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Thread: Please help the LC has confused me.

  1. #1
    Join Date
    Jun 2011
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    Default Please help the LC has confused me.

    I am after a bit of help and clarification.

    My second son is 4.5weeks old and is EBF. We have had some latch issues from the start but I have persevered and have managed without shields so far. When he feeds my nipple comes out squashed and really elongated and very white. As a result from the poor latch he is very windy.

    I also thought that I had a fast flow/letdown as he would start squirming a few minutes into the feed and when he unlatched milk would squirt everywhere, and you can also hear him gulping quiet loudly at the start of the feed. He actively suck/swallows for about 5-8minutes and then just starts softly sucking and doesn’t swallow much, but it is more than a comfort suck. He also starts squirming and yanking a lot when he is doing this and will continue to do this for another 10-15minutes before coming unlatched. That is when I pop him on the other side and he does the same thing. I have tried stopping him when he starts the softer suck but he isn’t satisfied. He does have a strong natural sucking need however.

    He is gaining weight well (approx. 300grams per week) and is having plenty of wet nappies. He is only pooing every 7/8 days but when he does go it is a “normal” new born poo. He is also a little sleepy still and is falling asleep during feeds (mainly I think because it takes him almost an hour to feed) but settles well and happily goes 3hrs (sometimes more) between feeds as long as I have done a good job of burping him. Also when he is due for a feed my breasts do feel full.

    Anyway, I went to the LC yesterday to sort out the latch, which we have improved but it is still not perfect and his wind has seemed to dramatically improved. Where the confusion comes in, is that she seems to think that my supply is on the low side (not really low but lower than it should be). She thinks this because of how he is sucking after the initial letdown and said that he doesn’t have good milk transfer, and that I am not really having subsequent letdowns. If she got me to hand expressed a little milk at this stage milk still flows well (so I thought). So she has recommended that I swap sides each time he stops actively suck/swallowing, even if he nurses off both sides 2 or 3 times during a feed. She has also recommended that I pump for 5min per side after a feed and use breast compression to encourage the flow.

    I can see her logic, but it doesn’t quiet make sense to me. I tried doing the swapping sides thing and I don’t feel like he fully drains my breast as well as he was before, despite his slow inefficient way of feeding. And when I do compressions it doesn’t really stimulate his swallowing anymore.

    I now kind of feel that I don’t know what I should be doing. I don’t want to take steps to increase my supply and then end up with an oversupply issue. I feel that more issues have come into play when I thought that if we sorted out the latch everything else would just kind of fall into place too. Sort out the basics and the rest would come right type thing.

    I am seeing her again tomorrow but want to get this all sorted in my head a bit better so I can ask the appropriate questions and get sorted a bit better.

    Can anyone make sense of what is actually going on here??

  2. #2
    Join Date
    Jul 2010
    Location
    Oregon
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    70

    Default Re: Please help the LC has confused me.

    Ouch! That latch sounds painful. Has your LO been checked for a tongue-tie? My DS had aTT which caused a bad latch and poor milk removal. Poor milk removal can lead to a low supply- maybe your LC is trying to prevent that? As long as you are making enough milk for your LO, I think you're right to be careful. I ended up over-compensating and then had to fight over-supply. Not fun, but way better than not enough milk.

    NAK
    Mama to
    - born at home on 4/27/10

    - born at home 8/30/2012


  3. #3
    Join Date
    Apr 2011
    Location
    Maryland
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    Default Re: Please help the LC has confused me.

    Let me preface this by saying that I don't really know what I am talking about..

    But, I would say that if he is gaining well, is content and is having enough wet diapers, then you are doing fine with your milk supply. You may want to pump just a few times a day, but maybe not after every feeding.

    Did the LC do a before and after weight to see how much he was getting during the feeding? That might help her (and you) feel better about the milk transfer. Maybe you can ask her to do that when you see her today.
    ~ Megan

    Mommy to Alex (born 2/27/11) and Katie (born 3/31/14)

  4. #4
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    Jun 2010
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    Maine
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    Default Re: Please help the LC has confused me.

    i would suggest the before and after weight too. If he's gaining well and seems content and has plenty of wet dipes, I would tend to agree that you don't need to be doing anything more to increase your supply (in terms of pumping). I don't think her idea of switching sides is bad, but you want to be careful that your little one is getting the hind milk that comes when your breast is getting on the emptier side.
    Julia and Maxwell (and Dan and Haddie)
    Maxwell, born January 3, 2010
    A year on Mama's milk and still loving it

  5. #5
    Join Date
    Jun 2011
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    28

    Default Re: Please help the LC has confused me.

    Thanks for your replies.

    A painful latch is an understatement, it certainly isn't fun but I am gritin gmy teeth thorugh it.

    The LC did check him for TT and she said it was fine. What she did notice was that the back of his tounge is quiet wide and doesn't go up as far as it should, but it is still fully mobile and not a posterior TT (or what ever they call it) Apparently when sshe looked at my tounge it is the same.

    She didn't do a before and after weigh but I can ask her to do that today.

    I am of the same opinion as you guys, he is gaining weight, weeing well and settling nicely after feeds, so is there really a problem. Is she trying to fix something that isn't broken??

    Don't get me wrong-the latch is definately broken, but I can't help thinking that if we get the latch right everything else will fall into place.

    I pumped for the first time last night to give my nipples a break and I got 55ish mls of each side in about 15min. Now i know pumping isn't a good indication of supply, but that seems a fair amount and not like there is a supply issue.

    Interestingly enough, when i was pumping I got the first letdown quickly, but the otherone took a long time to come down. Not sure how reliable that is though.

  6. #6
    Join Date
    Jun 2008
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    Landof2toddlers, Oregon
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    Default Re: Please help the LC has confused me.

    IMO the only sign of poor supply or insufficient milk transfer is the kid not getting enough milk as evidenced by inadequate diaper output and lack of weight gain.

    After I had DD I was really worried about transfer and supply because nursing hurt and I had LC's check her latch over and over in the hospy and they said it looked great and she put on weight like a champ (back up to birthweight in 3 days). But it hurt. And then the pedi put a finger in her mouth and said - ooh she has a super high palate, sorry, nursing must really hurt but she will grow out of it soon enough. I don't share this because I think it is what is going on, if you have bad latch you have bad latch that needs fixing, but because LCs re so used to seeing/looking for somethings that they forget about others.

    The sucking pattern you describe sounds fairly normal to me
    proud but exhausted working mammy to two high needs babies

    • my surprise baby: the one and only D-Man born 3 weeks late (5/5/08) at 9 lbs 14 oz and 21.5 inches, and
    • the shock H-Girl born about a week late (10/7/09) at 8lbs 15oz and 20.75 inches.


    If I am here I am covered in baby (probably two) and fighting for control of the keyboard.

    Family beds are awesome

    Wondering if you have PPD? Take the screening and see your doctor. You deserve to feel better.

  7. #7
    Join Date
    Apr 2010
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    46

    Default Re: Please help the LC has confused me.

    Sounds like he has appropriate output, happy, content, and gaining well! I wouldn't be too concerned about supply. But, I don't want to discount any LC because I'm not certified in any way...just have experience!

    I'm sorry you are having such a hard time with the latch. But, poor latch can also inhibit how effective the milk flow is. How is your water intake? VERY VERY important for supply. I drink tons and tons and tons...TONS!! But, probably more than normal at about 8, 32oz bottles/day.

    Are you using a feeding pillow? I started using my breatfriend at 3 weeks PP and that practically fixed our latching issue.

  8. #8

    Default Re: Please help the LC has confused me.

    Quote Originally Posted by @llli*missyb View Post
    I can't help thinking that if we get the latch right everything else will fall into place.
    I think you're exactly right. It's hard to distinguish between forceful letdown, oversupply, undersupply and latch issues, and when I have tried to tactically correct multiple perceived conditions like this at once is exactly when I have been most stressed out and least successful with breastfeeding.

    Fix the latch, and then just be a good reader of your baby. Congrats and keep up your great (hard!) work!!! LCs are awesome, but not perfect, so if something doesn't sit well in your gut, trust your own mama instinct!

  9. #9
    Join Date
    Jun 2011
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    28

    Default Re: Please help the LC has confused me.

    Quote Originally Posted by @llli*sonjuanja View Post
    How is your water intake? VERY VERY important for supply. I drink tons and tons and tons...TONS!! But, probably more than normal at about 8, 32oz bottles/day.

    Are you using a feeding pillow? I started using my breatfriend at 3 weeks PP and that practically fixed our latching issue.
    I do drink heaps as well-I always have. I probaly have 3/4L per feed, plus all the other drinks during the day.

    I have just been looking into getting a proper feeding pillow. I have just been using a normal pillow but when I was at the clinic the other day I used a feeding pillow and it did seem to make life a little more easier. So will get one sorted this weekend.

    Quote Originally Posted by @llli*firestar9s View Post
    Fix the latch, and then just be a good reader of your baby. !
    That is definately what I am trying to do. This is #2 and I trust myself so much more this time. I really struggled with #1 because he didn't do what the book said, and this time I am so much more relaxed and have slowed right down and really tried to read Nicholas, and low and behold, he is doing what the textbooks says he should be!!

    Quote Originally Posted by @llli*durhamgrrl View Post
    IMO the only sign of poor supply or insufficient milk transfer is the kid not getting enough milk as evidenced by inadequate diaper output and lack of weight gain.

    After I had DD I was really worried about transfer and supply because nursing hurt and I had LC's check her latch over and over in the hospy and they said it looked great and she put on weight like a champ (back up to birthweight in 3 days). But it hurt. And then the pedi put a finger in her mouth and said - ooh she has a super high palate, sorry, nursing must really hurt but she will grow out of it soon enough. I don't share this because I think it is what is going on, if you have bad latch you have bad latch that needs fixing, but because LCs re so used to seeing/looking for somethings that they forget about others.

    The sucking pattern you describe sounds fairly normal to me
    Thanks for your support. I so agree with the input=output theory and he is doing really well on the output side of things, so the input must be fine too, but like you it is hurting and needs to be sorted!!

    Did your little one grow out of it, or into her palate??

  10. #10
    Join Date
    Jun 2008
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    Landof2toddlers, Oregon
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    Default Re: Please help the LC has confused me.

    Quote Originally Posted by @llli*missyb View Post
    Did your little one grow out of it, or into her palate??
    Yup. It may have been a month or so, but it got better. I would not have nursed past a year if it was painful like that. I had massive cracks and scabs for a couple of weeks and then it kept getting better. Just like your dyad will get better.

    Can I just ask, was the LC you saw IBCLC or just someone with LC on her badge. While both types come in good and bad, we try to get women with issues to see an IBCLC as they really are qualified and trained, some of the others not so much. Also (as I know LCs are not cheap and often not covered by ins) have you contacted your local LLL leader (find a leader) many of them can do amazing things to help you latch and they are free. It is also a wonderful way to get in contact with local breastfeeding moms and get an irl support group in addition to us (also they can do playdates which we are not so good at).
    proud but exhausted working mammy to two high needs babies

    • my surprise baby: the one and only D-Man born 3 weeks late (5/5/08) at 9 lbs 14 oz and 21.5 inches, and
    • the shock H-Girl born about a week late (10/7/09) at 8lbs 15oz and 20.75 inches.


    If I am here I am covered in baby (probably two) and fighting for control of the keyboard.

    Family beds are awesome

    Wondering if you have PPD? Take the screening and see your doctor. You deserve to feel better.

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