Which advice should I follow? 17 day old BF baby

[belindarose]

It's me again. DS is now 17 days old. I did find a real life breastfeeding advisor but she was off sick on day of appt and is now on leave. I have continued to receive conflicting advice from HCPs and don't know what to do.

Issues:

Inverted nipples on both breasts. DS can latch onto right breast (DD fed only from this breast). Cannot (yet?) latch onto left.

On midwife's advice, I've been using a nipple shield on the left breast. DS's latch is terrible on it. He just sucks/ chews the nipple bit of the shield. He will usually refuse the right breast after this, but if he does take it, his latch is awful again and he doesn't open his mouth proper at all.

I think I have vagospasm(?) in right breast. Nipple goes very white and painful, mostly after a feed.

I am producing, and leaking, vast quantities of milk. If I collect it in a breast shell it is often 100ml per feed. DS often refuses second breast but continues to show hunger signs.

Because the flow is so prolific, it literally pours out as if from a tap, I don't think DS is having to work at all for it. It's more like he's drinking than suckling, especially on the shield side. I worry that this will have implications for supply later on.

Feeds are long. Regularly an hour or more. At least 8 in 24 hours.

Hasn't got back up to birthweight yet, although put on 5oz in last 7 days. HV not concerned about this.

Advice given by different HCPs, including BFC at children's centre:

Continue as I am doing

Offer the expressed/ leaked milk as a top up if he refuses second side or is still hungry after 2 sides

Don't switch sides during a feed. Don't offer any expressed milk.

Until I can see someone else in real life, which of these (or alternative) is most sensible for maintaining supply and improving weight gain.

belindarose - good that you are hanging on in there, but :( that things are still confusing.

Sounds like the shield is not helping - there are different shields. If the midwife thinks it's worth trying, maybe get a different shape/sort? Larger branches of Boots should have 2 or 3 different ones.

If needs be, you could continue feeding on one side only and give up on the inverted side. Some women do this in similar circumstances. The supply adjusts.

"I think I have vagospasm(?) in right breast. " You mean vasospasm?

"Nipple goes very white and painful, mostly after a feed." Could it be Reynaud's?

"Feeds are long. Regularly an hour or more. At least 8 in 24 hours."

That is well within normal for a new baby, in fact most babies will feed more often than this, with feeds lasting longer.

"Hasn't got back up to birthweight yet, although put on 5oz in last 7 days. HV not concerned about this." Still within normal. Good that the HV is happy about the weight which is clearly going in the right direction :)

"Advice given by different HCPs, including BFC at children's centre:

Continue as I am doing"

That's an option....

"Offer the expressed/ leaked milk as a top up if he refuses second side or is still hungry after 2 sides"

No need to do this, but nothing wrong with doing it.

"Don't switch sides during a feed. Don't offer any expressed milk."

Again, you could follow this - I think the 'don't switch sides' is academic, if your baby cannot manage the 'inverted' side. Normally, feeding both sides or at least letting your baby have the opportunity to have both sides if he wants, is good policy with a new baby, but in your case I think you need individual advice and your baby is doing ok on one side only ever....

"Until I can see someone else in real life, which of these (or alternative) is most sensible for maintaining supply and improving weight gain." But you don't have a problem with either of these issues. Weight gain is within normal; supply sounds fine.

HTH

Okay, thanks Tiktok. I'm still being silly, aren't I? I fed DD off one side only. I'll consider doing that again. So you don't think that offering the leaked milk in this case will have any impact on supply.

I might stop worrying soon...

If you fed on one side only before, then you know it is possible :)

I don't know why you would feel you need to offer the leaked milk....no need to chuck it out, as you can freeze it for mixing with solids at a later date or when you need to leave expressed for some reason. To actually use it now means messin' about with preparing bottles and teats and if he needs more milk then he can just go back on the breast again....if he doesn't want to go back, you can assume he has had sufficient for the time being, and you can try again in a little while if you think he 'ought' to want more :)

It sounds as if there are ways to make your life simpler if you take a break from trying to find a solution and trying to make things different. Your baby is fine, from what you say, and managing ok on basically one breast all the time.

If the leaked milk really is 100 mls, then it would be good for him not to have it - that's certainly enough to impact on supply, because he might then go longer between feeds, which is not good for supply.

Normally, leaked milk is only about 20-30 mls or so which is not really sufficient to make much difference with a term baby.

Yes it really is 100 ml, sometimes more! The reason I felt I 'needed' to give it to him is because that was the advice given by the BFC. Honestly, so many mixed messages it's unbelievable. And HV today told me the hour long feeds were far too long... No wonder I'm so paranoid and confused!

Hmmm.....it's not that it's wrong to give him the ebm (you might give ebm if there are serious weight gain issues which cannot be resolved quickly enough by frequent feeding- so you might suggest this to someone whose baby was struggling for weeks with weight gain and who had already tried feeding more often; or to someone whose new and vulnerable baby really does need to gain weight and who is too tired to bf more often/more effectively).

It's just that I don't see why it would benefit you - and routinely giving what you have leaked is going to reduce the amount of milk the baby asks for which is not what you want. As I say, 20 mls here and there is no big deal....but not 100 mls.

The HV who says hour long feeds are much too long.....I don't know where she gets that from. Many babies take an hour at a feed, esp when young and sometimes when a bit older. They might well be bobbing on and off, dozing a bit, stopping and starting, messing about....and the whole thing easily takes an hour (or more). Did she say what was 'wrong' with it, or what you are meant to do about it?!

Just that I wouldn't be able to look after my toddler and 'feed my family' if I carried on with them! I didn't think to ask what I was supposed to do about it.

I understand what you're saying about the EBM and was concerned that it would affect supply by prolonging gap between feeds.

Maybe we don't have any problems at all. Thanks Tiktok.

:)

Your HV sounds well-meaning but a bit ineffectual.....

Yes...
I thought she was very pleasant, but won't be relying on her expertise, I don't think.
Thanks again, Tiktok.