From exclusive expressing to nipple shield - 3 week old

[pandarific]

Hi everyone. I've had a bit of a pain with feeding my first baby so far short version is he did an enormous meconium poo on the way out, then I couldn't latch him in hospital (looking back it's not that surprising as I lost a higher than average amount of blood, he didn't really do the massive gape, I've got flat nipples and struggle horribly with coordination normally and was scared of holding my baby let alone be able to learn all of the complicated holds, and had had absolutely no sleep due to the next bed over having a baby that screamed every 45 minutes all through the night - I'd never been able to hand express anything and my milk didn't come in until day 5 when we were home in the end ).

On day 2 in hospital he was hypoglycaemic and had query for sepsis and we had to stay on post natal ward for 4 nights while he was monitored and had antibiotics. As I still couldn't get more than a bead of colostrum I decided he could be given formula as it was so scary him being unwell, and then from day 3 I got hold of a pump and could express for him, topped up with formula.

Since then he's been mix fed. I tried to get him to latch the first few days but honestly I was just getting stressed and upset as I really couldn't manage the holds despite many midwives helping me and he just wasn't getting it at all, so I decided to concentrate on expressing while we settled in a bit.

I still have low supply - with a hospital grade pump i am getting 430mls a day so lower than what he takes, so approx 1-2 formula feeds a day too, but he's gaining weight and thriving which is great.

I saw a lactation consultant who tried to get him directly on the breast, and we did manage it briefly, but only for max 6 half hearted sucks and even then it was chompy as she said he just hadn't learned to breastfeed. I didn't go with her plan of staying in bed with the baby for 4 days and just repeatedly trying to latch him at every feed because, honestly, I just didn't have it in me - too long housebound and after the hospital too I couldn't do any more baby mooning or I'd go mad.

So, nipple shields... I have got a pair which seem to be working pretty well, I got him on today for a feed on both boobs, so I'd like to transition off pumping onto feeding using the shields, with the aim of then when he's older maybe baby stepping toward breast only. but, I don't really know what I'm doing or what to expect - does anyone have any experience in this kind of situation they could share, or let me know any tips you might have?

Today he kept falling asleep at the breast, then I put him down, he woke up and cried, then I put him back on again and after a 10 min feed, he fell asleep again! Is this normal? How do I know when to take him off or if he's had enough if he falls asleep? I'm still pumping, I assume I should continue that too as using shields doesn't drain the breast as effectively? I would like to express a bottle to use at night as I can barely get him latched when I'm awake and also he is currently doing 5 hour stretches at night which I'd rather keep if poss

Oops posted too soon - I just wanted to add, my next goal is to get better at positioning and latching so I can be mostly breastfeeding him with the shields, maybe with 1 or 2 expressed bottle feeds for ease. After r, I'd love to work up to being able to breastfeed him out of the house, but that's a bit of a way off now I think! (I have struggled so much with the coordination required I'm even more convinced I am actually dyspraxic.)

Anyone have any advice or experiences to share?

No direct experience with this but it sounds like you’re doing a fab job.
With when to stop feeding- basically when your baby isn’t swallowing anymore. But at this age they do often suckle for a while before feeding again. Lots of cluster feeding, so don’t worry too much.

I’d recommend calling or going to a local La Leche League meeting if there’s one near. They are by far the best and most knowledgeable people I could find to help. The NhS “lactaction consultants” aren’t well trained and I found their advice varied. An independent IBCLC is also worth considering, although expensive!
Sounds like baby is taking
well to the boob with shields though, so I’d focus on that for a while. I’d weigh gain is ok, then no worries!

DS was formula fed for a short time as I was ill when he was born. I transitioned using nipple shields and he is now completely BF (7months).
One thing I remember the lactation consultant saying is you need to turn him into a BF baby - going cold turkey on the formula - as the more he feeds the more you make, and you don't want him to prefer formula.

With regard to transitioning off shields DS decided for himself that they were too much of a faff - batted it away, and latched himself.

Speak to HV team, they might have BF support workers attached to them, ours were a godsend for me. They helped with positioning and all sorts.Has baby been checked for tongue tie? Mine had one really far back and snipping made such a difference to feeding. I stressed about the shields as well but at about 8-9 weeks DS decided he wasn't using them anymore and kept nudging them off. He's now 15 weeks and still feeding brilliantly, good luck!

Thanks everyone! To answer a few things:

It was a certified private lactation consultant who I saw. She was quite down on nipple shields as she said it's trading one problem for another, and also that the latch isn't good with them so it will reduce milk supply.

She also said he definitely doesn't have tongue tie, he just needs to learn to breastfeed.

I don't think the latch is good, even with the shields as my poor nipples are chomped into a compressed shape now. But at least he's on the breast? I'm hoping it will all magically fall into place at some point, but it's feeling a lot like a hard slog at the moment.

Well done, you are doing great! I've been in a similar situation recently - now at 6 and a half weeks, but sadly we have now given up on breastfeeding with or without sheilds, but are sticking with expressing. Still not quite meeting demand, but getting closer!

Some of the useful advice I got...

To transition, at every feed you should first put baby at breast so long as there is active sucking and swallowing but for a max of 15 to 20 minutes. After that, feed the baby with expressed milk (or formula as necessary) then express. The theory is this will take no more than 1 hour in total, but I found it was always longer.

Sucking at the nipple shield is harder work than a bottle, it will take longer for milk to come through, and feeding will be less efficient which could explain them falling asleep on the job. My little one could only get milk through on one breast, nothing from the other, and would swallow irregularly, which made me think she was getting a very small amount. She'd also then go on to have a full bottle. I guess the volume they take from the bottle might help indicate how much they are getting from the breast first.

Babies are more efficient at removing milk from a breast than a pump. Don't treat the volume you're capable of expressing as a true indicator of your supply (instead, look for wet/dirty nappies and weight gain).

A midwife recommended this website to me, which I've found really helpful:

kellymom.com/hot-topics/pumping_decrease/

This all sounds very familiar...
Check the nipple shields are actually the right size for your nipples. (I used medium medela ones - corresponding to the smallest size of funnel bit for medela pumps.) The mention of the compressed shape made me wonder about that.

A lot of midwives etc are down on nipple shields as they can interfere with supply- i was advised to do as much skin to skin as possible to try to counter that. You are expressing too so might not be an issue. But definitely keep an eye on outputs if you transition to full time "direct" feeding.
The kellymom site has great tips on weaning of shields too if you want to in the future, but mine just decided one day she didn't need them any more (possibly having learned how to feed using them.)
You may find they have no effect on your supply and you have no need to wean off!

Positioning is hard when you are scared of hurting the baby-mine came out with a fractured clavicle and serious bruising on her face- and I was terrified of that. I'm also not the most coordinated, and let's face it - this is an entirely new skill, you're knackered, and baby hasn't read the books or done it before either.

I found cross cradle hold worked well; that I wasn't holding the baby close enough in (tummy to mummy is not just a direction it turns out, it's also a reference to how close in you need to hold the baby).
Until you get the hang of the coordination have you got pillows supporting you and baby? Lots of pillows.

The lactation consultant I saw mentioned "CHINS" principles for positioning
Close in
Head free (i.e. you bring baby to breast holding shoulders and neck, not head which needs to be able to tilt back to facilitate swallowing.)
Inline _head neck and body of baby inline
Nipple to nose
Sustainable- make sure you are comfy and able to maintain position for a while. (No hunched shoulders etc).

Check baby is swallowing regularly, look up breast compressions to help get milk in to baby if you haven't already, esp if he's sleepy feeding at breast and for expressing do you know about "hands on pumping"? (Breast compressions while pumping. Gets more out).

You might want to think about switch nursing (put baby on other breast if he feeds then falls asleep on one). The Good Place episodes are 22 minutes long which is as long as I was supposed to leave mine on one side at first, so that might be useful to know...

I posted too soon-I also wanted to say it sounds like you are doing amazingly well after a traumatic start. I completely understand wanting to get up and about after too long in hospital, having been there myself but I got into a bit of a mess and with hindsight should have taken to my bed with baby for longer than I did. Or rested more at least. Do keep that in mind.

It does get easier as you recover, practise and baby learns what to do. I still much prefer feeding in the house where it is comfy and there are fewer distractions for very distractable (nosy) baby, but once you get confident handling the baby it's easier. I took my pillow out with me at first. Probably looked like a weirdo. Didn't care.

Thank you everyone for being so supportive.

Three sessions of feeding today but I don't think I'm making enough. For example, I had him on for an hour today at a point where I should have been pumping so would have milk, and we did both boobs twice, but then he unlatched and was doing his hungry motions, so I had to give him a formula bottle (second one of the day) which he had about 60mls of. He usually has a 120-130ml bottle so he probably had about 60 from me, which rallied with what I tend to express in a power pump session.

Will my supply increase? Asides from supplements (I'm taking every galactogue under the sun already) is there anything I can do to help get it up? I want to stop formula altogether really.

Just checking in to see how your doing.

The only thing that will increase your supply is demand. So you’re doing the right things. Feed feed feed!
And it’s definitely better to have him feeding from the boob compared to pumping. He’ll be doing a better job (and he’ll need the practice on the boob).
Really hoping it continues to go well. Will you have anymore follow up from your lactation consultant. Did you look up la Leche league?

I did get very frustrated today after he kept starting to feed, falling asleep on the boob after 5 minutes and then waking up complaining about being hungry when I tried to put him down. Have read it might be slowness of flow so have been hand stimulating too - but I did give up and give him a bottle.

This is also what worries me about bf - he’s a dream usually, has bottle, goes off to sleep for 2-3 hours pretty consistently, and at nights he’s doing 5 hours, sometimes more. He’s always been like this since birth, and tbh I don’t want to give up the pump altogether as I like my sleep / alone time. Today was hard, I was pretty much on the couch for 10 hours, he didn’t sleep at all!

Don’t think I’m going to go back to that lactation consultant no - she was very down on the nipple shields and I know she’ll jist try to get him on the breast again. Not that I’m against that, but I just want to take my time and ease into it rather than be pushed iykwim?

I have looked up LLL previously but actually I think they are involved in our local BF drop ins, which I’ve not been to yet, but I am going to go to next week. (Felt too much at the time as he actually wasn’t bf at all)

Bless you, it’s hard enough at this stage without the pressure of trying to breastfeed a baby who’s struggling with it.

You just do whatever you need to do to be the best mum. If you feel like it’s breastfeeding (I know I felt this way) then keep doing what you’re doing and you’ll get there. But if it’s pumping and combi feeding, or even just formula don’t feel bad because you need to keep yourself well to be the best you can be for your son.

Make sure you have some good tv to watch while you’re glued to the sofa!

Another couple of helpful people to follow on FB are The Milk Meg, and Dr Jack Newman. They will have lots of advice on their FB pages.

Bit depressed with feeding at the moment.

I’m having a worry about my supply... it’s not increased as far as I can tell, and poor now 5 week old ds seems really hungry at the boob, and asides from eg the first feed in the morning when I'm full, is fussy and upset as there is not much coming out and then he gets tired sucking and falls asleep, but only for a little bit and in my arms.

I know he’s hungry as as soon as I put him down he wakes up again crying, mouthing etc until he goes back on the boob, rinse and repeat until I feel guilty and give him a bottle. He’ll nap very happily for 3ish hours at a time if he’s not hungry!

Idk I know the cluster feeding is meant to increase supply and so on, but it’s always been low and for the past week I’ve either been expressing or breastfeeding alllll day and I'm still having to give bottles and I think he's actually getting hungrier as he's obviously getting bigger.

I'm asking the doc for Domperidone tomorrow - I'm a bit knackered by this now, expressing plus bf plus bottles. I'm ready for something to get easier now - I just want to feed my baby!

I just wanted to say that I have been successfully feeding using shields for nearly 5 months and little one is doing really well, lots of people seem really down on them but if they are working for you thats what's important and just ignore the comments from others (which I know can be hard to do!).

Don't be too hard on yourself, it will get easier but do speak to people as this really helps x

Bless you. It must be so exhausting! How much formula is he having each day now?

I used shields and I remember basically spending the early weeks with a baby on my boob pretty much all day. I had flat nipples and it took a few weeks but my nipples eventually became more ‘pointy’ at which point I chucked the shields. I also used to give one bottle of formula a day. Usually before bed. It helped later on when she went to nursery and I could express and she would take a bottle easily. All I can say is keep going. The more he feeds the more you should produce. Eat plenty and drink plenty. Rest as much as you can. I eventually got a routine and fed dd for 12 months.
But if it doesn’t work out, don’t feel like you’ve failed you’ve obviously tried really hard.

This is so similar to my experience only I refused to pump when the midwife told me to.
I used nipple shields for twenty weeks and spent probably half that time worrying that I couldn't latch her without them, it'd affect my supply and mean a premature end to breastfeeding. I looked at so many articles and bought shields with cut away bits to try to reduce our dependence on them.
Then I just stopped worrying about it. I like to drink through a straw and I started to look at the nipple shields the same way. They stopped bothering me.
At 20 weeks she randomly took it off me, scrunched it up and fed without it. She's not had them since. I'm still breastfeeding and she's one next week. We've never needed to supplement.
You know your baby and as long as they're gaining weight and doing enough nappies there's unlikely to be anything to worry about. X

hi everyone - thought I'd update. Sadly, it's got more complicated.

DS is now 7 weeks old tomorrow, and I still have low supply. I thought I was just caught in the top up trap because of the bad start and the nipple shields, but actually I am 99% certain I have IGT (insufficient glandular tissue) too. I have PCOS and tuberous / hypoplastic breasts which I was aware of, but I was hoping it wouldn't effect breastfeeding, but here we are.

It sucks so much - I'm taking goats rue, blessed thistle and I started on 80mg domperidone on Xmas eve, but DS is outstripping me by 2 bottles a day and I still have to pump because he's still not as efficient as he could be because of the nipple shields. So my life is pumping AND bf AND nipple shields AND supplements AND formula so bloody complicated. And despite everything I've tried, my supply is still low.

I got the lactation consultant out again and she couldn;t get him latched direct but said to keep trying every day when he's in a good mood, but most importantly she said I'm doing really well and have worked really hard, which meant a lot to me.

I am really, really hoping the domperidone will be my supply increasing miracle - I know it's unlikely, but I'm hoping.