Baby (7 wks) will only drink when breasts are very full

[qwerty2013]

After a rocky start to breastfeeding (milk came in after 8-9 days following a C-section - DD was mostly bottle-fed during this period) my DD, now 7 weeks old has developed a rather erratic drinking pattern at the breast.

I have been pumping since the beginning - first to establish a milk supply, then to have extra milk to supplement when she does not drink well. Basically we have a 3-4 day cycle during which she will drink well on days when I have an oversupply in milk because I have been pumping the previous day after every feeding session when she has not been drinking much. When I stop pumping (because she is feeding well at the breast) and my supply regulates to accommodate her real needs, she starts drinking less and less at the breast. She is happy to stay at the breast and suck for ages, but rarely swallows, so I supplement with breast milk from the bottle. To complicate matters I was advised to use nipple shields since the beginning due to flat nipples - which IMHO are no longer necessary as my nipples have come out through all the pumping, but DD has got used to them and has difficulty positioning herself at the breast without them.

Just wondering whether anybody has experienced anything similar as I have received little helpful advice on how to overcome this challenge. The days when I have to pump are completely consumed by feeding/milk production. I am still trying to figure out whether it is a demand or a supply issue. DD's latch is not perfect although I have unsuccessfully tried to correct it (tends to suck lower lip in), she is possibly a lazy drinker due to the early introduction of the bottle so prefers the easy accessibility/fast flow of milk when my breasts are very full. I am always able to pump between 50 and 90 ml after her unsuccessful feeds and up to 150 ml if I get up in the night to pump so assume I have plenty of milk? Could it have something to do with milk flow?

Sorry for the long post, but would really appreciate some advice as I feel this is an uphill struggle and don't know how long I can keep this going.

Someone really experienced will come along, I'm sure. But the usual advice is that there's no way you can know how much your baby is drinking, whatever your breasts feel like. If you pump a lot, you'll be stimulating your body more than your baby will, which then means your breasts feel engorged because your supply goes up beyond her demand.

What happens if you just let her feed as much as she wants to and try to ignore whether your breasts feel full or not? Your supply should adjust in a few days, up to which you could just pump off a little to relieve any discomfort, but not keep going with the aim of filling a bottle. Can you go to a bf cafe to get advice on the latch?

Very best of luck.

Thanks Jkklpu - just to clarify, now I am no longer pumping to keep or increase my supply, but to have extra milk to supplement (to avoid giving her formula) when DD does not drink enough. But by the time I get round to pumping, it is usually 1.5 hours past the beginning of my daughter's feed, so I suppose it is almost like telling my body to produce another feed. I have tried getting advice on the latch, but unfortunately I don't live in the UK and knowledge about these things seems quite superficial here - health assistants have told me her latch is OK and to just pull her lower lip out (which is quite difficult to achieve as she just sucks it back in again).

When I let her feed as much as she wants to on one of her bad drinking days, she will fall at asleep at the breast, seem content for about two minutes and then start crying and rooting. If I give her the breast again, the same things happens. I know that I cannot tell how much she is drinking, but I notice that on days when my breasts have "normal" supply she very rarely swallows, but just sucks for ages with lots of pauses - she never really establishes that rhythmical movement of the jaw that shows me she is actually drinking. Occasionally I have also weighed her before and after feeding from the breast and her intake varies from as much as 130 ml in 40 minutes on a good day to 30 ml in the same amount of time on a bad day.

A healthy 7 week old with unrestricted access to the breast won't starve herself. If she has to work a bit harder or feed more often on some days she will still be fine. I would try to just trust her/your breasts on not worry if some days she feeds more than others.

I have now been more consistent weaning DD off the nipple shields and removing them has definitely improved her feeding although she is still sucking her lower lip in. I am now wondering whether she can get away with her poor latch when my breasts are very full (e.g. early morning after a longer break during the night) but that it makes it more difficult for her to feed when they are not so full. I have not pumped/supplemented with the bottle for a few days now (following the removal of the nipple shields DD seemed to go on a bottle strike and refused to drink from the bottle!), so I am now just trying to go with the flow as you suggest and to correct her latch. Thanks for all the advice so far, if anybody else has anything helpful to add (especially on correcting the latch), it would be much appreciated!

I would suggest getting someone who knows what they are doing to check her for tongue tie. It is common for tied babies to be able to get the milk at first, but then are unable to extract the milk from an "emptier" breast.

She could possibly be pulling in the lower lip to help "milk" the breast compensating for a restricted tongue movement.

this is helpful

Thanks mawbroon for the interesting comment and link regarding tongue tie. Superficially she seems to have quite an agile tongue but I guess a health professional would need to look at it in more depth (I had no idea there were so many different types of tongue tie). You are right, I get the impression that she is getting milk not so much through suction but suction in combination with mechanical stimulation of the area around the areola with her lower lip which is covering her gum.

Where are you based? Tongue tie is a subject that most HCPs are not clued up on. You need someone who knows what they are doing to assess.

DS1 was tied, and his tongue appeared to have plenty of movement and lift, however it was the back of the tongue that was tied (posterior tie) which prevented him doing the full movement that was required to extract the milk. He did ok, but was pretty inefficient. He was my first, so I had no idea there was a problem.

I agree you need to get someone who really knows what they're doing to check it. BFing support where I had DS was crap and an undiagnosed lip and tongue tie meant he was also a very inefficient feeder who did best when I had oversupply because the milk was just there for him.

Thanks both - having now read up on tongue tie and the difficulties it can cause for breastfeeding, I am surprised nobody has at least mentioned it in my conversations with HCPs so far. Everybody has seemed to think that I am a bit paranoid and has failed to acknowledge this pattern I have been observing for 8 weeks by now! I am based in Italy and will make enquiries as to whether there are any experts in my area.

Mawbroon and WhatABeautifulPussy, may I ask how long where you able to continue with breastfeeding?

Um, despite the difficulties, ds1 went on to feed for years and years (and years!!)!!

There is a facebook group called Tongue Tie Babies Support Group. ASk to join and they may be able to point you in the right direction for a knowledgable provider in Italy.

DS BF for 26months and only self-weaned because apparently pregnancy made my milk taste funny. He told me one day that the mamamilka (BM) was yukky and refused to latch after that. He's still quite attached to my boobs so I reckon he'd still be feeding if not for that.

Well done both of you for persevering with BF for so long! I am feeling a bit more upbeat about it now she is drinking better without the shields but not sure we can make it that long, especially as I have to return to work when she will be four months. Thanks for the Facebook link, that should be helpful.