Rubbish latch, nipple confusion... help! (Long!)

[Mamakath]

Hello, I'm a newbie here and in desperate need of some help. My DS is a month old and has had problems latching on since he was born (tongue tie which was supposedly fixed at 6 days but this made very little difference; we did go back to the hospital and got a bit more cut last week but again I haven't really seen any effect as yet.) I got very sore, bleeding nipples with deep cracks that would heal a little and then reopen every time he fed... feeding was agony and at 3 weeks I decided to give myself a break from bfing and try to heal, in the hope of starting again after a few days. (It was either that or just go to formula - which I really really don't want to do. I didn't stop bfing completely as I didn't want him to completely forget what to do - have probably been doing a feed or 2 a day bf and then the rest with expressed milk given by bottle.) 10 days on and things have healed a little but I'm struggling to increase the bf feeds and really don't want to be a slave to the pump forever. His latch is still pretty rubbish: I can generally get him on ok (provided he's not too sleepy and will open his mouth properly) but generally he slips off a bit after a few minutes and starts gnawing my nipple with his gums - ouch. He also gets agitated when I bf him, which I think is probably nipple confusion (he's annoyed that he's not getting the milk as quickly as with a bottle), and he doesn't seem sated after a bf feed, which I put down to him just not suckling efficiently. (Although he has been putting on weight ok, which means that he must have been getting the milk out of me somehow.)

I'm getting all the RL help I can (bf support group, bf counsellor, lactation consultant, cranial osteopath) but this just doesn't seem to be getting any better and I'm beginning to think that bfing is just never going to work for us. Giving him expressed milk only is fine as a stop gap but not sustainable in the long term (can't continue to spend hours pumping every day). So this is a desperate plea for suggestions - any tips for sorting his latch and training him to suckle better? If this is a physical thing to do with the shape of his mouth/ jaw (as lots of the professionals I've spoken to seem to think it is), is there anything I can do about it??

Hi, and welcome to Mumsnet :) First of all I just want to say how well you have done to get this far on such a bad latch. I'm sure that with determination and the right info and support you can do this. out of interest the irl support you've been recieving are they all fully accredited ie is the LC an IBCLC registered one? rather than just someone whom is refered to as a LC by say your health care providers? and also re the BFC check she is fully trained by one of the recognised groups such as ABM, NCT, BFN LLL.
Its a bit of a minefield as anyone can call themselves a BF "expert" and it pays to check up that you really are speaking to a person with the right qualifications.
When your DS's TT was snipped did they give you things to do to ensure it did not just heal back? and if so have you been doing them?
Also when your DS is latching on you can try breast shaping to get him to take more areola into his mouth. Has anyone shown you how to do this?
Another thing to try is Biological Nurturing lots of babies who struggle to maintain a latch seem to get on better when feeding in this laid back posistion. If you've not been shown it basically you just sit semi reclined and have baby layed on your chest this way they can get a deeper latch. I'll dig up some links if you are not allready familiar.
There is also the Flipple technique. Where you fold your nipple upwards and then let in explode into your babies mouth thus ending up at a deeper latch. Again i can link if you havn't been shown this.
I would try to eliminate artificial teats as well as each bottle or suck of a dummy just reinforces his current latch issues. as sucking on a hard plastic nipple is so very different to a soft pliable human breast.
Not easy when you are currently mainly bottle feeding I know. This would be something to discuss with your LC/BFC as she can help you with alternatives.
The other issue is of course healing your nipples I imagine you are using Lansinoh and not allowing them to dry? yes.
Anyway I know there will be others with better knowledge and understanding of this along soon. Well done on getting this far. :)

Hi, I had C Section and Pneumonia and was in agony trying to breast feed was Hell. However we persevered we took it each day as it came and so many times I nearly gave up, it was so painful. Tongue tie was no problem for us but it was hard work getting her to open wide to latch on and she often slipped off I was so sore. To be honest it was shear determination that got me through as it was unbearable at times. I had a CT scan at when she was a couple of days old which meant she had to go on formula for 24 hrs so it made any progress we made go backwards then a month later she had another 24 hrs on formula as the Pneumonia came back this time it was much better getting her back on the breast, I had to feed her constantly for a couple of days though.
I don't suppose this really helps your situation but I think if your Baby is putting on weight you must be doing a good job my milk supply wasn't great when I was ill but I told myself if she was gaining weight I wasn't going to worry.
I am no professional and have no idea what I am talking about really but I think you should try take it one day at a time feed your Baby as often as required which should increase your supply and as your supply increases after a few days perhaps your Baby will be more satisfied. I don't know what you can do about the latching on any different to how you already are you sound like you are doing a great job. I think your Baby will work around the problem with time and practice. The sore nipples ease in time but it is horrendous til they do. Just try to relax and not worry too much and see how it goes if all else fails maybe combine breast feeding and the bottle. The most important thing is you know you have tried you best you can't ask for more than that.
I hope I have helped a little I don't really know what I am talking about but I know how hard I found it to breast feed although for very different reasons but by my experience there maybe something in there that might help. Its three months down the line for me and I am only just starting to relax and be comfortable with it. I still find it awkward out and about though and secretly looking forward to weaning.
All the best

Hi both of you, thanks for your support.

Pesephone yes, the BFC and LC are both qualified and very experienced, and what they've said does seem to make sense of our problems. (As opposed to all the midwives and HVs who looked at my DS feeding and pronounced his latch to be absolutely fine. Um, why am I in pain then??) I have tried various latching on techniques (nipple flip, breast sandwich etc) and also biological nurturing but I think we're both too tense for the latter to work - I don't really trust my DS to latch himself on without mauling me.

The midwife who did the tongue tie snip didn't say anything about stopping it from healing back - what is it that I should have been doing?

As both of you say, the bottles aren't helping things here but I feel we're a bit stuck with them. Bfing DS is just about bearable at the moment but only because I'm only doing a couple of feeds a day; each one of these makes me sore (not dry/ cracked now, more bruised) and I'm worried that abruptly cutting out the bottles and exclusively bfing will just make everything agony again and we'll be back to square one. Or perhaps I should just go for it on the grounds that there's nothing to lose?

Been thinking of a couple of other things to try, breast compressions and taking a bath with baby are both great ways to improve his latch and get him back to just the breast from those bottles. A babymoon where you just go to bed and lay skin 2 skin is also often a great help as is wearing bubs in a sling as often as posible iether skin2skin around your house or wherever you happen to be. (with your top on that is lol )
Here are a few links that may help.
www.biologicalnurturing.com/
www.breastfeedinginc.ca/content.php?pagename=vid-4dayold
www.breastfeedinginc.ca/content.php?pagename=vid-cupfeed
vimeo.com/13267722

OK sorry bit of a cross post there with all the links.
Glad to hear your LC is IBCLC registered.
re the stuff to prevent TT growing back I can't really say I'm qualified on it tbh but as far as I know its things like running fingers around the underside of the tounge etc but you should really ask your LC about it. This BFC is amazing with TT.
milkmatters.org.uk/
I am glad to hear your no longer cracked etc bruising sounds nasty too though. I think persavering with the Biological Nurturing would be a good idea it really does seem tohelp in a lot of cases.
Another idea is to try an SNS some people call it a suplimentor its something your LC should be able to help you in using they are quite cheap from Amazon
www.amazon.co.uk/Medela-SMS-Supplemental-Nursing-System/dp/B000W73YKY/ref=sr_1_1?ie=UTF8&qid=1312816898&sr=8-1
you put the ebm/formula in it and tape it to your nipple so that baby recieves all the feeds at the breast rather than using bottles they can be very effective at getting a babyback to the breast full time as the baby takes more from you and less from the SNS you just put less and less in it.

I don't know if this helps at all, but I tried biological nurturing with my DD at a time when i had mastitis and my nipples were severely cracked and bleeding. I was terrified of what the pain would be like when she latched on, it was beyond toe curling normally and would have me in tears. When she decided to latch on it was completely painless, I had to really check she was even actually latched on.

Thanks for the links. I actually just tried the biological nurturing thing - and it didn't hurt when he latched on. As with other positions, though, it's a few minutes in when things start to go wrong, and I just can't get him to relatch properly. I'll keep persevering with it, though.

Mamakath just to say that I recognise a lot of what you're saying and can hear the frustration I know you're feeling with e.g. pumping, doing BN and then the latch slipping, it just taking so long to see improvement I've been there! There is a tongue tie support thread which I'll try and find and bump for you.

Worth getting the TT checked again in case it has reformed - my son's was snipped at 6 weeks and has just been done again at 12 weeks. Exercises would have been things like running clean finger along lower gum for baby to follow with tongue (it's a game!), sticking tongue out for baby to copy (mine doesn't do this), giving baby clean upturned little finger (keep nail v short) to suck on. I believe King's also advise sweeping under the tongue with a finger to keep the wound from reattaching - that sounds awfully painful to me. I think you probably need it checked again though in case it's reattached.

There may be other issues along with the tie e.g. high palate. Any chance your baby got a bit squashed/compressed on the way out? Some cranial osteopathy might help with latch if there is more going on - it really helped us but it took 3 sessions. Not sure whether you can/want to see someone privately but there is a list here of IBCLCs/others who do TT release: www.lcgb.org/consultants_tongue.html.

If you're using Lansinoh on cracked nipples keep an eye out for thrush esp if you have had antibiotics. Jelonet (comes in sheets from pharmacy) also v good for moist wound healing but same issue with thrush.

PM me if you want to for details of IBCLCs in London or cranial osteopaths or just some support - like I said I really do recognise a lot of what you're saying and how frustrating, painful and upsetting it can be, it feels like it's taken over your whole life (even more than a baby does normally). If I could find a way to stop pumping and start BFing (even just replacing the expressed feeds, my baby has been mix fed from day 3 as he didn't latch at all and then shredded my nipples, twice) I would. Well done for getting this far and still EBFing. I couldn't, but am still going on trying to BF at 12 weeks!

You've had loads of good advice already (and keep posting - this is a brilliant resource for BF support) but I just wanted to add my story in case it helped.

I have a 13 week old and your description of nipple pain brings back memories. From the first feed I had cracked nipples that were always sore and sometimes excrutiating. I've also had friction blisters. Lansinoh helped but I could only think about one feed at a time, even thinking about a day at a time felt insurmountable. Anyway, things improved after maybe a month or 6 weeks and then improved again. I now enjoy feeding - we both do - and I hope you get to this stage.

We had problems with positioning and attachment and I found the nipple flip and sandwich helped, but I can't say that any one thing was tried and then fixed it. I believe that we needed these things: practice and time for his mouth to grow bigger. He now feeds for 5 mins at a time whereas feeds seemed to merge from one to another in the early days - long, frequent feeds with a poor latch will cause problems. I would wonder whether it was worth the pain of re-latching (the first sucks were the worst) but I think it generally is. Anyway, feeding just got better, and then it got enjoyable. We're now at the stage where bf feels like an easy option. I know this may seem unlikely, it did to me, but it can happen.

Morning all. Orchidee it's good to hear that things gradually got better for you - gives me and others some hope! Mollcat DS does have a high palate, and as you anticipate got a bit squashed when he was born. He was delivered by ventouse, and apparently this has resulted in a stiff neck/ jaw, and a compressed/ receding chin (so the whole 'lead with the chin' thing for latching just doesn't happen). This combined with my fairly flat nipples = crap latch.

(Btw I had no idea that the delivery method could affect feeding - had I known, I would never have let them pull him out with the ventouse! It wasn't an emergency situation - more that they were mildly concerned that he hadn't come out after an hour and a half of pushing and they couldn't figure out why. I think I could have pushed him out myself tbh - and feel v v guilty that my failure to do so has caused him all these problems.)

I have been doing all those things to prevent the tongue tie reattaching anyway - except running a finger under the tongue (would have thought it's best to leave an open wound alone). DS will stick his tongue out and generally his tongue mobility has improved a bit since the first snip, so that's good.

We've had 2 cranial osteopathy sessions already, and the osteopath thinks we'll probably need a couple more. After the first session I did notice DS could open his mouth a bit wider so I'm hoping it will make a difference eventually.

Ah, sounds like you're doing everything you possibly can then which is why it's so blooming frustrating (well I find it frustrating)! I didn't know about compression etc either - in my case he'd wedged himself in wrong and had to be pulled out during EmCS, there is nothing either of us should feel guilty about though. He could easily have got squashed if you pushed him out.

I think flat nipples are a bit of a red herring - I think they don't help (especially with a high palate) but aren't fatal as my baby will happily latch onto the wrong bit of breast and the IBCLC I saw pointed out they'll try and latch onto your face given half a chance. I think it's the gape which is more of an issue because you just can't shove enough breast in. They'll get pointier the more feeding you do. I found a pump helped.

I hope you see significant and most importantly continued improvement soon.

I didn't know delivery affected feeding either - we went to forceps after 45 mins of pushing DS also has a high palate!

High palate can be caused by TT, rather than delivery. The action of the tongue smooths out the palate in the womb, but of course it can't do that if it can't reach the palate.

A difficult delivery can create tensions in the baby's head and neck or quite simply leave it with a sore head which makes being held in positions for BFing uncomfortable for it. It can make it less comfortable to feed on one side for example. Mine hated cross-cradle hold, and did more damage to the nipple on one side rather than the other.

^^ I have no idea why I wrote what I did on the above post

I do know that delivery can affect BF, that's why I thought that forceps after 45mins of pushing was a bit quick. All's fine now though....

The point about the high palate was just an "us too" comment, in the hope that what worked for us (time, practice, perseverance) helps you too.

No worries! I'll stick with the time, practice, perseverance then!

Hi everyone. Still here and still persevering. I think things may be getting a teeny bit better - although some feeds are definitely more painful than others. One thing that I've noticed recently is that my DS's lips don't flange out like they are supposed to (they are more tucked in), and I'm wondering if this is part of the cause of my pain; I can see my skin moving in and out of his mouth under his top lip, which feels a bit pinchy, IYSWIM. The BFC suggested he may have a lip tie - does anyone have any experience of this?