Breastfeeding. When is it empty?

[littleacceb]

Hello :)

DS (one week today) has been diagnosed with a tongue tie and is due to get it snipped in a few weeks. In the meantime, I'm finding it impossible to tell when he's done with a breast - he comes off and has to be relatched every two minutes anyway, or he falls asleep, so there is no clear indicator.

LLL's info says that too much fore milk = fighting the breast, milk coming back up, bad wind... Everything DS does. He's the right weight, with plenty of dirty and wet nappies, but with an excitable 26-mo and a husband due to go back to work, I'd like to try to get these niggles sorted!

Does anyone have experience of this? What do you advise?

My lactation consultant said to switch regularly because of this, but this advice flies in the face of everything I've ever read.

I don't think it's ever really 'empty' but I was told to switch sides (in early days only) when baby's sucking started to slow down. as they get older they know when they're done with a side and make it very obvious if they'd like the other! but don't forget breastfeeding is for meals, snacks, drinks and comfort so your baby won't always want both sides.

I think you may get better answers on the breast and bottle feeding board, the ladies over there are very knowledgeable. congratulations on your baby and best of luck

Baby care advice website has a good article called 'how to tell when your baby is getting enough breast milk'.
Thoroughly recommend reading

My DD had a tongue tie. We got it cut when she was 3 days old but she still couldn't latch properly as she has a high pallet. I use nipple shields (still do for every feed even though she is almost 8mo as she just can't BF without them).

They really helped me when she would come on and off all the time and fall asleep whilst feeding. Feeds often lasted 1hr30 because she really struggled but with shields I could see if there was milk in them when she came off. If there was, I still had milk. If not, I didn't.

I also had to express and do EBM top-ups as she had weight issues so did this after every breast feed. I consistently got 10-30ml out at the end of every feed in the early days so I know there was always milk left. I never swapped sides, and HV never advised that I did, as my DD needed hind milk as she was losing weight and struggling to put it back on. After 5 weeks of feeding and expressing for top ups she got back to birth weight and stopped falling asleep and coming off. HV said this was because she was finally getting enough milk and had enough calories to stay awake and feed properly.

My friend had the same problem with her DD and she kept swapping sides and her DD has never fed well and always been thin and in need of constant feeding as a result. I personally believe she isn't getting enough hind milk as a result of mum swapping all the time but I'm not an expert; it's just what I've assumed.

"LLL's info says that too much fore milk = fighting the breast, milk coming back up, bad wind... Everything DS does"

I will bet you anything you like that all this is down to the tongue tie rather than too much fore milk. Honestly, get the TT snipped (and make sure it isn't reforming) and you will see all this improve massively. at least I did. and it will become much more obvious when he is done with a breast too - you'll hopefully get a proper pattern of "fast sucking to get let down - steady swallowing during letdown - slower sucking - finished" rather than the current chaotic feed.

do you have to wait a few weeks?sounds like ages!

Gosh yes I missed that you have a few weeks wait. That is a long time - no way you can get it done earlier? Where are you based?

OP, depending on your financial circumstances, you can go private and someone will come out to your house, usually same or next day.

DD's cost £140 for the procedure and lactation consultation. Called Friday evening and she came to my house Saturday morning. For my friend, they even came out on Boxing Day. If you can find the money it is well worth getting it done asap!

Thanks guys :)

We're in Wiltshire and have Bupa cover, so decided to go with Dr Reynolds at PMH Windsor (www.tonguetie.co.uk/)

I tried looking for private ones, ringing around various hospitals and couldn't find anyone who'd do elective surgery on an infant. I must have been looking in the wrong place :(

Dr Reynolds is doing neonatal ICU for a few weeks so the tongue tie clinic is closed for that period, hence the wait.

If anyone has details they are able to pass on, that'd be amazing!

I went to Graham I Smith at Kingston Hospital and would recommend (he does private surgeries in the evenings and we were able to see him within days of calling) but appreciate that is a bit of a way for you.

Thanks, minipie - the in-laws are in Wimbledon so that could definitely work. Will give him a call tomorrow.

Ah good luck! hope he is available

We had DS's toungue tie snipped at 6 days by NHS, in Edinburgh. It could only barely be described as surgery, a lovely nurse took him, swaddled him and held him horizontally by the light while the doctor had a look. Then he was passed back to me and she said 'all done'. There was a wee dish with a little pair of scissors on the side that she'd used to snip the tie. DS had a quick feed to settle my nerves! He wasn't at all fussy.

If your's is a particularly complex tie or there are other issues, perhaps a wait for your BUPA doctor would be best. In our experience, it is such a simple procedure, with such immediate results that I'd suggest a quick referral to your local practice.

If you could afford it though, definitely do what Jammee suggests. Then you can move on with less stressful, happier feeds. Hope it works out for you quickly.

Thanks, oddfrog - DS1's tongue tie was done at the local hospital but they seem to be resisting these days so I'd have to go to Frome (lovely but completely different county and very hard to get to) and they've got a bit of a backlog at the moment.

Oddfrog, what type of tie was it if you don't mind me asking? I know people that have been turned away by the Edinburgh clinic being told there is no tie, when in fact there was a posterior tie.

Maybe they have learned about posterior ties since then.....

Really mawbroon? I hope they've sorted themselves out now!
DS's was really obvious, he had a deeply forked tongue and couldn't push his tongue forward beyond his lower lip. I don't know what it was called though, but certainly couldn't miss it. They did check his lips and gums at the same time, said he had a very slight top lip restriction, but didn't do anything with it.

littleacceb, the results were so quick for us, hopefully when you can have it done any feeding, wind, restlessness will resolve pretty fast.

We had this lady www.tonguetieherts.co.uk

If this is no good you can try www.tongue-tie.org.uk/find-a-tongue-tie-divider.html and scroll down to the map where you can click your county to find someone private.

A lot of counties don't do it on NHS now unless DC has a severe posterior TT so lots of people go private. My lady just put a little hook on her finger and ran it under DD's tongue. It took seconds. I breastfed to calm DD down and then she showed me how to get her to latch etc. as baby has to learn again now that their tongue can wriggle properly! Good luck.

Ugh, just had midwife visit and she's really anti the procedure. Explains why she completely ignored my pleas with DS1! Apparently none of the symptoms are down to tongue tie and all due to immature digestive system (too-small stomach, weak muscles), and he'll grow out of it. She thinks that I could make it worse.

I just don't know what to think!

Who diagnosed the TT? Is it visible or can your DC not move the tongue freely? Can your DC latch properly? If any of these apply, get it checked out. A TT can cause problems for feeding, speech and dental hygiene if left.

The lady that came to me was also a lactation consultant. She came over with a view to either cutting the TT or just helping me learn how to latch DD and feed her without her coming off all the time. If you can find someone who has skills in lactation and TT it is worth getting them to see you as they should be able to help you either way.

Have you tried the NCT. DSs submuscosal was cut by a nct consultant.

It was diagnosed by the infant feeding specialist midwife at the hospital where DS was born, referred by a lactation consultant. On the Hazelbaker scale ( tonguetie.ballardscore.com/scoresheet.htm ), he scored 3/10 for appearance and 7/14 for function.

The lactation consultant gave me some great advice on how to improve latch and that has certainly helped. I just don't know if his habit of feeding for five minutes every hour and a lot of possetting is tongue tie, as the LC thinks, or age as my usual MW thinks. Kellymom seems to point towards tongue tie.

I don't want to make things worse, but I don't want to miss the pretty narrow window to have the tongue tie released, if that is the problem.

Posseting and wind could be down to immature digestive system (or tongue tie) but fighting the breast and having to be relatched every two minutes are unlikely to be to do with digestive system and far more likely to be due to tongue tie.

Anyway if you see a surgeon and there is no tongue tie (ie if your MW turns out to be correct), the surgeon will simply tell you there is no tongue tie and will not snip it. So nothing to lose (other than the hassle factor) in seeing someone for tongue tie.

if two people already have said DS has tongue tie, I'd get it seen and ignore your usual midwife.

Agree with PP. My DD had tongue tie and a milk allergy but her latch and feeding were much improved after the TT was cut, despite her digestive issues.

Just do what you think best. You're the mum, not the HV.

DS1 with tongue tie used to find it easy to get the foremilk (have an insane letdown), but then his latch was too bad to get the hindmilk. Definitely get checked for tongue tie (and if it improves, but then gets worse again, go back, as it might have regrown while healing).

Frequent switching stimulates more milk production, so you'll actually have more foremilk 'sitting' in your boobs and it'll be harder for your lo to get the hindmilk. Personally I get around this by block feeding (I offer the same breast for 2 entire feeds - also because I have oversupply and this helps). YMMV but it could be worth a try, maybe 1 boob per feed. As long as they're suckling your body makes more milk.