how to bf without a proper latch on

[karlu]

I know it's a daft question but I am at the end of my tether here.

My son was born via emergency c-section and was admitted to SCBU as his blood sugar was crashing and he was not feeding at all. He also turned out small for gestational age, under 2500g for 37 and a half weeks. I desperately wanted to breastfeed him and started expressing straightaway but it was not enough to sustain him so he was getting formula via NGT and later in bottles. I contacted a lactation consultant while still with him in the hospital but she was busy and couldn't come. NCT counsellor, I think, was unreasonable with starving baby until he latches on so I did not call her again.

At home I expressed milk until he was on 100% EBM and he soon latche on but it was and still is very painful. My nipples did come out a bit but otherwise quite slippery. I started using nipple shields and thought that if I can maintain milk supply and just wait a little bit until his mouth is big enough for my boobs (huge) we can pull through. But I am loosing faith. He poos and pees alright and gains weight slowly but is still on 0.4 centile so we don't have much to fall on. The lactation consultant left me with information on positioning and another NCT counsellor suggested not to leave him on the breast if it hurts.

I just don't see how we go from where he is now to proper latch on. I read that breastfeeding can happen with not ideal latch on but the mother will pay with her nipples and hours on the breast. I am willing to pay the price but I started having problems with milk supply whether due to stress or lack of stimulation. I pump with Medela after each feeding. He is 6 and a half weeks old and I had enough encouragement but I am drowning here and what I need is help.

We moved from London and there is a very limited provision for breastfeeding support. There is not even LLL nearby. I might be going back to London from time to time so if there is somebody there with a magic touch can you recommend anyone? I am taking fenugreek, lactation teas, considering domeperidone. I really don't want formula but don't want to starve my baby. He seems to be permanently hungry now and sleeps well only if I top up him with an eyedropper.

Please, please help me.

I know it's a daft question but I am at the end of my tether here.

My son was born via emergency c-section and was admitted to SCBU as his blood sugar was crashing and he was not feeding at all. He also turned out small for gestational age, under 2500g for 37 and a half weeks. I desperately wanted to breastfeed him and started expressing straightaway but it was not enough to sustain him so he was getting formula via NGT and later in bottles. I contacted a lactation consultant while still with him in the hospital but she was busy and couldn't come. NCT counsellor, I think, was unreasonable with starving baby until he latches on so I did not call her again.

At home I expressed milk until he was on 100% EBM and he soon latche on but it was and still is very painful. My nipples did come out a bit but otherwise quite slippery. I started using nipple shields and thought that if I can maintain milk supply and just wait a little bit until his mouth is big enough for my boobs (huge) we can pull through. But I am loosing faith. He poos and pees alright and gains weight slowly but is still on 0.4 centile so we don't have much to fall on. The lactation consultant left me with information on positioning and another NCT counsellor suggested not to leave him on the breast if it hurts.

I just don't see how we go from where he is now to proper latch on. I read that breastfeeding can happen with not ideal latch on but the mother will pay with her nipples and hours on the breast. I am willing to pay the price but I started having problems with milk supply whether due to stress or lack of stimulation. I pump with Medela after each feeding. He is 6 and a half weeks old and I had enough encouragement but I am drowning here and what I need is help.

We moved from London and there is a very limited provision for breastfeeding support. There is not even LLL nearby. I might be going back to London from time to time so if there is somebody there with a magic touch can you recommend anyone? I am taking fenugreek, lactation teas, considering domeperidone. I really don't want formula but don't want to starve my baby. He seems to be permanently hungry now and sleeps well only if I top up him with an eyedropper.

Please, please help me.

Oh crumbs your story sounds similar to mine, fraid I don't have any answers just wanted to offer support, my dd is currently 4.5weeks fed ebm/formula top ups afters hours at boob, we were on nipple shields as couldn't get latch but somehow figured out latching on this week so many of her feeds are now without it but dunno how I did it and dd was born at term (oxygen deprived and v.traumatic delivery was on nicu for 5 days fed ebm through ngt for a week).
So I am a bit behind you on this bfeeding journey but I sympathise- hope someone with some answers is along to help soon.

P.s we had same story with hospital lactation consultants in end speech and language therapist sorted dd's latch but that was only with nipple shields- it hasn't been checked without.

Thanks, Thandeka. Congrats on figuring out latch on. I've heard that it's really up to the baby. I feel really helpless that I can't do anything about it.

karlu, what a desperate story

I am unclear about what's been happening, sorry...

I don't know what this means: "NCT counsellor, I think, was unreasonable with starving baby until he latches on so I did not call her again. " Can you explain - sorry if we have let you down (I am an NCT bfc) but difficult to say what happened.

Does breastfeeding hurt or not? What exactly is happening with his weight? What makes you think you have probs with supply? Are you still using shields? Are you sure latch is a problem? Are you using formula?

I may have other questions

Hope I can help with more info.

you sound desperate and at a loss Karlu, but never fear as us MNetters will try and help.

Try and find some time (!) to answer Tiktok as she is the bf guru and will really give you great advice.

Have you seen your Health visitor?
Does he take ebm through a bottle?

IMO getting the latch right isn't just 'up to the baby'- it's a two way learning process. It will come, but you just need the right help.

Hi - sorry to hijack but I'm in a similar situation myself. DD - 6 weeks now, born 4 weeks early and is small - initial nipple confusion resulting from bottles and shields now solved, but latch still not great, meaning inefficient milk removal leaving DD hungry and me with concerns about supply. After a few unsettled days and nights, I'm now expressing after some feeds and offering DD EBM top-ups from a bottle after she's fed from each breast. Supply and her fussiness improved as a result.

But what to do to improve latch, which tends to nipple sucking - causing tender nipples, although not too painful, thankfully. I already make a sandwich of my breast for DD, which sometimes helps, and also gently pull her bottom lip down to encourage a wider mouthed latch. Are their other techniques to try? I suspect the OP would likewise be grateful for advice on this.

Good luck to karlu, I totally sympathise with your situation.

Thanks.

Sorry, it was feeding time.

I don't know what this means: "NCT counsellor, I think, was unreasonable with starving baby until he latches on so I did not call her again. " Can you explain - sorry if we have let you down (I am an NCT bfc) but difficult to say what happened.

She explained with a knitted breast at hand how a baby will open mouth wide if brought to the breast correctly but he just does not do it. The only wide mouth I've seen was when he screams. Whether it's because of aggressive bottle feeding in delivery suite when his blood levels were crashing or not I don't know. She suggested if he was hungry enough he would eventually take the breast correctly. And I wasn't happy about that considering that his blood sugar levels were unstable for a while.

Does breastfeeding hurt or not?
It does without nipploe shields because he is using his bottom jaw to extract milk and squashes nipple inside his mouth. Every time I managed to get a decent amount of breast into his mouth (sandwich style) he squirmes until he gets it out of his mouth.
What exactly is happening with his weight?
It's been going up but recently slowed down to the half of his earlier weekly gain. I read this is exactly what happens with poor latch on because while demand goes up efficiency stays the same.
What makes you think you have probs with supply?
He cries after feeds and growls at the breast. Or falls asleep. I can't express more than a few drops. He looks satisfied only after top up (EBM with eyedropper).
Are you still using shields?
On one breast. A NCT counsellor advised cutting it slightly smaller so that areola gets stimulatioin from baby's skin (?).
Are you sure latch is a problem?
It's practically nipple sucking. My nipples are always misshapen and I certainly never felt his tongue on my areola just the bottom jaw.
Are you using formula?
No, but HV said that if his weight does not improve I will have to. I am just so upset that after all this effort on both of our parts he will end up with a bottle.

crikeybadger, I really hope there is an answer to my problem out there.

My HV is well intentional, I think. But she really confused me at the beginning when during an initial phone conversation she said I should stop breastfeeding and give him a bottle because it should not hurt. The last time we spoke she suggested a pacifier for settling him to sleep.

We are not using bottles just eyedropper and syringe. I was thinking about SNS but it says a baby needs a proper latch on for this to work.

Or and I forgot to say that my nipples go white at the end of feeding and hurt as well as having cracks.

OK, so we just need Tiktok to pop back up now!!

In the meantime... I don't think your HV is being very helpful by telling you to put him on the formula. This is just undermining your desire to bfeed.

I had latch problems with DS1- he basically would not open his mouth. What worked in the end was pulling his chin down with my thumb and I think opening his mouth wide with my first finger and then pushing him on the breast. It felt quite brutal at first but it did work eventually.

Re, supply: how much you express isn't an indication of your milk supply. Some people can express gallons, some can't.

Have a look at this link www.kellymom.com/bf/concerns/mom/nipple-blanching.html about the white nipples...there's lots of good advice on this website.

I think really Karlu you just need to actually get someone to sit down with you, watch you feed and get you sorted.

I'm pretty sure that this is achievable. Don't feel pressured in to resorting to the formula - you say DS is putting on weight, so hang on in there!

sorry to bombard you but if you look at that kellymom link, there's a whole section on latching and a good Jack Newman video.

Also have a look at biological nurturing..
www.biologicalnurturing.com/index.html

I was really hoping that biological nurturing would work but he clamps on my nipples after bobbing down the breast. I still let him have a go from time to time.

We went to a cranial osteopath who said that DS has a slight tightness in his jaw and that she worked on it. Can't say I've noticed a lot of difference but then it was just once.

Karlu, yes, rough handling with or without a bottle can make it harder for a baby to latch on to the breast...they can 'switch off' or fight when near the breast. But this can be changed.

I honestly think a talkboard is not going to help you much. Biological nurturing positions can help - but not always straight away, esp not with babies with quite serious issues of some weeks standing. So you do need someone who knows what to look for to be with you and to observe a feed - from what you say, not your HV. I still don't understand what was so wrong about the NCT breastfeeding counsellor, knitted breast or not! It is true that a baby will open wide and latch on....but if there are other problems and 'interferences' of different sorts, then it may not happen, and this needs to be fixed.

The white nipples are a sign all is not well, and I agree with you that the weight gain is not reassuring - it's hard to draw conclusions from weight gain, but coupled with the other bits of your story, I think you do need some pretty intensive help to turn things round.

try NCT again?

Tiktok, I didn't think the talk board would help me to sort out the latch. I was after ideas what helped others and after people who can help me. My issue with NCT counsellor was that suggesting to wait until a baby is hungrier when the reason for admission to SCBU was unstable blood sugar is not very helpful. The knitted breast has become for me a simbol of how things should be even though it just doesn't work in some cases. As I said I went to another NCT breastfeeding counsellor who suggested carrying on with offering a breast until DS opens his mouth wide. We tried it there and then and he just screamed. I can't understand what else can be done to get him to accept a mouthful of breast. And if not what am I supposed to do? Express and feed him this way? A lactation consultant said that babies grow bigger and eventually just get it. In the hindsight it does not sound like a very good advice. I got a tonne of advice and don't know anymore what would and would not work in the long run. By the way DS does not look stressed while breastfeeding and never did. I called LLL helpline and they told me that I am doing everything they would suggest to somebody in my situation.
So what are other things you would suggest trying now? Or is it hopeless?

karlu please don't stop asking for help. Phone your health visitor again and ask for numbers of local bf buddies/councellors whatever.
It is very difficult to offer advice over the phone/internet etc... it is much better in person. There must be somebody who is local and can help you. You must keep on asking until somebody helps you.
My experience of bf councellors is that they are very helpful and thorough and there is no shame in telling them that it's still not working out for you.
Their goal will be to make bf a sucess for you and they will want to help you until your issues are sorted. It's not something you just chat about for 10 minutes and it's all done and dusted, I had probably 5 or 6 visits from the councellor plus follow up on the phone until I was confident that all was well.
Stick with it.

What about your midwife? Can you phone them to ask for a referral to a bf advisor?

Hi Karlu, still reading this thread and now thinking dd's latch isn't great either as I have nipple blanching too (which doesn't bother me too much as had breast reduction and nipple sensivity isn't great. Do your nipples go White using the shields? Mine don't only with her "latched" without them. Btw I used the medela sns sucessfully with nipple shields (haven't tried it without) so that may be an option. I am so impressed how you are avoiding bottles- we syringe fed, cup fed etc for first week but gave in to bottles but so far madam seems happy with boob feeds followed by bottle top ups so hopefully okay.

Can your Ds latch ok with shields? What I found was initially dd wouldn't latch at all without them so I would do first feed with them on (so she had some food and wasn't to fractious at breast) then as soon as she came off for winding or whatever I would whip them off and let her play for a bit with nipple sometimes we would get a latch sometimes not and would revert to shields again initially it was 1 in 7feeds I managed without shields but gradually she and I learned (although possibly not correctly reading this - better get latch check!) how to latch without it and it's only been in last couple days or so she latches much more without it than with. In my case the issue was flat nipples so I used a lasinoh latch assist (sold by amazon) which really helped (although the suction would spray dd with breastmilk!) as did pinching nips into shape and offering boob like a hamburger! I really hope something starts to work soon, if not come to where I am (north London) seems to be a bfeeding drop in every day of week round here and the woman leading them apparently is royalty amongst bfc's!

karlu - you have been trying so hard to get help I wasn't suggesting you stopped posting to ask here, just saying that I think there is no substitute for a knowledgable person being with you in real life, observing what goes on.

I agree with humpty - tell the bfc what she suggested was not working for you.

I still don't fully get your complaint about her - though if she was suggesting a baby actually in SCBU with low blood sugar should be left for longer periods to become hungrier then she is either in need of training, or you misunderstood. Bfcs do get things wrong, though, I know, and even when they get things right it doesn't always happen straight away. You can speak to another bfc, or another organisation, if you feel you don't have sufficient confidence in them...please do continue seeking the right help. You deserve if after all the mess you have been through

Karlu - I do truely feel for you. I had such a hard time with my ds1 (very bad ventouse birth). At first I couldn't get into a position to bf due to spinal block (seemed to effect my whole body, very weak). Then after a few formula feeds he didn't seem to want or be able to latch on. After a couple days saw bf advisor and went to nipple shields and breast pump. Went off nipple shields at about 4 weeks (can't remember exactly). Shortly after, ds1 started losing weight when he caught a cold and refused to latch on. Was told off by hv and started pumping and topping up with formula. I was really upset, frustrated, and ready to give up when I called a bf advisor from hospital. She was lovely and gave me tons of things to try.

We tried everything, and what seemed to work was the oddest of her suggestions -- cranial osteopathy(sp?). I'm not an alternative medicine sort of person, but it did seem to work. His latch really improved. You could try it.

I would also call the hospital where you had you dc and ask to speak to a bf advisor. It might help.

My thought are with you; I hope you crack it. Keep trying, and don't lose hope.

Sorry for not responding, we are going to London this weekend and it's a logistical nightmare plus feedingsa are becoming lengthier and more painful. I did go to see an NCT advisor in the drop in cafe. She asked me if I would consider topping up with formula if DS seems unsatisfied after brests. Hope it was just a tricky question not that she's really meant it. Then she suggested stretching DS's mouth with fingers and checking with HS that he can physiologically open it wide. The bottom line is that positioning is fine, he just wouldn't open his mouth. She said he might grow out of it. And in the meantime I can ask for domperidone from GP. It's the second person who says that with age babies become more efficient feeders and it's a matter of time. I don't believe it and can't imagine what would make him change his mind to put his tongue over gums and massage areola with it. By the sound of it the most I can do is to go to expressing but it will be more formula then, I don't have a great supply.

Thank you for your suggestions and kind words.

Sorry things are no better Karlu
You say you don't believe it that babies do become more efficient at feeding- I think they do though.
Sounds like you've tried lots of things to sort this out but it's still difficult.
Can you get him to open his mouth wide? You said he had some tightness in the jaw at the cranial osteopath- does he need some more sessions?
Yikes, I'm not an expert, just wish someone could help you with your LO.
Have a good weekend anyway.

'can't imagine what would make him change his mind to put his tongue over gums and massage areola with it."

sorry to jump in on this thread...your sentence above, has baby been checked for tongue tie? when the tongue is held back it stops baby putting it over the bottom gums and mum can feel chewing on nipple. it's often missed in hospital. a trained HP, who can also snip the tongue tie, can give the best assesment. they are a bit few and far between but the local infant feeding co-ord at your hospital will know.

can also try holding baby between the breasts at the start of a feed...slightly further away than you feel comfortable. keep his chin touching your skin and hold round his shoulders so he can move his head, preferably along the skin and along the breast. as he begins to root and open his mouth slightly, keeping his chin on the breast that you are aiming him at, slide him along so his bottom lip kind of drags along the skin and hook him over the nipple. this, hopefully, has the effect of putting him off centre on the nipple and drawing his bottom lip down so it's flanged and opening his mouth wide.

nipple flip, or flipple might be useful too.
breastfeeding-questions.com/the-flipple/

please do keep asking for help. if you ring the LLL helpline again you will get a different person, so you can choose to speak to the same one (assuming you have their number) or try someone else. also the national breastfeeding helpline and Association of Breastfeeding mothers...there are lots of people out there would like to be able to help you!

Karlu this is anecdotal but the majority of my friends experienced painful breastfeeding for about 2- 6 weeks then it became pain free. I have read this is because the baby's mouth grows allowing a more efficient latch - if your baby was premature maybe there is an element of this? Obviously carry on trying to improve the latch because blocked ducts can still be a problem even when breastfeeding no longer hurts.

Position wise I found lying down was less painful and if you express afterwards that should help prevent any blockages caused by breastfeeding lying down.

Maybe also look at kellymom for the section on increasing supply, it wouldn't help with pain but may help to reduce the length of time spent breastfeeding. Possibly if the breastfeeding sessions are going on for an unbearably long time you should finish them have a breather and try again in half an hour or so because app it is the frequency of feeds rather than the length of feeds that stimulates extra milk production?

Sorry just reread your post I am guessing the fact you are taking fengreek etc means you have already looked into improving supply. It probably was about 8 weeks for me before it stopped hurting and my baby was actually quite big, but I can imagine even the prospect of 2 more weeks of painful breastfeeding is hard to tolerate. Sorry I haven't been very helpful, but despite painful beginnings with both dc I did eventually experience pain free breastfeeding despite poor latch but always had to watch out for blocked ducts. By the way I initially supplemented my ds with formula and exclusively bf my dd but had far more breastfeeding problems with dd. I hope things do improve for you soon x

Karlu, I don't know how much of the weekend you'll be in London, but there's a good BF drop in in E14 on Sunday afternoons, 2pm to 4pm. At the Barkantine Centre.

They don't have magic wands, but will listen to you, and try to help with the latch. (They don't care if you live in borough - they have a form for people in-borough to fill in, but they'll help anyone.)

One thing, has anyone checked your baby for tongue tie?