I need some fairly expert advice on attachment issues, nipple refusal and subsequent supply problems.

[Olihan]

I think this may need someone with Tiktok's level of knowledge and experience but if anyone has any experience that could help I'd be grateful!

My Dsis has an 8 week old dd and has had major bf issues from birth. She was born by EmCS after a 54 hour labour, baby was stargazing and Dsis had every type of pain relief going. As a result both mum and baby were fairly out of it for 24 hours or so after birth.

Dsis had initial problems as her dd wouldn't latch on for more than a coupple of seconds. She saw a (supposed) bfc who worked on the PN ward who put her on nipple shields on Day 2 to help her latch but failed to mention that she shouldn't use them for more than a couple of days. Dsis went home on Day 6 still using the shields and whenever she tried to feed without them her dd refused to latch on.

When her dd was weighed on Day 10 she'd gone from birthweight of 7lbs 15oz to 6lbs 13oz but no one was overly worried as her milk hadn't come in until Day 5/6. However, she was still having no luck feeding without shields. By Day 16 she was up to 7lbs 7oz so it didn't appear to be a problem.

Since then though, she has had major weight gain issues - by week 6 she was still only 7lbs 9oz (that really is 2oz in 4 weeks) and her dd becomes absolutely hysterical if she tries to latch her on to a naked nipple. She was also feeding constantly, wouldn't be put down, was permanently unsettled, didn't sleep, etc, etc.

Dsis has been in touch with an NCT bfc who has been to see her, she's also just spent a fortnight with our step mum who is a retired mw. While she was with her they worked on increasing her supply by feeding at least every 3 hours using both breasts, expressing off both breasts for an hour after every feed, topping up with the expressed milk (using a syringe). After a week of that her dd had only gained 2 oz so she started topping her up with formula.

She's now cup feeding her with 1 - 1.5oz of formula after each feed and her dd is up to 8lbs 8oz. She's also continuing the expressing and bm top ups.

Obviously, this isn't sustainable and she is desperate to get her off the nipple shields and feeding properly but she is completely at a loss as to how to do it.

She's tried breastcrawl and her dd can get to the nipple but appears to have no idea what to do with it when she gets there. She's tried going cold turkey but her dd just becomes completely hysterical, our step mum managed to get her to latch on a couple of times using the old fashioned 'hold head, hold baby and force them together' but dsis can not do it by herself.

The bfc also helped her to latch her on for a couple of seconds but her dd would only stay attached for a couple of seconds.

So, where does she go now? Does any one have any tips on helping a baby to latch on? I suspect that her dd just doesn't know what a nipple feels like because she was on the shields from such an early point so how do we encourage her to recognise it as 'food' rather than the plastic?

Any advice would be so gratefully received, she is desperate not to have to fully ff but it seems inevitable if she can't get her off the shields.

I think the issue is that she never has full, uncomfortable breasts, which is compunding her worries about the slow weight gain and low supply.

Her dd does get milk out (you can see it in the shields and in her mouth) and has wet and pooey nappies, etc. The only real sign of a problem is the slow gain and general unsettledness.

Sorry, tried to poast again last night, but network died...

The more modern shields - NUK/Avent, have cut out sections so that the baby can get their chin on the breast, so they can milk the breast properly. If she is using the little mexican-hat-Boots ones, then suggest she try another brand as they don't allow this contact.

I would suggest the old abbymoon idea (with shields!) of doing nothing but bf, don;t worry about getting rid of the shields, just let the baby feed as often and as much as they want, and keep trying even if baby falls asleep, gently try to get them to continu feeding so her supply gets more of boost.

If baby is weeing and pooing that is good, an unsettled baby does not necessaruly mean a hungry one. Obviously the weight gain is important, but I think she needs to just feed,feed,feed, not top up, and see how that goes.

Hwr, I am not a BFC! I am just someone who used shields for a combined total of about 14 months with three childen. They all grew slowly (two fell off the centile charts), but I had overabundant milk, and they are all small now, so we just meant to be petite.

How is your DSis and babe today?

How are things now? Just wanted to add that this behaviour is very similar to my ds2, eventually were able to get rid of the shields, would second all the advice with as much skin to skin as possible, trying to stay reaxed when feeding, (difficult in practise when they won't latch on I know) and having a bath with baby and trying to feed in there - ds2 would latch in the bath and nowhere else at first.

Olihan - I don't think it is essential to have breasts which feel full in order to feed. Personally I could never feel the "let down" for dd1 as other mothers could. I only felt full if a feed was overdue. As Tiktok says, you take the cues from the baby and feed as frequently as the baby demands - quite likely to be more than 3 hourly, but no need to watch the clock or worry too much about weight gain unless there's a drastic loss and baby seems unwell.

I have heard this story, or variations of it so many times: bad advice from the start and then stress from yet more bad advice, (often well intentioned) leading to loss of confidence on the part of the mother.

I think the best thing you can do is try to bolster your sister's confidence in her ability to bf and counter some of the alarmist, unfounded advice she has had re supplementing with formula.

Situation today is that she's managed to get her dd to latch onto the breast and suckling well quite a few times at each feed. She hasn't given any formula top ups at all and only an ounce of ebm after each feed. I found her loads of info on Kellymom re boosting her supply so hopefully things are on the up.

The only remaining issue is the frequency of feeds. Dsis says she has about 6 feeds a day which I don't think is enough, at all. But, each feed takes about an hour to an hour and a hlaf, then she has to express, give the ebm top up, by which time 2 hours has gone by and it's time to start again but baby needs to sleep. I'm not sure how to respond to that one, tbh but I know things won't improve on 6 feeds a day.

Agree with Starlight, better and much easier to offer more milk direct from the breast rather than express after each feed, also gives mother and baby time to rest inbetween feeds.
Also would suggest trying to feed as often as the baby wants to, rather than clock watching and counting the number of feeds per 24 hours. Babies have no idea about what time it is and how long it was when they last fed - its easy to forget that when you are pregnant you are drip-feeding your baby 24 hours a day.
I fed both my sons at least every 1.5 hours at this stage, probably much more, IME breastfeeding is much easier if you can just accept it seems to happen a lot in the first weeks/months and not stress about it.

Am hour seems an awful long time to be feeding. Can I ask is she your dsis eating enough and is she eating the right things? Although she may be getting a lot out is the milk substantial? Quality rather than quantity?
Sorry if thats asking the obvious

Starlight, I think the issue is that it's such a struggle for the baby to get milk through the nipple shields that she gets too tired after an hour plus feeding and just starts messing with the shield. I don't think she's getting sufficient milk through the shields to a)keep up the supply at a decent level, or b) get all the calories that she needs. Hence the expressing and the top ups until she will feed more consistently without the shields.

She latched a few times yesterday without the shield but will only do that very occasionally through the feeds. I'm encouraging Dsis to remove the shields as often as possible through the feeds, and to keep perservering without them, unless the baby is getting distressed. Is that the best way to proceed?

I know the problem is the shields, because she doesn't need to gape to latch on with them, so neither of them really know what a 'proper' latch is like.

I've told her to get in touch with a bfc to get help with the positioning, etc and see if that helps with the milk removal of milk both with and without the shields.

DS1 was 5 weeks premmie and was severely jaundiced and the only way I could BF was with nipple shields. He also suffered nipple confusion as in the hospital they gave him bottles of EBM topped up with formula for the first 2 weeks. The shields didn't affect my supply and he gained weight acceptably and I took his lead with ditching them. We were completely off them by 4 mths and I went onto BF him till he was 16mo. My shields were Medela contact ones - very fine with a cut out area where the babies nose/face still had contact with the breast while feeding. I have just had my third DC and haven't had to use them for the last two, but I don't consider them evil - better than giving up and going to a bottle. I hope your friend is not beating herself up too badly - there is enough guilt associated with being a mum without feeling that using shields means that you have 'failed'.

Different shields are worth trying, it's true. I don;t think there is any good research on any of them - just personal experience. I have certainly supported mothers who have found a different shield seems to help a bit with transitioning to the breast. Of course, as breastfeeding counsellor I tend only to hear from mothers who don't like the shield or who have found its adverse effects have an impact on their breastfeeding - I am aware that some people use them with no problems.

AussieSim, of course this mum should not blame herself. But it looks from what Oli says that the right help was not given in the hospital - people who only speak to bf mothers on the maternity ward do not follow through, and they don't see the sometimes devastating effect their advice has on subsequent breastfeeding - this doesn't just apply to nipple shields, of course.

Fantastic news - baby had a complete feed this morning direct from the breast, pulled off looking very milk drunk and went to sleep.

I'm so pleased for her .

Great news ! Hope that she has the confidence to just keep offering the breast now and to stop expressing and topping up.
Does she have a sling so that she can keep the baby close all the time and allow unfettered access to the breast ?

All feeds today have been directly from the breast and she hasn't had to top up so things are definitely on the up .

Superb!!!

She's fed all day again with no shields and baby appears to be going through a mega growth spurt, feeding constantly but latching and sucking well. BFC is coming monday to check latch, etc but fingers crossed she's cracked it.

Thanks for all your advice. 2 days of MN on the case and she's sorted .

Not posted before, read the early posts with worried face and then bingo! Olihan it sounds like she's cracked it to me, that's so fantastic!

Am so happy for your DSS, BF is lovely. x

Oh so pleased for them both, long may it continue.
Starlight that's interesting, I only mentioned the food thing as my HV actually told me if you don't eat enough and of the "proper" things the quality of the milk will be poor, no wonder I am not losing weight
My kids must be gobblers 20 mins is the longest either of them fed for!