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Thread: Trouble latching

  1. #1
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    Jul 2012
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    Default Trouble latching

    Hello,

    My son is 3 weeks old, and we are still having trouble getting our latch down. I went to see my IBCLC today, and she told me the latch was pretty bad, but couldn't get a better latch herself. We spent 40 minutes trying to latch him better, but ultimately we couldn't get it to work. She says that my nipples may just be too large for his tiny mouth (since we couldn't get much else in his mouth), and that I may just need to wait until he is bigger to get a good latch.

    We did a pre and post weight check, and he's barely taking 1/4 ounce over a 40 minute nursing session, so he just isn't transferring the milk well at all.

    I have a great supply as I've been pumping after every feeding since he was born. If I pump exclusively, I will get about 30 oz in a 24 hour period.

    Right now, I give him EBM after each feeding, and he usually eats 2-3 oz.

    I was hoping someone might have some experience with this, and could give me some guidance/support.

    Thank you.

  2. #2
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    Default Re: Trouble latching

    I don't have experience with this particular issue personally, but I did recently work with a mom who has huge nipples and a new baby with a tight, clamping latch, ouch and ouch. Then she got thrush on top of that! But she kept at it and is now doing great and nursing pain free for some time now.

    Here is what helped her: 1) Laid back positioning and encouraging more or less self attachment. Also since baby was never going to get a wide enough gape for those nipples, this mom found that taking baby off and on constantly to try to get a good latch did no good and caused more injury & frustration. Instead she would gently push more of her breast tissue into baby’s mouth after baby latched.
    2) Nursing very frequently, at very earliest cues and also offering when baby was not cuing, as this baby was so voracious she would chomp on there like a barracuda if she was the least bit hungry.
    3) Being VERY proactive with healing her nipples-she used lanolin and APNO I believe, coconut oil is also being suggested more and more as a help to sore nipples.

    Are you nursing now AND pumping or just exclusively pumping & supplementing? I would encourage you to keep nursing if you can. Damaged nipples can heal while moms work on the latch issues. On the other hand, some moms find they do better to pump only for a few days to heal.

    That is a distressing milk transfer but one before and after weight check does not tell you much in my opinion. It's just a snapshot of that one session.

    You are pumping plenty so that is great. Keeping up you supply is very key.

    How are you giving baby the supplemental feedings? A lactation aid may be out since latch is so painful, but there are other ways to supplement that may help lessen nipple/flow confusion. You also may want to consider supplementing first and then letting baby finish at the breast.

    Did your LC check for tongue tie or lip tie?

    More info:

    Laid back: (Adjust your posture as needed, no need to lay so far back) http://www.llli.org/docs/00000000000...astfeeding.pdf and http://www.biologicalnurturing.com/ (be sure to watch the short vide.)

    Feeding cues: http://www.llli.org/docs/00000000000...eding_cues.pdf

    Bottle feeding the breastfed baby: http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Alternatives to bottles: http://www.askdrsears.com/topics/bre...atives-bottles

  3. #3
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    Default Re: Trouble latching

    I am pumping and trying to nurse, but he has developed a nipple preference in the last 24 hours. My IBCLC had me try using a nipple shield to see if that would help, and now he won't latch without it (I've been using it for almost a week). We were also supplementing with the bottle because it takes him almost an hour to eat 1 ounce with the SNS. I switched back to the SNS last night (I was using the bottle exclusively for almost a week), but we're feeding almost constantly for two hours before he drifts off to sleep, and then he's up 10 minutes later hungry. I'm trying to feed him with the bottle after that while he's sitting up so he still has to work for it, but I'm not sure how effective all of these efforts are. He still clearly prefers the bottle.
    I will try watching the video and doing the laid back nursing. We tried a couple of times yesterday, and I failed at it miserably. I think that's where his frustration with the breast started. My nipples point down, so it was difficult to get him and my breast positioned so that he could latch. My LC did check for tongue tie, and said it looked fine. I'm not sure if she checked for lip tie. I've never heard of that before, but I am assume if she checked for tongue tie, then she probably checked for other issues as well?
    Thank you for your reply. This is becoming so overwhelming so quickly. I'm just so sad that I can't seem to get it to work. I am terrible at helping him latch, no matter how many videos I watch or books I read. It is definitely an art, and not one I am proficient at in the slightest.

  4. #4
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    Default Re: Trouble latching

    First of all, congrats on your little guy! I have a daughter, but I do hear that boys looove their mama!
    My personal experience was somewhat similar, although I didn't receive much help with mine and DD's latch except at the hospital and from reading these forums! My little girl was born at 35 weeks, and everything was fine physically with her(thank goodness!), but she was little bitty! and I have LARGE nipples! So, we used a nipple shield for about two weeks and then one day I took it off in the middle of a session and she re-latched perfectly without it. Needless to say, I couldn't get her to latch without it again for another 3-4 days, but I just kept envisioning that momentary breakthrough and she finally decided to just get on with it!
    My first-time mommy opinion(so others may have better-experienced suggestions) is to keep at it with the shield for now. My DD also nursed for what seemed like hours on end & the few times I wasn't too delirious to notice the clock, those sessions did last for at least 45 minutes at that age. I watched a lot of tv those first few weeks...
    Good luck! And stick with it! Once your little guy gets a little bigger, you having bigger nipples will probably make them easier for him to find in the dark while you're half asleep and he's hungry in the middle of the night. (Don't know if you're co-sleeping, but we are & it puts us both to sleep during what might turn into an hour long comfort nursing session. I think DD is comforted just as well by laying next to me sometimes!)

  5. #5
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    Default Re: Trouble latching

    I am sorry you are still struggling, but glad you are still working on it!

    I am pumping and trying to nurse, but he has developed a nipple preference in the last 24 hours.
    Nipple preference? For the bottle, nipple shield? What do you mean?

    Because no baby on earth ‘prefers” a bottle to momma’s warm breast. Don’t undermine yourself thinking that. Rather, all healthy newborns have an innate need to suckle pretty much all waking moments. They may even suckle in their sleep. And they will suckle whatever they are given to suckle. So many a mom has convinced herself her baby prefers a bottle becaue the baby wants to suckle more after nursing (normal) but instead of offering the breast again, instead offers a bottle, which of course the baby takes even if he has gotten plenty of milk, as he needs to suckle more. Also if a baby has difficulty transferring milk at the breast but can drink easily from the bottle, or even in cases where a baby can transfer milk fine at the breast but the milk comes more quickly from the bottle (as it will if paced bottle feeding is not used) they may develop what some call a “flow preference,” which just means the baby is not dumb and figures out that the milk comes more easily from the bottle. This can be a very tricky thing to navigate when supplements are actually needed, and this is one reason why, in such cases, it is strongly recommended that baby get the supplement first and then be allowed to finish at the breast.

    My IBCLC had me try using a nipple shield to see if that would help, and now he won't latch without it (I've been using it for almost a week).
    I have never understood the use of a nipple shield for the situation when the nipple is too large. I agree with pp, if the shield allows baby to suckle at the breast when he otherwise would not, then keep using it…but a nipple shield makes the nipple even LARGER, doesn’t it? So I do not understand how this helps if that is the problem. Also nipple shields can cause injury on large nipples because baby can suck the nipple tissue right through the holes in the tip and cause pain and damage. So look out for that.

    We were also supplementing with the bottle because it takes him almost an hour to eat 1 ounce with the SNS. I switched back to the SNS last night (I was using the bottle exclusively for almost a week), but we're feeding almost constantly for two hours before he drifts off to sleep, and then he's up 10 minutes later hungry. I'm trying to feed him with the bottle after that while he's sitting up so he still has to work for it, but I'm not sure how effective all of these efforts are. He still clearly prefers the bottle.
    See what I said above about bottle preference. Wanting to nurse pretty much constantly is normal, but of course you want to make sure baby is getting enough. So, how much IS baby taking from the sns in 2 hours?

    I will try watching the video and doing the laid back nursing. We tried a couple of times yesterday, and I failed at it miserably. I think that's where his frustration with the breast started. My nipples point down, so it was difficult to get him and my breast positioned so that he could latch. My LC did check for tongue tie, and said it looked fine. I'm not sure if she checked for lip tie. I've never heard of that before, but I am assume if she checked for tongue tie, then she probably checked for other issues as well?
    Thank you for your reply. This is becoming so overwhelming so quickly. I'm just so sad that I can't seem to get it to work. I am terrible at helping him latch, no matter how many videos I watch or books I read. It is definitely an art, and not one I am proficient at in the slightest.
    I suggest you keep meeting with your LC, another LC, or a local LLL Leader. someone who can sit and watch you nurse. You never know who will make the suggestion that turns things around. Mostly, just keep relaxing with baby by yourself and try figuring things out. Videos and pictures are just a jumping off point, to give you ideas but not as step by step instructions. Many mosm find they need to work with their own body and baby when both are as relaxed as possible to see what will work best for them, as unique individuals. For example, if you are trying to do laid back just like the mom in the video, that may not work, as all moms have different body shapes. But if you, like many moms, have breasts that point down when you are sitting upright or standing, then in a laid back position, they would point more up or out to the side, it seems to me-and in any case, it is fine to sit up more or less and to still shape your breast for baby in any position including laid back.

  6. #6
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    Default Re: Trouble latching

    I thought he had a nipple preference because he wouldn't latch onto my breast without the nipple shield. I did get him to latch on yesterday evening without the nipple shield, but I have to have the SNS attached. After feeding for an hour with the SNS, he has had about 1/2 an ounce. Is that amount okay, or is he still too sleepy when nursing? He isn't sleepy with a bottle, although I don't always use the paced bottle feeding when giving him a bottle.

    He still acts as though he isn't getting any milk when I breastfeed him even after I use the pump to get the milk flowing. He pulls off, and starts crying. I did try the laid back nursing again, and got him latched on, but it was just as shallow as when we are using the football hold or cross cradle hold. I took him off, and had him try again a few times, but it was still painful each time, and he wasn't extracting any milk (he never swallows until I start sing the SNS).
    I am feeling discouraged because I do not have the greatest support system. Dh is helpful with the other kids (5 and 2), but he feels like we should just start formula feeding because it will be less stress on my and the baby. My mom doesn't understand why I need to breastfeed since I turned out fine, and my IBCLC isn't really all that up to date with her information. I called my local LLL leader, and she gave me the number for another IBCLC, since the one she was going to refer me to is the one I am currently using. However, the new one lives almost an hour away, and charges a pretty hefty fee to see her.

    I will try giving him his supplement before breastfeeding, and allow him to finish at the breast with the SNS (if I need it).

    At this point, am I basically just waiting for him to grow, or could it be that I am just that terrible at getting a good latch (I feel like it could totally be this. lol)? In fact, he had his circumcision today, and I saw him open wider than I have ever seen him open when I was holding prior to the procedure. Perhaps, at home he knows that it's time to eat, and if I take any time at all, he starts to get frustrated? Because he has never given me as much time to feed him or a moth that wide before when I'm actually sitting down to feed him.

    It's so frustrating to have the supply he needs, but not be able to get a good latch. Each night, I pray that I am just going to see him start swallowing at the breast so I can enjoy breastfeeding.

    Thanks again for all of your help. I really appreciate you taking an interest in me. :0)

  7. #7
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    Default Re: Trouble latching

    Oh! And, she had me start using the nipple shield because I couldn't get him latched onto the SNS correctly. The shield made it easier to get the latch down. I did get him latched on a couple of times yesterday with the SNS and without the shield though (although, it definitely is tough).

  8. #8
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    Default Re: Trouble latching

    It sounds like the main issue is super slow milk transfer, which may or may not be related to shallow latch, because some babies get plenty of milk even with a shallow latch. I am not up enough on the sns or what could be happening there but that does seem like really slow milk transfer.
    I am thinking you need to see someone who is up on suck training and on identifying physical barriers to nursing to figure out why baby is unable to suckle effectively when you clearly are able to make enough milk. This (usually) means seeing an IBCLC who has this kind of experience, which you can find out by asking the person on the phone what her experience is. An IBCLC is required to keep up her education and is retested every 5 years (I think.) Even so, not all IBCLCs even are going to have the experience you need or be the right person for YOU to see. You need someone you have confidence in, so I always suggest moms call at least three IBCLCs prior to hiring one (of course this will depend on the availability of IBCLCs where you live.) I also have heard of an IBCLC who uses Skype to see moms, or did anyway. I do not know about where you live but in Northern California where I live an initial consult with an IBCLC ranges from about $75-$125, (long range transportation not included if doing a home visit) with follow ups (if needed) being typically less.

    If you crunch the numbers, even adding the cost of the pump and sns and several IBCLC appts, it would still probably be cheaper than the cost of formula for a year. With my oldest, we had to rent a pump for 8 weeks and I had three IBCLC visits before we got it all figured out.

    Maybe there is someone closer to you your LLL leader does no know about. Try www.ilca.org to look up IBCLC's for yourself. You could also ask the Leader you talked to if she knows of any Leaders who do home visits, but this situation may well be beyond the expertise of a volunteer Leader.

    As far as what your husband and mom say-I believe very strongly that whether or not a mother keeps on trying to nurse her child despite difficulties should be the decision of the mother. Input from the father is important as well, as he is more or less directly affected. But anyone else? idk. Here is the thing- Either you believe the mountain of evidence, cited in the child feeding recommendations of every child health organization of any repute on earth, that shows the inferiority in health outcomes of formula and bottles to nursing at the breast, or you do not. My whole family of 5 siblings were formula fed and we all turned out ‘fine’ as well, except the two of us who had childhood obesity, the three of us with severe GERD, the two with food allergies and the one who had severe enough ear infections as a child that she has permanent hearing loss, all that may have been avoided if my mother had been supported in breastfeeding us when she wanted to. But the worst of it was, that my poor mother, who was undermined by terrible medical advice in the early days with my eldest brother, had regrets she did not nurse us for her whole life. The last thing you need at this point is to be defending your choices. You certainly ARE having big challenges, and if YOU are done, and ready to move on, you will know it and have peace with that decision. In my experience, moms who feel they have done all they can are able to move on from nursing without the regret that so often plagues moms who were not supported in their desire to nurse.
    Last edited by @llli*lllmeg; July 17th, 2012 at 07:29 PM.

  9. #9
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    Default Re: Trouble latching

    Thank you again. That website is great. There are actually quite a few around me. I will call a few of them, and find one who has had some experience with this, and can help me out.

    Btw, I am also from Northern California, so it's nice to know how much the consult should cost. Thank you, again.

  10. #10
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    Default Re: Trouble latching

    Quote Originally Posted by @llli*littlemissmama View Post
    Thank you again. That website is great. There are actually quite a few around me. I will call a few of them, and find one who has had some experience with this, and can help me out.

    Btw, I am also from Northern California, so it's nice to know how much the consult should cost. Thank you, again.
    I am near Sacramento, Bay Area may well be more for obvious reasons. Feel free to PM me if you would like to chat on the phone or would like me to look more into local resources for you.

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