'nipple confusion' - comments anyone ?

[hub2dee]

Hi all,

Our baby (one week old) was in NICU / SCBU for a few days, fed mostly on NGT (nasal tube to tummy) and bottle. A few sucks on the breast, but not much so she could conserve her energy.

We are now home, and have been continuing to bottle feed, and try at the breast, but not for extensive periods as the baby seems to find it difficult / boring / tiring - it's obviously not as 'easy' as sucking on a shaped teat with gravity assisted milk delivery !

A health visitor today said to dw that our baby has 'nipple confusion' and basically she should have been bfing more, earlier, and that in her experience, if we don't 'crack' bfing in one week, that will be it.

Perhaps unsurprisingly, DW was somewhat upset at this.

The HV suggested a nipple guard might help.

Wonder if anyone had similar experience to relate.

I appreciate that at the end of the day, DW must be the one to make the decision, and she must do what she feels happy with. I think if she felt perseveering might work she would feel happier trying, IYSWIM. As it is, having the baby struggle /cry for 15 / 20 minutes is difficult IYSWIM.

It was suggested to us that the 'baby to breast for 5 minutes, followed by a bottle' would not be a helpful way to develop the baby's ability to bf. Possibly feeding from a cup would....

Hmmm.... any comments MN crowd ?

TIA.

PLEASE ring a breastfeeding support line. HVs don't have a clue what they're talking about usually.

You need to talk to a bfeeding counsellor pronto.

Perhaps cup-feeding or syringe feeding would be better - and bfeeding as often as DD can manage will help with Dee's supply and establishing bfeeding. Skin to skin too.

Why did she suggest nipple shields? Is Dee sore? Otherwise, no need, I don't think, but do get proper advice.

Hello Hub2Dee - first, big congratulations on your dd's arrival. Have you been in contact with your hospital's breastfeeding counsellor? The counsellor at our local hospital is an absolute miracle worker and would be experienced in situations such as yours. Best wishes, Dinny

The suggestion that if you don't "crack" breastfeeding within a week is not only astonishing, it's complete cobblers. I can't speak for anyone else but it took me and dd six weeks to "crack" it. It's all new for the baby as well as for the mother, and it takes time.

Does your hospital have a breastfeeding counsellor you could ask to see, or a breastfeeding clinic? Otherwise call the NCT breastfeeding counsellors - and do it soon, the sooner you get help the more likely it is that Dee will be able to feed as she chooses.

OK. On hold now for Royal Free hospital's baby feeding advisor. Will try NCT helpline later too.

Nipple shielded suggested for slightly flat nipples I think (although the pump pulls them out nicely IYSWIM).

OK. Hossie's person is 9-5. Will try NCT and contact hossie.

Thank you MN friends.

X

HI hub2dee

I'm having the same issues with my DD2 (7 days old now). Basically she was on breast a few hours after she was born, and was getting quite good by day 3, and then it all went pear-shaped. She was given bottles in the night.

I met with a lactation consultant the day after my milk came in and she thinks its because DD2 got used to the bottle and got lazy with the breast. That happened on Monday and since then DD2 has only had breast. The monday evening, it took her 30 minutes to take the breast but its now been reduced to about 10 mins.

What helps is when baby is one breast, to squeeze the breast a little so she's getting the milk quicker, hopefully get him/her to suck. It has worked for DD2. Also positioning is really important. all the fighting they do really does make the nipples sore and therefore adds to the pain.

I'm hoping breastfeeding will be easier and perseverance is the key, although i can really understand why i gave up with DD1. its so much easier to bottlefeed and you definitely get more sleep - i survived until 2.00pm on only 3.5 hrs sleep last night.

hope this helps - let your DW know that there is someone else going through the same thing as she is and she's not alone ....

DW says thanks to everyone for the input, particularly blossom as you're in the same boat right now, so to speak.

After this (bottle) feed, we're gonna call the NCT helpline.

We'll call our hospital's feeding consultant tomorrow, and will post any helpful comments / ideas.

We've got two nipple shields which we might try out tomorrow morning (I think it can give the baby something bigger / more sticky-outy to suck, as well as being used to protect sore nipples).

I think flatter nipples are also more common in c-section births IIRC, which DW had.

Don't see why the manner of birth would affect nipple sticky-outness, Hub. Use the pump a bit to pull them out before DD tries to latch maybe? Has Dee's milk come in yet?

Hi sneaky, I read it somewhere vaguely sensible / official IIRC. (Though of course that may mean nowt). Possibly the hormones involved in labour have something to do with it ? Or the fact that the birth was at 36+1...

Yeah, I thought of the breast pump-assist method too. The HV tried it this PM. We'll continue trying that.

Dee's milk has come in really nicely, but of course, when the baby screams for ages in hunger trying to latch / suck etc. it miakes her tense (despite copious hub2 cuddles etc.) and this can affect / stop milk flow.

Will call NCT after current feed and our dinner.

Thanks for the suggestions.

H2D, can Dee pump until letdown? Then latch DD on quickly then? Or have you tried that?

We will be trying exactly that.

I think on the bottle, the shape of the suction and the amount of work is different to what is needed on the breast, and maybe the baby isn't quite awake enough / persistent enough etc... lazy just like her dad ? LOL.

You can use a thing called a supplementer which means she still feeds at the breast, but with a tube in her mouth too that's linked to EBM so she won't get too hungry and cross to feed.

Yes, the HV mentioned a client who had done that hunker.

Might be a great way to give the baby great flow, but associate it with the breast...

Thank you for your ideas.

X

here is a site with v. good information on breast feeding. congratulations to you and dee & good luck with the b/feedingh2d

www.bflrc.com/newman/handouts/0501-HO05-Lactation_Aid.htm www.bflrc.com/newman/handouts/0501-HO15-Breast_Compression.htm

Slightly taken aback by the health professional's advice, hub...was it a health visitor or a midwife (more likely a midwife at this early stage)? Either way, what utter tosh about 'cracking it' in a week. There are a zillion stories on Mumsnet that prove this one wrong. What a terrible thing to say to a new mother.

If by nipple guard she meant a 'shield', then they have their uses, but they need to be used with great care as they have drawbacks.
It is not a good idea for a tiny baby to be struggling and crying....instead, give skin to skin ad lib day and night, and enjoy the closeness and cuddles, and this will relax, calm and stimulate happier feeding.

I really hope you get to talk to/see someone who knows what they are talking about....

My sister has very flat nipples and has used shields all the time (her ds now 4 weeks). I think they tend to be frowned on for reducing the supply but she swears by them & her ds is putting on huge amounts of weight. I suppose they could "add" to the nipple confusion iyswim by giving the baby something more akin to a bottle teat to suck on but if it was the difference between that & not BF at all then they'd be worth it I think.

oh another peice of advice, get a nipple cream called "LANSINOH". fantastic stuff, you put it on after each feed and helps smooth the pain and strengthens the skin. You also don't need to wash/wipe off before each feed.

Meeting a specialist lactation consultant who stayed with me for a good couple of hours, just talking and teaching me was the best thing i ever did. I do have the name of a good consultant in london, if you want the name.

I really hope things get better for your DW (and for me too).

H2D, if you can't get to the hospital BFC easily, it's probably worth trying NCT/BFN/LLL/ABM. Because different areas are covered by each - our area is entirely BFN, for example.

If your DW can get to a baby cafe or similar tomorrow, that would be a very good idea.

In the interim, I gather it's best to avoid trying to feed the baby, and maybe just let the baby have a go? Lots of skin-to-skin, lots of proximity to the boobs, and see what happens? (I've heard that bathing with the baby is a good technique?)

I used shields with DS1 for similar reasons (he wouldn't latch, I had flattish nipples), and really regretted it. Shields add a whole level of faff, and they do reduce supply. If you can get the baby feeding directly from the breast, that will be best for everyone.

(I would be inclined to do cup feeding, as well, as I'm twitchy about nipple confusion.)

Hub, sorry to hear about your problems. We had very similar ones - and 'cracked it'
Potted version: ds in hosp for 8 days (4 with me and 4 in special care with jaundice), had ebm and formula bottles, started refusing breast at most feeds while we were still in hosp, carried on that way for a while, I persisted with putting baby to breast at start of feed then giving a bottle (exactly the thing suggested as not helpful in your case), very gradually he started to go on at more and more feeds and by 3.5 weeks had stopped refusing and we are now fully and happily bf. So it can be done!
I'll link 'my' thread later.
Another thing you could try is a medela 'supplementary nursing set'. This is feeding ebm or formula through a little tube but at the breast. We didn't try it but I was made aware of it during my troubles.
Good luck!

berolina's bf troubles thread

medela supplementary nursing system

Haven't read whole thread so forgive me if I'm doublng up but I would contact the Breastfeeding Network if I were you. They're great and have more specific knowlege on this subject.

All the best.

Would also advise against nipple shields. tried them briefly and they seemed to give an improvement the first couple of times, but it didn't last - also seeing ds 'slipping' up and down on them made me convinced they weren't the solution.

surprised itn hasnt been mentioned, but loads of skin to skin contact. baths with baby, let baby snuggle up to the breast but not actually feeding IYKWIM. offer breast often, but try not to get too stressed. Breastfeeding very rarely comes naturally, its something that your dw and baby need to learn together.

hope fully it wil lall fall into place soon.

agree with misdee - try not to get too stressed. it started to fall into place for us when i managed to take a more relaxed attitude. it was hard though as i was devastated at the thought it might not work out.