Problems Latching

[@llli*islandclo]

I've been dealing with a low supply problem since 5 weeks (my lo is now 3 and a half months). I was given a nipple shield from the start and not told it could effect my supply as well as his latch.
I have been pumping after each feed for about the last 2 months and have just stopped as I was really dreading each feed and not enjoying breast feeding at all because of the pumping.
I've been seeing a lactation consultant through out and have been on pills to help increase supply.
I think we've finally cracked it because he's not needed any top ups for two nights now (tonight will be the 3rd night!) which is really exciting for us!
My problem now is that nursing has been painful since weaning off the shield (two months ago) and I attempt at each feed to get him latching deeper but he just does a couple sucks and then pulls off... or he starts on a deeper latch and then just turns it into a shallow one. I've tried different holds, and re-latching but they haven't worked.
Any help or ideas would be appreciated, my poor nipples are sore and blistering and feeding isn't the special time that I would really love it to be.
I go a couple feeds that don't feel so bad, and then they become sore and blistered again.
Thanks for your time,
Chloe and Jack

[@llli*mommal]

Welcome to the forum and congratulations on the baby and on making it to 3.5 months despite what sounds like a very significant challenge!

Has your baby ever been checked for a tongue-tie? That's the first thing that springs to my mind when I read that a baby has had difficulty latching from very early on and continues to have trouble maintaining a deep latch even as an older baby. Of course, it is possible to have latch problems without a tongue-tie: my firstborn was not tongue-tied but the combination of her very high palate, very short tongue, and my semi-flat nipples led to significant nipple damage that lasted for months, and difficulties with supply. I did a lot of what you're doing: shield, supplementing, pumping, LCs, fiddling and fiddling with the latch... But what ultimately helped the most was time. I had a small baby with a very small mouth, but she grew and her mouth grew and she got stronger, as those things happened she became more able to achieve and maintain a deep latch every time.

Hang in there, mama!

[@llli*lllmeg]

I know you are frustrated but your story is one of fantastic progress, actually. You are off the shield, you may very well have gotten your supply back to normal assuming it was low, so you may not need to pump or supplement anymore, or at least can cut way back. So now it’s just a matter of tweaking that latch and you will be home free.

When you say you have seen a LC throughout-what do you mean? private appointments where nursing is observed? is she an IBCLC? Has she offered ideas for improving latch? Positioning ideas? (laid back is often helpful for when a baby tends to 'slip off' the breast during feedings.) As mommal suggests, has baby been to a specialist to check for tongue tie? (posterior tt in particular is difficult to see if one does not know how to getting there and find it) It should not hurt & injure you like this to nurse!

As far as feeling confident in your milk supply- how was low milk supply diagnosed in the first place? Was anything else considered as at least part of the problem (poor milk transfer, not nursing frequently enough, baby just a normally slow gainer, etc? How do you know your baby needs a 'top off?' Why were you still pumping after every single feeding even after getting off the shield?

Also if you think you need to supplement, have you tried giving baby a small amount of supplement and then letting bby finish the feeding at the breast?

[@llli*islandclo]

Mommal- I don't think he has tongue-tie as he sometimes sticks his tongue out over his gums and out his mouth... Can babies with tongue-tie do this?? And thanks for your reply!

LLL Leader- From the very start he was gainging weight slowly (maybe half as much as he should in one week). He has sufficient wet nappies, I change him every 3 hr feed, but at the start he was only having 1 dirty nappy in about 7-10 days which I didn't learn was too little for a new born until I read it somewhere as my midwife told me that's normal for a bf baby (which it is but not until they are older!). So at 5 weeks he started waking up about every hour to two hours and I'd end up sleeping on the couch with him while he fell asleep sucking. This was all still with the shield. By the time I switched to the plunket nurse from the midwife (community nurse) at 5 weeks she suggested I see the LC. She works out of the hospital so I assume she has all the qualifications etc.
I've been pumping after every feed in an attempt to bring my supply up, because thats what she suggested to do. She has seen me nursing and agrees that hes on too shallow and given some position ideas, but I need to talk to her again because it is sometimes so painful that I'm in tears and I know this is not how it should be!
I think this was all caused by a number of different things, the nipple shield, and at the begining maybe not nursing frequently enough as he would sleep for long stretches and sometimes go 4 hours between feeds, which my midwife was telling me was alright.
I feel like I really wasn't getting the information and advice I needed at the time and it has cause a lot of trouble! But on the positive side I know a lot more about bf then I did before!
I'm hoping we're past the need for suppliments.. but I usually just gave him the suppliment after feeding, which I see now after reading through the forums that its good to finish with the breast! So I'll be doing that from now on.
Last night he was once again waking up every two hours so I gave him a top up because I was too sore to nurse every two hours. If it wasn't so painful I would have just nursed every two hours all night... but honestly night time is the only break my nipples get and get to do a bit of healing.
I'm starting to wean off my pills (Metamide) which I was taking 10mg 3x a day and have gone down to 2x a day since Monday (its Thurs am now)... could this be why he seemed to not be getting enough last night?
Thanks for all your help! It certainly has been a long up hill battle, but I feel like if I can just get him latching properly then everything will be smooth sailing!
Chloe and Jack

[@llli*lllmeg]

She works out of the hospital so I assume she has all the qualifications etc.

Unfortunately, where I live in the US at least, you cannot make that assumption. Many 'LCs' who work out of hospitals are "lactation nurses' and may have had no special training in lactation assistance at all, and even some IBCLCs who work out of hospitals sometimes really only have experience with brand newborns, and things change so much after that period...

Look this person could be perfectly well qualified, obviously I have no idea. I just get concerned when latch issues drag on this long even after mom has seen an LC.

Sorry I have to run I will be back-what have you tried re: healing your nipples? What positions work best (are most comfortable?)

[@llli*islandclo]

The blurb I have on her says she trained as a General Nurse before becoming a midwife and is now a midwife at the hospital as well as an LC.
I looked up another LC on the nz lactationj consultant association website so maybe I'll have more luck with the lady on there.

[@llli*auderey]

if the blurb about her doesn't say IBCLC, chances are she's not. i agree you should find someone who is.

[@llli*mommal]

Mommal- I don't think he has tongue-tie as he sometimes sticks his tongue out over his gums and out his mouth... Can babies with tongue-tie do this??

Sometimes a tongue-tied baby will be able to stick his tongue out past his gums- it all depends on the type of tongue tie. When your baby sticks his tongue out, how far past his lower gum line does it go? And when he opens his mouth, do you ever notice a "heart-shaped" divot on the top of his tongue? Here are a couple of pics of tongue-tie for reference: http://www.tonguetie.co.uk/

[@llli*lllmeg]

Something is causing this severe latch pain. It may only be a matter of finding the right position or latch technique, but a physical issue should be ruled out, and you may need to see a specialist for that. Besides tongue extention, baby needs normal tongue mobility (up and down movement) to nurse approprately. Also there is lip tie.

I don't know what you have tried for positioning or latch, so I am just going to throw out some ideas in the links below. Even if you already tried something before, you could try it again. Things change.

Laid back positioning: http://www.llli.org/docs/00000000000...astfeeding.pdf and www.biologicalnurturing.com

Latch and positioning basics: http://www.llli.org/faq/positioning.html

Long but informative article on latch and positoning: http://www.lowmilksupply.org/latching.shtml

[@llli*islandclo]

Thanks guys!
I've seen a lady from a mum 4 mum group who was helpful with positioning and also called a board certified lactation lady for me for some more advice. I said I'd try all the advice and if it wasn't working in a week I'd be booking in w the lactation lady.
Also have an appointment with the Dr on Monday to get on the donperidon instead of the one I'm on now. I will have him take a look at his tongue for me and see if he thinks it should be seen by a specialist.