5 day old not latching, sleeps for upto 8 hours, cup feeding

[cherrylola]

Advice needed for my best friend please. She had her 7lb12oz LB on weds last week. She had an episiotomy and took a long time to be stitched so didn't get any decent skin on skin for quite a while (not sure exactly how long). Baby not latching, very fractious (or course) so being cup fed every 3 hours on advice of hospital staff (they are still in). She is pumping.
He lost 1lb in first 3 days, and had not got back up yet but being discharged with feeding plan (pumping and feeding every 3 hrs by cup). She is really scared he won't BF, and it takes her almost an hour to get enough for a feed pumped for obviously hasn't slept since he was born.
Sorry it's Such a long post but I really want to offer up so good advice to help her through. She is being so strong

You sound like a really good friend.

Has baby been checked for tongue or lip tie? Both or either of these could make it hard to latch.

I would advise getting into the bath with the baby, a nice warm bath in a warm room. Make sure someone is on hand to help mum get out when she needs it, ready with warm towels for both! Have her have baby lie in a cradle hold. Get her to express a little, making her nipples erect and cover them with breastmilk, and just lie baby next to her breast. If she's lucky, he may begin rooting and searching for the breast. Rub the nipple gently against his cheek, upper lip and chin.

Have they tried a bottle?

Totally agree re checking for tongue and lip tie.

Your friend might find a technique called exaggerated attachment helpful.

Scroll down to pages 12 and 13 of this

She needs to hold her boob from underneath (so fingers in a u shape, outside of the aureola), wait until the baby opens his mouth then aim the very outside bit of the aureola at his bottom lip and quickly move his head round and over the nipple (imagine the movement your head would make if you took a very exaggerated bit out of an apple - that's what you're aiming for the baby's head to do)

This sorted bfing for me and ds1 when literally all else had failed. I walked into the bfing clinic unable to latch my baby on and left a breastfeeder. As a bfing peer supporter I have used this with many mums with great success (although I don't do the peer support any more)

Good luck to your friend OP. Happy to answer questions if you need more info.

OP can she get a proper bfing counsellor to visit her in hospital? Some mws are amazing but many don't have the time or expertise to help properly.

Thanks all, great ideas, I'll suggest the bath idea. That document is great Shoe, thanks so much I am sending it to her now (wish I had had some of the info in that!). I too had big BF issues with my LO but for totally different reasons so I understand her worry but can't give advice specific to her LO so these suggestions are great. No tongue or lip tie detected and I'll ask about breast feeding support person too.

She needs to offer the breast, skin to skin, offer the breast, skin to skin and repeat. And feed 1-2 hourly - v few newborns would go three hours between feeds, so he needs more milk to be honest.

Make sure they've checked baby for posterior tongue tie, it gets missed so often and is a major barrier to baby latching!

the bit about her pumping for an hour at a time for a feed and not sleeping I can sympathise with. Pumping drove me to distraction way more than the feeding did in the early weeks.

Is she pumping from both sides at once? She could buy a hands free pumping bra so she could flop her arms down and get some rest whilst pumping. Also, pumping for a whole hour at a time, is probably not as useful as pumping for 20minutes, having a break n(and a rest), and then pumping for another 20 minutes. Should get the same volume (if not more) in the same time.

Finally, and I know I might get shot down for this. Days when I didn't pump enough for DD's top up I was super stressed, which of course damaged milk supply. It helped when I was told we could make up the top up a bit with formula if needed, that helped because I knew if I took a nap instead of pumping, she wouldn't starve.

Hope it sorts itself out soon.

Hi all, thanks for the new suggestions. I'm trying not to overwhelm her with ideas at the mo as she has just been discharged and is settling in at home with LO. I have suggested seeing a lactation / breast feeding councillor now she is out of hospital (this helped me immensely as midwife didn't take me seriously but I was frantically worried when my LO had feeding problems).
I too thought 3 hours was a long time but I'm not sure how to tell her without going against the feeding plan the hospital discharged her with and throwing a spanner in the pump/ sleep deprivation works. I have also been thinking formula top ups (I did this with my LO through SF system) but would this damage her supply as it is so very early on?
Thanks all

Sending hugs to your friend. A very similar thing happened with my DS, now 6mo. He had a tongue tie cut on day 4 and finally latched for the first time on day 6. Agree with suggestion of exaggerated latch, also try different feeding positions. She should try and rest, eat and drink as much as she can, pumping is so draining. Also seriously limit visitors to those who will enable her to keep up this course of action by caring for her. I do hope the baby gets the idea soon she is doing so so well.

This was me 5 weeks ago. DS wouldn't latch due to a combination of problems so we fed colostrum through a syringe then cup fed/ continued to syringe as top up. After about 10 days we moved to giving the expressed milk through a bottle when he needed larger quantities. He is now breastfeeding pretty well (possible TT/nipple soreness aside) and gaining weight brilliantly. It does get easier! That first week was miserable though, I feel for your friend.

My advice would be:
Always offer the breast first then use the cup/bottle as a top up so he gets used to it.

Consider a bottle. I was worried about nipple confusion but it hasn't been a problem. We found with a cup most of it was just poured down him - such a waste after all that pumping! Bottle also much quicker leaving more time for sleep/pumping.

Wake the baby to feed every 3 - 4 hours. 8 hours is too long at that age. If he asks for food more frequently then definitely give it, but this should be the longest you let him go for.

Be prepared for lots of contradictory advice from midwives eg over how much to give, how often to feed etc. some tried to force formula. I found this very upsetting. Don't do anything that doesn't feel right (eg I hated moving to a 4 hourly schedule on day 10, and the advice not to let baby cry when trying to latch and just give up and give the bottle if he did as it was wasting calories was ridiculous - but I felt I should follow advice)

To increase what you are pumping make sure you are drinking enough and compress the breast pressing all over as you do it. Swap sides when it slows down then come back to that side afterwards for more. Look at the kellymom website for advice.

Get someone else to do the cup/bottle feeding. At day 5 I was feeding every two hours, taking half an hour to breastfeed, half an hour to pump while DH cup fed, half an hour to wind/ hold upright and change. If I was doing the cup feed as well that would have meant 0 sleep. As it was 15-30m sleep every two hours round the clock was bad enough and I was quite delirious.

I agree with bees - limit visitors so she can just focus on feeding. Spend all day in bed in easy access pjs. Lots of skin to skin time and cuddles. Don't try to do anything else other than sleep, feed, eat and drink at first.

Another thing you could do to help is bring snacks. Cereal bars, dried fruit, grapes/blueberries. Anything one handed. Feeding and pumping made me ravenous.

Just wanted to add my experiences.
My baby refused to latch- there was no reason for it, she was perfectly healthy, she just didn't know what to do with a nipple. I didn't receive much support and there were various health service failures along the way, but those who did try to help just observed that she wasn't attempting to do it but they didn't know why.
BUT we made it work. I was exclusively pumping for several weeks. I'd thoroughly recommend renting a hospital grade pump- it is a lifesaver when you're pumping round the clock.
She should get as much support as she can- lll are really good.
Eventually my baby latched using nipple shields and I successfully breastfed for a year using them. They're not for everyone and I know some people say they might encourage a lazy latch, but for us it was a choice between that and no latch at all.
Get as much help from partner and good friends like you.
Most of all, help her remember she's not a failure. Breastfeeding is really hard. fx
Also if she needs to move to formula- it's ok. Her baby will still thrive and her sanity is more important. The exhaustion and feelings of rejection can be really hard in this situation. So so hard.

How are things going now?

Just popping back to give you all an update!
Things are getting better thankfully, I got a text last night saying that LO had had 9 feeds so far that day and 5 had been directly at boob so everyone is feeling a bit of relief now!
Mum is trying to stay as positive as possible and is being so strong that I'm sure he will be knocking the cup feeding on the head in no time. He is back up to 7.8lbs now. She is having a Bf councillor visit the house every couple of days which has helped.
Thanks everyone for your advice, it is much appreciated and squish is so gorgeous I'm sure he'll have chins and leg fat rolls before too long!

excellent!

The cup had been completely ditched now yay!