Struggling and so confused

[missmargot]

DS is two weeks old and spent the first 10 days of his life in intensive care then special care as he contracted pneumonia. I expressed religiously every two hours night and day to make sure my milk came in and so he could be tube fed breast milk. I then spent two nights in the transitional ward with him to get feeding established. This was tricky as he was used to being tube fed and the nurses had given him a dummy which meant he struggled to latch. I also have flat nipples which weren't helping so the nurses suggested nipple shields. These worked well and he started to feed much better.

He hadn't started to regain weight but the hospital were happy with his bloods so discharged us last Saturday. On Monday the midwfie weighed him and he'd gained 2oz, but since then he's been weighed by the health visitor twice and hasn't gained at all.

He is quite a sleepy baby who often drops off after five minutes at the breast. He is more alert in the evenings and can feed for 20 minutes at a time without me having to stimulate him, but during the day I have to tickle his jaw etc to keep him feeding.

The health visitor has worried me by telling me that nipple shields will affect my milk supply. The hospital breast feeding advisor said they weren't a problem at use ongoing. I've researched the issue myself and opinion is really divided but I am worried that he's not getting enough milk.

I am trying all sorts to get him to latch without the shields and also to get him feeding for longer. I have also started expressing milk and bottle feeding him twice a day, which I know won't help with the latch but at least I know he's getting something.

I feel so upset and guilty that he isn't gaining weight. I want to breastfeed so badly but I'm worried I am putting his health at risk by persevering.

Any advice much appreciated.

I don't have any experience regarding baby coming from being fed in intensive care. But DS was slow to gain in the first weeks and the midwife had to come round on an extra visit when we should have been discharged- this was despite succesful feeding. DS was off the charts in weight by 5 months- he was just slow to start.

Was this 2oz gain recorded on the exact same scales? It can make a difference?

What exactly is not working with latch? Can't position? Mouth not wide enough? Lips flanged? Suction not good?

Can you access a breastfeeding drop in where someone can actually sit with you and see how he's latching? They checked for tongue tie?

Please don't feel guilty. You are doing a great job and it's hard in these initial tiring weeks.

I had a roughly similar start to breastfeeding with my ds and got there in the end so it can be done.

Have you tried a little device called a latch assist? It can help with flat nipples and getting a latch going.

Also I would suggest using a teat like the Medela Calma when using bottles. They need to create a vacuum to get milk which helps them practice their breastfeeding action.

There is also something called the exaggerated latch (or flipple!) which could help with improving the latch. There are videos online that show how to do it.

Wow, you're doing amazingly, it sounds like you've had a really hard time. Respect, and well done.

This may be rather obvious advice, but it made a big difference to me with my second babe, as Ive rather flat nips and very huge boobs - a mw told me to shape the nipple - just to squash it flat between fingers and post it into the baby's mouth. I don't know if this was by-the-book advice, but it worked. My wee one was also sleepy (still is), Kellymom had a lot of advice which helped - tickling feet, switchfeeding, etc.

I don't know about nipple shields, but my sis in law successfully managed to ebf after using them, and I know lots of people do manage to successfully get back onto bf after struggling a lot, so try not to worry.

Rest, and take care of yourself as much as you possibly can, and bear in mind its really early days. Wth my first it took me eight weeks to get feeding well established.

best of luck

X

Thank you so much, I really appreciate all the advice. DS just flat out refuses to have anything to do with my nipple, he is too used to the exaggerated shape of the shields and the dummy. The latch assist looks interesting, I guess my breast pump could also do the same job if I expressed for a minute before feeding?

I will try the shaping the nipple too and there is a drop in breastfeeding group locally on a Thursday so I will go along next week and see what they say.

I wonder if LaLeche League has any specific info, there's a trove of stuff on there ...

www.llli.org/nb.html

Also might be worth calling them for a chat?

www.llli.org/nb/nbnippleproblems.html

looks worth exploring

Oh, and tonnes of info on shields here: www.llli.org/llleaderweb/lv/lvjunjul00p39.html

Breast compression is a particularly good technique to get moire milk into a sleepy baby.

Some flatter nipples are less flat when erect - if yours are like that, having a tweak just before feeding may help?

We had a similar start - DD was tube fed, bottle fed and I expressed for her so we had minimal formula top ups.

She was a sleepy baby due to lots of jaundice. Feet tickling, stripping baby off so they're a bit chilly, and having a nappy change misdeed are all good tactics for waking them up and keeping them feeding.

For the latch, you need face to face support so someone can see your boob and baby's mouth at the same time. Expressing feels like a good idea to keep your supply up, but as long as baby is at the breast regularly you should keep producing milk.

We're still ebf at 13 weeks. I think the flipple technique saved us, as did DD growing so her mouth matched my huge nipples better.

Congratulations!

I think I rubbed mines hair to keep her awake for feeding.
Have you expressed / squeezed milk onto your nipple as maybe they can smell the milk

The links look fab, off to read them now. I will try all of these tips, thanks so much.

I have a friend who has just gone through the same thing and I think the only thing she did differently was to change health visitor! It sounds very common with breasted babies. Keep trying, your baby will let you know if they are hungry! :-)

I had a similar start with my twin boys. Due to flat nipples and tiny babies started using nipple Shields in scbu. Still using them now 15 weeks later. No supply issues!

Still no weight gain and whether it's down to the nipple shields or his latch he's constantly hungry. The HV is really supportive and is trying to get me a session with the local breastfeeding mentor but there's a waiting list.

I am so worried about him re-admitted to hospital that yesterday after sobbing for an hour due to a combination of guilt and sleep deprivation I decided to start mix feeding. He is now having one formula feed a day and I am expressing three of his breast feeds so I can be sure he is getting plenty. So far it is working well, he slept much better last night, waking for feeds but then going straight back to sleep, plus there's been an increase in wet and dirty nappies.

I don't love the decision I've made but hopefully when the HV comes back tomorrow there will be some weight gain and I will feel less guilty.

:( :( *mismargot :( :(

Being put on a list for a bf mentor as a gesture of help from the HV is ok, and the mentor might be great when you see her. You are not short of support or motivation, however. You are short of informed help now to resolve your quite complex and long-standing feeding problems with your baby.

A baby not gaining weight at 2 weeks old is a serious situation. It sounds to me from what you say here that the nipple shields and the dummy and the time in intensive care and scbu and the pneumonia have all combined to make it really hard to get bf off to a good start. Sleepy babies are a worry - it could be they sleep because they don't have the energy to feed well, and so feed less.....which makes the problem worse.

You are doing the right thing in getting milk into him by whatever means. This does not need to be permanent, but he absolutely has to have the milk - in fact the more you express the better at the moment. Obv you continue to breastfeed him direct as well.

There should be a breastfeeding specialist in your area or attached to the maternity unit. She would be a good person to see - can your HV arrange this or can you call the unit yourself and speak?

Hope things go better soon.

Thanks tiktok, that makes me feel much better about mix feeding. There is a breast feeding advisor at the hospital (who interestingly recommended the nipple shields) but we live outside the catchment area for the hospital so she can't come out to us. I might give them a ring and see if we can go to her instead of a home visit.

My milk supply seems to be benefitting from expressing as I am getting more every time and he is still happy to feed from the breast as well as the bottle.

We tried again without nipple shields but using the breast pump first to draw my nipples out. He did briefly latch well but when we tried again later he cried until he was sick. I don't want the breast to become a negative place for him but I know I need to persevere too.

Some good news, the HV came again today and he's gained 2oz in two days which they are really pleased with. I feel more relaxed now I know he's gaining and hopefully he will pick up on this and won't stress so much next time we try and latch.

My wonderful sister has offered to pay for a private lactation consultant, however I want to give it a few days to make sure the weight gain continues before trying anything new. I want to be able to breast feed but my immediate priority is getting milk into him and putting the weight on. He is still getting breast milk both from direct feeding and expressed feeds even if it is supplemented by formula at the moment, so I'm trying not to stress and take the next few days as they come.

Thanks again for all the advice and suppirt.

I just wanted to say well done - you've not had an easy start to feeding, but it's obvious you're doing all you can.

I had to pay to see a lactation consultant at the beginning, as there was no support in my hospital (cuts, according to the midwives), but it was the best £80 I could have spent.
Thanks to her help, we breastfed all the way.
And don't forget it could well save you money - I believe it costs £700 in formula during a baby's first year!

Good luck

missmargot, that's good news and it's sensible to continue to be watchful until you're confident all is well.

Just wanted to say well done, you're obviously doing really well and. Doing all you can. I hope things continue in the right direction x

Great news- he has now put on 7oz and is only 1oz off his birth weight. My plan is to carry on as we are over the weekend to get him back to his birth weight and then spend next week focussing on his latch.

Thanks for all your support.

FAntastic miss argot, well done x