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Thread: Pain & milk transfer issues

  1. #1
    Join Date
    Mar 2014
    Location
    KY
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    Default Pain & milk transfer issues

    My son is 8 weeks old, and he is our first child. He was born via emergency c-section on his due date and was a tiny 6lbs 3oz, which was likely due to the fact that he was no longer getting the nourishment he needed from the placenta. He was taken to the NICU for several days due to low glucose issues. In the NICU, we supplemented nursing with my pumped milk in bottles, as it was necessary to ensure that he was getting plenty of milk to boost his glucose levels. The NICU nurses suggested that I use a nipple shield to help his latch so that's what we did.

    Once we were discharged from the hospital, nursing seemed to go fine. We did not supplement. He would nurse for what seemed like a long time (he would constantly fall asleep), but he had sufficient (we thought) diaper outputs. At his 2 week appointment, he was back up to his birth weight (he had dropped to 5lb 11oz at the hospital). However, at his 4 week appointment, he had only gained 3oz (he was 6lb 5.5oz). The doctor advised us to supplement but wanted us to supplement with formula instead of my breastmilk. We reluctantly complied, and he gained 19oz during the next week. The doctor then let us supplement with my breastmilk. His weight gain has been fine as we've been supplementing with my milk, but I would like to get back to EBP. It is exhausting to nurse, feed, and pump all of the time, and I hate being tied to my pump.

    The whole situation was really discouraging...based on how much I was able to pump, I didn't think I had a supply issue, but somehow, my baby was not getting enough milk from me. I thought that it might be the nipple shield so I visited a lactation consultant, and we worked on latch without the shield. He was able to latch on and the consultant thought his latch looked good, but my nipple looked compressed (with a crease in the middle), and he only got about 2oz of milk after 15-20 minutes of nursing on each side. The next day I was experiencing almost unbearable pain when he latches. He also screams when I take him off the breast so I know he's not satisifed. We visited the lactation consultant again, and we discussed a possible tongue tie. The consultant recommended an ENT, so we took him there last week, and the doctor indicated that he didn't really see a problem with the frenulum...he said he didn't think a correction would make much of a difference. So now I feel like we're back at square one. I didn't necessarily want something to be wrong with his tongue, but I thought it might be our answer. I am stubborn and do not want to give up on breastfeeding, but I am really starting to dread it.

    On top of all of this, I suspect I might have some sort of infection. I would sometimes characterize my pain as burning, and it occurs after he nurses, but I thought it was due to my nipple being compressed. I'm pretty sure I had an oncoming case of mastitis the other night, but I may have caught it in time. The left side of my left breast became hard and very sore. Even though I massaged as much as possible while pumping, the hardness didn't seem to go away, and then I felt sick all of a sudden. I had a sore throat, low grade fever, and felt like I could pass out. I took some ibuprofen and kept aggressively massaging that area during pumping. The next morning, my breast was finally soft after pumping, my temp was back to normal, and I felt so much better.

    Sorry for the extensive post, but I could really use some advice and encouragement!

  2. #2
    Join Date
    May 2006
    Posts
    21,369

    Default Re: Pain & milk transfer issues

    Mama, I have to run and take my older kid to her violin lesson. But I just want to say you are doing great, you will get help here, and welcome to the forum! Be back later with much, much more. Until then, just keep on keepin' on!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    May 2006
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    Default Re: Pain & milk transfer issues

    Okay, I'm back. I've been thinking about your post all throughout violin lesson and dinner afterwards!

    So, first question: how are you feeling? Physically, I mean, aside from the breast issues. Are you recovering okay? Feeling strong? Getting enough help around the house? Not trying to do much more than take care of baby and yourself? Because I think that's all you should be doing right now. Regaining your strength and focusing on nursing!

    My guess is that the reason you saw such low gain between weeks 2 and 4 is that your baby was so sleepy, so small, and nursing with a shield. Small, relatively weak babies take a long time to nurse, find it generally harder to transfer milk, and tend to be more sleepy. Sleepy babies can fall asleep before getting a full meal, and stay asleep longer than more alert babies. Shields can impede milk transfer and lead to lower intake, and when intake is low supply can decrease.

    Second question: during the first 4 weeks, about how often did your baby nurse? Was he sleeping long stretches? Being swaddled or petting a pacifier?

    Third question: are you sure your baby was actually full-term? When a term baby is born with a low weight and is so sleepy, I am always curious to know if mom thinks the doc's little wheel was off!

    Now, when your baby showed up at the 4 week visit, your doc made a huge error (IMO) by telling you to supplement with formula rather than breastmilk. Breastmilk actually has more calories per oz than formula, and when there is a problem with weight gain the reason is almost always because the baby isn't getting enough breastmilk, not because the milk he's getting is lacking in calories. Also, it's vital that when low supply is suspected, the mom use the pump to make up for any stimulation the baby isn't giving her. But that's immaterial now, since it sounds like your baby was on an all-breastmilk diet by week 5, which is just terrific! You must have done some hard work with the pump to make that happen.

    It was really smart of you to try to ditch the shield. The fact that the baby can get 2 oz when nursing without the shield is encouraging, since a typical feeding at the breast is just 2-4 oz at a time. (Breastfed babies are designed to take in small amounts of milk quite frequently.) But it sounds like nursing without the shield caused you a huge amount of pain, which isn't good. Seeing creased, painful nipples is very suggestive of latch issues stemming from tongue tie, though they can also happen when the baby is very small.

    I'd love for you to go back and see the IBCLC, for another session with positioning. Ask about reclined nursing positions, the football hold, the sandwich technique, and the asymmetrical latch technique. They are all helpful in getting a tiny little mouth to latch on more deeply. I'd also love for you to see a third doc about the tongue tie. Maybe a pediatric dentist? Make sure the doc is familiar with lip ties, tongue ties, and posterior tongue ties.

    The burning pain you're experiencing are nursing is suggestive of 3 possibilities, all of which are difficult to separate out. The first is vasospasm, which is a sudden constriction of blood flow in the nipple (or other extremity), often stemming from compression of the nipple due to a shallow latch. The second is thrush, which is a yeast infection of the nipple and/or breast and/or baby's oral cavity. Thrush can cause a burning pain, and often follows a course of antibiotics, which are almost always given after a c-section and to babies who spend time in the NICU. The third possibility is bacterial infection. This is another strong possibility based on the you experienced the other night (sore, hard breast, fever, malaise).

    If it were me, here's what I would do about the pain:
    1. See the IBCLC and the dentist (or other specialist), as mentioned above, for help with positioning and for another evaluation of the tongue/lip tie possibility.
    2. Treat with heat. Keep a hot water bottle or heating pad handy after feedings, and slap it on as soon as the pain starts. Vasospasms tend to abate when heat is applied. If heat makes the pain go away, this is probably vasospasm and not thrush or bacteria.
    3. Read up on thrush: http://kellymom.com/bf/concerns/child/thrush-resources/. In particular, look for the following symptoms: oral thrush or diaper yeast rash in baby (pediatrician should be able to diagnose either of these), vaginal yeast infection in mom, nipples appearing more red or shiny than usual, flaking or dry-looking skin on the nipples/areolas.
    4. Adopt thrush-fighting practices. Try to practice good breast hygeine. Wash bras, towels, and shirts on hot and change them daily. Cut simple starches and sugars from your diet. Eat some probiotic foods (yogurt, Kim chi, sauerkraut, etc.)
    5. Stay alert for a return of the mastitis symptoms you had the other day. If they return or worsen, you may need a course of antibiotics.

    I am really sorry you're having such a rough time. But I don't think this is going to last forever. My guess is that the root problem here is a latch issue caused by your baby being so small and young and perhaps having a tongue tie. The best thing about this sort of problem is that it's almost always something the baby outgrows. The baby's mouth grows, he can latch on deeper, and when he gets to that point the pain and nipple trauma ends. So hang in there, keep on pumping the supplements, and keep on occasionally offering the breast bare of the shield. One day your baby should be big enough to latch without hurting you.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  4. #4
    Join Date
    Mar 2014
    Location
    KY
    Posts
    3

    Default Re: Pain & milk transfer issues

    Thank you so much for getting back to me! I appreciate all of the information!

    First question: I am feeling okay - just tired! My husband helps a lot, but I don't like to put too much on him because he has a job in which he cannot go to work sleepy (he's an air traffic controller). I just try to let some things go around the house that really aren't that important.

    Second question: During the first 4 weeks and even now, he feeds every 3 hours or sooner if he gets hungry sooner. If he was not awake, we would wake him to eat so he didn't necessarily sleep long stretches. The only exception would be at night...I would set 3 alarms to get up and feed him. Sometimes, I would be so exhausted, I would sleep through all 3 alarms and would wake up at the 4-5 hour mark feeling super guilty. We put him in a swaddlesack at night. He does take a pacifier, but he didn't really take one much the first few weeks because we had the soothies, and he had trouble keeping them in his mouth. We have since switched to the mam pacifiers, and he is able to hold onto them better.

    Third question: I'm not sure the due date was correct, but I actually thought it was sooner than the doctor determined (based on timing of last period, pregnancy test, etc). The doctor determined the due date based on measurements taken during the first ultrasound. We had a doctors appointment on our due date since our LO hadn't arrived yet. The ultrasound showed that the blood wasn't coasting through the umbilical cord as it should anymore (so he wasn't getting nourishment from the placenta). We're not sure how long this was going on, but I think his growth was stunted by the lack of nourishment. In layman's terms, the doctor said that it meant that the placenta was old, and he needed to come out that day. They were going to induce, but once I was hooked up to the monitors, they discovered that his heart rate dropped slightly with each contraction so a c-section asap was best.

    Regarding the formula, I questioned the doctor initially, and he said that he knows exactly how many calories the baby gets from an ounce of formula so that's why he wanted us to supplement with it. He did indicate that he needed to make sure that it wasn't an issue with the calories in my milk, which definitely made me feel inadequate. When we went back in for a weight check after the week of formula supplementation (when he'd gained 19 ounces), the doctor told us to just keep doing the same thing. I asked if we could supplement with breastmilk instead of formula, and he was fine with it at that point. If not, I was going to consider switching doctors! I was not okay with supplementing with formula, but I was so worried about his weight gain that I felt I should follow the doctor's orders. I wish I'd had the confidence to question a little more or even follow my instincts and supplement with breastmilk regardless of the doctor's orders.

    I failed to mention this before, but another reason I wanted to ditch the shield was because he sucks so hard that he actually pulls my nipple through the holes in the shield...even after I switched shield sizes. Besides being really unpleasant, that also kept him from getting as much milk when we used it (because my nipple was actually blocking the holes).

    We have another appointment at the lactation clinic this Friday so I will mention those positions to the IBCLC. She had also recommended a pediatric dentist along with the ENT so we can check and see how familiar they are with the tie issues. I'm glad you think another opinion is a good idea...I was definitely considering it before.

    I had read up on the different pain possibilities you mentioned. I will definitely try some of your suggestions and keep an eye out for any specific symptons.

    It's encouraging to think that maybe he will just grow out of this latch issue. I hadn't really considered that, but it gives me hope!

  5. #5
    Join Date
    May 2006
    Posts
    21,369

    Default Re: Pain & milk transfer issues

    How are things going at this point, mama?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6
    Join Date
    Mar 2014
    Location
    KY
    Posts
    3

    Default Re: Pain & milk transfer issues

    Thanks for checking back up on us. Not much has changed. It is still painful when he nurses, and he does not seem satisfied afterwards. We went to see the lactation consultant again, & she took another look at his tongue. Now she thinks that it's fine. We mentioned it to our pediatrician, and he checked it out and thought it was fine, too. He also indicated that the ENT that we saw previously is probably the best in town.

    I really think it's an issue with his upper lip. Is that possible? It just seems like his upper lip is tight and doesn't flange out like it should. It's also noticeable when he takes a bottle so I try to correct it by pulling his lip out, but it's hard to do (and even harder to do when he nurses).

    We haven't nursed in about a week because I've been hesitant about it. I hate the pain and the way he screams afterwards (and we usually end up giving him a bottle). The lactation consultant said she's stumped. She can't figure out why it hurts & he doesn't get enough. She said that if I was her daughter, and she was just giving me advice, she would basically just tell me to give up on trying to nurse & just keep pumping. But I don't want to give up yet. I really want this to work. Any suggestions would be great. I only have 2 1/2 more weeks before I go back to work.

  7. #7
    Join Date
    Jun 2009
    Posts
    5,925

    Default Re: Pain & milk transfer issues

    I really think it's an issue with his upper lip. Is that possible?
    Yes. Have you looked into the possibility of lip tie? Your IBCLC should know about this at least as a possibility. Unfortunately, this is even less recognized in the greater medical community than tongue tie as a barrier to comfortable nursing. I think Lawrence Kotlaw may have info... unfortunately there is not much out there generally on lip tie, but it is certainly a possibility. I think there is a facebook support group that may be able to point to more info??? I am not on fb.

    Can you talk to another lactation consultant? If this one is out of ideas, but you like her, can you ask her if she is able to consult with a colleague for a fresh perspective? IMO professionals of all kinds should have a network they can go to when they are stumped.

    Reading your history though, (I am sorry but I missed your posts before, but mommal said everything I would have) I am confused. When did the pain start? Was thrush or a bacterial infection of the nipple (different than mastitis) ruled out? Does it not hurt to pump, or not hurt anymore, except when you nurse?

  8. #8
    Join Date
    May 2006
    Posts
    21,369

    Default Re: Pain & milk transfer issues

    with LLLMeg. Lip ties are less well-recognized than tongue ties. But you know who is sometimes up on them? Dentists. A tight upper frenum can cause a gap to develop between the upper incisors, or even cause the child to need braces due to the frenum shoving the upper teeth apart and pressing them against their neighbors. So I'd go and see a dentist, preferably a pediatric dentist or orthodontist.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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