Baby is reluctant to latch and isn't transferring milk

[@llli*lulusmom]

Hi,

I'm new to the forums (and website), but feeling desperate for more advice...

My daughter is 18 days old today, and I'm enjoying every moment with her except for when we try to breastfeed. At first, when we were in the hospital, things seemed to be going well. According to the nurses, she was latching well and doing a great job. However, by Day 3 (we were in the hospital for 4 because of a cesarean), she had lost 10% of her birth weight, had jaundice, and my milk hadn't come in yet. Both her pediatrician and the nurses felt I needed to supplement with formula, which was so devastating as I not only had recently had to give up my dream of a natural birth, but now was being told that breastfeeding wasn't starting off well. To top it all off, I had yet to have a consultation with a lactation consultant. At this point as well, my little girl would latch, but fall immediately asleep and only stay latched for a couple minutes. (We were told this can be commom with jaundiced babies.)

For the next 3 days, I pumped to get what milk I could and we supplemented formula with a syringe. (I really didn't want to use bottles as I was afraid it would interfere even more with breastfeeding.) The pediatrician then told us we needed to use bottles and increase what we were supplementing because she had lost 12.5% of her birth weight and we needed to get her weight back up. I then met with the outpatient lactation consultant at the hospital, who suggested using slow-flow bottles, helped her latch, and then also suggested I use nipple shields to add with helping my daughter not reject my breasts. At that initial appt, my daughter got about 11 cc of breastmilk after about 15 mins of being latched and sucking. At home, latching was less successful, so I continued to pump, attempt to get her to latch and we supplemented with formula.

This week, I saw the same lactation consultant again, who weighed her and we were so excited both that day and the next at the pedi's to find out she was an ounce heavier than her birth weight. At this appt, the consultant was able to help get her latched without the nipple shields and she was able to take in 20 cc after about 15 or so mins of breastfeeding. However, at home, I could not get her to latch without the nipple shield.

Because I really want to nurse, I'm determined not to give up, but I'm feeling so confused about what to do. Things will be okay at the consultations, but then not be at all the same at home. Earlier today, I had a different lactation consultant come to my house, hoping that it might help to see someone in our own environment. We were so excited that she stayed latched, was sucking and swallowing for 18 mins on my left breast. However, when we weighed her, she had only transferred 4 cc. We were so disappointed and baffled. We tried the right side, and she took in 4 cc after about 8 mins.

I'm pumping every 2-3 hours (at least 8 times/day) and I pump anywhere from 1.5 oz to 4 oz. I'm using slow-flow bottles when feeding her the pumped milk, and supplementing with formula when I do not have enough breast milk since she's typically eating 3-3.5 oz/feeding. (Oh, I'm also taking fenugreek and reglan as possible ways to increase my supply.)

I just ordered the SNS thinking that perhaps that method of supplementing might be better than bottles, but I'm just not sure what to do. I don't want to give up, but I also don't want the first months with my daughter to be filled with so much frustration and disappointment for both of us.

Any ideas???

[@llli*paytek]

WOAH!
That was pretty much MY birth and postpartum story.

I'll tell you how my lactation consultant AND how experience has told me; babies are smart. They know which nipples give them milk and which don't.
Saying that, I'll move into my story;

Desmond, wanted a natural birth, after 50 hours of induced labor at 42 weeks 2 days, had to emergency c-section.
Same as you--latched in hospital. Fed in hospital.
Got home--wasn't moving milk. Lost 10% of birthweight.
MANY MANY trips to lactation consultant.
Breast/nipple shield.
Didn't work, baby still wouldn't move milk.
Moved 1/4 an ounce in 30 minutes. Devastating.
Pumped every 2 hours on the dot. Bottle fed baby expressed breast milk for 2 weeks.
Baby went from 7 10 (birthweight was 8 14!!!) to 9 5 in those 2 weeks.

During the two weeks, what I found was that I would latch him with the breast shield.
My LC suggested only letting him latch n nurse for 15 minutes and then bottle feed him the ebm (expressed breast milk).

Confession; I stopped the shield. He wasn't moving milk with it, either.

I ended up just not even latching him for the first week. I really wanted him to gain weight. It was her idea that perhaps he was just behind the power curve. The second week, I latched him for 15 minutes at a time and bottle fed the ebm. Did that EVERY feeding.
The end of the second week of bottle feeding, she suggested I slowly wean out the bottle as he had gained a substantial amount.
I did one better and bottle fed one meal--and breastfed every meal on demand after that. He gained 4 oz in 4 days. And now we're EBF.

She suggested the SNS for me--and I gotta say..she did say for moms who can get it down, they loved it, for moms who can't..their babies got smart and used the tube as a straw.
I did NOT want the SNS. I wanted no more interventions.

So, in summation..pacifiers and bottles won't mess your kid up, bottle feed her LOTS of ebm to get her weight/strength up, keep putting her to breast every chance you get, see a Lactation Consultant, and understand that you aren't alone in these specific frustrations.

..it ended up my LO was just relearning to suck from his tongue tie.

[@llli*canne]

Hi - I hope I can be a little bit of help. I am currently still struggling to nurse my 3.5 month old.... but I have gained a lot of info during this time and have been given a lot of advice on here and from a couple of lactation consultants.

First of all... it's awesome that you can pump that amount of milk! Congrats on that! And it's also good how often you pump. It's also great that your baby continues to latch. Keep on offering the breast and keep her happy there. You do not want her to start preferring the bottle rather than the breast. Therefore, since she CAN latch... try to stay away from the nipple shield. Nipple shields are silicon, like bottle nipples, and she will get used to that in her mouth. Again... that will encourage the bottle preference and you do not want that. Also, nipple shields can hinder milk transfer if the baby doesn't latch well on it.... and hindering milk transfer will ultimately lower your milk supply because the breast will not be properly drained. So, in my opinion.... I think you should try to stay away from the shield.

I have had the same experience with things going great with the lactation consultants and then coming home and it's completely the opposite. I think this happens often... I've heard of others being frustrated with this too!!

I have heard the SNS can really help and also keep the baby happy at the breast... so the baby continues to recognize the breast is a happy place and a food source. You said that you were syringe feeding, but the doctor said to use bottles?? Have you tried any cup feeding or finger feeding? Those could possibly also help you feed her if you still are trying to stay away from bottles so much.

In my personal opinion... do what you can to keep the baby happy at the breast, familiar with the breast, latching on the breast, etc. Not to discourage you, but my lactation consultant told me to pump and bottle feed to get my daughters weight up... and three months later, I'm struggling with getting my baby back on the breast. She now has a nipple preference, and it is HARD to get them back to breast. So... you DO NOT want to go down that road. Also, I wonder.... since she is only 18 days old, she is still small and her mouth could be small possibly? As she continues to grow, her mouth will get larger and her suck will get stronger and she might really be able to start transferring milk better and better from your breast as she nurses.

I don't know if any of this is a help... but I think you are on the right track!!! Just keep trying and it sounds like you are doing great! Give her as much of your milk as you can.... and good luck!!!! Keep us posted!!!

[@llli*paytek]

and three months later, I'm struggling with getting my baby back on the breast. She now has a nipple preference, and it is HARD to get them back to breast. So... you DO NOT want to go down that road.

I only gave my LO cold ebm through the bottle. Maybe it was mean, but now he knows hot meals come from the breast.

[@llli*canne]

I only gave my LO cold ebm through the bottle. Maybe it was mean, but now he knows hot meals come from the breast.

Actually, someone just suggested that to me.... and I think I should try it. I'm willing to try anything to get her back to the breast!

[@llli*maddieb]

Hi lulusmom, sorry you having issues. But I think you are actually in pretty good shape. Here is why.
The amount you are pumping per session is quite good. A 3 week old baby would typically transfer about 1-3 ounces per feeding. So if you are pumping about that, that is a good sign your supply will be OK, as long as you keep up the pumping (until baby can nurse effectively.) I hope you are using a hospital grade rental pump, and I would suggest your pump one or two more times a day-aim for 10 times a day if you can. It does not have to be every such and such hours, if it works better for you to "cluster pump" then do that, that is more like how babies nurse anyway. This pumping log may help: http://www.llli.org/docs/00000000000...umpigchart.pdf

As long as you need to supplement, I think an SNS (or any lactation aid) is a v. good idea. here is why. Babies learn to breastfeed by breastfeeding. That does not mean to never use bottles, of course, some babies need to be supplemented and sometimes that is the best method, it depends on many factors. But bottle feeding is not going to help a baby learn to transfer milk at the breast, and a lactation aid probably will help. The other issue with bottles is babies routinely overfeed with bottles, no matter how slow the flow of the nipple happens to be. You are being undermined in your confidence about making enough for your baby in part because your baby is taking quite a lot with every bottle, much more than she would likely take at the breast.

A three week old baby needs approximately 25 ounces of breastmilk per 24 hour day, some more, some a little less, and will typically nurse a MINIMUM of 12 times a day. That translates to about 2 ounces a feeding. At the breast, the transfer amount will vary, with some feedings being short and lazy with little transfer, and others being longer or more intense with more transfer. So this is just an average, but you get the idea.

I do not know how many times a day you are feeding baby, but I suggest you make sure it is at least 10 or 12 times a day, as that is more like breastfeeding. And until you get your sns, use these ideas for giving bottles that are more breastfeeding supportive http://www.llli.org/docs/00000000000...astfedbaby.pdf

Now, the before and after weight checks. They can be a helpful diagnostic tool, but these are very tricky, as they 1) have to be done very carefully, as even a pee or small poops between the weigh-ins mess up the result, AND they only tell you what happened at that particular nursing session, and babies do not nurse the same at every session. So, while I get it there is a concern, I would not take as gospel what your baby transferred at either appt. We know you are making milk, based on your pump output, so your biggest worry at this point, as I see it, is baby will not latch at all when you are not with an LC. So let’s get baby latching & nursing frequently and then worry about if baby can get enough, which you will be able to tell from poops and weight gain. And remember some babies do need to nurse more frequently than others to get all they need-the rule in the early weeks is baby must nurse a MINIMUM of 10-12 times a day. Many babies nurse more often.

So, why is baby only latching at consultations? Here are some possibilities: 1) The LC is doing lots of things you are not able to absorb/remember later (you are exhausted, after all.) 2) The LC helps you feel relaxed, and that in turn is relaxing baby and nursing goes better. Once the LC is gone, you are scared and tense. 3) It's just a coincidence.

So, I would suggest you work on finding YOUR OWN way to latch your baby. Use what helps from what the LCs said, and don't worry about the rest. There is no wrong or right way. It does not matter how latch looks or how you get there. If nursing does not hurt you and baby is transferring milk (listen for tiny swallows) then you are doing it "right."

I suggest 2 things. 1) nurse (or offer) VERY VERY FREQUENLTY and at the earliest cues. IN fact, no need to wait for any cue. Just relax with baby and give it a go. Do not start trying to latch with a frantic, starving baby. If baby needs to eat, first give baby a LITTLE expressed milk or formula. An ounce, 2 at the very most. THEN when baby is calm, bring baby to the breast. 2) Try laid back positioning. This allows mom to be in a very supported and relaxed position, and in turn baby is supported. Gravity works for you both, rather than against you as when in a straight sitting up position. And there are few if any rules! Just get comfortable and hold baby in close proximity to your breasts. When baby starts to look for the breast, help her as needed, but stay relaxed. Baby may just sniff the breast, lick, head bob, whimper, etc. that is OK. It may take a few trys to get baby on there. It's fine. Relax. If it gets too frustrating, stop and try later-but not too much later, kwim?

Now, nipple shields. Of course, if you do not need them, or baby was unable to transfer milk with them, then it’s not really helping. On the other hand, if baby CAN latch and transfer milk with a shield, and not without-then I think using a shield makes way more sense than using a bottle. Again, babies learn to breastfeed by nursing on the breast. So anything that gets baby on the breast is likely a plus. Just keep pumping as shields can mess with supply.

And the typical recommendation when there are latch issues is to avoid pacifiers or use them only in emergencies. You want to encourage baby to do ALL nursing at the breast, including comfort nursing, which is what pacifiers are a substitute for. In fact, often comfort nursing is what will bring baby back to the breast.

Ok some more articles that may help: Laid back nursing: http://www.llli.org/docs/00000000000...astfeeding.pdf
laid back video (look at the early cues when baby is still asleep! : http://www.biologicalnurturing.com/video/bn3clip.html
encouraging baby back to the breast: http://kellymom.com/bf/concerns/child/back-to-breast/
Feeding cues: http://www.llli.org/docs/00000000000...eding_cues.pdf

Diaper log: (frequent poops help you know baby is getting enough) http://www.llli.org/docs/00000000000...diaper_log.pdf

Lactation aids: (such as sns) http://www.nbci.ca/index.php?option=...tion&Itemid=17

This page of videos shows one with a baby using a lactation aid: http://www.nbci.ca/index.php?option=...id=6&Itemid=13

[@llli*djs.mom]

WOAH!
So, in summation..pacifiers and bottles won't mess your kid up, bottle feed her LOTS of ebm to get her weight/strength up, keep putting her to breast every chance you get, see a Lactation Consultant, and understand that you aren't alone in these specific frustrations.

Nipple preference is real and should always be considered. What works for one mother will not always work for another. Obviously pumped milk vs formula will be LESS detrimental to supply. But even if you need to bottle feed in the early days you should always be aware of bottle preference and Be CAUTIOUS in regards to trying to prevent it. New babies, Especially babies that are STRUGGLING with milk transfer need to PRACTICE breastfeeding as often as possible. Being put to the breast as often as possible. 8times a day is actually the MINIMUM amount of time you want to pump. Because that would be a low number of times during a 24hour period a child would eat. I would try to up your pumping sessions so that you are upping the amount of milk you are making so that you can at least be supplementing with all your own milk. Doing this will cause your child to go shorter periods of time between feeds. And then if you are always starting at the breast (which it sounds like you are) you will be getting MORE opportunities in a 24hour period to let her practice being at the breast. Sometimes it's simply a matter of their mouth growing to the point where they can effectively latch. But they need to be given as much opportunity on a daily basis to do the work.