oversupply, bad latch and biological nurturing position

[nearlyreadytopop]

Hi all

I posted last week about having thrush and had great advice so Im hoping for some more.

Basically the 'thrush' wasnt improving, in desperation I had a lactation consultant come out. She thought I didnt have thrush and instead have an over supply issue. Basically ds (10 weeks old) is biting down on nipple to try to slow flow of milk. This is whats causing the pain and then a couple of seconds after feeding vasospasm starts. This is despite me taking him off when the let down burn starts. She advised trying to reduce milk supply, I already block feed (one side each feed, he feeds whenever he wants but mostly its every 2 to 3 hrs). And has shown me the biological nuturing position. I have also found its not as sore when feeding lying down. But its still really sore and after a feed my nipples are still wedge shaped.

I really want to continue breast feeding, I know its best for ds but at the moment it doesnt feel very good for me!

any ideas?

Was your lactation consultant an IBCLC? That's the qualification to ensure someone can be called a lactation consultant but unlike, say, a doctor or midwife there's no legal status there, so actually anyone can just call themselves one. IBCLCs are very, very highly qualified.

She may well be right, but the wedge-shaped nipple raises questions of tongue tie to me. Ann Dobson is an IBCLC who specialises in tongue tie and will travel to most places. As she's an IBCLC she's also very, very experienced with pretty much any breastfeeding problem. www.ann-dobson.co.uk

Hi
Yes she is IBCLC.
Since I met with her I have looked up tongue tie on the internet, I spoke to my health visitor about it but she said that as ds has good weight gain that it cant be that. also that the latch looked fine and maybe ds had got into a bad habit. Her suggestion was paracetamol, ibuprofen and lansinoh cream. Obviously this works in the short term but I want to get to the root of the problem.
thanks for the info organiccarrotcake, I will check it out.

Oh good, that's really reassuring that she's an IBCLC.

Don't rely on the HV about TT (or indeed anyone other than a TT specialist, even an IBCLC, brilliant as they are, as there's not enough training about it. Some IBCLCs are fab at TT but not always unless they specialise).

Good weight gain does not exclude TT.

Latch isn't good as otherwise your nipples wouldn't be wedge-shaped.

Another excellent source of info is Milk Matters: milkmatters.org.uk/international-service-tongue-tie-talk/

The Analytical Armadillo on Facebook (she's Milk Matters).

Rushing out but hope that helps :)

Oh and:

www.ann-dobson.co.uk/tongue-tie_symptoms.html

Useful list of symptoms.

thank you so much, a good few of those symptoms apply to us. The IBCLC never mentioned tongue tie. I will see if I can find a specialist in my area.

today we had an appointment with a paediatrician at the hospital and she checked for tt. She said that he has a prominent tongue muscle but is not tt. DS was hungry so she was able to watch him feed and said the latch looked great. However afterwards she observed that my nipple looked very sore and inflammed. She has advised a visit to the GP for an 'ointment'. So Im not really any closer to sorting this out. Im getting more stressed out about the pain, ive had an eczema flare up which usually only happens when im really wound up.
Im using a saline wash and lansinoh after each feed. Does anyone have any other ideas?

Four paeds (and all the other NHS staff) missed my daughter's (posterior) tongue tie. It was diagnosed by a lactation consultant from LLL. And latch can look good from the outside when it isn't.

My thoughts exactly regarding the latch, my response to the doc, hv, midwife, lactation consultant have all been' if its right then why does it still hurt, ??? Back to my gp on mon and i will get het to take a look.

My DD has mild TT and was picked by the very experienced community MW. I saw the specialist in the hospital when we were there for DD's jaundice. The specialist said it can be snipped on NHS if it interveres with feeding. But my DD fed really well so nothing was done about it. (She gained back her birth weight in 5 days despite being severely jaundiced and needed phototherapy).

Just to say that gaining weight isn't an indicator of no TT.

thanks lilham,
Im back to the bf group on monday and the GP as well, I will ask them both to check him.

Sounds like we're having almost the same (bad) experience, nearlyreadytopop. I've also been being treated for thrush (admittedly, at my insistence after advice from a bf drop in centre and reading the leaflet from The Breastfeeding Network).

Initially the GP prescribed antibiotics (having examined my nipples with a magnifying glass ) which did nothing, the HV suggested having a break from BF by expressing and topping up with formula as necessary. This made life a little easier for a few days but as soon as I started BF again, the pain resumed.

Went back to the GP and got the cream for me and the gel for DS. Although how anyone is expected to coat the inside of a baby's mouth with a gel without it being sucked off their finger is anyone's guess.

One week later, went back to the GP for Fluconazole, and I'm nearly at the end of a ten-day course of that. There was some improvement but I think that may have been more psychological than anything else.

Saw a lactation consultant (IBCLC qualified) on Thursday, who suggested the same: no thrush, fast let down causing DS to fuss and pop on and off while kicking manically and pulling away from the boob while still attached (ouch). She also suggested biological nurturing positions, but I can't seem to get the hang of it all .

Initially it seemed better than traditional nursing positions but now the (previously relatively ok) left hand side is hurting as well as the (always been bad) right. I've set up a "nest" of pillows etc and DS seems to prefer the BN method (less kicky etc) but this morning it hurt so much I ended up punching the sofa cushions in frustration . DH was holding the baby at the time, before anyone gets worried.

DS is eight weeks old and I've been almost constantly in pain for at least four of those. I feel like a failure, because we had a couple of weeks a lifetime ago where BF was working fine and was actually a nice experience - so I know we can do it.

Clearly BN isn't going to work outside the house, so I need to get the other positions sorted too - but I'm now so confused about it all I don't know where to start.

Sorry for the essay, any help/advice/cyber hugs gratefully received. I really want to carry on BF but I just don't know if I can .

Hi Bunny
I really sympathise. I dont really have any answers but I will tell you what I have been trying.
Feeding lying down has worked well for us, when let down happens he just opens his mouth and the milk trickles out (need a towel or folded up muslin under him). I wait until it has settled before putting him back on. I also think that as he has got bigger (15 weeks today) he is better able to cope with the let down.
I have been treated for thrush and have had swabs taken to check for bacterial infection, these came back negative. I stopped using lansinoh and found it helped. The lactation consultant suggested trying Dr Jack Newman's All Purpose Nipple Ointment. You need a doctor to perscribe the ingredients and then to find a pharmacist willing to mix it. I used it after each feed and after a saline wash. After a week of this I felt very little pain in the sore nipple and I thought that was us sorted. But after a week of nearly pain free feeding I am again getting soreness. My nipple has never cracked or bled more looks red and irritated. So back to the APNO.

For the past six weeks I have stopped expressing and use one side per feed. DS feeds every 2.5 to 3 hours during the day and has recently been sleeping from 10 pm to 4 am. I think this helps give my sore nipple a rest and has helped it heal.
The HV suggested using paracetamol before feeding to help with the pain.
I should say I am painfree on one side and its super, I really look forward to those feeds.

www.breastfeedinginc.ca/content.php?pagename=doc-APNO

for info on APNO. This website also has useful info on latch, positioning etc. Dr Newman also responds to emails very quickly.

Thanks so much - all helpful advice. I've started using diluted grapefruit seed extract diluted to swab the nipples after feeding.

I also found feeding lying down to be better than upright, but after trying BN positions, even lying down seems to hurt! Grrr.

Having said that, the last feed I did felt relatively ok - I think perhaps all my frustration at being at home all week on my own (DH works long hours) is contributing to the pain.

Will keep soldiering on - if you find a magic cure, please let me know! :) I will do likewise.