Problems hand expressing and really problematic nipples

[@llli*roly]

My baby was born at 35 weeks and was in intensive care for a week. I tried to express by machine but was unsuccessful only getting 5-10 ml after 5 days. Once he was well enough to start breast feeding expressing got a bit easier but still not brilliant. I have been trying to breast feed since then but have developed blisters on the end of my nipples and the most excruciating pain whilst latching on and now also persisting throughout feeding. I have also developed a rash on my areolas and just outside it which corresponds exactly with where the expressing plastic was but also the breat pads that I am using. My dr has given me an anti fungal cream and steroid cream as we don't know if this is thrush or an allergy/contact dermatitis. I have been using lansinoh. It's got to the point where I cannot bear to breast feed or express with either an electric pump or hand held pump. Havingbdiscussed with GP, midwife and lavtation consultants (who are happy that baby latches on well and they think it's likely that expressing caused the initial trauma now worsened by baby sucking) we have decided that i need to rest my nipples because of the blisters and sucking trauma and have been trying to manually express but can only get a few drops out. I have watched several videos on utube on how to manually express but just don't know what I'm doing wrong. Now I'm getting engorged and it's the weekend so no one local can help me. Please don't tell me to continue trying to breast feed as I cannot bear the pain, it's making me cry with each feed. Just need to leave it a couple of days and want some help on hand expressing so I don't need to use formula and so that I don't become more engorged/dry up. Baby is perfectly happy switching between bottle or breast as we had to do that when he was intensive care as I couldn't be with him all the time so I'm not worried about that so much.

[@llli*mommal]

Welcome to the forum and congratulations on the new baby!

I am extremely sorry to suggest it, but in a situation where a mom is having trouble emptying the breast by hand, emptying the breast using either the pump or the baby is probably the best thing she can do. If you get engorged, getting milk out may become even more difficult, supply will decrease, and you increase your risk of coming down with nasty things like plugged ducts or mastitis. And you just don't need a bout of plugs or mastitis on top of what you are already experiencing! Again, I don't mean to be cruel by suggesting this- it's just that the pump or the baby are likely to do a much better job than hand expression, particularly if you haven't mastered hand expression yet.

I know this sounds extremely weird, but if you cannot bear the thought of using the pump or nursing the baby, you might want to have an adult partner help you get the milk out. It's possible that your partner could get a letdown started and then you'd be able to continue expressing by hand.

[@llli*roly]

Hi. Thanks for that. The weird part made me laugh at least! My GP and LC think that more suction from baby or machine is going to make the blisters worse at the moment so will make it even more sore with prolonged healing. Why am I only able to get a couple of drops out by hand when I know I have a good supply? Is it just poor technique?

[@llli*lllmeg]

I don’t know what videos you have seen or if you have seen this info sheet: http://www.llli.org/docs/00000000000...expression.pdf and this video: http://newborns.stanford.edu/Breastf...xpression.html

Just like much else, hand expression is a learned skill and how to best do it will vary from mom to mom.

I wonder if the awkwardness of trying to hand express into a bowl or cup or whatever you are using is making it harder for you. Comfort and relaxation are sometimes important for good letdown, and with some moms any tightness in the body can impede letdown-so crouching over a receptacle may just be too uncomfortable for you at least at first. Since this is just temporary while you heal, I would suggest that, if you think that is part of the problem, it may be easier to lean back and hand express into a towels, or in the shower, or even to not worry so much about "hand expression" and just massage the milk out. Yes this means the expressed milk will be lost but at least it will ward of engorgement and maybe protect your milk supply at least somewhat-so you may not be able to save enough expressed milk to feed baby right now, but you can protect your supply at least to some extent so your nursing relationship can resume after you heal.

[@llli*aprilsmagic]

I have many years of practice and experience, and hand expression still doesn't work for me. It makes me sore too. I have tried and tried. I just can't do it. So I have nursed through the pain instead and pumped while extremely sore. I EP for my fourth baby, and I spent 9 months incredibly sore because nobody could figure out what what going on.

I woukd suggest perhaps trying to pump again, making sure your horns are the right size (super important) while lubricating with olive oil, not lanolin (maybe you have an allergy to that). Make sure it is a hospital grade pump; that is what finally got the soreness to go away for me. I stopped using anything else for a while and just used my hospital grade pump, and the extreme soreness I had been having for months and months went away. I had also tried all different sizes of horns, and what looked right felt wrong, but what looked wrong ended up being right.

And I know it's painful, but maybe try a different position to nurse in, and has anyone checked baby for tongue tie or anythng that interferes with nursing on baby's end?

I have super sensitive skin, and even with a perfect latch, I get super sore and blistered that first 7-10 days when I have a newborn It does go away. When you are nursing, how does your nipple look when baby comes off: is it pointed, creased, lipstick shaped, etc?

[@llli*roly]

Thanks for all the advice. Tried hand expressing in bath and managed to get some off (small amount and only whilst nipple under the water so couldnt save any but thats not the end of the world for now). May try the suggestion of pumping with oil instead of lanolin and see what happens. Many thanks again.

[@llli*roly]

If I use olive oil can I give the baby the milk?

[@llli*mommal]

Yes, a small quantity of olive oil in the milk should not present a problem for baby.

[@llli*joe.s.mom]

Have you tried pumping with bigger flanges/nipple shields? I think small flanges are a common cause of blisters and problems. You may be surprised that if you can find the right size nipple shield, it won't put direct pressure on your nipples, and pumping may be more comfortable than you thought possible. I would keep trying to perfect your latch, keep latching your baby on a couple times a day at least (I know it's painful, believe me, I have been there), keep trying to get the pump to work out. Because the alternative - hand expression - just isn't going to keep your supply up well enough on its own. That's not to say that you should also be trying hand-expression to give your nipples a break - you should. But I don't know that it's a great idea to rely on that alone.

Obviously, breastfeeding should not cause blisters and pain. That's not normal. But once you've got the blisters (I had the same experience with my baby) you just have to do your best to heal them while keeping your supply up, and that can be a somewhat painful process. I know what it's like to have toe-curling pain with latching on, so I genuinely sympathize. But for me, NOT nursing was almost as bad. And not pumping would have been way worse.

The pump shouldn't be making the blisters worse if everything is fitted properly.

[@llli*joshuas.mommy]

Sorry you're having these problems. I had blood blisters on my nipples for the first week or two of breastfeeding so I know they hurt! I agree with the advice others have given about hand expression probably not being enough to keep up your supply or even prevent mastitis, etc. especially if you're not yet skilled at it. However, doing some hand expression certainly can't hurt and will help some. I've always had the most luck with hand expression in the shower. Get in there, let the warm water run on your breasts, and then just try to massage the milk out the best you can. I think the warmth and the water makes it easier to have a letdown.