Breastfeeding help - 5 weeks and have resorted to nipple shields

[Breastfeedinghelp99]

Hi all,
I have a 5 week old, who is has been breastfed 90% of the time (1 max 2 bottles a day, usually expressed) He was in the NICU for a few days and supplemented with a tube, then bottles while my milk came in. I’ve been trying to wean off them but it’s been a journey.
we got diagnosed with thrush at 2 weeks but it’s not improved so they have now done as a swap as it might not be thrush. Yesterday I saw the feeding specialist and GP who both advised nipple shields due to severe nipple cracking to give them a break. I’ve been using medela ones all day, things are less painful but I can still feel it.
can anyone give me advice about how to heal the cracks? I want to wean off the shields asap as I can see he is latching terrible with them.
i know his latch isn’t great on the breast, been assessed for tongue tie but told its fine. I’ve seen so many people who have said his latch looks fine, I just feel like I’m going mad! Thank you!

When you say baby has dropped weight - do you mean they've lost weight or dropped a centile while still gaining some weight ?

I mean, he was in NICU and in 5 weeks you’ve established a sufficient milk supply? Bloody hell, woman! Go you!

I’d try the biological position or, given you have to hold your boob, the side lying position (I found my baby was more likely to get a mouthful of boob this way).

To answer your original question, My Expert Midwife nipple balm was great for me (I would put it on my nipples and air them out and/or squirt some on cotton wool pads and put my bra on over the top. Don’t need to wipe it off before a feed either). The Lansinoh stuff for me was way too thick and sticky.

He’s gained 10g in 10 days, dropped from 80-90 centile to 9th. I can’t understand it as we have lots of wees and poos and he feels bigger, filling his clothes better and he doesn’t looks scrawny at all.
I have an older boy who was tiny and looking at photos by little one is massive in comparison (filling 0-3 at 6 weeks). I’m just baffled.

Hi, I didn’t read your post fully but just in relation to nipple shields- I used them until six months and then one day she just decided she didn’t want them anymore. I was panicking because all the advice was that nipple shields are temporary fix but the LC I went to said if it works it works

Well he's gained 10g , he's not losing weight, which should be of some comfort that things are going the right way!

Hi there,

Midwife again.

I am glad you are seeing a consultant again tomorrow. I am slightly concerned that you already paid for 3 sessions and you are nowhere near solving the problem.

With good positioning and attachment you should be on your road to recovery by now, please see a link from the Breastfeeding Network below.

https://www.breastfeedingnetwork.org.uk/factsheet/moist-wound-healing/

A few things to try....

To a woman with large breasts and flat nipples (or after a Caesarean) I would definitely recommend the rugby hold position for the first few weeks (until the baby gets bigger and can take a big mouthful of breast more easily).

For rugby hold position to work you MUST have at least two folded up pillows behind your back to make room for the baby's legs. And one or two pillows underneath your arm.

You need to position your baby nose to nipple, wait for the baby to tilt their head backwards and open their mouth wide. You then need to quickly bring the baby to the breast in such a way that the top lip just brushes over the top of the nipple and the bottom lip touches the breast as far away from the base of the nipple as possible.

The mistakes I see - women don't wait for a really big wide open mouth. You must wait, 2 or 3 minutes if necessary.

If you baby is not tilting their head backwards and opening their mouth wide - your baby is not hungry, it's looking for comfort sucking, not food.

If your baby is screaming from hunger - give them 20-30 ml from a bottle and then try again.

Another common mistake - women start well, nose to nipple, aiming for the top lip to brush over the top of the nipple and the bottom lip to touch the breast as far away from the base of the nipple as possible. Then at the last possible second they bring the baby up. This is something to avoid, go in a straight line (I hope it makes sense).

You can absolutely support your breast with your hand or make "a tit" with your fingers - just make sure your hand or fingers stay away from where the baby needs to latch.

Sometimes a rolled up tea towel underneath the large breast helps

If the baby latches and you count to 10 slowly and it still hurts - you need to release the latch and start again.

Please check if the baby can stick the tongue out to cover the bottom lip. If they can, tongue tie is not a problem.

You might have been told to avoid pumping in the early days as your milk was coming in. Things are different now. Your HV told you to increase the amount of formula. Since your breasts are full, I suggest you try to pump instead. For breastfeeding to work, two ingredients are crucial - the baby needs to latch and mum needs to make milk. Milk is made on demand and supply basis.

Any amount of pumping would be beneficial. I would say, at least 3 sessions a day, more if you can manage. 20-30 minutes should be fine.

I am also thinking that both you and your baby are now so tired that your baby might be feeding for comfort rather than food a lot of the time. A 6 weeks old baby should be able to go for 2-3 hours between feeds, not feed every 20-30 minutes. Do you have a partner or another relative to help?

It might be worth trying feeding a good amount from a bottle and then not feeding for at least 2-3 hours. I am not suggesting leaving the baby to cry, I am suggesting trying to distract the baby with patting and rocking or a walk in a pram so that the baby has a good stretch of sleep and this will hopefully reset their need to feed to feed every 20-30 minutes.

Sayting this, another reason for non stop feeding could be your milk supply has come down. If you pump for 30 minutes and you don't get a good amount, it could be your milk supply has come down. (The baby will always take more from the breast compared to the best pump.However, if you get less than 60 ml from both breasts- I would say - start pumping regularly to bring your milk supply up. You should see a difference after 3 days of regular pumping).

Last words - you have done very well so far. Your survived your baby being admitted to NICU and a few weeks of hell with cracked nipples, endless feeding and your baby dropping off 2-3 weight centiles. Winter always turn to spring. Do what sounds most sensible and achievable to you at the moment. You are a great mum, you are doing a great job under most challenging circumstances. Give yourself credit where credit is due.

I hope it helps and good luck.

Ah bless you. Cracked nipples are NO joke! The only thing that worked for me (with both DC) was dabbing breast milk on my nipples and letting air to them. I would then pump (I rented a medela hospital grade pump, amazing) and give baby bottle I’d still BF but only in the night. Took a good few days of doing that and they healed. Tried all the creams, shields, positioning everything with my 1st and nothing worked. As soon as they started cracking with number 2 I went straight for the pump to give them a break during the day and healed a lot quicker!