Four day old baby, no idea whether I'm doing this right, please help

[msnovember]

This will be long - apologies.

We had such a difficult start after a hoped-for waterbirth, wasn't able to initiate bf at the start as firstly the placenta wouldn't deliver, and when it eventually did, a 3rd degree tear was discovered and I had to go to theatre for an epidural and repair.

I have flat nipples, and the first time she latched on was about 5/6 hours after birth. A mw latched her on in recovery, and although it was painful I assumed it was because my nipple had never done this before. Sure enough, when she came off it was cracked and bleeding. Couldn't get her latched onto the other side at all, as my right nipple is SO flat it wasn't triggering her suck reflex. Support down on the postnatal ward was so awful, I was catheterised and immobile, and they kept trying to get her onto the right nipple when it clearly wasn't going to happen. The left nipple, meanwhile, just got more and more cracked as I decided to ignore the right in favour of the left. She eventually got a cup feed of formula at about 22 hours old.

The following night was worse, I was half mad with sleep deprivation and I either got a disinterested mw who stayed for five mins and told me she wasn't latching because she wasn't hungry, or someone who promised to come back to me and then didn't. She got another cup feed of formula at Saturday lunchtime because a long time had again elapsed since feeding from the "good" side.

I then came across a wonderful, supportive student mw who recognised that I was a good candidate for nipple shields, who sent DH out for some. They've made a massive difference - she can now latch onto both boobs, although I know the latch isn't perfect as they are both sore even when I use the shield. But at least she was latching! I was encouraged to stay in hospital an extra night to improve the feeding, which was a bit of a joke as the person tasked with helping me that night never returned after about 9pm. Thank god they allowed DH to stay with me (I had my own room), otherwise I probably would have broken down.

We were discharged yesterday. Still wasn't feeling particularly confident but there was nothing at all to be gained from staying. I've spent the last 24 hours feeling confused as to when she wanted feeding and when it's wind. Maybe I'm labelling her fractious behaviour as "wind" when she's hungry?

The fact she seemed to be breastfeeding quite well, albeit with shields, has been such a relief to me, maybe I've relaxed TOO much.

Milk only came in last night. Don't know know much weight she's lost as the community midwives didn't visit as planned today. I plan to hit some BF groups, but I'm still very sore and physically/mentally delicate and I'm not sure I'm up for leaving the house quite yet.

Now to the pertinent questions:

She pooed quite a few times from soon after delivery to about 30 hours old, but nothing since. I put it down to milk coming in, and difficulty with getting colostrum when in hospital. When can I expect to see this improve? She has wet nappies, although the wee seems dark which is a worry.

She has really smelly farts - can this mean anything? This is why I often don't know why she's crying - is it wind or hunger? If suckling comforts her, should I just let her or would it make any wind worse?

I know using nipple shields isn't great, but it's either that or no boob at all

boobmeister - some women have flat nipples, just as some people have flat feet :) It's just a normal variation, but it can sometimes make it a little more difficult for the baby to latch on. The nipples are literally flat - no, or very little, 'sticky out' bit at the end.

Aha thanks tiktok!

Sorry for not updating, manic day yesterday. Typing on phone so will tell full story later, but my instincts were right and boob + shield was more pacifier than food. Feel awful for thinking my baby was feeding well when she wasn't. Have moved to mix feeding and formula had an immediate effect on her poor empty digestive system. We had a lot of pop yesterday!

A lot of poo that is, damn autocorrect.

msnovember - hope this resolves. No need for you to feel awful. The person/people to feel awful are those who failed to give you good help in the maternity unit. The 'wonderful, supportive' student midwife who gave you shields needs a kick up the arse in my view - she gave you no indication that shields have risks and risk undermining bf effectiveness, did she? Shields can sometimes be useful, but they are far from the whole answer to everyone's prayers.

Effective bf with flat nipples can be more tricky, but it is not something that a competent maternity unit should find defeats them. In fact, they made your situation worse. Now you have a six day old baby who has some catching up to do, and you are still not bf in the way you planned to do :(

TT what tips would you suggest to help a mum with flat nipples?

organic - I always suggest biological nurturing positions, but when the mother is already cracked and bleeding this is not always great, as the baby's searching for the nipple can cause pain. If the mother is not doing BN for this reason, a wide open mouth, a keen baby, and a mother prepared to experiment a bit with different holds and angles, usually works just fine.

The OP did not even get to bf until 5-6 hours after birth - that doesn't help. The midwife latched her on for her (why? maybe the OP was too 'out of it' but 'passive' feeding like this is not good for learning comfortable feeding, either). Sleepy baby doesn't help - many babies are too sleepy at 5-6 hours postnatal to bother feeding, too, esp if the birth has been difficult.

Then there has been a huge amount of handling when the poor OP was catheterised - people trying to get the baby on, which can turn the baby off :(
(sorry - talkin' 'bout you here, msnovember!)

Sometimes, if the nipples are really flat, manual stimulation helps a bit. I have heard of mothers putting an ice cube in a muslin and dabbing to make things stand out.

Then there is a device called the 'niplette' which I have only read about but which is supposed to draw out flat nipples.

Nipelette!!! Thanks TT really couldn't remember the name. I have never heard feedback from anyone that used it but an ex-colleague of mine who specialised in feeding products (bottle or breast) said she was extremely impressed when she went on a course and this product was one of the things shown. Worth a try OP?

Def worth considering but I'd be concerned about someone using it with already damaged nipples....it works by stretching the skin (I got sent a sample a few years back and had a go!).

www.boobybits.com/avent-niplette.shtml

Ouch!

Tiktok you seem to really know your stuff. When I was pregnant I was recommended to start using lansinnoh a few weeks before birth to prepare my nipples. I did it and was never sore as such. Was it because of the cream or was I just lucky? I got slightly uncomfortable but nothing relevant.

surprises she should do, she's our resident fully qualified breastfeeding counsellor (minimum 3 years of training - none of this "1 day" stuff). :)

TT thank you :) Yeees - niplette - I'd heard of that but also couldn't get the name. I've made a note.

Lansinoh as preparation would not really make sense - I dont suppose there is any harm in it, but it works by coating the skin, not by actually altering the structure of it. It coats the skin with (harmless) gunk which allows for 'moist wound healing' underneath, so a scab does not form. This is important with cracked nipples because if a scab forms, it then falls off with the baby's feeding and raw skin is exposed....owowowowowow. The moistness can be soothing and prevents clothing from roughing up already sore skin.

But use in pregnancy is a bit pointless, I would say! The nipple/areola skin itself has tiny weeny grease-secreting glands (the montgomery's tubercles) whose function is to keep skin supple, ready for bf. Maybe the Lansinoh acts as a back up for this, who knows, though?:)

I don't think a niplette will work if you're already bf as it works on suction so will just express a tiny bit of milk and then fall off (one of the many things I tried in desperation!).

Expressing with a breast pump for a short while before latching the baby on can work in a similar way though.

Op, I've been there. I also didn't try to feed ds until a few hours after he was born (noone told me to and I was still in that bewildered state where I was expecting to be told what to do) and he damaged my nipples quite badly before anyone realised the latch was no good.

It was a long, slow process which needed a lot of help and practice, but we got there and I bf ds until he was 14 months old.

Ironically, bf actually helps pull out flat nipples permanently - mine are definitely more "pointy" than they were pre-ds.

Thanks for the reply TT. I always wondered if it was correct or not.

suzi, good idea about expressing....a pump does indeed pull out the nipples (use with care if nipps are already damaged, though, and if the broken skin strethes with its use, it might not be a good idea. Depends on the pump, though, as some are more stretchy and pully than others.

Did you write and tell the maternity unit how poor their help was? :)

tiktok - I didn't have to. My Community Midwife was appalled at the state of my nipples when she came to see me (would have been day 4 or 5 probably as I spent 3 days in hospital). I'd developed an infection by then and my right nipple had closed over altogether - it needed swabbed and antibiotics.

Anyway, she complained and also referred me to the amazing bf midwives at the hospital where ds was born (didn't even know they existed before that) who lent me a hospital grade pump, did several one-to-one sessions with me on latch/checked for tongue tie etc and were all-round great cheerleaders and not once suggested that there was the remotest possibility that we wouldn't get through this, which was important for me.

Unfortunately one of the bf midwives retired the following year and wasn't replaced, and the other now has responsibility for bf support for the whole city so I don't know how things would go now...

Good for your CM :)

I struggled to get started with BF too.

Although managed to 51/2 months with DS1 and 1yr with DS2.

I used to use peppermint tea to sooth my sore nipples. I would make up a strong brew & then store in a bottle in the fridge. When needed I would soak a couple of balls of cotton wool & put them in my bra.

and DS2 had the smelliest wind! No one would believe a little baby could make such a stench - think DH got the blame most often He was quite crooked at birth, being born at 10pounds and 57cm (I gave birth to a 3 month old!) I think his insides might have been a bit squashy, it seemed to improve after a few visits to the osteo.

Also I have forgotten the required amount of newborn-poop, but older bf babies poop very rarely as there is no wastage in bm. I know DS did not poop the required amount as a newborn, but that was because I think he was so big & had a sluggish bowel system. He used to poop about once a fortnight! although I think once a week is more "normal"

It is, getoutmypub, but not this early on. Here's a good indication of nappy output:

www.kellymom.com/bf/supply/enough-milk.html