Close to giving up!

[TippetyTapWriter]

Gave birth to dd 4 days ago. Second dc but couldn't breastfeed first time round and was hoping this time would be better. It's not!

Had a planned c section, but did some skin to skin in recovery and dd latched on. It was uncomfortable for me but my ds never managed to latch so no idea what it was meant to feel like. Dd cotinued skin to skin in ward, latching often then falling asleep. Over 24 hours it got more and more painful for me until nipples were cracked and bleeding and I was in tears at the thought of it. Google suggests shallow latch is the problem but saw multiple midwives and breastfeeding peer support worker who all said latch ok and gave same suggestions. Tried nipple shield but my nipple tore the minute dd latched on to it and the whole thing was full of blood!

Decided to rest my nipples for a bit and hand express colostrum and give formula top ups as dd very hungry and slightly jaundiced.

Saw lactation consultant today who didn't seem to approve of this and had little sympathy for my pain. Said I needed to put dd to breast or pump every two hours. Today my milk also came in and my breasts are engorged and painful. LC watched dd feed and said she isn't even feeding just 'nibbling', so all that pain and she hasn't even been getting any milk! I've tried pump to reduce engorgment but can only get a tiny bit of milk from one breast and nothing from the other. Even hand expressing which worked before isn't working. Scared my boob is going to explode! Or more seriously that I'll get mastitis. And my dd is still living off formula...

LC has diagnosed a tongue tie but said it isn't restricting movement of tongue so isn't causing the problem and nothing can be done anyway until dd is 1 week

Argh. Sorry this is long but what should I do? Nipples are too sore to latch dd, hand expressing and pump aren't working, my breasts are so painful and I just can't see how this is ever going to work!

Thanks everyone. Just read this on another NHS trust's site about criteria for being frenulotomy ready:

"you must have a good milk supply where you are providing your
baby with at least 50% of their needs, based on their weight,
either from your breast or with expressed milk"

I think this must be what the LC meant. And I don't think I do meet this criteria because the amount we're topping up with is close to 100% what a fully ff baby would have (60-90ml 8+ times a day). I do put what I express in the bottle but it's

Well you could ahem spin the facts slightly...

I did think that but surely there must be a good reason for it? Don't want to put dd at any risk. I'll just have to see what they say tomorrow. Seems bizarre though as if bfing was meeting her needs I wouldn't need the tt snipped in the first place!

I don't think it's so much about putting babies at risk, it's more about having limited NHS resources to divide tongue tie and provide breastfeeding support afterwards, so maybe this is their way of filtering out patients... in other words they might be arguing that there's no point dividing it if baby is mostly formula fed anyway. Which would be a stupid argument because a) you can still reduce formula and increase breastfeeding and b) tongue tie CAN create problems for formula fed babies (albeit not as much as for breastfed babies) such as wind, reflux, speech problems later on, etc.

I'm guessing it's NHS policy (cost reasons) rather than risk to baby. Like pp says, tt can still affect bottle fed babies and cause problems later on.
It could also be that if baby is breastfeeding infrequently and taking more bottles, reattachment is more likely (one of the reasons I mentioned cranio osteo).

Is the LC you have seen IBCLC do you know? Just you mention seeing her in the sure start centre, I know it varies between areas but a lot of surestarts just have breastfeeding advisors (basically anyone can call themselves a lactation consultant) who are not IBCLC.

The advice/help you have been given doesn't seem like the best (it must be so frustrating for you as it sounds like you're doing really well considering). I understand money is tight but you may be best getting a really good private tt specialist. See what they say tomorrow anyway, hopefully they will be able to cut the tie and you'll see a big improvement.

Thanks again for the support and advice everyone. I think I might have given up by now or at least doubted myself a lot more without it.

Went to tt clinic today and they snipped it without a single quibble. Apparently she had an 80% tie! They used something called a hazelbaker score to assess it and she scored significantly on all areas. They said she definitely needed it done, so though I feel bad for dd having such an unpleasant experience I'm feeling hugely relieved and optimistic for the first time that we might be able to bf successfully. Still got a way to go, need to carry on pumping for a bit to build supply up to the point where she can get enough to not need top ups. And she has to learn how to use her tongue and I have to learn how to latch her properly etc, but these all seem like 'normal' bfing issues that at least we can work on and resolve.

Thanks again everyone.

Woohoo! I'm so glad they divided her tongue tie And a little bit smug that I was right

Onwards and upwards - they probably told you this but just in case not: it can take a few days for things to improve, they will improve though!

Well done for hanging on in there and good luck for the rest of the journey. You've done the hardest bit!

Just another tuppence worth- don't let you success (or not!) at expressing worry you too much on the supply front. I'm 2 ebf babies in and have never managed to get enough to make a sensible feed through expressing. However my supply was fine for feeding each of them- expressing doesn't come easily for everyone but that doesn't mean you don't have enough supply.

The only real way to measure what baby is getting is to put them on the scales at the start and end of a feed and work out the difference. If it would ease your mind it would worth asking someone with good scales (midwife/health visitor) to do this and see.

Otherwise be proud of every day you persist- every day of breastmilk can make a difference to baby's health - both long and short term. And it does get easier. Much easier- I think once you're through the first few weeks it's so much easier as milk is always prepped and to hand, at just the right temperature!

Good luck, hope it's all up from here now the tongue tie has been fixed!

I'm sorry you were fobbed off by so many hcp, particularly the LC who identified a tie but said it wasn't affecting her range of movement. That's the most ridiculous thing I've heard. It clearly was affecting movement as she wasn't able to feed!!!! No wonder breastfeeding rates are so low when mothers are left to muddle through with inconsistent and incoherent advice.

I hope things continue to improve and give yourself a bloody big pat on the back for persevering the way you have. My first was easy to breastfeed, my second was harder (though nowhere near as bad as your experience). He's now 4 months and it's fine however I felt so totally despondent to start, and as I said I had it easier than you.

Huge well done

Also yes to expressing not being an indicator of supply. I can express sweet fuck all but my baby has big chunky thighs

Glad you got her tie cut, OP.
Remember, your baby will be more effective at getting milk than a pump so put her to the breast as often as you can. Lots of skin to skin will help too.

Thanks for the support everyone. But I can see now getting a tt snip isn't a magic cure. If anything we seem to be back to square one. I stopped using the nipple shields st the suggestion of the LC I saw at the tt clinic. And I agreed with her because I wasn't in any pain, they're a faff, and they interfere with milk transfer. But though I've been trying my hardest to latch dd properly and we had a few comfortable feeds, from yesterday evening I've been getting more and more sore again to the point I was in tears with the pain last night and I've had to start using the shields again.

Dd still doesn't seem to be getting much from the breast. She latches furiously, sucks for a minute with maybe one or two swallows then falls asleep and nibbles, exactly like she was doing before. She'll quite happily stay latched on and nibbling for 30-60 mins but as before she's hungry the minute she comes off and rouses.

I calculated that she's having about 750ml formula a day, which is the guideline amount for a baby her weight. So she's not having formula 'top ups' she's a ff baby having the odd mouthful of breast milk. With the best will in the world I'm not able to pump more than a few times a day, and as she's just nibbling still I don't see how my supply is ever going to catch up. I try breast compressions and swapping sides, tickling her feet etc but nothing seems to get her to take more from the breast (obviously I always try breast before bottle). Not sure what to do now. I'll go back to the breastfeeding group tomorrow but I'm not feeling optimistic. I know it's only been a couple of days since the snip but I genuinely can't see myself ever making enough milk to cut out the formula.

Sorry to hear you're still struggling, OP. I did say it could take a few days before you see an improvement. I also think the formula is probably complicating things - maybe it's satisfying her hunger so she is only breastfeeding for comfort rather than food? It's a bit chicken and egg really, because she might not breastfeed better until you reduce the formula, but equally I can understand not wanting to reduce the formula until she is breastfeeding better.

Firstly for the painful nipples, see if you can get some Silverette cups on eBay or Gumtree or a FB selling group (or just splash out and buy them new!)

Secondly did the tongue tie clinic offer any follow up support or give you any information about breastfeeding support groups? I really think you need some face to face support and preferably from someone new rather than the lactation consultant you saw before (who has never sounded great tbh).

She always wakes up seeming very hungry, goes from hand sucking to full on screaming in a minute or two. So I think she is properly hungry when I put her to the breast. It's just she falls asleep the minute she gets there! But if I move her eg to wind her she's instantly back to hand sucking and crying. I'm sure the latch is wrong because it still hurts despite me trying everything (flipple etc) to get a deeper latch and relatching her multiple times to try and get something that feels right.

When I was 'only' giving her a couple of top ups a day and bfing on demand round the clock she stopped pooing and lost weight (9% at day 10). She's getting weighed again on Friday so maybe if she's back over birth weight I'd feel more confident at reducing the formula but if she's hungry and she's not satisfied from bfing I'm not sure what else to do. Ideally I'd top her up with ebm but I'm only getting 15-30ml a few times a day.

Bah! Feel like I'm going in circles!

Thanks for tip, will look at those cups. The cold weather isn't helping! Going outside hurts!

The only group near me is the one I've been to with the LC. To be fair I don't think she's so bad, just working at a very busy drop in clinic and perhaps a bit harried. The advice she's given me seems to match the Jack Newman protocol for babies that don't take in much milk (www.asklenore.info/breastfeeding/not_enough_milk.shtml).

Oh dear, it all sounds like really hard work- think you're doing an amazing job.

She's only really little so it's certainly not too late to get the supply sorted out, but if she's a mainly formula fed baby it will take some effort, time and patience.

The other thing you may be finding is that she may not have the correct suckling action for extracting milk, especially if she's been using bottles a lot. This wouldnt be helping with the painful nipples either. Its normal fornthe moment of latching on to hurt for a while after you start feeding, but once she's on then the pain should go really quickly.

Lots of patience and skin to skin time will certainly help. Can you look on the nct site to see if they have a breastfeeding councellor in your area who could possibly even give you some one on one help?

I think the action of expressing should still help with supply, even if you're not getting a lot. In terms of the expressing thing, a few things that may help... be somewhere warm and try to relax. Maybe try it in the bath or the shower. Try thinking of your LO- even sit and look at a photo while you express. I also used to listen to songs that reminded me of baby as well. Or try putting her on one boob while you express from the other. As i said upthread I never got the hang of it to the point where i could extract a really good amount, but i did get something when i used these techniques- its one of those things that some women seem to be find simple but for me it was hard work and required a lot of advance planning!!

I also found the pump itself made a big difference. I started with a tomee tipee electric pump, and got literally nothing. Spent what seemed like a fortune on a medela electric double pump kit and started getting something not huge amounts still (70ml per side was good for me, but with a 6 month old baby that wasn't a lot still!!) but it was better than absolutely nothing.

However I did still have a supply which was fine for EBFing- as I said upthread you also need a set of scales work out what your supply is up to really.

Also google recipes for increasing supply- one of my friends had made some great cookies with ingredients for upping supply- they were pretty effective too!

Try and see if you can get some one-on-one expert support, as pp said, support in person should get you further than a message board.

Is there any way you could stretch to pay for a private LC? You've got a number of issues going on;

• TT (cut but healing/may still need looking at/some reattach, especially if baby not feeding well)
• Latch difficulty (although it does sound like you are clued up and doing everything you can-sometimes a someone good can just make a minor adjustment which can make a massive difference).
• Milk transfer issues.
• You're also in the 'top up trap' with formula which can be a bit tricky to get out of.

Someone good can spend time with you taking all DDs history in detail, look at latch, weigh baby before and after feeding as pp said. This is really important as it will indicate whether or not there is a supply/milk transfer issue and if not, will give you the confidence that your DD is able to get sufficient milk from you. Even if the LC is good, it would be difficult to do all that in a busy BF clinic.

Remember, at this stage your DD will be 'putting in her order' for milk for the coming days so her feeding constantly is good and normal. She is trying to tell your body to make lots of milk for her for the next couple of days so basically just FEED FEED FEED. Lots of skin to skin. You will need support too, so someone to supply you with food and drinks, do all the nappies, etc so you can just literally sit and feed.

Thanks everyone. You're all giving me good advice and I feel like I'm being negative. Really don't think we can stretch to private help. Money for basic groceries is tight at the moment. I do put her to breast as much as possible especially as I'm hardly able to pump. It's tough though with my 2 year old to look after too. He's pretty demanding at the best of times but even more so with new baby in the house. My mum is here to help (dh is great but back at work) but she's in her 70s and busy just doing the food shopping and cooking lunch, dinner. Maybe if dd had been my first I'd have the time and energy to put into solving that very accurate list of my issues! All I hope is that if I keep feeding her my body will get the msg and she'll get more practice and time will eventually help... at the very least she'll be getting some bm which is better than nothing. Support group again this afternoon so I'll try and get as much help as possible with latch. Maybe 1 time in 10 I get an ok one and I see her take a few good swallows. If I could crack that I feel I might make some progress.

You're not being negative, it's really hard when you've got another DC to look after and expressing is really demanding and disheartening when you don't get much.

Maybe turn up a little bit early at the breastfeeding clinic and the LC may be able to spend a bit more time with you. See if they will weigh your DD before and after feeding.

It sounds like you are aware when she has a good latch and is swallowing so at least you know what you are looking for.

Are you doing paced feeding with the bottles you give her?
Have you tried biological nursing position?

Feeding during the night also helps with supply.

It does sound like you are doing amazing though

I hadn't meant to imply private help- the nct have a breastfeeding helpline you can ring to speak to a breastfeeding counsellor for free.

Our local branch also employs a breastfeeding counsellor who comes to our bumps and babies group- also free to attend. She can also be contacted 24/7 for mothers who need some additional support at any hour. She's full of great advice and really takes her time to speak to everyone who needs assistance. I don't know what she does in terms of visiting people/providing support outside the bumps and babies group but she is qualified to give advice and help without health care professionals there too.

There's also a network of breastfeeding peer supporters here who run breastfeeding cafes with local health visitors - also free. The peer supporters are volunteers and aren't nearly as well qualified as the counsellors but are a good source of support and advice none the less, especially if you've never done it before. (i think they are called baby cafe in our area).

Have you had a google for these sorts of things going on in your area? If you are urban then there are probably a lot of different face to face sources of support.

OP have you contacted LLL Kent? If you look at the website you'll see they have groups and meeting all over Kent. There are FB groups for East and West Kent. There might be a group leader or peer supporter who can give you support over the phone or in person.

I'm sorry your having a hard go, Tippety. Something that stood out to me is that you said going out in the cold hurts, and that you're having pain with feeding. Look up Raynaud's of the nipple and see if any of that sounds familiar.

I've been dealing with a lot of the same issues as you, minus the tongue tie, and things are improving a bit since I started treating the Raynaud's. I have a thread on here, called something like I don't want to give up but I don't know what to do, if you're curious - though it's mostly me feeling sad and sorry for myself! But there's some good Raynaud's info in there.

Regarding pumping and formula - I've continued pumping throughout our attempts to establish breastfeeding. My mental approach has been to consider pumping as something I do to maintain my supply to keep the door open to BF, rather than something I do to replace formula. Over time, my output has increased and his bottles have been more and more breast milk bottles but I still don't pump for that reason. And on days that I manage to feed him at the breast more, I pump less and he ends up taking more formula and that's fine because we're working on breastfeeding.

My DS does the same thing with zero to one hundred hunger. One thing that helped when we were first starting to try to latch and use the nipple shields was to feed him some formula to take the edge off and then try latching, and then go back and forth like that until he was satisfied and i was done with practicing breastfeeding (or he seemed to be). He suddenly got much better at trying to breastfeed when we took that approach.

Our decision has been to not let him lose weight in the name of breastfeeding and rather try to play the long game with establishing breastfeeding. The bigger he gets, the more we figure out and the easier it gets.

Also, have you tried the koala hold? For whatever reason, DS seemed to get it more easily and I had way less pain with it.

I read your post about Reynaud's and the pain you were in. Sounds awful, you're a brave woman! I'm very glad things are improving for you. I think I possibly have a bit of vasospasm as I get a burning pain that builds and builds a few minutes after dd comes off, and I've seen the tip of my nipple go white.

Also the LC mentioned yesterday that dd has a high arched palate, which is news to me. I've googled and it seems to be common in tongue tied babies and can cause feeding problems as babies need an extra deep latch. Possibly this is why we're still struggling after the tt snip. She suggested a new position where I lean over dd to let gravity help get as much breast in as possible. Tried it just now and it only took 2 attempts to get an ok latch. Possibly a fluke but I'll definitely try it again. I'll look at the koala hold too, not heard of it before.

I'll look at other local support groups too. I've been a tad put off so far as a joined some bfing Facebook groups when I was pregnant and the tone of some of the posts is a bit evangelical. They remind me of a woman I used to know who I found very hard work - I had to ff my son so I have no problem with formula and find the negativity from some pro-bf people a bit hard to handle. This woman often reduced me to tears! I've already been frowned at by one bfing peer supporter for giving top ups even though half a dozen health professionals advised me to and dd was pretty much starving without them. But I'm sure there's sensible people out there if I look. Or I need to be less touchy!

Thats great that you've got a position where the latch works better- hope that helps you to make some steps forward in the coming days.

It's terrible that tye peer supporter made you feel like that, they certainly shouldn't be making you feel judged- they are supposed to make sure you are informed, supported and empowered whatever you choose to do!

Some of our local group certainly post pro-breastfeeding information of facebook, but never anything anti-formula, and in person they are lovely.

I guess the other side of it is that formula top ups do make establishing breastfeeding harder, as you are well aware, and so it probably would concern a peer supporter if you were saying that you wanted to bf but were giving top ups. For some cases there obviously a real need to top up, but I think many women who dont have any medical issues get spooked by cluster feeding, apparent hunger and not knowing what baby is gettting, give top ups right at the point where baby is working to increase supply and then end up beating themselves up when the supply hasn't ramped up and they get into a vicious circle of more and more formula when it's not what they wanted to do.

It sounds like you're doing an amazing job, fingers crossed it all pays off for you!

How are you getting on, OP?

Some of the Facebook groups can be good, there are lots of women who have been in a similar position to you and are now exclusively breastfeeding so it might be helpful to have a read. Maybe join a few and you can always unjoin any ones you don't like!

I'm sorry to hear a peer supporter made you feel like that. It sounds like you've done everything right, you seem very aware about latch, etc and went out of your way to get a second opionion re:the tt. No one should make you feel rubbish when you are doing your very best for your baby.

I think the reason why people get frustrated with the top up advice is that it's often given as the solution to the problem, rather than finding out what the actual problem is. The peer supporter should not be taking this out on you though.

I hope things are going well for you anyway.

I think I'm just touchy about the formula thing, but I had just told her that dd had lost weight and stopped pooing so not sure why she seemed so sceptical. Anyway, it's not a big deal.

I'm doing better at latching, seem to have got the hang of the 'sandwich'. The trick seems to be keeping hold until dd is sucking then gently letting go. And being patient and waiting for her to gape as wide as she does (which is only ever half as wide as she yawns!). I'm also going without the nipple shields for now and the pain is ok, just a bit of tenderness from use. So that's all positive.

Supply is still pants. Bit disheartening to feed her for 40+ mins only for her to pull off and start hand sucking and crying like she's never been fed! She's always so happy and relaxed after a bottle. I need to make more effort to pump. Already putting her to the breast as much as possible. Need to stay hydrated too!

Thanks again everyone!

I was referred to a breastfeeding consultant with my dd who was a great advocate of biological nurturing which really worked for me.

One thing she said is that you can't tell is a baby is well latched whilst they are feeding. They can be getting milk and swallowing but destroying your nipples. She said the only way to know is to pop them off and look at the nipple. If it is like a cherry you have a good match and if it is at all pinched at the sides then it isn't a good match.

Don't know if that is useful information?