Please, I desperately need some help

[lookout]

Here is the background

www.mumsnet.com/Talk/breast_and_bottle_feeding/1321772-Tongue-tie

My last post is today's situation. I just don't know what to do. I am seriously considering giving up, i dread every feed. I just really need someone to tell me what to do.

thanks for the link. very good indeed. i will try breast shaping when i'm nxt brave enough to feed from the breast.

i will see if the pain gets better before going back to the gp. the lc was quite sure that it was nipple compression that was causing the pain, and the trauma caused by poor latch. i did see the gp about thrush and she prescribed me daktarin and him nystatin, but i stopped using them when the lc said she was certain it wasn't thrush. tbh, i only get the thrush like pains after a bad feed, so i'm not sure it's thrush either.

i am using a mini medela electric. a friend lent it to me and i'm using the shell that came with it, so it's nnot sized to fit. i wouldn't even know where to get a different size shell, do medela even do them??

thank you so much for your help and advice.

Medela do sell what they call PersonalFit shields (some places call the plastic bits that goes on your breast a shell, some a shield). You just pull off the cone bit and fit a new sized one on to the main part of the pump. I got a 21mm sized one off Ebay a year or so ago but it's still too big (freak of nature that I am!). Just google PersonalFit and you should find suppliers aplenty.

The Ardo link showed what to look for in fitting a pump shell/shield as you don't want it pulling in too much areola into the shell but at the same time you don'r want the nipple rubbing against the sides or being squeezed into it.

Has baby been checked for tongue tie and palate anomalies (high or bubble palate)? Sorry if you have already gone through this I just can't see it on the thread (late night and all!). Has the LC talked through ways to minimise the nipple compression? Does it get worse with cold air at all?

Just a thought - do you know how old the pump is? Have you replaced the little white rubbery valve on the pump (it's attached to the yellow plastic bit that protrudes into the bottle) as that can affect the amount of suction available so it might be worth while getting new ones.

Or you could try asking at LC if she knows of anywhere that hires hospital grade pumps out for free/low cost as double pumping is a very effective way to keep up/build up supplies with minimal effort (well as minimal as pumping 8-12 times a day is....).

FFS - please ignore the drivel about TT/palate probs - it's late sorry

don't worry, i don't expect everyone to remeber our whole history!

the pump must be nearly 7 years old as a friend had it for all 4 of her kids, the eldes will be 7 in dec. when she gave it to me it had two little white things, i seems to have pretty good suction, i can't put it on the highest setting as it's too painful so i presume it's working ok. i'm not sure about the fit of the shield - nipple doesn't rub but a bit of the areola does go in, can't tell if it's too much or not though. i know my lc does hire out pumps, will ask her about it when i next see her.

today i only pumped 6 times, i couldn't have physically fit in anymore without having been constantly attached to the pump. i hope that will be enough for a couple days just to let my nipples heal .

lc didn't say anything about how to reduce nipple compression. can you give me any ideas?

pumping at 3am is a lonely business indeed.

Just wrote a long post on my phone and then lost it. Grrr!

Anyway this jist of my post was have you seen an Osteopath (one that's paediatric trained)?

OrganicCC might be able to provide more info as I'm sure it was her that suggested it on another thread I read, but often when
they have TT it creates a lot of tension and some Osteo treatment can help release it.

All I know is that it's worked wonders with my LO. His feeding still isn't very effective, but we had the TT divided late (3 months) as it wasn't until I posted on here and someone suggested TT that I pushed and pushed for someone to check him.

However everything else is lots better, the sleep is better, the screaming has subsided and he'll lie on his back or front happily (doesn't need to be upright). He doesn't react as badly to loud noises either ( he used to burst into tears every time we had a loud noise) Admittedly some of that is just him getting older and not being a newborn anymore, but I do notice a difference after each session.

Someone more knowledgeable than me might be able to help with more specific information about why it helps.

I realise that I can't diagnose your problem over the Internet and that I can only tell you what worked for us, but maybe ask your LC about seeing an osteopath and see what the suggestions are?

We're all hoping it gets better for you very very soon!

titania, in fact i'm going to see a baby chiropractor next week! when i spoke to her on friday, everything she said made perfedct sense and she seemed sure she could help. i may be clutching at straws but i am really hoping she'll be able to make a difference to how settled he is.

Lookout, I hope so too. What I found helped was going through everything from the beginning and writing it down - the chiropractor should ask you for a history.

Labour - how long each stage, any assistance, any pain relief
Birth - any issues.
All issues from birth - we had not liking lying on front or back, only on side or upright. Doesn't like loud noises, screams in the car. Wouldn't put left arm down by his side for ages after birth.

Also what has happened since birth, tongue tie snipped etc.

I found going through it all really helped to see a pattern of what the problems might be!

I really hope you get your issues sorted soon.

Nipple compression happens when the latch is shallow and the nipple is squashed up against the hard palate (if the latch is deep enough the nipple will be at the juncture of the hard and soft palate - nearly all the way to the back of the throat).

Exaggerated latch (aka the 'Flipple' latch) can help get a baby to draw more of the nipple/areola into their mouth.

There is a good animation here but the website is in Russian so don't think your computer has crashed!

Has your LC explained the things to look for so you can recognise/feel a good latch?
If she hasn't then what you are looking for is:-

position is comfortable for you (not hunched over or twisted - baby to the breast not breast to baby),

if there is an discomfort/pain it is only at the very start of the feed not continuing for the duration of the feed,

nipple aimed more to the roof of the mouth not straight down the throat,
baby's chin is touching the breast and the nose is clear,

baby's body is well supported and in a straight line (this may be different if you are doing biological nurturing feeding),

baby's lower lip is curled down (upper lip not so important),

soft and rounded cheeks (not sucked in),

more areola is visible above baby's mouth than below (your OH might help with this),

there is visible swallowing and pausing (baby might do a fast 'suck, suck, suck, suck, pause' to start with to get the letdown but then move on to a 'suck, pause' or 'suck, suck, pause' type of rhythm - each pause is a mouthful of milk),

baby stays attached and doesn't slip off or need reattaching,

baby comes of the nipple on their own (this might not always happen as some babies like to hang out and snooze/nibble/snooze esp. in the evening or cluster feeding but baby shouldn't be removed because feed has been X mins long),

your nipple still looks nipple shaped at the end of the feed (it may be elongated esp. if you have flat/inverted nipples normally) but it shouldn't be lipstick, wedge shaped or have a ridge running around it) it should also be a normal flesh tone not blanched (whiten/pale/bloodless looking) or bruised looking - if it is a warm breast pad/cloth can be held over the nipple until the bloodflow improves and the pain subsides.

Hope I haven't upset you by posting something you already know but if you don't I hope it helps.

it does help, and there are some of those aims that we are not attaining ie i have to take him off cos of the pain, lipstick shaped nipples after feeding. i can't seem to aim towards roof of mouth, god knows i've tried! i do nose to nipple, wait for gape then roll nipple into mouth but it doesn't always work. off to look at flipple!

Have you heard about Dr Jack Newman before? He is North America's leading bfig specialist and runs a clinic in Vancouver. I have read on his site that if you keep latching and relatching you can end up causing more damage than if you let the feed go on with some pain (easy to say I know as nipple ain a special kind of pain!). He has lots of info on how to get a good latch and how to work on sore nipple healing here

CRANIAL osteopath is the critical thing, not a normal osteopath. Often TTd babies need tension releasing after a TT release - can make a big difference. No experience of a paediatric chiropractor but would be very interested in hearing the results.

Personally I tend to flipple all the time as despite the snip really helping (at 9 months!) it was so late that I couldn't change his latch really. We'd flippled all the way to there and it had got us through. After the snip had healed he could open his mouth a lot better which helped too.

Sounds a lot like the TT needs another look and you need someone really experienced with TT to see how you can improve the latch.

See I knew I'd miss something out. It's a cranial osteopath i've been seeing!

truthsweet, thanks for all your great info. i am definitively not doing it properly - ds doesn't tilt his head back, chin doesn't touch breast first, nipple points into throat rather than roof of mouth... i am tring breast shaping and flipple (though this one sounds harder to get the hang of) at next feeds.

organic, my lc is very experienced with tt, so i'm disappointed she hasn't been able to help so far. i wish i could afford to pay someone as the chiltern bf peeps have been recommended several times now. i'm just hoping my lc gets back to me tomorrow. also will let you know how the chiropractor goes.

lookout - I used to chant 'chin, lower lip, nipple in mouth, upper lip' as I latched on DD3 so her chin hit the breast first, then her lower lip, etc, etc to help as I was latching her. You kind of peel them on with the chin leading. I find it very difficult to describe in words so I used to used DD3 as a prop (always asked first before hand though so no-one was surprised by it!) to show how to do it. She was remarkably tolerant at being latched and un-latched multiple times so a mum could watch and see if it worked for her and her baby.

Also, a little tip, if you wait for the gape to start latching by the time they are almost on the breast they are closing their mouth. If you can catch them as they are on the opening of the mouth bit and then start the peeling on you can hopefully get a deeper latch.

Sorry to hear that LO :( On the positive side if you are seeing ways of improving latching then there's something to work on :)

titania :)

LOL truthsweet yeah, I've done that too - much easier than with a knitted breast and doll! He's a bit big now really to show it properly. Well, it's my excuse for making a new one .

lookout I really do feel that there's plenty of opportunity to improve things given what you've said, you just need that RL support. Truthsweet's descriptions will hopefully help though. Will try to check in tomorrow.

OCC - are you having a new demostration tool baby?? Or just wanting to get the go ahead to order a new one

4 months into the construction . Sorry, thought you knew . Will email you.

sorry lookout

UnMNetty alert

I love hearing friends are expecting - congratulations to you and DH

Sorry Lookout for the hijack but have some , and a too for all your hard work with baby DS. You certainly deserve a bit of pampering.

:) Thanks :)

haha, no worries. nice to have some good happy news on my gloomy thread! congratulations occ!

i will try latching with your description next time. i think your tip about the gape is gonna be crucial for me. will let you know how it goes.

Lookout - how have things gone today?

Thanks for asking titania. Well, I thought we may have finally cracked things. We had 3 great feeds, both sides, no pain at all, he came off by himself without me having to take him off. No bottles, no expressing. I was very excited! He was incredibly unsettled all day though and by 6pm feed had hardly slept since 8am this morning. I could not get a good latch at all then, he was pulling and chewing my nipple, causing great pain and by 8pm, I was so sore and he was so hungry that I had to take him off and give him a bottle. He eventually fell asleep after that and has slept since. I am now expressing again cos nips sore again after dreadful feeding this evening and i am disheartened. It always seems to be like this, couple of good feeds, couple of bad, sore nips and back to square one. Will we ever get it right?

lookout - from an impartial observer that sounds like a great day! Not so great for you at the end but a few bottles isn't the end of the world (though it can feel like it at times!).

Don't expect DS to make the transition from lots of bottles to none in a day or so, a few babies might manage it but from personal experience it can take a while to get technique cracked, get your confidence back and get supply up to snuff.

Giving bottles/cups while you are working towards bfing is no bad thing, it's just like using crutches and a plaster cast while your broken leg heals, okay? No one would expect you to walk on a broken leg on the first day - the same as no one expects you to stop all bottles/cups in one day and not have any blips.

Sometimes if a feed is so painful you can't do it, or damage is being done, a tactical retreat to an alternative feeding method really is fine. It's just a short term measure until you feel able to do that next feed (be it the actual next feed or one later on - just keep up with the expressing in the meantime).

If you do stop a feed due to pain/damage, be gentle with pumping (turn down the suction as too high can hurt) and if possible hand expressing may be preferred as you don't pull on the nipple to get the milk.

Have you ever heard of finishing the feed at the breast? It's an especially good technique of baby hasn't latched well to start with and a feed has to be stopped.

You give baby their bottle/cup but slightly short of what they would normally take. When they have had a good feed but are not totally full you try them back on the breast so they can learn satiety cues and comfort at the breast.

Also, babies can be easier to latch on when they aren't really hungry. It can be a nice way to cuddle with baby too, even if they aren't interested in latching, just skin to skin with a warm snuggly baby is good for boosting your confidence in mothering.

All the best for tomorrow Lookout.