Can nipple shields stop newborn weight gain?

[hopingforapeainapod]

Hi all, FTM and need some advice. Baby was born 3 weeks early by c section. Difficult start to breastfeeding as baby super sleepy and wouldn’t latch well, and he lost 11/12% of birth weight by day 5. Was told to supplement each feed with expressed milk / formula, which I have done and I started using nipple shields as well which have made breastfeeding so much less painful. Anyway day 7 his weight had gone up 100g in 2 days and so was feeling much happier and more confident about everything - baby doing lots of wet and dirty nappies, seems satisfied after feeds, etc.

Anyway, had our day 10 check up and baby has only put on 10g in 3 days, and I’m pretty devastated. This means he is still pretty much 10% below birth weight at day 10 (we have another 300g to go).

Midwife said I’m clearly producing milk but thinks there’s a transfer issue, either caused by tongue tie or the nipple shields. Has advised I up the amount we top up with and spend more time pumping so we know exactly how many ml he is getting.

The thing is I really don’t enjoy pumping; I really dislike being hooked up to a machine and on top of breastfeeding it is exhausting. It’s fine a couple of times a day but I’m just not sure mentally I can commit to doing it round the clock…

I’m just confused because the nipple shields are often full of milk / he has milk all round his mouth after a feed, but I don’t know if he’s just not getting milk very efficiently through them and just tiring himself out in the process of doing so. I thought they had saved our breastfeeding journey and now I have no idea what to think…

From my experience they can affect milk transfer, my DD took in milk more rapidly without nipple shields. She had to work harder to initiate a letdown with shields but they allowed her to latch properly (she was premature and couldn’t latch at all without the shields for a few weeks)

@BFhelp2024 that’s useful to know, thank you. I thought baby seemed happy and satisfied and sleepy after feed but now I’m worried he is just tiring himself out trying to get milk through the shield. They are definitely helpful for his latch and my pain levels but I don’t know whether to keep going with them or not…

Does he has lots of wet nappies, that's the best way to tell how much is going in?

Pumping is a really bad well of telling how much the baby is taking in - babies are often much better at getting milk out than a pump is and some women just don't respond well to a pump.

Can you borrow or purchase a baby scales? I didn’t get anything out via pump so weighed baby before and after a feed and then topped up by formula if they didn’t get enough (so if formal feed for that age was 150ml per feed and I breastfed 75ml I’d top up 75ml of formula so baby had full amount). Same situation as you re 3 weeks early via section, weight loss, difficulty feeding. The scales were great.

I would suggest, if you can, just staying in bed with the baby, the remote control, you phone , lots of drinks and snacks and just feeding all day. If you can manage without the shields, then do. Babies feeding is the best way to increase supply!

How does he seem after feeding without the shields? If your son can effectively latch and transfer milk without the shields it’s probably better, I only used the shields as my daughter couldn’t latch at all without them & dropped them the minute she could!

I was told to drop using them too. They were brilliant for establishing feeding, and for preventing pain for the first couple of weeks, but when I was feeling stronger, I gritted my teeth and we worked on babys latch. It worked, and he went from strength to strength.

Best of luck.

@TheOneWithUnagi yes doing lots of wet and dirty nappies so that seems fine. I seem to be producing decent amounts when I pump I just really don’t enjoy it and really don’t want to end up in a situation where I am tied to a machine all day!

@SpinninandReelin so my husband and I actually tried this earlier but I wasn’t sure how accurate it was necessarily - we tried after a 30 minute feed and he only put on 30g so we assumed that meant he had only taken in 30ml? Which again implies maybe he’s not getting enough through the shields :(

@CurlewKate the problem is we can’t really rely on hunger cues - don’t know if that’s just because baby is still early / slightly jaundiced but he doesn’t really cry out of hunger so we just have to rely on alarms to feed him every 3 hours… he is slowly waking up / building up a bit of an appetite but all feels a bit counter-intuitive / like we are trying to force it down him at the moment!

@BFhelp2024 his latch is getting better but unfortunately it is very shallow and mostly nipple - he just can’t seem to open his mouth that wide and when he does he shakes his head back and forth so quickly I can’t always get my nipple in in time! I can grit my teeth through a feed without them and who knows maybe my nipples will harden up but at the moment I can only bare to take them off for the occasional feed…

@Notquitegrownup2 I think this is probably what we will have to do too. I had hoped to be able to use them for at least a couple of weeks / the first month just until baby got bigger and found it easier to latch, but if they are stopping milk transfer / weight gain I will probably have to give them up earlier than I had hoped :(

Have you had any support from a feeding specialist? If not, definitely do. And I would get checked for tongue tie.

Triple feeding as uou are doing is exhausting and not sustainable. Your midwife suggestion to pump more isn't totally helpful as most women find pumping yields much less than direct feeding.

Meanwhile breast compressions, and try removing the nipple shield once the letdown has started.

It sounds as though you're doing an amazing job to keep going. Well done.
I had a similar challenge - tongue tie cut at 2 wwwks and it just clicked jnto place 2 weeks later.

I know you mention not liking to be hooked up to a "machine" zo I'm assuming you have an electric pump. What I found helped the most with pumping was a handheld pump and put it on the breast that I was not feeding from. Loads came out. I could also switch sides as baby could get more out after.

Nipple shields with prolonged usage can affect latch and supply but they can also be the way to get breastfeeding established. Have you tried without lately? Or without when/if you switch sides midway through and he may be less frantic for food.

Also try silver cups and lansinoh, and look up the flipple techique

@hopingforapeainapod we found the scales accurate. We first used them in conjunction with a private lactation consultant who confirmed this. Could be worth finding someone (not a zealot) to come out and look at it with you. If the scales are correct that is very little milk but it is early days. I had a complex breastfeeding experience. I used the scales and initially got very little breastmilk and had to top up with formula. By 3 months I was exclusively breastfeeding and stopped using the scales. By 5 months I thought my child was having a sleep regression as very unsettled and upset. Turns out my supply randomly dropped massively and I had to introduce formula again. I combi fed until baby was 8 months and my lactation consultant prescribed me a routine of when to feed and when to give formula to ensure my supply didn’t drop any further. Same as you sleep jaundiced baby having to be woke every 3 hours and stripped etc. I would add in formula so the weight goes on and persevere with the breastfeeding too but try get some guidance on how to do this.

I should say my now 2 and half year old is a very happy healthy intelligent child who is rarely ill. So please don’t worry. You are in the trenches at the minute. I well remember trying to force feed the child every 3 hours. My priority would be getting the weight on.

@OMGsamesame lanisoh is no longer recommended for use. It can cause allergens in baby.

I’ll just echo what others have said about the silver nipple cups. Using them religiously in between feeds probably saved my breastfeeding experience in those early weeks, they helped so much with sore nips. Just don’t use them with nipple cream - they’re meant to be used as they are, and they work.

@hopingforapeainapod "the problem is we can’t really rely on hunger cues - don’t know if that’s just because baby is still early / slightly jaundiced but he doesn’t really cry out of hunger so we just have to rely on alarms to feed him every 3 hours… he is slowly waking up / building up a bit of an appetite but all feels a bit counter-intuitive / like we are trying to force it down him at the moment!"

That's why I suggested the day in bed with him. Let him feed whenever he wants-little and often. The smell will encourage him to root, the feeding will stimulate your supply. And you can get some rest. Honestly/try it. Pretend you're a cat with a litter of kittens!

I bf mine with nipple shields - dc1 mixed fed, dc2 ebf. Dc2 definitely had a tongue tie - health visitor wouldn't snip it or refer me as dc was gaining weight well.

Sounds like you need a tongue tie check if feeding is painful. Have you been to any local clinics or groups? Has your midwife referred you? They should be sending you to the tongue tie clinic. You shouldn’t need to put up with that.
Shields can help a baby latch without without pain for some mums I wouldn’t write them off yet. Spend lots of time feeding and doing breast compressions to help baby along.

I used nipple shields as DS wouldn't latch on properly. I managed to wean off them gradually by about 5 weeks. For the first 8 weeks I also pumped in the morning before feeding (handheld here as well; it should be quick when you're full) so I could top up in the evening if necessary. It helps keep your supply up too.

So I went to see a lactation consultant yesterday and turns out baby boy has a grade 4 lip tie and a severe anterior tongue tie (90%). She said there is no way I can feed without nipple shields and that his anatomy explains why his latch is so poor / he can’t open his mouth wide / he has been finding breastfeeding so exhausting. She showed me some techniques on how to use the nipple shields / get him to latch better and so will keep trying with that until we see a doctor and hopefully get the ties sorted next week…

I guess that answers a lot of the questions then ! Does your hospital have a tongue tie clinic you can refer yourself to or your Hv? That’s how it works in our area we don’t need to see a GP - or is it a dr who does tongue tie snips? X