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!

Well Tiktok all I got from the NCT - 2 weeks after I made the inquiry was a 3 page Questions and Answers (nothing that would let me know what topics are covered... which is what I wanted to know and asked for) + list of tutors + costs.

LKM - how are you getting on ???

Pupuce

I look forward to hearing about your training as a lactation consultant. From what I have read on the net, many lactation consultants have quite a different approach to GF! If you have a look for example at the boards on Parents Place (US ivillage site) they are very pro feeding on demand, feeding at night, no dummies, no bottles before six weeks, etc etc. Maybe you can bring a new perspective?

Florence, lactation consultants are not breastfeeding counsellors....very very different kettle of fish - or milk

There are lots in the US, not many here.

Properly qualified lactation consultants have passed an exam to allow them to join the International Board of Certified Lactation Consultants. It is a clinical qualification. Some of them in the UK are also breastfeeding counsellors.

A breastfeeding counsellor does not do clinical work and all the bf support organisations train their counsellors in counselling, being mother-centred, supportive and non-judegmental, as well as the technical side of bf.

Peer supporters are different again - they have a much shorter training (maybe a total of 10 or 12 hours) and offer informed friendship to breastfeeding mothers.

Confusing, I know....

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Thanks for the advice re nipple shield. I have used it for 2 days now with the end result that dd is able to latch on but fights it and we end up having a battle for 30 mins as she sucks for 30-60 secs, starts shaking her head from side to side, comes off, screams, is calmed and then goes back on again. After 30 mins of this we are both exhausted so I put her down and express 2-3 fl.oz(btw, very difficult if I am alone as she is usually still hungry and fretful and how do you hold a baby and express at the same time??!) and bottle feed her this which she gulps down and is then satisfied.
Is this worth the battle? DD doesn't enjoy it and I certainly don't! My NCT teacher has suggested buying an electiric pump and continuing to express and bottle feed breast milk - I am willing to do this, any views welcome!

On the subject of lactation counsellors my NCT teacher has given me a contact name and number that she recommends for those in London (I am going to make an appointment with her today myself!) Maud Giles 07939 820651. I believe she is Australian or kiwi.

thanks for the advice- we seem to be making progress. we've tried the maws variflo teat today which seems to be made of softer silicone than the avent teats, and also has a cross-shaped hole.about an ounce went down before she got tired, refused and fell asleep!
Can any other mum who has bottle fed ebm tell me roughly what volume is an average feed for a 3 month old? obviously babies and feeds vary, but has she just had a snack or would that constitute a meal?-it doesn't seem all that much to me!

LKM, sorry to bang on about this, but have you had your baby checked for tongue tie?

It is possible to express and bottle feed EBM, but oh-wot-a-hassle....someone who knows what they are talking about needs to see what is happening here before you do that, truly.

Good luck...and remember you don't need to pay to get help with bf, as you can call the helplines of the bf support organisations.

Tissy, glad to hear that worked for you. There is no magic answer to the amount of EBM a baby of a cetain age will take. I used to freeze milk 3oz or 4 oz at a time. If the baby took 4 oz and was looking for more dh would defrost more. If only 2oz was used then there wasn't too much wasted. It is liquid gold and you get very cautious about waste!
Trial and error is the key I am afraid.

If you are going to give EBM on a very regular basis (express more than once a day)... RENT an "industrial" pump... it's 1 GBP a day and far more comfortable (also quieter) than medela min elctric for example which 40 GBP anyway.

Tiktok - the midwife told me she is a "tongue-curler" if that is the same thing. But what can I do about it?
Where do I hire an "industrial" pump? 1 pound/day sounds reasonable but then if I manage to keep it up for say 3 months I might be better investing in one of my own. Does anyone recommend a really good one to buy?
I had a home birth so don't think I have access to hospital equipment.

LKM

You can rent from either Ameda or Medela:

www.ameda.demon.co.uk/

www.breastpumps.co.uk/yellrental.htm

Both offer courier delivery. Your NCT teacher should also be able to give you the number of your local NCT breastpump agent.

Hand expressing is a lot cheaper than hiring a pump. I actually found I could hand express more quickly than using the pump. I think it is a very overlooked way of getting EBM and is a much better stimulus for milk production than mechanical means. Mind you it took me till baby number three before I worked that out!
It's not everyone's cup of tea - so to speak

Mears- I read that experts I think it's either Sheila Kitzinger or Penelope Leach who say that to get any sort of quantity it's quite impractical. What sort of quantity did you get ???
I have hand expressed myself when I had too much and no pump at hand but not sure I'd get 5 ounces which is what I express every day (twice a day) for DD while I go to work.

I always hand expressed and got pints and pints....well, maybe not, but six ounces at a time was easy. When you get the technique right, it's as productive as a pump.

Tongue curling - this can happen with tongue tie, though it isn't diagnostic. You can tell tongue tie by looking for it. Tongue tie means the frenulum that joins the underside of the tongue to the mouth is either short or placed near the tip of the tongue. This means the tongue can't poke out enough. It is sometimes called a heart-shaped tongue, as the tip is pulled back making the tongue tip sort of dipped in, IYSWIM; if this happens then it is a very significant tie. More often, it's not quite as frank as this. If your baby can't poke her tongue right out, then this could be what is making it hard for her to latch. Hope you can get it sorted. If this is what it is, you might need to see about having it clipped - simple little snip, done w/o anaesthetic, over in 2 seconds. Hardest part is finding someone to do it - paediatric or ENT surgeons do it.

Pupuce,

When I was at work (night shift)I could express 7oz at a time during my meal break. Depending how full I was depended on how quick it was. At home I would stockpile milk in the freezer, collecting 2-3 oz at a time between feeds. I didn't express straight after feeds because it took longer.

I also expressed milk and donated it to the neonatal unit of another hospital.
Once mastered, hand expressing is a very efficient technique.

So where do I find the directions ??? I'd give it a go.
Still bf DD but have to express twice a day so I am fed up of the blxxxy pump !

pupuce, I am giving you the link to a booklet that we give out to all breastfeeding mothers in our hospital. It is a booklet so it will take a bit longer to download. Page 9 shows diagramatically how to hand express. All I can say is "practice makes perfect".

www.babyfriendly.org.uk/bfyb-english(2).PDF

Let me know how you get on.

Its amazing how much you can express when you get used to it, whatever you use - I use the avent pump and get 6-8oz in 20 mins. In fact when dd was 5 months I went on holiday with my Gran (had promised before I got pg) and I expressed literally 2 gallons of milk and left it in the freezer. My friend calls me 'Big - Sue - The - Happy - Coo' !

Tiktok, I don't think she has tongue-tie - she can poke her tongue out a reasonable way and will imitate me if I do so! I think the basic problem is my nipples being so flat. I am getting rather deperate now and considering supplementing with fomula (dd is now 9 days old).
The nipple shield helped a little in that she can latch on but not very successfully and after 30 minutes of battle we never achive "let down". I then have to give her expressed milk but the problem now is that I can't keep up supply to meet demand. I seem to be expressing every 1-2 hours and get maybe 3oz when she wants close to 4oz (I suspect my milk is rather thin as I am expressing so often). I am trying to drink lots and get a reasonable amount of rest but still feel tired after getting up at midnight, 2am and 5am to feed her the last lot of expressed milk and express more for the next round (all in all takes an hour). She wants more milk at least every 3 hours, sometimes every 2 hours. Would the Medela pump solve this? Or should I start supplementing - looks very attractive right now!

LKM

If the problem is still flat nipples have you tried to start expressing by pump to start the flow before trying to latch baby on - she may find it less frustrating. I also had problems getting ds going on breastfeeding and also used Shields at the beginning until he got into the habit of breastfeeding without. Incidently I was pressured into giving him formula and expressed milk by bottle in hospital but fortunately resisted enough that we were only breastfeeding again by the time we left hospital.

It is normal for her to feed 3 hourly at this stage but I can well understand the exhaustion expressing each time is causing. However if you do decide to supplement at this stage, while you supply is still establishing itself, you may find it difficult to maintain your own supply unless you still express/feed as well rather than purely replace feeds with bottles.

If she is already regaining weight it might be worth persisting a little longer.

Good luck

LKM, You're EBM will not be too thin expressing so much. You may notice that the colour varies at certain times, that is normal. When I expressed at night it used to be a pale shade of green!

You are doing a terrific job persevering for so long. Remember that the baby 'breastfeeds' and does not 'nipple feed'. Have you tried making the breast/nipple area biscuit shaped to narrow the area down to make it easier for her to latch on? Also have you tried giving some EBM prior to trying to fix her on so that she isn't frantic?

Well done for persisting, LKM! Your milk will not be thin as a result of expressing often - quite the reverse. Short intervals between expressings/feeds increases the fat content of the milk. Difficult to kow what to suggest, other than some of the good stuff already posted, except to say again you really need to see someone who knows what they are talking about...good luck. Don't worry about drinking lots - not crucial in bf at all. The important thing is that the milk you make gets into the baby.