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 your baby isn't getting enough breast milk 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 weight. You may be struggling with these 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 after every feeding. Sometimes with donor breast milk. This sounds good in theory but if you are trying to preserve breastfeeding, it can be devastating. Many young babies cannot go back and forth between breast and bottle. They can develop nipple texture and flow preference. Bottle feed takes less effort than breastfeeding up to 72% less effort according to some experts. So, you can see the attraction for a newborn who is struggling with milk transfer.
If the mother is not taught how to pump and properly empty her breasts, she may think she is breastfeeding a baby before giving it a bottle. What is really happening is this baby cannot breastfeed and it is “pacifying” patiently at the breast until you give it something it can use. A lot of mothers will say my baby is "lazy" or "sleeps" at the breast then wakes up when I give it a bottle. Newborns are hardwired to do three things: breastfeed, grow and breathe. If one of these three things are not happening. Something is wrong.
Some mothers are told to “triple feed”: breastfeed, pump and bottle feed. Triple feeding is often used by care providers who don't understand lactation. It can cause early cessation of breastfeeding if used improperly. It is impossible for most women to keep up this grueling schedule of pumping around the clock with little sleep for days or weeks. Another growing trend when using the triple path is to only allow the baby to breast feed for 10 minutes, then give a bottle. Even newborns who are nursing well will struggle to completely empty their mother’s breasts in 10 minutes. If your newborn is not triggering a letdown, they are most likely pacifying until their bottle comes.
Often the most basic question has gone unanswered. Why did this baby fail to breastfeed from birth? If weeks have passed, why is this baby still unable or unwilling to breastfeed?
Reasons babies fail to breastfeed:
Small for their gestational age or preterm. These babies often have immature sucking skills. Underdeveloped facial muscles and small cheek fat pads known as buccal pads on their face. Most twins fall into this category. They are often born early and smaller than their gestational age.
Large for their gestational age or born to a mother with gestational diabetes. These babies will often have low blood sugar after birth. They will nurse sluggishly or not at all. Showing very little interest in breastfeeding and when they do, they nurse poorly.
Both SGA and LGA infant can have a choppy and uncoordinated suck making it difficult to trigger the letdown reflex so they can get to the real meal with copious amounts of milk flowing.
Long difficult labor or an induction. Both types of labors can be hard on newborns making them sleepy at birth. This can quickly snowball into low blood sugar or newborn jaundice because they are too tired to feed for days and need the first 7 days after birth to recover from labor. Their suck may also be uncoordinated or worse very painful from a mold head because facial muscles are out of line.
Severe tongue tie, if an infant’s lingual frenulum is too tight for the baby to bring breast tissue into their mouth or keep inside their mouth. A lot of infants will refuse to breastfeed sometimes at birth or stop within the first 24 hours. Others stop once supplementation begins, they will refuse to nurse first and be supplemented last.
Newborn jaundice. A condition where your baby has too much bilirubin. Their skin may turn yellow and the whites of their eyes. Your baby will be very sleepy and show almost no interest in feeding. When they do latch, they stay in an extended sucking phase getting little milk. This is a problem because the only way to flush out excess bilirubin is by frequent bowel movements but if your baby isn’t feeding well, they will produce few stools.
Newborn jaundice can be caused by a variety of factors:
Blood type incompatibilities such as rhesus factor (Rh) or ABO causing a breakdown of red blood cells (hemolysis).
Excessive bruising from labor.
Conditions that affect how the body processes bilirubin like Gilbert’s syndrome and Crigler-Najjar syndrome.
Gestational diabetes from the mother.
Congenital hypothyroidism
An intestinal blockage
Pyloric stenosis
Breastfeeding related jaundice, which can happen when an infant is not feeding well.
Pathological jaundice can also be caused by certain medications, such as certain antibiotics.
All of these problems can be addressed with different types of therapies and treatments. Some performed by your lactation consultant, and others handled by other providers. Sometimes it is not just one problem that needs to be resolved before exclusive breastfeeding can be established. Do not wait, get help soon. Very few newborns who have stopped breastfeeding will spontaneously start nursing again. Look for a board-certified lactation consultant in your area. They will be able to examine your baby and you as well to see why your infant is struggling. Take a full history and come up with a customized lactation care plan to get you back on track.
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