Expecting major problems breastfeeding because of nipples and prev' experience etc - advice please someone?

[StrikeUpTheBand]

I am hoping to get some advice on here because I am starting to become anxious.

I am 36 weeks pregnant and this is the furthest I have ever been. My DS was born at 31 weeks and he's now 2.9 I exclusively expressed for him for over 6 months because I couldn't directly breastfeed. I carried on trying until he was 4 months with very limited success - he just couldn't latch on at all.

I sort of expected to have problems because my nipples are extremely flat, made up of very soft skin and the nipples themselves are not so much inverted as embedded inside a tiny hole - they don't stick out at all and they sort of shrink back into the breast when you try to grasp them. I had lots of very good help trying to get ds to latch on and he never ever did. It didn't help that he was premature and therefore quite sleepy and in special care, but I really believe he tried him damndest and so did I. We came home using nipple shields but within a few days he was showing signs of not getting enough (dry nappies, no poos, losing some weight, sleepy and lethargic) and after the midwife had visited and I tried to express I got barely 30ml. I know that this is not an indicator before people say, but I had built up my supply over the 5 weeks that DS had been in hospital and was getting about 160ml a time normally, so this was saying to me that my supply was dwindling as a result of using the nipple shields. So I gave him his first bottle of EBM, cried and cried for ages and then got on with feeeding him EBM in a bottle, trying every feed to latch him on and failing.

When I found out I was pregnant again I fully assumed (due to my previous history) that this one would be premature as this is my third pregnancy and I had preeclampsia and HELLP Syndrome with my first 2 pregnancies (early onset, my first baby was just 24 weeks and died ). However, this baby, my first DD, is still inside me at 36 weeks and I am hoping to get through the next 2 weeks when I will have a planned C-section. Since I'd expected her to be early I had planned to try to breastfeed, but not to keep her in hospital as a result of not accepting a bottle of EBM (I refused a bottle last time and he was in hospital for another week or 2 because of the feeding issue). I was planning on expressing again if I had to.

However, with her being a larger baby this time and also likely to be full term, plus I have gestational diabetes (quite severe - need insulin and have done since 11 weeks), I am not wondering how possible it will be to express for her if she does not breastfeed right away? Does she have a hope in hell of latching on if she's bigger and stronger than DS? Will the hospital try to persuade me to give formula if it's not all working right away? I know babies don't take much breastmilk right away, but I get the feeling that it won't be as well received if I am only producing drops to feed to her in the first day or so? Is my milk likely to take a while to come in? Also, how likely is it that she will have low blood sugar die to the diabetes and will they push formula on her then - and if so should i accept it with good grace as the best thing for the baby?

Sorry, that's a lot of questions. I have a dodgy power cable so going to submit this now before something goes wrong.

Please, any help or input or even experiences of your own to share would be welcome....!

First of all - congratulations!

I can't help with the nipple issue (I'm sure someone will be along soon who can though) but I can share my experience of GD.

I had GD with my DD and was advised by the hospital BF advisor to express and freeze colostrum twice daily from 36 weeks. I expressed into syringes and by the time DD was born had a bag full of them! The first few days were tiny amounts (think 0.2-0.3 ml) but after a week or so I was easily getting 2ml each time - again still a tiny amount but that's all you get with colostrum.

It was my hospitals policy to suggest mums with GD do this so there was milk available to use instead of formula if baby did have low blood sugar - I was told to bring in my syringes when I came in to deliver and they put them straight in the freezer - perhaps you could see if your hospital will do the same?

It's known as colostrum harvesting - there's quite a few threads about it on here if you want to do a search to find out more.

HTH - good luck!

Also, I'm sure it's more tricky after a c-section but try to have skin to skin and your first attempt to breastfeed within 1/2 hour to 1 hour of delivery in order to try and stabilise babys blood sugars asap - I think they test the babys bloods 2-3 hours post delivery then regularly after that for 24hrs until they are happy the readings are stable.

If I remember rightly I was told it takes 1ml of colostrum to raise a babys blood sugars by one point,compared to 10ml of formula.

Not the answer to all your questions, but I'm doing the La Leche League breastfeeding peer counsellor's course and the tutor has mentioned the Lansinoh Latch Assist. It's designed to help babies latch on to inverted or flat/engorged nipples.

I have no direct experience so this isn't a recommendation, but I thought it might be a good start for further research.

There are some bits, like your diabetes that I don't know much about and will leave that for others, but didn't want to leave your post unanswered.
I was unable to bf dd1, due to flat nipples - was even told by mw that would be unlikely to be able to bf any subsequent dc's.
However, I have now been ebf'ing my ds for almost 5 months - hoorah! So it is def possible, even if you have had problems before.
That you are so concerned about it is a great start. I bought Avent Niplette. Quite expensive, for a couple of suction cups, but they definately did draw the nipple out. I used it for the last couple of weeks of pg and then for first couple of days after ds was born, just before putting him on my breast each time. Found it much easier to get him to latch on. Only used them for a few days as after that he and I both "learned" how to get him to latch on. I also fed him pretty much immediately after birth, which is supposed to help and fed him as much as poss for first few days. i think that way we learnt the latch and also meant i didn't get engorged when my milk came in at 4 or 5 days, which is where i think I went wrong with my dd.
Hopefully the hosp will be very supportive of you and your obvious determination to bf. Don't worry too about quantity - the colostrum of the first few days is hardly anything in quantity, but your baby's tummy is just as tiny and will grow at the same rate as your milk increases.
Best of luck to you and mn is definately a great place to get great advice. Hope my expereince may be of some help

like flabbyapronbelly my dd I couldn't bf but I wasn't told it was because of flat nipples I expressed and mixed fed for the first 4months!

I'm not 17 weeks pregnant with DC2 and I bought the Avent Niplette when I found out i was pregnant had have corrected nipples after 2 days overnight use!!!

However i don't think your supposed to leave on overnight after 6months!!!

But it can get the nipple out to help with the latch! Also check out kellymom.com its full of bf advise!

Hi and thanks for all the replies. I really do appreciate all of them .

Niplette - I used it in my first pregnancy but all it did was make me very very sore and not bring them out at all. I used a little in the second pregnancy but again similar results. I was a little disappointed that after over 6 months of constant electric pumping, my nipples didn't stick out any more than they ever had .

MrsKitty - thanks - I am very interested to hear about the colostrum harvesting thing. I started of with syringes myself with DS as he was needing to be tube fed, and remember getting 0.4 of a ml the 1st time! I haven't been told about it in our hospital, but wonder if I am going to be looked at like I am crazy for asking about it on Tuesday at my appointment? I am treated mostly by obstetricians and diabetes doctors working as a team - but maybe someone will have heard of it perhaps if it's happening in other hospitals? I shouldn't need a clinic as such as I have previous expressing experience (looks great on my CV ).

Any more responses welcome!

started off with syringes

strikeup Consultants/Diabetic docs unlikely to have the foggiest what you're on about IME - Do you know if the hospital has an Infant Feeding Specialist / BF Adviser? If so, ask if you can have a chat next time you're in for an appointment to discuss it with them. It would be worth seeing them anyway to discuss a plan to avoid the problems you had with your nipples previously. (BTW if you end up with nipple shields again I understand that you need to express after each feed as the nipple doesn't get as much stimulation from the shield as it would direct from baby, which might explain your dwindled supply last time?)

Even if your hospital don't do colostrum harvesting/have never heard of it, I don't see any reason why you couldn't do it anyway and even if they're not happy to keep it in their freezer you could send DH home to collect it if needed or ask someone to bring it in perhaps? It would seem a good 'safety net' to have some, particularly as you're having a C-Section.

I was given my sterile syringes and caps by the hospital but you can buy them if you need to here - also seen them on EBAY (Don't forget to get caps too though)

Also suggest that if you're doing a birth plan you include that you want to BF if that and that you have expressed colostrum for use if necessary (if you have). Make sure your birth partner knows the score too.

Re: your milk coming in, it's usually around day 3, but the colostrum you produce prior to that is extremely high calorie and even though it seems a tiny amount is enough - you need to feed baby AS OFTEN AS SHE WANTS or AT LEAST 2-3 hourly in the early days in order to stimulate your supply and ensure she gets plenty (I'd forgotten this this time around and nobody reminded me so we ended up with problems in the early weeks with supply and weight loss - all sorted now though after a lot of effort and DD is 9 wks and exclusively BF)

I hope things work out the way you want them to - Make sure you get the support you need to aid BF, and be prepared to stand your ground re: formula top ups at the hospital - I found being educated about what actually constituted 'low BS' and knowing how much was needed to correct it allowed me to make a more informed decision regarding DDs care in hospital.

Apologies for long and slightly rambling post - DD sleeps like an angel (goes straight back to sleep after night feed ) but DS (2.10) was up at 5am and it's DH's turn for a lie in

Thanks again, Mrs Kitty.

Sorry for the delay in replying - my computer shut down after I wrote a long reply yesterday.

I will go tomorrow to my weekly appointment and hope someone knows what I am talking about. I attend the diabetic clinic which has a huge number of women to see and you can often feel like you're on a huge conveyor belt. I guess it depends on who you see. Due to my previous complications I never see a midwife but often see a variety of obstetricians paired up with a diabetic doctor. Occasionally I see a consultant but it varies every week .

I actually found the breastfeeding support in the main ward quite shocking from snippets I overheard (didn't need it as DS was downstairs in neonatal so had accesss to better ones down there). Lots of times people who were struggling were offered formula as a matter of course. I don't have high hopes, despite what it says on their posters on the wall .

Thanks again for all the replies, and please, if someone else has anything to add I'd be most grateful .