any advice?

My friend really wants to BF. Her baby was born at 8 lbs 15 ounces. She wound up having a C Section, and it took her milk almost a week to come in. So at his first check up he was down to around 8 lbs. Now she is with him at the doctor and he has only gained 2 ounces (he is at his 2 week check up) so still not at his birth weight. He seems fine. He nurses regularly and poops every feed and pees very frequently. She's had no indications that he isn't getting enough milk other than the fact he's now at his 2 week check up and still isn't back to his birth weight.

She is waiting to see the doctor now. Anyone have any suggestions? Is this normal or is something wrong?

ETA: She just texted me that he is pooping and peeing 6 or 7 times per day, each.
She just texted that the doctor is giving her the option of supplementing this week or not. She brings him back in one more week and I guess then if he's still not to his birth weight she'll have to supplement. So any advice is appreciated.

 

It wouldn't hurt to see a lactation consultant. Spencer did the same thing. He nursed but not well, at first. And he wasn't gaining much weight at all the first few weeks. An LC helped me get him to latch better and nurse longer. Now you'd never know. He's 3 1/2 and totally solid. He's taller than any of my other kids were at 4 1/2.

 

She went to a LC last week b/c she was so worried about not getting milk in. They told her that one of her nipples was too big for him but he would grow in to it. So she's been pumping on one side after she offers it to him. (I believe). But on the other side they said he was latching well. I wonder if she plans on going back to the LC again this week.

 

I'm on my phone now so I will send a link later but kellymom.com has lots of god info about expectations for weight gain etc. I personally would not supplement unless the dr said it was really needed as long as the pees and poops seemed up to snuff.

 

Here are the articles from Kellymom (at least I'm assuming these are the ones PP mentioned ):
http://kellymom.com/health/growth/weight-gain_increase/
http://kellymom.com/bf/normal/weight-gain/

Also for an almost 9 lbs baby your friend's nipples would have to the size of King Kong's fingers to be a problem. If she can, I would suggest meeting with a different LC.

Is that 2 oz from his lowest weight or 2 oz from his birth weight? Did she have a lot of IV fluids during labor before her ceserean? If so, baby's birth weight is likely higher then it should be due to retained water. Has baby been weighed on the same scale each time? If not, I would request that before panicking - scales can be off by a LOT & at this stage every oz counts. Last, but not least, if she's going to supplement, she should have a plan with her doc to also protect the breastfeeding relationship.

 

I messaged her just now to confirm but I'm fairly certain he's up 2 ounces from his lowest weight (from a week ago). So still down several ounces from his birth weight.

Like what kind of a plan would they come up with to protect the relationship if she's told in a week that she needs to supplement? Like I said, going off baby's diapers it seems like he's doing fine. He does fall asleep at the breast almost every time she said. She is hoping he is close to being a little more awake and willing to eat. But she says that sometimes he'll nurse for a whole hour.

ETA: I had already emailed her those exact same two articles earlier today.

 

If she had an unplanned c-section, she was probably on IV fluids for a long time prior to the birth. The baby also takes on lots of fluid from the IV, and probably peed out several ounces after he was born and weighed and then lost a few more because he's a big baby and her milk took a while to come in. If I was her, I would not worry for at least another week, probably even two, if he's not crying and he is pooping and peeing.

 

Those were the links. Thanks! Also, the same scale issue is a big one. By having my twins weighed on different scales, it looked like they gained no weight one week and a ton the next. Those little ounces make a huge difference on the chart at first. (Oh, don't even get me started on the weight chart!)

 

With an 8+ lb baby at birth, I probably wouldn't worry unless his gain stays low the next couple of weeks--that might signal he's not transferring enough milk. Average gain is 4-7 ounces/week. Some babies do gain less early on and some gain more.

That said, never hurts to see another LC--it doesn't sound like the first one was very good. Most LCs around here do not recommend supplementing with formula so early and instead work on latching, position, etc, to make sure baby is optimally transferring milk and that mom is making milk. If supplementing is recommended or she feels she wants to supplement because she's worried, I would recommend doing it through pumping. So a nurse-pump-feed pumped milk process--this is what I did with my first baby and it was recommended by the LC--who never once mentioned formula to me through all my nursing problems.

If he's sleepy, she might find her supply does not come in as needed so it might be worthwhile to pump after feedings if he really is having short feedings and falling asleep really easily. (cool cloths on bare skin, tickling, stripping him down to nurse, etc, can work to wake him up while nursing too)

 

A few things to consider when supplementing & wanting to protect the breastfeeding relationship - whenever babe gets a supplement, mom should be pumping to maintain the supply/demand cycle, ideally supplements should be given at the breast with an SNS, if not then finger feeding, cup, spoon or syringe (bottles would be ok if babe doesn't seem to have any nipple confusion but they can introduce more problems then they solve). Those would be the two big ones for me.

 

I think a big part of the problem has been she's had a house full of guests ever since he was born. Her company just left today, so I bet she will relax more and have more down time w baby and he will wind up gaining more this week. She decided to go one more week w o supplementing and really give it her all. She's trying to nurse more frequently. Fingers crossed!

She also started pumping on each side before she nurses and then giving him the expressed milk after he nurses. Sounds exhausting but she's really making an effort.