I'm in a state over whether to BF DD or not

[CremeDeSudo]

Can someone help pls?

DD is 9 days old, born at 36wks. Until my milk came in I hand expressed colostrum and topped up with formula. Once my milk came in I started feeding with nipple shields as her mouth is so small and she gets tired easily.

Then she lost 11% of birth weight and MW advised waking to feed every 3-4 hrs, boob then formula top up. Only offer boob during the day(when she's hungriest and most awake), express for other feeds 10 mins on each boob. We've somehow stopped offering the boob at all for fear she's not going to take the formula so I've basically just been pumping twice a day.

She's almost regained her weight now but the plan continues.

Another MW has told me I need to be expressing 10-12 times a day to keep my supply up (which already seems to be dwindling).

I don't know whether to continue with trying to BF. I hate pumping. I really hate it. I loved the feeling of feeding her but now I'm solely pumping and don't know how long I'll have to continue to do so.

Also, I'm really struggling with spending such little time with DS and being unable to hug him due to engorgement.

Selfishly, I also really don't like the way my boobs look, how big they are. The let down pain is horrible. I don't want them to look like deflated balloons in the future. I don't like the leaking and the constant stickiness. I've been desperate to feel like myself again after a shit pregnancy and MMC before that but I don't know if I will if I'm BF'ing.

I think I've decided to stop but then I cry because I still want the closeness etc. And I love that I can settle her instantly. I also have a bad case of baby blues. I wonder if I'm quitting too soon but then I can't face all that pumping either. I'm so torn about what to do and I can't stop crying about it! Can someone tell me what to do pls?

I remember people asking me if I could see them swallow - I thought I could but they weren’t really.

I realise this may sound like a stupid thing to ask, but are you sure she’s latching correctly? Took me an embarrassingly long time to realise mine weren’t, and no professionals mentioned it either when I asked them. No wonder my nipples were destroyed.

I'm using nipple shields atm. I'm too scared of the pain to try latching her on myself at this stage. I was hoping the consultant would advise how to progress there.

Tbh, I've seesawed back to not wanting to carry on again. Yesterday did not go well at all. I felt like I was fussing her all day and she kept getting fussy and over tired as a result. The boob1, boob2, keep calm while I sort a bottle, have the bottle, wind, attempt settle for ages, express1,express2. It's all taking about an hr and a half a time and she's just not been settled. I've started getting irritable and am being short with DS. Just given a bottle only for her last feed as I couldn't face the whole rigmarole again.

I'm getting on my own nerves with constantly changing my mind!

I have a suggestion - feel free to ignore - but this might feel more achievable while you wait to see the lactation consultant

Alternate between the following:
Feed 1: breastfeed, offer both breasts, limit time on each breast to whatever feels reasonable to you (maybe 10-15min?) so that you and baby don’t get too frustrated and tired, then offer small top-up, but don’t express after this feed (also can your DH prepare the top-up bottle while you’re breastfeeding?)
Feed 2: just offer a bottle (no breast) and pump (both breasts, preferably with a double pump) so your boobs learn they are supposed to be producing milk for this feed
Feed 3: same as 1
Feed 4: same as 2
And so on...

Also please don’t put pressure on yourself to make any decisions. You said you were going to wait until you’d seen the lactation consultant and i think that’s a good idea.

Nb the above suggestion is not the best way to maximise your supply but you will maintain some supply and it’s a compromise until you can get proper advice/support and get the tongue tie sorted.

Don't feel guilty whatever you decide to do & don't feel pressured into doing anything that isn't right for you. As long as your baby is being fed & able to thrive, that's the main thing.

I agree with NC - similar theory to what we were doing at that stage which was alternating bf and ng tube feeds, and later on bottle feeds. They found it much less tiring than bring, but it can mean they’re less interested in working for the milk from the breast when it comes to that. It’s so hard to know what to do for the best, I remember it well.

Thing is NameChange I don't think we're going to get the tongue tie 'sorted'. Neither of us want to do it. The NCT support person said the tongue tie doesn't necessarily mean a bad latch though. My nipples hurt from feeding via a shield and expressing and I'm scared to try without the shields.

Sorry, I know I'm getting tiresome!

I would take advice from the LC but if you want to continue breastfeeding then either the tie needs to be resolved or you need to find ways of improving the latch without resolving it, which may not be possible.

If the latch isn’t good and the baby isn’t draining the breast well, they won’t get enough milk out and your supply won’t do well. Is there a reason you don’t want to sort out the tie? I really wish I could go back in time and sort the twins ties out - both now have speech issues and we don’t know if it’s related yet, waiting on referrals.

I relied on shields as well because my twins just couldn’t manage to latch on without them but looking back I think it was definitely a hindrance. If it’s very painful to feed without them then theres a problem with the latch, and that may not be fixable with a tongue tie in place. Many babies improve their latch as they grow even with a tongue tie (mine did as initially they would dribble out so much milk via any oral feeding method) but you may have stopped by then or your supply may be very low.

Are your nipples misshapen (like a lipstick) and / or white after feeding? Mine always were, ended up with vasospasm which was super painful. The baby shouldn’t really have any contact with the nipple, their tongue should be on the Areola underneath and the nipple should be pointing at the roof of their mouth. Most of your areola should be in their mouth and that’s really difficult when you have a preemie with a small mouth.

I would get through the weekend until the appointment and see where you go from there. Definitely look at the flipple technique as that can really help to get a deeper latch. I tried everything (aside from having the ties cut but I didn’t know fhey were there early enough) and failed and I struggled with that for a really long time so I know how you’re feeling right now.

Unfortunately a lot of things that HCPs suggest to women (topping up, shields etc) can really sabotage breastfeeding and when that’s what you want to do its really hard to cope with that.

I’m sorry you’re struggling with breastfeeding. I did too in the early days and it’s really hard. DD also had a tongue tie but it didn’t get picked up for a few weeks as for some reason it only really affected me on 1 side (I must have seriously wonky boobs). The HV were completely unhelpful, but my local breastfeeding drop in were great. We got the snip on the NHS but my friend had a private practitioner come to her home. It compeletley changed everything for us and I went from having a baby who would feed for 7-8 hours out of every 24 and serious nipple damage, to a happy big fat squidge I bf until she was 14 months.

When you say you don’t want to get the tongue tie sorted, what are your reservations? I had someone talk me through the procedure before we had it done which really helped to demystify it and would be happy to do the same for you? Having said that, nowt wrong with deciding that it’s not working and switching to formula

If you are worried about the pain of her latching on without shields, you need to get the tie divided. I described breastfeeding DS1 as worse than Labour- both boys were tounge tied. DS1s took longer to diagnose - I asked about DS2s tongue when the midwide counted hes fingers and toes and we were refered at about 3hours old! I went on to feed both til we moved to cows milk.
If bf isn't working for either you or baby, move to formula. At the end of the day, fed is best.

“Thing is NameChange I don't think we're going to get the tongue tie 'sorted'. Neither of us want to do it. The NCT support person said the tongue tie doesn't necessarily mean a bad latch though.”

Well as I’ve said all along the tongue tie is clearly hindering the breastfeeding and if you refuse to consider division you might as well give up breastfeeding now.

Tongue tie may not necessarily mean bad latch but your baby clearly isn’t latching properly and also has tongue tie so it doesn’t take a rocket scientist to conclude that in this case tongue is probably causing or at least contributing to bad latch.

Lots of us have shared our experiences of babies with tongue tie, those of us who got it divided found it helpful and those who didn’t regret it. I have shared a link with detailed information about the impact of tongue tie and what the division involves.

If you really don’t want to do it that it of course your choice but it’s absolutely puzzling especially given that you havent explained your reasoning and you are clearly struggling a lot and wanting to breastfeed.

Unless you don’t actually want to breastfeed and that’s fine.

Aozora13
“ DD also had a tongue tie but it didn’t get picked up for a few weeks as for some reason it only really affected me on 1 side (I must have seriously wonky boobs).”

Interestingly my DS latch was ok on one side but excruciatingly painful on the other. When the tongue tie specialist assessed him, she said he had more flexibility on one side than the other, the tongue tie must have been a bit asymmetrical, so I concluded that must have been why we had more issues on one side than the other. I still got mastitis in both boobs though!

I'm a little bit ahead of you DD is 15 days old and our situation is very similar. She's little, my nipples are flat. We couldn't feed directly at all initially tho as she was in phototherapy for jaundice and it was taking too long so the docs advised me to bottle feed her. I did carry on expressing every 3 hours tho so my supply is ok, I think. The fussiness and coming on and off and waiting for a bottle (how can a tiny baby do that!) is slowly getting better. We are also managing most feeds without shields as she gets better at it, in spite of her teeny mouth.
So what I think I'm trying to say is if you keep at it you may find another few days is all it takes to make things much easier. If you don't then there is no shame in ff and your mental health is important.
And I am using this super cheap double pump www.amazon.co.uk/Electric-Breast-Pump-Rechargeable-Breastfeeding/dp/B078HZ84BQ/ref=sr_1_6?s=baby&keywords=Breast+pump&tag=mumsnetforum-21&ie=UTF8&qid=1529842334&sr=1-6 altho only pumping once or twice a day now. And it works really well.

We don't want to cause her pain when there's a viable alternative. I know it says/you say it doesn't hurt but I'm still not sure we can do it. And whilst I might be on the fence after reading up, DH feels really strongly about it and we both need to agree. It's also bloody expensive if we do it and BF'ing still doesn't work out.

Say we did get it done and stopped the shields, how much pain am I looking at? It's going to hurt regardless isn't it? And how long does the let down pain continue?

I tried latching her on without a shield yesterday as she wanted to comfort suck and didn't have one to hand. My nipple was round, it didn't hurt anymore than using the shield (however it wasn't for v long and not full force). She didn't really get my areola in, I can't get it in tbh.

I think I'm wondering about even bothering with the consultant if the plan is going to be a variation of what I'm doing now, we're not up for snipping her tongue tie and I've still got to get through the latching pain. Should I just save my money if I'm not going to want to follow her advice?!

We had dd's 'slight' tongue tie divided and were told that it might make no difference. It was like a miracle. I haven't had a painful feed since! And dd didn't even wake up while it was being snipped. Did you know in the 'old days' midwives would spot a tongue tie and divide it with their finger nail? That's how small a deal it is.

But if you don't want to breastfeed that's fine too!

OK.
There is some help available for free. It’s usually quicker and better if you go private, but free is still an option.
Where I live, there are free breastfeeding drop-ins run by the nhs and voluntary groups. There is even a lactation consultant who is an expert on tongue tie (she trains people on it) who runs a free fortnightly drop-in. So I suggest you research what’s available near you. If you’re lucky there will be a drop-in with a good lactation consultant or breastfeeding counsellor who can diagnose/assess the tongue tie. Once you have a confirmed diagnosis you can see your GP or midwife and ask them to refer you for division on the NHS. Sometimes it’s offered, sometimes it isn’t, unfortunately. But if you could get some free advice to begin with, from someone actually qualified to make a recommendation about whether division is necessary, perhaps that would help you and your husband to make up your minds. Then if division isn’t possible on the NHS you could make an informed decision about whether to get it done privately.

To answer your question about pain, no breastfeeding should not be painful. It was painful for me because of the tongue tie but the pain stopped after it was divided. I am not sure about others’ experiences, I think many experience pain when establishing breastfeeding, but the pain should not continue.

These directories include NHS/voluntary as well as private

Lactation Consultants
www.lcgb.org/find-an-ibclc/

Tongue Tie Practitioners
www.tongue-tie.org.uk/Mobile/m-tongue-tie-important-information-for-parents.html

I understand OP. We had our first babys tt divided due to pain when bf (poor latch, my flat nipples, tiny mouth- your story sounds familiar) and my husband and I agreed that we wouldn't do it for our next baby. It was short but I still don't think it's a nice experience for a new born to have to go through when as you say there is an alternative. I say that knowing a lot about tt...v close family member is a tt practitioner. Not trying to sway you either way I'm just saying that I understand your concerns.

Hi OP.. well done for sticking it out this long, you've certainly had a rough start with all the shields and pumping etc. Every single bf you've given her will have helped her. My sense is that you want to switch to formula now. If on balance that's what you want to do you should go for it and not look back.

My own view, having breastfed two children with tongue tie (and only had the second child's tt divided) is that you are in for a much tougher ride if you won't do the division. It might even cause you and the child more "pain" in the long term coping with difficult, very regular feeding.

Op you've had loads of good advice, but considering your feelings towards getting the tongue tie sorted I reckon you have two choices-

Continue mix feeding and accept that breastfeeding is going to be painful and frustrating

Formula feed

Bear in mind that tongue tie can affect more than breastfeeding though- it can also cause issues around weaning and speech. That's not to say it always does, but it can.

Whatever you decide I hope it goes well.

From what OP has said I think she is actually a bit more open to division since starting this thread, but her husband is dead against it and presumably hasn’t read up on it, and she probably feels it’s just too much to have to fight with him over it on top of everything else.

One thing that is vastly underestimated when it comes to breastfeeding is the importance of a supportive partner.

My DH did all the nappy changes, brought me drinks and snacks, basically waited on me hand and foot, came with me to the breastfeeding drop-ins, listened to the professionals and agreed with me that we should get the tt divided. He actually held DS while it was done. Meanwhile I was waiting with my boob out to breastfeed him straight away.

IMO the long term benefits of breastfeeding for baby and Mum vastly outweigh the minor, brief pain/discomfort of division.

Just my two cents though. Everyone makes their own choice.

I was amazed what a difference dividing the tt made - DD had a severe one that was missed by several midwives but I kept pushing to see the infant feeding specialist at the hospital and it was diagnosed at 3 days old and snipped immediately (we were still in the hospital).

We had thought it wasn't too bad as we could see her tongue a little, but the difference afterwards was huge - suddenly she could stick her tongue right out and wiggle it around a lot! At this point we discovered that DH also has a severe tongue tie!

TBH I didn't consult DH before having it snipped. It never occurred to me - he was only able to visit the hospital for two hours each day so there wasn't an opportunity to discuss it with him - I pushed to get it checked one evening and by the time he visited the next day it was done. I knew from a friend's experience
that it could affect both breast and bottle feeding - she'd eventually got her baby's snipped privately at four weeks, and until that point he'd been taking in a lot of air with each feed which made him fussy and uncomfortable. She'd already stopped BFing but having it divided dramatically improved bottle feeding too. Clearly it doesn't stop bottle feeding (my DH was eff because that was the norm when he was born!) but it can make it difficult.

The snip itself took about half a second and she really didn't seem bothered about it.

Sorry, meant to add that I'm not suggesting going against your partner to get it done, as he is against it! It's just what happened to us!

By three days old DD had already had several blood tests and an IV line in plus antibiotic eye cream administered several times a day (she'd picked up infections from the birth canal). All of those things were a much bigger deal than getting the tt snipped.

Dh was against having dd's tongue tie snipped... because he hadn't done any research whatsoever. It was a gut reaction based on total ignorance. I got him educated on the topic. We got the tongue tie snipped.

Did you look up the flipple technique video? It really helps to get more of the areola into their mouth. If you can get the latch right, the pain will not be an issue. Right now if she’s just sucking on your nipple that’s going to hurt a lot.