Breastfeeding agony

[Poppymillie]

Hi,

I've not posted before but am at my wits end and am desperate to breastfeed but am really struggling.

To give a bit of background, I have a 3yo who breastfed for 18 months with no problems (apart from a sore week or two at the start) and I absolutely loved nursing and assumed I would have a similar experience with my new daughter who is now 2 and a half weeks old. However, from the start this has been so difficult I just don't know what to do.

So the first week of feeding quickly became unbearable. My daughter fed non stop through the night and most of the day and by day 6 both nipples were cracked and bleeding. I was crying before each feed with dread, knowing how painful it was going to be. The pain was throughout the whole feed. Midwives who have observed me feed said my latch was fine but picked up my daughter has a heart shaped tongue. They observed her move her tongue to the top of her mouth and poke her tongue out so insisted she does not need treatment for tongue tie. I have seen two people who specialise in tongue tie since then who also confirmed this. I have, however, noticed that my daughter has a significant lip tie (I think although am obviously not an expert) and have read that lip tie is usually linked with tongue tie. The other thing they noticed was I have thrush. I went to GP and have Nystatin for my daughter and Daktarin for me.

I've been attending breastfeeding clinics for support. At the first one I attended they told me to stop feeding to let my nipples heal so I started expressing from the worst side and using a shield on the other. When I was expressing I noticed I only pumped 0.5oz per session (only from one breast) and at the next clinic my daughters weight dropped again to - 8%. The midwife also noticed milk was not pooling in the nipple shield when I was feeding so suggested my daughter was not using them well. I was told to top up with formula to get her weight back up and stop using the shield so I exclusively pumped for 4 days to work on building my supply. I upped my calory intake, drank lots (Inc. Non alcoholic beer) and started taking fenugreek and my supply did increase (I could pump around 20oz per day, the bad breast produced far less than the good breast though...) and at the next weigh in my daughters weight went up to - 2.6%.

At this point my nipples had healed and I finally got my daughter back on the breast. Again I had lots of support and lots of midwives checked my latch and said it was fine. I am not convinced it is and sometimes my nipple comes out of her mouth in a pinched shape. I have been feeding her exclusively from breast for 4 days now. There's pain at the start of each feed and an uncomfortable feeling as she continues once the pain has subsided (nothing like it was in the first week but it just doesn't feel right). She was weighed again 2 days ago and her weight has dropped again (around - 4%)!!! I also just noticed after my last feed my nipple has started to crack again. I'm terrified of getting myself into the situation I was in after the first week so don't want to continue feeding if it will make the crack worse and lead to my nipples breaking down again. I've just bought a larger nipple shield to try (maybe that's why they weren't successful last time-too small?) and am thinking of using them and pumping for a night to rest my cracked nipple but am worried it will lead to further weight loss. Also, I'm a week into the thrush treatment and it has not gone so have just picked up another dose of Nystatin and daktarin. I just don't know if all the pain/issues are thrush, latch or tongue tie related and just don't know what to do next!!

I feel like I'm failing my little girl and I literally don't know what else to do. I'm also struggling to give my 3yo attention at the moment as I'm so fixated on sorting my baby's feeding and I feel so guilty all the time. Luckily my husband is still off work and has been great at entertaining our 3yo but he goes back in one week and I don't know what I will do then!! Any advice?

Thanks in advance xxx

How long have you been treating for thrush? It’s hell and I suspect part of the cause of your pain. I’ve had it with both of mine around that age and it was excruciating. It took about a week or two to feel better and then you should treat another 7-10 days after symptoms end to truly get rid of it. So while the tongue may cause issues, definitely persist with sorting that out for several weeks and see how you get on. After we got that sorted though, it was plain sailing, so hang in there.

I'm so sorry you're going through this - it sounds awful.

Unfortunately lots of women come across healthcare professionals whose training is basic to say the least. What you are describing is absolutely textbook for a shallow latch - it doesn't matter what it looks like from the outside, if the nipple is coming out pinched, it because it has been pressed against the baby's hard palate, which shouldn't be where your nipple is during a feed.

This can be due to poor technique, or TT, and the two are frequently mixed up and misdiagnosed as thrush. This leaflet describes how thrush should be diagnosed: http://www.breastfeedingnetwork.org.uk/wp-content/pdfs/DifferentialDiagnosisofNipplePainMarch2009.pdf

You will see that it should not be assumed you have thrush if you haven't had a period of pain free feeding, and skilled face to face help. (Added to the fact that medication hasn't helped, it might suggest it's not the cause of your pain).

I'd suggest that in your position, good quality help is required - ideally an IBCLC, otherwise La Leche League, BfN and ABM all have good counsellors.

Also check that the person who assessed for tongue tie is registered with the Association of TT practioners - lots of people claim to be able to assess, not all are equally good, these people know.

The National Breastfeeding helpline is brilliant to talk through and tease out what's going on.

You are doing a brilliant job, I can hear your pain and determination, I hope you can get past the hurdles in front of you

Forgot to add - the evidence base supports moist wound healing for cracked nipples: treat it as if it was a crack in your lip, slather in Vaseline/lanolin/moisturiser/hydrogel pads (there's no evidence that any on is better), and keep it moist for swifter healing, wash with mild soap x2 daily.

Definitely see to her tongue tie. My son had one which wasn’t picked up as he had very good mobility of his tongue. But after 6 weeks we did have it cut and the difference was amazing. You’re complaining of pain- therefore there is an issue. You could look at privately funding this, as you’ll probably get it done tomorrow- and they may do the lip tie too (NHS here won’t).

I’d also definitely recommend la Leche league - google to see if there’s a meeting near you, or call their 24/7 helpline.

Thanks so much for the advice all. I've been treating for thrush for just over a week now. I think it is thrush, my symptoms are:

Stabbing pain in breast when feeding then throbbing after a feed, red shiny skin around nipple, itchy nipples, raised Montgomery glands and a burning sensation. My daughter also has a white tongue.

I will take your advice on nipple healing and keep beating the drum on the tongue tie. My daughter is due to be weighed again on Tuesday and that will be very telling. I just hope she is starting to put weight back on. We are constantly feeding and it's so demoralising when she is losing weight!!

Thanks again for taking the time to reply. Xx

Can you get your hands on Silverettes? They were a game changer for me with second baby and chapped nipples.

Those do sound like thrush symptoms, I agree, and thrush is always more likely when there is pre-existing nipple damage.

The main thing in the short term is to protect your milk supply and keep your little one fed - expressing can be a great way of doing that. As long as those two things are done, there's time for the rest to come later - learning an effective latch is easier when there's no thrush, TT or shredded nipples.

You sound totally on the ball and like you know where to get good info - keep on keeping on

Tongue tie. And probably thrush.
Find a lactation consultant that snips tongue ties to come and see you for a consultation. Well worth it as they are true experts and will advise on the latch.

Is your daughter also being treated for her thrush? Could be she's just reinfecting you all the time.

If she has a heart-shaped tongue then I suspect she has a degree of tongue tie even if she can stick it out a bit.

So two possible reasons why you are battling.

You’re not failing your daughter. You’re working your socks off round the clock to get her fed! I had this experience with my firstborn and after 12 weeks and her gaining less than 1lb (and losing a lot in the interim), I couldn’t take the stress any more. But having now had a third born with tongue tie (heart shaped tongue but no obvious tie picked up by midwives initially), I’m convinced she was TT too. Good luck OP, I hope it works but you’ll both be grand either way. xx