Shallow, painful latch with 34-weeker who just reached term

[@llli*sanyabee]

I'm not doing much to care for my nipples. My doctor prescribed me some creams, because I thought I might have some sort of infection. One is for yeast, one for bacterial infection and one is for inflammation, I believe. I try to put them on in between pumping and nursing sessions. I use lanolin when I'm pumping to reduce the friction.

[@llli*lllmeg]

I tried every size that Medela makes and all of them seemed to do more or less the same thing and cause me to be a bit swollen on the right side. I've given up on finding a solution. My breast must just be strange. Once lactation consultant suggested trying a PJ's Comfort pump, which has soft silicone flanges. She said it might be more comfortable for me. Right now I'm looking into getting one through my insurance.

Did you look into pumpin pals flanges? http://www.pumpinpal.com/ you use them with the pump you already have I think. If you can get a pjs great, but the pumpin pals are a much more affordable option and have a money back guarantee if they don’t help.
Until you can get baby nursing exclusively, it is a pretty serious issue if your pump is injuring you.

I have seen lactation consultants through the Swedish Hospital Lytle Center here in Seattle. I don't know if any of them were board certified. I had a couple 1.5 hour long consultations and they helped me nurse. But like I said before, when I get home I usually can't figure out how to do what they showed me in the appointment. It just doesn't work as well and I get quite frustrated. Noone has looked in my baby's mouth. One lactation consultant stuck her finger in his mouth and felt him suck. She said he had a tight such and he would occasionally move his tongue from where it should be and sort of chomp down on her finger. I think that's what he does to my nipple.

So it does not sound as if anyone has assessed your baby for tongue tie? Have you researched tt yourself? I would suggest start with the website of Lawrence Kotlaw, pediatric dentist in Albany NY.

What about a private home visit with an IBCLC? This might help you “recreate” what happens at the sessions. You can also call your local LLL and see if any volunteer Leader in Seattle does home visits, which would be free.

Baby is held by me part of the time and sometimes he is in a co-sleeper. It's hard to be with him all the time when I have to pump and eat, etc. I check on him constantly when I'm not with him. He's never alone for more than five minutes or so. I tend to feed him on a schedule of every three hours, but I feed him sooner if he is showing clear signs of hunger. This schedule has stuck from when he was in the NICU. I know it's not natural for a baby to be on a schedule, but it seems that all of us are just used to it (including baby, I think).

I have not been doing skin to skin time. Again, I find it a bit complicated when I have to get up and pump constantly. And I don't want him in just a diaper if he's not doing skin to skin and I don't want to be constantly taking his clothes on and off, because I don't want to disturb him when he's sleeping. Should I be doing skin to skin time? Do you have suggestions of how to make it work?

Baby is given a pacifier quite often. He was given a pacifier in the NICU and we've been giving it to him ever since. Baby is rarely swaddled.

Babies tend to show the subtle cueing signs we want to see that are normal and lead to normal nursing frequency (even in sleep) when held by mom. If you don't want to do skin to skin, you can try just keep baby on you as lightly dressed as is comfortable for you both, but with 'easy access" -a shirt you can quickly pull up or open to nurse when baby cues.

Just being laid back while holding baby might be enough. If you are in the laid back position, this has been shown to facilitate better latch and more frequent cueing even when mom and baby are not doing s2s, but there is no denying the research on S2S and the way it helps facilitate normal nursing and weight gain is also quite compelling. (And now shown to help even with ‘older’ babies not only brand newborns) Either is fine, you have to do what works for you, but it really might help to hold baby more in general however you can figure that out. If you are worried about baby being cold when you have to put baby down to pump, what about a baby blanket or turning up the heat if you can. Also have you ever tried a sling or wrap baby carrier? That way baby is right on you getting that close to mom time even as you get yourself something to eat or take a walk or have coffee with a friend. Some moms can even hold baby in a ring sling and pump at the same time. Make sure you get a carrier that is correctly made and know the guidelines for safe sling use. It's not complicated but does take a little practice before you feel confident.

Pacifier overuse can be very harmful to breastfeeding. Babies need to suckle a lot and that should happen at the breast as much as possible. So the pacifier competes with the breast, leads to longer than normal sleep stretches and less cueing, can lead to poor gain, and may cause bad suck habits. I strongly suggest cutting back on pacifier use.

Seattle appears to have more than one local lll group. Have you called a local Leader or gone to a meeting?

[@llli*lllmeg]

ps the

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[@llli*lllmeg]

some nipple care articles, try what makes sense to you and stop if it hurts or makes things worse! http://cwgenna.com/nhygiene.html and http://kellymom.com/bf/concerns/mother/nipplehealing/

I use lanolin when I'm pumping to reduce the friction.

if this is working for you great, but I think lanolin can be too sticky for this job. The Womanly Art of Breastfeeding suggests olive oil to lube up the flange. Lanolin applied very frequently to the nipples does promote healing via moist wound healing when applied to the nipples directly, although I think it is not reccomended if mom has thrush.

the doctor prescribed APNO it sounds like? http://www.breastfeedinginc.ca/conte...ename=doc-APNO many moms have found this helpful.

[@llli*lllmeg]

Any thoughts?? Is it possible for baby to suddenly just figure out how to latch correctly on his own??

yes. And maybe you were to tired to worry and overthink things and instinct took over for you both. It is also posssible baby nursed less furiously because baby had just eaten, which is again why I suggest really frequent nursing helps with almost everything. A baby who is ravenous when baby comes to the breast is almost surely going to have more difficulty with latch. This pain free session is a very good sign. If it happened once, it can happen again.

[@llli*sanyabee]

The Womanly Art of Breastfeeding suggests olive oil to lube up the flange

Is olive oil safe for consumption by baby? I tried using olive oil just now and it felt better than the lanolin, but I may have applied too much and a little bit got in the milk.

[@llli*lllmeg]

Yes in the scant amounts that might get into the pumped milk from using it as a flange lubricant, olive oil would be fine for baby. Olive oil is an edible oil and no more objectionable than the various vegetable oils found in infant formula. It does not have to be olive oil, but you want to avoid a typical allergen like peanut or corn oil.

Here is the exact quote from the Womanly Art of Breastfeeding, (8th edition -2010) page 298: "you can always use a little edible oil (such as olive oil, but not possible allergens such as peanut or corn oil) to cut down on the friction, but if the flange really does not fits the way it should, you won't need any lubrication."

Speaking of oil, some moms have found coconut oil helpful with healing sore and/or injured nipples.

[@llli*sanyabee]

Hello again. I'm here with an update and some new questions!

A couple days ago I saw an occupational therapist/lactation consultant at Seattle Children's Hospital. She looked at my son's mouth and said she didn't think he was tongue tied, but that he has a very strong and tight suck and that he has bad habits from using the bottle for so long. She taught me some exercises to try to loosen up his jaw and get him to open his mouth wider (massaging the jaw in a downward motion, pulling down on his chin while opening my mouth wide and saying "ahhh", and sticking my thumb in his mouth and pushing hard down on his jaw while he sucks). She told me to do these exercises with him 8-10 times per day. I've been finding it difficult to do them so often because he's either asleep or awake and feeding. When he wants to feed he gets really upset with me when I try to do the exercises, but I'm trying.

She told me to nurse him 3-4 times per day for now only on the left side (because the right side is so much more painful for me). She also showed me how to pace his bottle feeds and to feed him in a side-lying position.

Today I haven't really been following her advice. I rented a Medela baby weigh scale and breastfed him for the last three feeds. I weighed him to see how much he took in. I was ecstatic because he took so much. He took 4 ounces in about 20 minutes! At the next feed he took about 3 ounces in under 10 minutes, and an hour later he had 1.7 ounces. His latch was still a bit painful, although the last time I fed him it felt a bit better. I also end up with a lipstick shaped nipple at the end and the pain is a pinching that lasts through the whole feed. I had this idea that maybe I could try for the next couple of days to exclusively breastfeed on my left side. Maybe he'd have a better time learning to latch if I just did away with the bottles all together. What do you think?

I'm still pumping some on the right side, but I haven't pumped on my left side since I started nursing today. I have an oversupply and I figure he's doing a good job of getting the milk out anyways. Also, I've read that having an oversupply can contribute to a shallow latch and gumming of the nipple. When he's nursing he often seems quite overwhelmed during letdown and he fusses and often pulls off. Sometimes he even comes off and cries, which is a big deal, because my baby almost NEVER cries. Once it even seemed like he choked a little. If I got my supply under control, could this help with his latch? If I just stop pumping and have him nurse on the left side, would my supply regulate to meet his needs or is it more complicated to get an oversupply under control? I know it seems odd that I'm only breastfeeding on the left side. Honestly, I just don't even want to deal with the right side now. It just hurts. I would be willing to only nurse on my left breast and just let my right breast dry up. I've read that it is possible to feed a baby with only one breast. I don't care that they would be different sizes. I'm definitely making enough milk in my left breast alone to feed him.

Anyways, what do you think of my idea of exclusively nursing him on my left side for a few days? Would that be a mistake? Am I risking him giving me bloody nipples because his latch is shallow?? I'm just so tired of doing bottles and nursing and this process just seems so slow. I will continue to try to do the exercises with him to try to loosen his jaw. Please let me know what your expert opinion is on this matter. Please excuse the long and disorganized post. Thank you!

[@llli*mommal]

I rented a Medela baby weigh scale and breastfed him for the last three feeds. I weighed him to see how much he took in. I was ecstatic because he took so much. He took 4 ounces in about 20 minutes! At the next feed he took about 3 ounces in under 10 minutes, and an hour later he had 1.7 ounces.

That's terrific! The average intake at the breast is 2-4 oz. Of course the will be larger and smaller feedings in the mix, as well. But the fact that your baby is able to get such significant amounts is really reassuring that whatever his latch issues are, he's able to get his meals.

His latch was still a bit painful, although the last time I fed him it felt a bit better. I also end up with a lipstick shaped nipple at the end and the pain is a pinching that lasts through the whole feed. I had this idea that maybe I could try for the next couple of days to exclusively breastfeed on my left side. Maybe he'd have a better time learning to latch if I just did away with the bottles all together. What do you think?

I think it's a good idea. If it starts causing you trouble, you could always go back to what you were doing previously. If you do it, just watch the baby's diaper output- if that remains normal, he's getting enough to eat- and pump the right side. I know you're so distressed about the right that you're prepared to let it dry up, but I would encourage you not to do that yet for the following reasons. First, it's always nice to have a spare breast, just in case something happens to the one you prefer to use. And second, even though you are currently having difficulties, there's every reason to expect that things will improve with time, at which point you may want to start using both breasts.

If I got my supply under control, could this help with his latch?

It depends on what is causing his latch issue. If he's compressing the nipple in order to control a fast flow, then a less abundant supply and slower letdowns would reduce his need to clamp down on you. But if the latch issue stems from something like a tongue tie, or a small mouth, or a tight jaw, then changing your supply may not help much or even at all.

Before you decide to control your supply, I would give baby a little more time to manage it on his own, just by nursing more.

[@llli*sanyabee]

Hello again!! I'm here with an update and another question.

The other day I tried exclusively breastfeeding my baby on the left breast only. By the fourth feed my nipple was very sore and I was in tears. I could see that it could get a lot worse if I continued, so I started pumping again and have since only nursed him a couple times a day, interspersed by pumping.

I have noticed that when my breast is not as full, he can latch on a bit better. However, no matter what I do now, I always get some sort of lipstick shaped nipple. My question is: if I were to exclusively breastfeed him, even with the lipstick nipple going on (he does transfer a lot of milk!), do you think my nipples would just end up cracked and bloody? Or would they eventually toughen up? Of course I'd like to get his latched fix, but it seems that might take a lot of time and patience and I'd love to get him nursing exclusively as soon as possible. I've heard a lot of women experience soreness when they first start breastfeeding, so maybe I just need to go through that before it feels better. What do you think? Do women successfully nurse with lipstick nipple? Often time when he's nursing it just feels like a small pinch. It's really not a big deal. It's just that when I did it many times in a row I started getting really sore.