Nipple confusion - no way back?

[mines]

I'm new to mumsnet (and mothering!) and I want to pick the brains of all you breastfeeders/experienced mummies out there.

So here's my sad little tale: my son is now coming up for five weeks old. Breastfed from birth, but major problems with establishing feeding in first week (lost 25% of body weight, poor little mite) meant he now feeds through nipple shields and I am a nervous wreck where his weight is concerned.

The nipple shields allowed him to get a grip of the breast and stopped the hideous fighting every time there was meant to be a feed (he just would not latch properly and would get extremely cross and distressed). He regained his birth weight and went on to put on another 11 oz in week 2 - 3.

But then week 3-4 he stopped putting on weight again. Cue concerned questions from health visitor, who identified the nipple shields as a possible problem. I thought it was probably time for me to be brave and try and get rid of them too, so they went - for 24 hours.

The regime the health visitor suggested was to feed him (without shields) for 30 minutes and then ensure we topped him up with a bottle feed and this is where the problem started. Within 24 hours, ds had worked out that bottles were easy and fun and the bare breast was not. We went back to hideous flashback fighting about feeds and I'm afraid my nerve cracked.

So here we are, back with the nipple shields and now topping up with a bottle (this has worked to get more weight on him - 7 oz in two days).

But I would really like to get rid of both the bottle and the shields! Is it possible to undo this level of confusion? Has anyone had this problem out there? Do nipple shields really cause that much of a problem?

Any advice or comments appreciated!

Tiktok is probably the best person to advice you - but here are some of my own experiences.

The mum who talked at the ante-natal b/f workshop I went to had a "breast refuser" who she was successfully b/f through nipple shields. I got to know her later at the b/f support group and at 6 months her ds was still refusing to feed without the nipple shield (she'd managed it once, while he was half asleep) - but she had successfully kept her supply going. She was planning to continue to b/f until he was one.

With regard to weight - is your son still happy and alert? My own ds was EXTREMELY slow to gain weight - but through a combination of giving him expressed milk for alternate feeds and waking him up for feeds during the night, having him checked by the paediatric consultant, and our own observation, we all came to the conclusion that that was just his own growth curve. Dh and I are both "small" and were skinny when young - so he's just taking after his parents. We were then relaxed about watching him drop down the centiles: he was on the 91st at birth (which is apparently more a reflection of maternal health) until eventually he was chuntering along just below the curves. He started to move back up the growth curves once he was on solids and I think is now somewhere between the 25th and 40th centile. I continued to b/f until he was over a year old.

BTW - my Dad is a paediatric radiologist, so as my dh said, "If your Dad isn't worried, then I'm not worried". Ds is the first, and long awaited, grandchild, so if Dad had thought there was anything amiss, he would have pulled whatever strings necessary.

Ds is now 17 months old, eating well, and I don't have a clue how much he weighs - he's a small boy, but solid! Definitely NOT skinny! He remains a happy, healthy and alert wee boy, as he was from the start.

I got loads of support from the b/f midwives who ran the b/f support group at my maternity hospital. If you don't have access to that sort of support, it may be worth contacting a b/f counsellor, who may be able to give you some more specialist advice than your HV (I have to admit I avoided HVs! ). I'm sure someone else will be able to provide you with contact numbers.

Janz mentioned breastfeeding counsellors. You can contact an NCT counsellor on 0870 444 8708 between 8am and 10pm. Having just had someone praise NCT to the skies for the help their counsellors gave, I'd recommend them heartily! Good luck.

Congratulations on your new baby.
I think most people who have used nipple shields have often gone on to feeding without them successfully and a friend of mine who used them in the early days now swears that they were pretty useless. Logically, they cover up part of your nipple and, as I'm sure you know, milk doesn't just come from the end of your nipple but mostly from the surrounding area, the areoli (no idea how to spell it!!!!). It makes sense then that the nipple shield is actually preventing quite a lot of milk getting in to your baby.
What I would really recommend is getting in contact with La Leche who specialise in giving breastfeeding advice over the phone (sorry don't have the number but I remember getting it from directory enquiries). I am pretty sure the first thing they will recommend is throwing away the nipple shields, my friend did and within a couple of days had a huge improvement and now is really annoyed with the health visitor who suggested them.
I used bottles of expressed breastmilk from about 9 or 10 weeks onwards as this is the time they recommend that babies will not get nipple confusion, I only used it once in a while when I just need 4 hours sleep together but she certainly never minded getting something off her Dad and I loved the little bit of sleep!!!
If you don't get any joy from La Leche (who were brilliant in my early, confused days) then NCT offer a similar telephone line you can ring, again number from directory enquiries.
I so remember going through this confusing time but it does all fall in to place and I wish you a happy time.

Hello mines

I used nipple shields with my ds and I found them the only way to get him to breast feed. I think confusion is why he needed the shields in the first place. He was born 3 weeks early and developed severe jaundice which left him fairly weak. In the week we were in hospital following the birth he had to have bottles as I couldn't get my supply sorted out in time. I am convinced that this early introduction to teats made him lazy when it came to the breast, hence the shields. My thoughts are that if you want to continue breastfeeding but your baby won't feed without them then maybe for all your sakes you should stay with them. I realise you want to get rid of them but if it causes more heartache for all of you then my advice is to let it be. I'm sorry if this is unhelpful.

P.S. I managed to breastfeed for 6 months doing it this way with a bottle of formula last thing at night as well.

I used nipple shields for a couple of weeks with my daughter but we were there able to go on to reading "normally" without them. The " are because she fed very frequently. I used to express milk after a feed. That reassured me that there was plenty of milk there even if she wasn't able to take it and allowed dh to take a turn feeding her while I tried to catch a nap. Breastfeeding often gets easier after about 6 weeks so perhaps you could try again in a weeks time. Better to breastfeed with the nipple shields then go for bottles totally.

as for weight its normal for breastfed babies to be lighter and possibly good for them in later life. Good luck.

Mines ? I also had a baby who would not latch on properly. I tried nipple shields but he didn?t like them. Some people seem to right against them ? I think it depends upon the baby. I can only encourage you by saying that as the baby gets older they are bigger and stronger and are able to latch on much more easily. So I would persevere with trying without shields/bottles and obviously resort to them if things are taking forever. I had a routine of breast first (so that he always associated the feed with the breast) and then if he wouldn?t settle he had the top-up bottle, and then once he was asleep it was expressing. All this was exhausting and time consuming but at 8 weeks old he had his last ever bottle and was totally breastfed from then on (and still is at age 2.7!). I also used to find that after he had been fed I?d put him to the breast just for comfort to allow him to fall asleep. Night times are good as there is less distraction. Good luck.

'Nipple confusion' is controversial. There are many in the bf support world who feel it's more accurate to say that babies can show a preference for the bottle when the breast has proved unrewarding in some way. It's the same with shields. Sometimes, shields are a help, but they need to fit well, so the baby latches on the shield and is able to stimulate the milk removal/milk production by the right jaw and tongue action on the breast. Mostly, nipple shields don't fit all that well, and the baby doesn't manage to get this stimulation going. This can mean long feeds, to compensate, and/or falling milk supply. However, it doesn't always mean this, and shields can save the day. Mothers who use shield do need follow up by someone who knows what they are talking about, and I have to say, Mines, your health visitor does not fit into this category. Timing feeds and then topping up with a bottle can be a recipe for the end of breastfeeding.

But all is not lost, by any means : ) Call a breastfeeding counsellor and talk it through. You can talk about going back to the shields; getting the positioning of your baby without a shield amended so it works as well as it possibly can and your baby and you are both happy and comfortable. Topping up with formula has drawbacks - mainly because it reduces the amount of breastmilk made because the baby does not feed as much at the breast.

I can't comment on the weight gain - sometimes babies' weight does plateau, although of course babies do need to gain adequately over time. It's not correct that breastfed babies are necessarily lighter - I have just checked the charts on this to make sure I am right. Breastfed babies (and all babies) vary in their rate of weight gain and in any case, weight is only one aspect of health, and should not be held up as the only marker for it. Good luck!

Thanks to everyone for their ideas and advice - exactly what I was looking for! I'm pleased to report success from following your advice, Pamina. We are now totally shield free and have been since Saturday. I think ds has a way to go before he becomes an efficient feeder (feeds still taking 45 mins - 1 hr) but I'm going to hang in there and let him feed as long as he wants because it seems to be increasing my supply.

Hopefully before too long I will not have to top him up at the end of feeds. In the meantime he has put on a hell of a lot of weight this week and fingers crossed if he maintains steady gain then I can ditch the bottles too, before too long.

Thanks to everyone - my morale is much better now.

Hi mines, I was following this thread with interest and am pleased to hear your news, that's really great that you've come through it and I hope that its a bit more like plain sailing for you both from now on (if there is such a thing!) Well done for sticking it out

glad you're making such good progress mines. I have a theory that what you eat makes a difference to how long the baby sucks for - he probably isn't feeding all the time. If you'd like to try it you eat foods with a low glycaemic index like fish (especially oily fish as vitamin D is important) or meat with vegetables, fruits like apples and oranges but no potatoes in any form and bread only if its granary. MIlk and youghurts are fine.

I would urgently appreciate some advice. Baby is just 4 days old and so far has not been able to latch on for more than 4-5 sucks which is not enough to bring out milk. I have been expressing successfully and cup feeding exclusively. Milk has now come in (plentiful supply). Midwife says problem is my flat nipples and baby is a "tongue curler". I have tried expressing to bring out nipple but baby still gets frustrated very quickly and starts to scream. Midwife now suggesting nipple shields to give baby an easy "latch" (she sucks vigorously on a finger). Also to buy something called a "nipplette" (I think). We need to get this sorted as she gets much comfort from finger sucking when all else fails and little comfort from the baby cup which is just causing a rash around her mouth. Help!

LKM - why don't you get a professional bf counsellor to talk to you and come to see you - they are free/volunteers (which is something I never knew but just discovered). They have 2 years training so I am sure they will have seen this before.
Call the NCT (0870 444 8707 )or the Association of BF mothers (020 7813 1481) or La Leche (020 7242 1278) all are 24 hours helpline... if they have a counsellor in your area, then ask for a FACE to FACE visit !!!!

LKM, congrats on the birth (DS or DD?)!

My breastfeeding book advises either trying to shape the breast to make it easier to latch on (squeezing it at around the 9 o'clock and 3 o'clock positions so the nipple "pops out" ), or a nipple shield. I can expand on the first procedure if you like, but your midwife may already have tried it. Personally I found it quite difficult to get a nipple shield to stay on - it would crinkle up and I was worried it would smother the baby. Plus for my problem (sore nipples) it didn't seem to make any difference. I know our local hospital has a breastfeeding counsellor (St Georges) who runs a drop-in clinic - have you tried yours to see if they can help?

Another related problem-my 3month old daughter, totally breastfed so far, won't take a bottle of expressed milk. I'm going back to work full time in 5 weeks, and need her to take a bottle while at nursery.HV has suggested trying formula but I'd rather not...
We're using the Avent system, as I have their pump and have tried all the teat sizes, and their soft spout to no avail.She won't take it from Dad or Grandma either! Any ideas?

Tissy, had the same problem with my dd who went to nursery at 6 mths (she HAD taken a bottle at 2 mths, but we didn't bother for a few wks and regretted it ever since..) - and switched to the Playtex disposable range - more nipple-like in their action, they come with disposible bags (only slightly bigger than the avent ones) and you just boil the nipples the first time you use them, then clean in v hot water after that. I bought mine from an independent chemist..they are about £4 and you get a few liners included, so you can try before you buy a big bundle. I expressed for ages after I'd returned to work and gave her this milk to take to nursery. Now I have a nearly 2 year old who won't drink milk out of anything but these..aaghhh. (if I put it in a beaker, she just dribbles it out of her mouth - she will use a beaker for juice/water. any help with that???

Tissy, From my experience you are just going to have to keep trying. I don't think that it is anything to do with the fact that it formula milk, it is because it is from a bottle which is less comforting for baby and they need to learn a new technique to suck it.
I tried every teat and style of bottle possible but this did not help. In the end I had to NOT give in and only offer the bottle. This was really difficult to stick with but, for me, turned out to be the only way to succeed. My 2 never had a dummy. If you baby uses a dummy have you tried quickly taking the dummy out and replacing it with a bottle??

Tissy,I found that Maws Resolve teats worked well when I returned to work. They have a slit in them so that the baby can regulate the flow of expressed breast milk. I had 4 babies and only one of them wouldn't take it. I used start his feed on the breast then slide him off and pop the teat in.
Some babies just won't take from bottles from mum or when mum is in the room. A friend of mine had the same problem and her baby still wouldn't take a teat when she went back to work fulltime shiftworking as a midwife at 12 weeks! The baby actually took EBM from a bottle when she wasn't there! Try to relax over it, your baby will not starve.
Try warming the teat with boiled water. Either have the person giving EBM to the baby holding them against their skin or try a completely opposite thing and walk around with the baby facing away from them. Sounds weird but worked for my sister.
I certainly would not give formula in the hope of getting them to take a bottle. Good luck. Let us know what works. NCT has great leaflet on returning to work.

LKM, check for tongue tie - this can make latching on difficult. Pupuce - the NCT breastfeeding line is not 24 hours, and nor are the others as far as I know. We are volunteers working from our own homes and we go to bed!! It's 8 am to 10 pm and the number is not the one you gave (though this will offer you a menu which can go to the bf line) - it's 0870 444 8708. Also, most of us have rather more than 2 years training, though it is possible to do the training in two years. Most take about 3 or more. Sorry - we can't promise a face to face visit. Many of us will do face to face if we can, but it depends on travelling, family committments and work.

Back to LKM - you do need to at least talk to someone...but honestly, I would first of all rule out tongue tie. Keep us posted.

Thanks for the clarification - I was trying to respond quickly to LKM and providing the numbers I found on the web.
The ABM is 24 hours a day... I kow I am training with them and they told me that I would be on call some of the time.
I know you can't promise face to face but when I read all the questions we have on Mumsnet or all the stories from my friends... no wonder so many give up ! And LKM's question seems that if possible a face to face would be valuable !
I have asked my ante-natal friends if they knew that the NCT or ABM offered free advice... they didn't (and were amazed when I told them!). All they had was conflicting advice from well intentioned midwives, no moral support from "anyone" and they gave up.

Suew.... you are right I don't read all the posts !!!!

When I was pregnant my antenatal class teacher told us about a local bf counselor and she was clearly private.... no one mentioned (including midwives) the free help I could get. Talking to a girlfriend 2 days ago who is hoping to bf successfully her 2nd child, I made the point that she should talk to a bf counselor to which she replied that she could not afford it !!!

Anyway, I haven't started with ABM but have registered. It is 2 years, it is free and unlike the NCT (sorry don't mean to have a go at the NCT), they have contacted me immediately after I made my interest know, I have the full curriculum of the course (that's not the case for the NCT) and a lot of literature about what role they expect me to play, when to help the helpline,....
Anyway I found them very responsive, well organised,.... we'll see

Hi LKM,

Well it sounds like your problem is similar to what kicked off my situation (ds would not get more than 3-5 minutes worth of sucking before falling off and screaming).

I have no experience with a nipplette but, with the benefit of hindsight, the nipple shields were helpful - as you can see from my original post, they did allow ds to get a latch and feed.

As he has grown, his co-ordination and strength improved enough (by week 5) to allow me to wean him off the shields. I did this by basically following Pamina's advice (below) - taking him off the shields after his initial feeding frenzy (but before he was completely full) and letting him just 'mouth' his way onto the nipple without directing him too much. He actually caught on quite quickly (now 75 centile weightwise....so I feel a bit silly looking back at my concerns!)

Assuming you wish to breastfeed, it sounds to me like shields could be a useful prop to help you establish breastfeeding but just remember to keep trying your baby without them as the consensus is that they are not a good idea for the long term.

Re FlorenceUKs point - they do tend to curl up at the edges and waggle around which means you have to use two hands to feed (one for the baby and one for the shield if you see what I mean) but that is another incentive to get rid of the things quickly!

In summary, despite their bad press, I think they might be worth a go in your situation and they don't have to be a permanent feature of your feeds.

Let us know how it goes.

Good luck with your training, Pupuce. I think it's good we have different organisations, though I know people outside the 'world' of bf support think it's crazy....it isn't

NCT's training curriculum is available, but you would only get the whole manual once you registered as trainee (it's a hefty A4 ring binder, quite expensive) but the main details come in an inforation pack which should be sent out to all enquirers within a short time, together with the home phone number of a tutor which enquirers are invited to ring, so they can speak in person to someone. I'd be concerned if someone enquired and was then left dangling....not ideal at all.

There are a few private lactation consultants in the UK - usually they have done the international exam in this. All mothers in the UK are only phone call away from a range of free volunteers - of which there are several hundred - and I wish more mothers knew about it. The NCT breastfeeding line (0870 444 8708) is just over a year old and now takes about 1700 calls a month. Bfcs also get calls direct to them.