good about leaving them at the breast for 10 minutes or supplementing them with as much pumped milk.

Plus, Anna is (was) a spit up queen, so we were backing off the hammer with her. If she coughed, got lazy or tired, etc. at the breast, we let her stay off. And sometimes, she got no extra from the stash in the fridge. We also started aggressively burping her and keeping her upright for 20-30 min. after she fed, which helped drastically.

Like I said above, we felt punched in the gut at our last appointment. I do not want to resort to formula, if we can help it. I know supplementing with formula does not mean I am a failure as a mother. But I can’t help but feel a little that way.

I left the appointment pretty weepy, while Christopher came away challenged to stick it to the jerk doctor.

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So, we’ve been on our new feeding plan for 5 days now, and it’s going really, really well. We’ve even gone back to feeding the girls at the same time (one on each breast). We’ve had a couple of “monster” sessions, where the girls might be at the breast for 20-30 minutes, then take down 10+ mL of pumped milk. And neither one of them has spit up much.

We’ve also gone back, briefly, to disposable diapers because the girls were sweating so much in their cloth diapers. The disposables have allowed us to better track wet diapers, because they have a color-changing line on the outside (foolproof, eh?). The cloth (especially the fleece) diapers were so absorbent that we couldn’t tell the difference between sweat and potty.

The kicker with all of this? The girls are healthy and beautiful in every other way… Maybe they’re a little small. Maybe they’re a little slow to put on weight. But they are breathing, eating, peeing, pooping, gurgling, burping and wiggling like healthy newborns.

** ** **

Well, our follow-up weight check showed the girls have grown a bit. Anna has put on 3 ounces, while Elise has put on an ounce in the last five days. It’s not the growth that the doctors want – they expect babies to put on about an ounce a day – but it’s something…

(Side note: The pediatrician – our regular one, not the jerky, fill-in one – said both girls are healthy. They simply need to put on weight more rapidly.)

The pediatrician recommended we keep up with our breastfeeding but supplement with preemie formula “a couple of times a day”. The instructions were pretty vague. Christopher and I, naturally, had a lot of questions.

So, as instructed by the nurses and lactation consultants in the birthing center at the hospital, we had a sit-down to discuss our next steps. (They told us that the moment we were urged to introduce formula, we should come see them.)

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The big X factor, because the girls are considered late pre-term babies, is whether they are strong enough to get the nutrition they need from the breast and subsequently whether they are stimulating me enough to produce enough for two babies.

So, we were instructed to “pump a feeding,” that is, instead of putting the girls to breast, pumping for about as long as they normally spend there (15 min.) plus the 10 minutes…or a total of 25 minutes. The object was to find out exactly what I am producing.

The answer? Not enough, it turns out. I yielded just shy of an ounce per breast, and I really should be producing 1 1/2 to 2ounces per breast.

Luckily, we had enough stored in the fridge to make two 45 mL (1 1/2 oz) bottles, which we fed them and they took down in about 10 minutes.

The trick now is figuring out how to proceed. I’ve been instructed to pump every hour for 10 minutes to increase stimulation and, hopefully, increase production. I’ll do that until we go to bed tonight, then we’ll proceed with feedings as normal, and then I’ll pump every hour again for a while in the morning.

Christopher and I are basically holding out as long as possible on using formula. If we absolutely need it, we’ll use it, but if we can get by and get the girls the nutrition and satisfaction they need with just breast milk, then we’ll consider it a huge win.

In the meantime, we’ll continue to check in with our lactation consultant, Kim, in the birthing center at the hospital; she has been a doll and such a kind, level-headed person with whom to work – just like several of the nurses up there. She had me call her after I pumped the feeding this afternoon, and she wants me to check in with her again tomorrow. She even texted us her number, so we can check in or call/text with questions. How awesome is that?

So, wish us luck in the next 24-36 hours. Send good vibes and pray these girls fatten up a bit.

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14 Responses to “On baby weight and breastfeeding preemies”

  1. thebabydoctorswife August 26, 2013 at 8:02 pm #

    Sending you lots of love your way! The girls look darling and you and Chris are doing such a great job. I am so impressed with your dedication to breastfeed. While I too hope to be able to strictly use breastmilk, I will supplement if need be. Just know that if you do you are NOT a failure at all. You are an incredible mama! Keep it up girl. xo

    • kaylabee18 August 27, 2013 at 8:51 am #

      Thanks, sweetie. Sometimes all you need to hear is that you are doing a good job. 😉 Oh, and I’ll send good vibes your way. Hope all is still going well with you and Miss N.

  2. Wendy Wade August 26, 2013 at 8:08 pm #

    Hey Kayla…you rock mama!! Have you tried Mothers Milk tea. I have had a few friends try it and it seemed to help lots! The girls are adorable, healthy,loved and fed…the most important things in life!! ❤ ya girl!

    • kaylabee18 August 27, 2013 at 8:50 am #

      Thanks, Wendy! I haven’t yet tried it, but I plan to add it to my Amazon cart today. Hugs!

  3. Tiffany August 26, 2013 at 9:04 pm #

    Have they suggested doing a weighted feeding? The lactation consultant weighs the girls before a feeding and then again right after to see how much they are taking in. It could help you guys figure out if they are nursing efficiently. If it’s a supply issue, the extra pumping will make a difference. I found eating oatmeal and drinking plenty of fluids helped with my production.

    Nursing is both so rewarding and frustrating at the same time. I remember crying many tears when Hugo wasn’t gaining enough. You are doing a wonderful job and I wish you much success. At the end of the day, you have two beautiful and healthy girls, no matter how you end up feeding them 🙂

    • kaylabee18 August 27, 2013 at 8:50 am #

      Hey Tiff, No, no one has done or suggested a weighted feeding. The RN/LC in the birthing center yesterday mentioned they don’t have a breastfeeding scale up there (but that they want one), so I wonder if they just don’t have the capabilities? Anyway, you’re right: rewarding but frustrating. I have shed many tears already in the last 18 hours over this issue, and I’m sure to shed more. I just have to focus on that last part: They are beautiful and healthy no matter how they eat. 🙂 Thanks, hon.

  4. Amanda Staudinger August 26, 2013 at 9:56 pm #

    Kayla and Chris-

    We had a premie (34 weeks) in Jan. She was born @ 3 lbs 9 oz, went down to 3 lbs 2 oz (at her lowest) and the day we brought her home from the NICU (16 days later) she finally hit 4 lbs! Anyway for the 1st month of her life we added Neosure by Similac (1 tsp) to each bottle, she was only bottle fed for about the 1st two months (b/c she wasn’t strong enough to breastfeed), all breast milk plus the little extra to help her add weight. She has strictly nursed now since she was about 3 months old, but until then we continued giving her one bottle/day with the 1 tsp of Neosure. She is almost 8 months now and weighs probably 14 lbs (12 lbs 9 oz @ 6 months). She has only been in the 3rd percentile since 4 months old. (Hope that all makes sense).

    I have always produced enough but agree with the Mother’s Milk tea and oatmeal as well. I feel they have helped my production. I wish you guys nothing but the best and have been keeping you all in my prayers. Continued success to you guys, keep up the good work! You are truly amazing parents and your girls are incredibly blessed!

    Hugs,
    Amanda

    • kaylabee18 August 27, 2013 at 8:46 am #

      Hey Amanda, Thanks for the heads up. We have given the girls two bottles that have had formula in them — one was exclusively formula, one was about half breastmilk — after they were on the breast. They don’t seem to have a problem with the bottle/nipple thing, which is good and something I definitely was worried about. I’m hoping this is just a temporary thing and that in a little while, the girls will be old enough and strong enough to get what they need while nursing without the aid of formula. We’ll see. We’ll get through this bump in the road, if for no other reason than we have people like you cheering us on. Thanks. 🙂

  5. Opa Adam August 27, 2013 at 7:05 am #

    I like what you’re writing; it’s honest. You’ll get through this, the kids will be fine, One day someone going through the same situation may read this, and not feel so alone; this isn’t just a cathartic writing; you’re putting some good karma out there, and that’s never a bad thing. So proud of you, you’re doing a great job, and Chris seems to be working out ok, maybe you should keep him around :}~.~Adam

    • kaylabee18 August 27, 2013 at 8:43 am #

      Thanks, Adam. You hit the nail on the head: This is, in part, why I blog. You never know who is going to stumble across it and need it just for commiseration. We’re trying, and it’s nice to know that you’re proud of us and think we’re not totally screwing up our kids. 🙂

  6. acuriouskatie August 27, 2013 at 2:08 pm #

    I’m so glad you shared this as it’s something that I think all breastfeeding mothers need to hear and know about. You’re doing a great job and the fact that you’re using all your resources is really encouraging. I honestly believe many people stop breastfeeding because they get discouraged and don’t ask for help and I’m glad you’re not that case. It sounds like everything is improving and it’s great that they are healthy little girls – that’s the most important thing to remember. I don’t know what I would have done without the help of the lactation consultants the first little while so glad they are helping you as well. Keep up the good work and I look forward to seeing more updates on your little ones.

    • kaylabee18 September 11, 2013 at 5:34 pm #

      Thanks, Katie. That’s the point. I really hope others find comfort and support in our trouble.

  7. Heidi Murphy September 11, 2013 at 4:50 pm #

    Hey Kayla,
    I can totally relate to your breastfeeding struggles. Ours didn’t happen right away, but between three and six months Clare was actually losing weight. And we couldn’t figure out why. Our pediatrician was wonderful in offering solutions, I talked with two different lactation consultants and countless numbers of mama friends to try to figure anything out. I wasn’t ready to give up nursing and it was sooooo hard to stick with it. It took us a month and a half to figure out the issue (hindmilk/foremilk imbalance, doesn’t apply to your situation unfortunately) but we figured it out and our 10 month old is still nursing. We’ve spent less than $7 on formula so far and hope it doesn’t go up too much from there. Stick with it if you can, and if you can’t you’re still an amazing mama. It’s a wonder what we’ll do for our children, and as long as you’re doing what’s best for you and for them it’s all that matters. It sounds like you’ve got some really great support in your corner so follow your heart and intuition, cause only mama knows. ❤

    • kaylabee18 September 11, 2013 at 10:01 pm #

      Hiya Heidi,
      So nice to hear from you. I’m glad I’m not the only one… I’m not ready to stop breastfeeding, either, and I was worried we were using too much formula (all of which we have gotten free from the pediatrician or hospital), but our lactation consultant has encouraged us that we’re doing the right thing. Plus, the girls are still nursing (not turning it away), so we must be striking the right balance. And now they are gaining weight, so we really have gotten a boost in our confidence.
      Thanks for commiserating! Hugs!

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