'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.

I was given the same advice in SCBU, i.e that bf was tiring for baby and top-ups of EBM essential. I pretty much ignored it when I got home and just bf ds but he didn't seem to mind and after a bf would only take 10ml from the top-up bottle anyway. My hunch would be skin-to-skin contact, there was something on here about "re-birthing" a while back which looked good and I think the cup feeding might be better as it would help with confusion. Also, not sure if this would help but I have one of these which stubborn ds3 never took to, used it about twice. I can send it to you if you want.

Also, if your dw is getting stressed about the whole thing, her milk might not be "letting down" making it hard for baby to get any.

First of all, congratulations on your new arrival! Please don't worry about the fact that your dd isn't feeding yet - I had similar troubles with my dd, who is five and a half weeks old now. Perseverance and expert (and I mean expert, not your average health visitor) help will pay off. My dd breastfed for the first time ever at four weeks old exactly. For some babies, it takes longer. I am currently attending the breastfeeding clinic for 'problem cases' at the John Radcliffe hospital, which is run by two fantastic midwives - I can't praise them enough. They truly are experts, and people travel from all over the area and beyond to see them. They are firmly of the opinion that the idea of nipple confusion in cases such as yours and mine is complete tosh - the babies have never properly breastfed, so the don't know what to do, that is all. They actually advised me not to use a nipple shield, but to continue to use the bottle as a teaching aid. My dd's problem was twofold - first, she wasn't latching because she didn't know to open her mouth wide enough and push her tongue forward to do what they call 'gape', and second, because it wasn't working, she got more upset and frustrated, to the point that I only had to put her close to my breast and she would fight me. I think that her upset was actually exacerbated by much of the 'help' we received early on - some less expert helpers really grabbed hold of her head and almost tried to force her into the right latch, and naturally she hated that even more. The best advice I have picked up is to find one person who really knows what she is doing, and stick with that - consistency is the key. Keep doing lots of skin to skin cuddles without necessarily trying to feed, to reinforce the idea that the breast is a nice place to be, and when you do breastfeed, try for a maximum of 5 minutes, or until the baby becomes distressed, whichever is sooner, then give a bottle quickly, to avoid her becoming upset. I know that is the opposite to what has been suggested to you, but it really is good advice. And when you give the bottle, if you are trying to train a baby to breastfeed there is a 'correct' way to bottlefeed, although no-one ever tells yu about it.... Make sure that your dd opens her mouth really wide and puts her tongue forward, ashe should in order to latch onto the breast correctly, and then quickly put the teat in, as a kind of reward. She will very quickly learn the action to do to get milk, and will do it automatically (or most of the time, anyway ) - for us it only took a day or two. But be consistent.

I hope that you get some good advice from your hospital advisor - seeing someone good in the flesh will be more useful that any of us, just because she will be able to watch and see what your baby is doing. If you're not happy with her, please let me know and I'll give you the phone number for the Oxford clinic - they have a couple of colleagues in London who they recommend to people who call in for advice.

I hope this helps - at least to reassure you that it isn't hopeless. I was ready to give up, and then out of the blue dd just 'got it'.

Also - I meant to post on your sterilising thread this morning but didn't get a chance - I've been at the BF clinic all day . I found that the answer to all the timings was just to use a cold water sterilising solution for now, and just take things out as you need them. The solution lasts for 24 hours.

Good luck - and keep smiling. At the end of the day, whether you get breastfeeding going or not is less important than having a happy baby - and that means having happy parents.

(mini hijack) Jenny - that's fantastic that things are still on the up

You lot are so fab.

X

JennyWren - DW's uncle is an obstetrician in Israel. He gave us the number of an expert lactation adviser over there, who suggested..... someone at the John Radcliffe ! Are we talking CF and SI ? LOL

I would not have a moment's hesitation to drive DW and Camille to see them, nor to spend a few days in Oxford if that is useful (we live in North London).

Thank you for the suggestions, everyone, of whom to call. I have an e-mail out to the contacts above, and if they can't see DW, or they suggest 'locals' I will check them all out.

berolina - thanks for your input and the bf tube contraption thingy. Something similar has now been described by a few people in this thread and that might be worth trying. I will see what 'the pros' tell us to do.

Thanks also to misdee for the skin to skin and baths.

chipmonkey - pretty sure the milk is there - dw has been leaking everywhere all evening !

We kanga'd all evening, and fed, more or less constantly from about 9 till about 1 !!! Flipping exhausted, as is Dee. Give or take some nappy changes, some time in the crib, burping time etc. dd has been drinking EBM non stop ! She is underweight, so I guess this is the beginning of her making up for it !

DW would like to make the bf work, but the rocky experience at first is scary, so I would deffo like her to see an expert, rather than just someone with opinions IYSWIM.

OK. I must get some sleep now, but thank you all.

X

Hi. Congratulations on your new arrival.

My DD was in NICU for 2 weeks, first week on intravenous fluids, second on NGT and bottles. I phoned a LLL counsellor and read books etc. The advice, as I understood it, was:

1. at each feed BF and bottle top-ups (formula or breast milk) and reduce top-ups gradually until totally BF, or
2. at each feed BF and bottle top-ups and skip one bottle top-up totally, very gradually (e.g. one a day) The main thing is - it can take weeks (2? 3?). I'm sure a counsellor will explain this better.

We muddled through and now DD (4 months old) is exclusively BF. When she was getting only 10-20 extra mls from the bottle I realised I could probably skip that bottle altogether. It took a while to gain the confidence as I really didn't want to feel I'm starving DD.

It's not too late. Good luck.

Yeah, it looks like it might be a 'long lesson' IYSWIM...

I've just given ANOTHER bottle, LOL. (perhaps with 40 mils in ?)

My word !

OK. Off to bed.

They did all say 'get some sleep in'

LOL

Yes! Sally and Chloe are fab. The clinic is only open 2 days a week, but I happen to know Sally will be at the hospital tomorrow, and I would huess that she would check her messages. I would suggest that you leave a voicemail message in the morning if you can, as well as your e-mail - the number is 01865 221695. The clinic is open next week on Tuesday and Thursday, so maybe that would be a good opportunity for you to come? We'll be there, so maybe we'll see you .

I should have said earlier, by the way, that the other part of the bottlefeeding technique is to make sure that the teat is always angled up into the roof of your dd's mouth, not towards the back. The idea is to make the feeding technique as close to breastfeeding for the baby as possible.

And if anyone wants to reada breastfeeding book, Chloe has co-authored a book called Bestfeeding
I would really recommend it, but unfortunately some bookshops have muddled up their listings, and call it by the subtitle Why Breast Feeding is Best for You and Your Baby , so if you have trouble getting hold of it, ask for it by author name or ISBN number to make sure that you get the 2004 edition.

Good luck, and maybr I'll see you next week!

I'll hijack this thread a little, too
Hi Berolina! We are still moving forwards in leaps and bounds. We still need 3 hands to latch on, so we're only breastfeeding at the clinic, but dd has every feed at the clinic straight from my breast, and she is getting better at it all the time, so hopefully next week we'll graduate to 2-handed latching so that we'll be able to start practising at home.

dd still asleep, so I guess the max 5 hours between feeds is about to kick in !

JennyWren: I'll phone at 08:00 / 08:30 and maybe drive over there today to see them if they have any time free, else will make it a point to say hello to the woman with three hands next week, LOL.

Small world, eh...

I'm sure the folks at the John Radcliffe are lovely - but I'd still be tempted to find someone local, particularly in case you need a few visits. Which bit of North London are you in? I can maybe find you a baby cafe.

One of the BFN/LLL/ABM/NCT should have counsellors in your area. And any BFC will be better than a HV for counselling.

NQC - yes, local would be easier, and could pop in more often, so will look into it. Our postcode is NW11 (neaar Golder's Green).

Our NCT teacher, RP is the local bf counsellor but she's on holiday IIRC.

I'd appreciate any local contacts.

Nonetheless will call the John Radcliffe now for advice etc.

Thanks all.

I have just realised that what I said earlier may be confusing - middle of the night brain, sorry. Although I think that Sally is in the hospital today, it's not a clinic day, so she wouldn't be there for you to drop in on. I just think that she will probably pop into the office to check her messages. Sorry to cause confusion...

I can't seem to find one in NW11 easily. Here's a list of the London BFN ones: here . The one in Gospel Oak is Friday 9:30 - 11:30. Highbury is Friday 1:00 - 3:00.

I will dig some more and post again, but I'm putting this up now in case Gospel Oak is doable. These are all drop-ins. The BFN is good (as are LLL, NCT and ABM).

There may well be a BFN member nearer to you, by the way, their helpline is: 0870 900 8787. They work out where you are from your landline and link you with whoever's closest. (I expect all the supporterlines do this?)

The LLL don't seem to have UK groups listed on their website. Their helpline is: 0845 120 2918

NCT bf: 0870 444 8708

Association of breastfeeding mothers: here . They have one in Crawford Street (no postcode given). Only on Thursdays though. One in Tottenham on a Thursday, too. 0870 401 7711. (Good webpage, but you can't c+p the phone number. What's up with that?!?)

Hi Jenny, I've had an e-mail from CF.

Will be going there on Tuesday I think !

Will you be there ? What do you look like apart from having three hands ? Dee and I both have dark brown hair (mine short, messy, hairs long, tidy LOL) and large smiles. Camille will probably be in a shiny new black Maxi Cosi Cabrio unless I can get my head around slings for teeny babies pdq !

Thank you NQC for the input. I think dw feels like seeing the people her Uncle / JennyWren recommended rather than regailing details to more folk, getting half nekkid all the time etc. but we may call. Thank you for finding all these numbers:

misdee / RTKM - Kanga'd a lot last night and she slept from about 1:45 / 2AM till 7ish. After 50 mils bottlefeed this AM, she's been stuffed down my shirt in my dressing gown. I'm gonna post some hub2dee photos later to scare you all.

(hers long, tidy LOL)

oh do it soon, i am off for the weekend at 2pm.

you said she had lopts of EBM last night, i am going to assume that Dee offered the breast as well during each feed. you will probably find that ones Camille gets the hang of latching on it'll become easier.

I do strongly recommend the BFN. I don't know the people in North London, but our local BFN folks are lovely. I'd recommend seeing my mate who is a BFN supporter and trainer, but I don't think she's running a clinic today. Oh, her Monday one here is very nice. I've been.

Is she successfully feeding from the breast? If not, it would probably be wise to get to see someone in person quite soon ...

And if you want company there, I'll happily meet you there. Or not, if you don't want company.

hub2dee a wrap/ring sling are ideal for tiny babies.

The "Bestfeeding" book recommended below is very good, as is the NCT's. I e-mailed LLL for local phone numbers. It took a few days to reply (and another email from me), so I'd persist with the phone, if you have the time. The counsellor was v good and there are support groups in London, although they only meet once a month.

BTW my DD (4 months) still hasn't got a textbook latch but she's managing fine.

i second misdee (again ) - though it's distressing when they refuse and cry, it's important to try them at the breast as - ime with ds - they do get better at it with time, growth and practice.

i am not an expert btw. had problems with dd1, slow to gain, was told my milk wasnt enough, no help offered so gave up sooner than i wanted. but with dd2 she was such a hungry little guzzler (ok a big guzzler at 9lb) that breastfeedeing became easier and not such a battle. dd1 was an induced birth and wasnt put to my breast til lwell over an hour after birth, no skin to skin and found things hard. with dd2, she was delivered straight onto my tummy, was latched onto my breats before she was weighed, and the experience was a lot easier.

so i wil lsay again, lots of skin to skin with dee, just tell her to spend a day or two in bed not woprrying about anything except getting the baby to try and breastfeed, but not to get too stressed.

this breastfeeding business is actually quite hard to get the hand of lol.

hub2dee... you've probably had all the advice you need (haven't time to read whole thread)... but just wanted to say there IS ligt at the end of the tunnel!

DS was bottle fed in hospital because he refused to latch on at all.. when we went home he was being fed EBM in a bottle, but i would try latching him on before each feed.
About a week after we got home (he was about 10 days old) he just did it! took it and was then exclusively bf for 3 months.

No real advice except to stick with it. keep trying her at breast, but don't force it if she gets upset. let her have lots of skin-to-skin so she realises that booby is a lovely place to be!

It IS possible! good luck!

Thanks all. We are getting plenty of kangaroo cuddles and I have perfected tucking bean into my shirt and typing at the laptop to DW's hilarity.

We will explore the local bf cafés, and also see this contact on Tuesday. NQC, if we go to the one you suggested, I'll ask dw if she wants me to CAT you - thanks for the offer.

DW is much more chilled about things now having read all your messages, some agreeing the HV was spouting rubbish yesterday. Will probably write to the hospital about what she said because misinformation is my pet hate.

Thanks all.

Will hopefully update with good news soon.