Need Tips for Positioning

[@llli*laura23rn]

So, I've got a 4 week old baby. He is gaining wonderfully. Urine and stool output are fantastic. I have a bit of an overactive letdown, but it seems to be regulating itself as the weeks go by. He eats every 1-3 hours during the day, and gives me one longer stretch at night.

So here are my two questions:

1. I can only use the football hold. Which is fine at home, but its not so easy to do out in the real world, and I would love to get out of the house more without feeling tied to waiting until he's just eaten and whatnot. Plus, I'd just love to use the cradle hold for a change of pace. I am larger breasted (42DD), and so I would love some tips on how to make the cradle hold work.

2. Nipple shield. I used one with my first son, that went horribly, and I swore I would never do it again. This time I have an extreme determination to make breastfeeding work. Well, when I got engorged after my milk first came in, he refused to eat for 8 hours straight (I was dribbling pumped milk into his mouth via syringe), and the only way I could get him to finally latch and eat was to attempt the nipple shield (which we briefly had tried in the hospital when he had a rough time latching on day 2...but then day 3 he figured it out and he was latching great). So for the last two weeks, we're about 50/50 with and without the nipple shield. I want to be completely off of it, but occasionally I'm still full enough that he has a hard time latching. Due to reflux and my letdown, we only do one side a feeding. With the nipple shield, he eats for around 10 minutes, then he's done. Without it, sometimes he only eats for 6 minutes or so (and I'm not sure if its because he gets tired of working a little harder to stay latched or if he's so much more efficient without it that it takes way less time). And today, I've noticed that he's started great without it, and then gotten really fussy, although still rooting, but would only take the breast again if I put the shield on (seems a little backwards to me). Any suggestions???

[@llli*mommal]

Welcome, mama, and congrats on the new baby and in successfully nursing 2 kids! Awesome!

I think the answer to your first question is to give it some more time. It's tricky dealing with the combination of OALD, large breasts, a shield, and a newborn. There's so much to position! I think you basically have to wait until your supply is more in sync with your baby's needs and your baby grows up a bit- when the OALD lets up and the baby is stronger and can position himself better, it's all going to get a lot easier. The only thing that I can think of that might help you right now is a well-stuffed diaper bag. Put a few extra receiving blankets in there and use it as an on-the-go nursing pillow. It might help you position yourself better in a booth at a restaurant or on the floor of the grocery store, or wherever you end up.

Regarding the shield, what you describe sounds normal. Most babies feed faster without the shield than with one, since the shield can slow milk flow. That may be why your baby wanted the shield at the end of the feeding: he still wanted to suck but without the shield to slow down the flow, he was getting flooded with milk. This link talks about shields and how to wean from them: http://www.kellymom.com/bf/concerns/...an-shield.html

[@llli*lllmeg]

OALD & engorgement can be helped a lot by very frequent feedings, so while baby is clearly getting enoug, you may want to thnk about offering the breast a bit more for a while. Fine to let bb do one side per feeding if that is what he likes, but it really can help to nurse very frequently overall. Also have you tried reverse pressure softening prior to latching when you are feeling engorged? Or expressing a bit to soften the breast before latching?

As far as positions while out.-I nursed in a football for months with my oldest, even out and about. I also used a nipple shield. Ugh. Very hard when out but I did it. I felt funny about it, at first I found places that had nursing rooms or at least a chair in the ladies, but eventually I basically had to get over the fact that someone might see "something" as with all that going on a nursing cover was out. I have a theory that people jsut don't notice or care about a mom nursing in public nearly as much as we think they do. Anyway, I bought a small, mini nursing pillow at a nuring/maternity store,-it did not go around me, it was maybe a foot long, it just sort of sat on my knee, and that helped, I don't know if they make them anymore but mommals suggestion of folded blankets etc. works too, or even a firm couch pillow maybe?

Can you go to a mommy and me meeting or a La Leche League meeting? Many moms find it helpful to "practice" nursing out while in a semi-private, supportive environment. Alternatively, practice in front of a mirror or a supportive friend.

Is the issue with the football hold that he has nowhere to put his legs if you are sitting up in a chair say, at a restaurant? maybe a pillow or folded blankets or something behind your lower back would help in that case, puch your body forward slightly and give bb leg room. Or trying a slightly leaned back postion (aka laid back but not so far as its usually depicted, just kind of leaned back in a chair or whatever) that allows baby to be more in front of you rather than under your arm but still coming up to the breast from below similar to how baby does with a football hold?

Have you ever had any success nursing standing up?

good OALD article http://kellymom.com/bf/supply/fast-letdown.html

[@llli*laura23rn]

Just to clarify...I didn't (by my definitions) successfully nurse my first child. By a week, he refused to latch (I realize now that a little patience and perseverance probably would have gotten us through, but you live and learn)...so I EP'd until 6 weeks, at which point I'd let myself become so stressed out that I (guilt-ridden) chose to stop. For whatever reason, that experience made me want it to work even more so this time. And, all things considered, I'm not at all unhappy with this breastfeeding experience...some things to work on, sure, but overall, going much better than last time (determination and patience have been extremely beneficial).

I had a feeling that time might be the answer to different positions, but, hey, if there was some magical trick that I wasn't trying yet, it was worth a shot. I don't dislike the football hold, just seems a little easier to be discreet and comfortable in public in the cradle hold. Its not extremely easy to hold his getting heftier by the day self in that position without the comfort of all my pillows at home. BUT...I will make it work in the meantime. Thanks for the suggestions, I will definitely give those a try. I have nursed in the football hold standing up for brief periods of time (like when we were walking out the door and he suddenly decided he was hungry, so we had a quick little session).

As for the OALD...now that my supply has tamed down a bit, its not nearly as problematic as it was. Switching to just one side per feeding made a HUGE difference. We only cough and sputter maybe 2-3 times a day instead of every single feeding. I would certainly be willing to let him eat more IF he wanted it, but he simply does not. When that boy is done, he is DONE, and if he doesn't want it, he makes it very clear. And since he continues to gain about an ounce a day (I have a scale at home), I haven't felt the need to press the issue. Would there be any reason to, if he finishes one side, and is full and content after?

I did read about the reverse pressure softening before I had him, I tried it at my most engorged when the milk came in, but nothing was successful then. And before we were having more success without the shield, a couple times I expressed a little bit prior to latching, but it kind of seemed one day he was unwilling and then suddenly he would just do it without the shield. And so far, for the last 24 hours, we've always been able to start without it (like I said, though, he sometimes wants it after he's eaten for several minutes...makes sense what mommal said as to possibly why). Should I continue to put it on, then, to pacify him...or if he's not upset, just wait and see what he does and follow his cues as to when to eat again and try not to use the shield? I try to keep him as content at the breast as possible, rather than let him get frustrated. He does take a pacifier. I started offering it last week because with the letdown, he just would not comfort nurse at all, but it was obvious that at times, he just really wanted to suck but didn't want milk (as he would refuse the breast/nipple shield).

[@llli*lllmeg]

Would there be any reason to, if he finishes one side, and is full and content after?

No, but I was thinking it might help keep you from getting engorged, and being engorged often makes latch more difficult, which could increase the need for a shield. Also I always give the "nurse more" suggestion because so many moms think they should be sceduling or are concerend that bb nursing alot suggests a problem, or don't even consider 'offering" while in fact nursing frequently is normal and helps with many problems. But if bb won't, he won't, and since weight gain is great no worries.

it sounds like you are following your instincts and bb's cues as far as the nipple sheild goes. Weaning from a sheild can take time, so I suggest just keep doiing what you are doing. Keep encouraging whatever comfort nursing you can at the breast, and use the pacifier very carefully and judiciously as it could possibly cause latch and even eventually supply issues if used as a substitute for mom too much.