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Thread: I need help/suggestions/encouragement

  1. #1

    Default I need help/suggestions/encouragement

    New to the forums, as someone recently suggested I may find some help or suggestions here for my ongoing breastfeeding struggles. I'll try to be concise but it's a long story.

    41+2 - LO born after being induced due to high bp, laboring 18 hrs, getting stuck, and getting taken by c-section. Colustrum was in that day, but my milk didn't come in until 5 days later.

    First week (hospital)- LO lost quite a bit and had moderate jaundice on day 2. Pediatrician said we needed to supplement with formula to get her system moving and cure the jaundice. I started breastfeeding every 2 hours, followed by pumping and feeding by syringe, followed by supplementing with formula. We had some latch issues because LO wouldn't open her mouth wide enough it seemed, and I worked with LCs twice/day every day I was in the hospital. By the time we left she had a decent latch but I had some minor nipple damage. Left hospital on a Friday at 8 lbs 2 oz

    Week 1 checkup- 3 days later, at week 1 checkup, LO was still at 8 lbs 2 oz but pediatrician said I could/should stop supplementing with formula and just breastfeed on demand. Did that all week to an increasingly upset baby who screamed all the time and was doing more and more damage to my nipples causing open wounds and searing pain.

    Week 2 checkup- LO was at 8 lbs 3 oz, for some reason ped was not concerned. We told her that LO had been screaming 5-7 hours/day and she said some babies are just fussy (????????). Kept on with BF on demand. LO seemed to latch well and was always eager to breastfeed, but was causing tons of pain and damage.

    Week 3- Went to an outpatient LC who said I had far beyond the normal amount of nipple damage and when she weighed LO, she was only 8lb 5 oz. She said due to slow weight gain all the screaming was probably because she was just hungry all the time and I should spend the next week going back to breastfeeding, then pumping and feeding that, then supplementing with formula until LO was full. Also tried a nipple shield but due to the placement of my wounds it was just as painful as direct feeding. So that week I did as directed and LO was a much much much happier baby. But the bf/pump/supplement cycle was killing me. After BF I was generally pumping somewhere around 10-20ml combined from both breasts. No real change over the course of the week. LC also recommended all purpose nipple ointment, which I got an rx for from my midwife and started using that same day.

    Week 4- Went to LC appointment and LO was 9 lb 6 oz and LC was thrilled that LO was catching up. LC told me my supply probably just was what it was at that point and wasn't going to increase. At this point my pain with feeding had increase to the point that I was literally clenching and crying with every time LO latched. My wounds were not getting better and were actually getting a little worse. At this point LC said she suspected a posterior tongue tie. Told me to go see a specialist for that, and in the meantime stop BF LO until my wounds healed and just pump/bottle feed. I didn't want to stop BF entirely so I decided to just BF at night and pump during the day. Did that for a week and it worked fine, LO was happy to BF and to bottle feed. Was getting around 30-45ml or so most times I pumped.

    Week 5- Still BF at night and pumping during the day. Every day nipples would improve a little, every night they'd get ripped open again. Still using APNO. That Friday we had an appointment with a specialist who diagnosed LO with a posterior tongue tie and a lip tie. Got both clipped by laser. BF immediately after the procedure and she did okay(ish), but that night and through the weekend LO refused to latch onto the breast.

    Week 6- Monday AM LC said to take a 24 hour nursing break and try again Tuesday. I did that and LO started latching okay again. Sometimes she would be fussy at the breast but through the week I could always get her latched. Breastfeeding was still painful but not as bad, and she seemed to be doing less damage with each session. I am starting to heal, slowly. Started BF every other or every third session through the day and pumping/bottle feeding otherwise. Still supplementing with formula. (Making at this point around 10-14 oz/day + 3 nursing sessions).

    Week 7- Sunday morning LO flipped out at the breast and refused to even try to latch. All through the day she would wail and refuse to nurse-- not even attempting. Monday (yesterday) I talked to the LC and she said she thinks LO has developed a bottle preference and to try a nipple shield but if that didn't work I'd probably have to EP or use a SNS. Neither of which I want to do. I feel like she just gave up on us. I tried using a shield but LO wasn't getting milk, just comfort sucking (no swallowing noises). Today so far we've had two successful breastfeeding sessions and she hasn't flipped out on me at all. I'm still pumping e/o session to try to give my nipples a chance to heal. Feels like maybe the start of a turn around but I'm not sure where to go from here?

    I want to know what to do when LO flips out and refuses the breast. I want to know if its possible I could still get my supply up. I want to know if I'm being over-anxious and should BF less to heal faster so I could get back to BF exclusively? Or if I'm being not aggressive enough and should BF every session, wounds be damned.

    Any advice would be appreciated. I feel like our LC just gave up on us and I don't want to go back to her at this point.

    ETA: a few more details that may be relevant. Prior to starting to see the outpatient LC, LO would nurse for over an hour at a time, every time. When we got to 30-40 min per side I'd pull her off and switch her. The LC said that she was probably burning too many calories trying to nurse for so long without getting much of anything, and also she was not helping my boob situation. She said to nurse no longer than 20 min per side moving forward, so that is what I have been doing. LO almost never pulls off herself unless she is super sleepy and falls asleep. Generally she is still going at 20 minutes on both sides. Also we did weighted feeds at both the 3 and 4 week LC appointments. At both appointments she got 70 ml combined from both breasts. When I pump now (to pump/bottle feed-- not right after a feed) I usually get 60-70ml. So that is double what I was a few weeks ago-- which makes me feel like my supply is not hopeless since it has improved I think.
    Last edited by @llli*clerksgrl; July 1st, 2014 at 02:56 PM.

  2. #2
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    Default Re: I need help/suggestions/encouragement

    Sorry to hear about your challenges, feed, supplement, pump is not an easy treadmill to keep up with.

    Have you gotten any help with exercises for the baby to re-train the mouth/tongue muscles? I'm actually seeing a speech therapist for oral motor therapy for my LO since we didn't get his tongue and lip tie corrected till 8 weeks.

    I've been trying to limit bottles but the use of the SNS I find also needs to be limited since trying to get the tube in place while latching usually means latch winds up a bit tricky there too.

    I'm lucky in that my nipples have never reached the point of bleeding, I'm just contending with compression, creasing, and bruising. If it helps to read through another story, here are my threads
    http://forums.llli.org/showthread.ph...te-milk-supply
    http://forums.llli.org/showthread.ph...upply-struggle
    And a thread I started to help others running into tongue tie issues
    http://forums.llli.org/showthread.ph...ransfer-Issues

  3. #3

    Default Re: I need help/suggestions/encouragement

    Thanks for you comment! We do the rubbing exercises to keep the ties from healing back together, and also some sucking exercises. I feel like she is doing much better with latch now. Her top lip is flanged out and she is not flattening my nipple so much like she used to. Also I feel like the pain I'm still having is from the fact that I have open wounds still on my nipples (and even like... wearing a bra or showering hurts) and not from a poor latch anymore. She doesn't really seem to be re-injuring me much if at all now when she nurses (or at least no worse than my pump does). So really the main issue is keeping her interested in breastfeeding! And then my supply. When she out and out refuses to nurse I don't know how long I should keep trying to force it before giving up and pumping/bottle feeding? If I should then give her a break from nursing or if I should offer every time? I'm also really torn on how to proceed with pumping v. direct feeding for her benefit and the healing of my wounds. Part of me thinks I should just take 3 days off like the LC wanted me to weeks ago to really let myself heal up and then be able to dive into BF her at every meal. But another part of me thinks that I should just do what the LC recommended (since I didn't want to take a total break) and alternate bf and pumping to give myself some chance to heal, if slower (but it feels like it is taking forever). And then another part of me thinks I should just say screw the wounds, I'm going to just bf her every session from here on out to really cement our BF relationship and avoid using the bottle so much and I will eventually heal (I'm sure.. I hope.. some day?). Obviously I'm feeling very conflicted on the best path here.

  4. #4
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    Default Re: I need help/suggestions/encouragement

    Any possibility of seeing a different IBCLC, as it appears you have lost confidence in the one you have been seeing?

    Generally, if baby can latch well enough that baby is no longer injuring mom, healing can occur while mom still nurses. It sounds as if nursing is getting more and more comfortable, I am not sure why you want to risk that progress at this point.

    However, taking a break from nursing and just pumping is something that works at times too. Be very sure pumping is not injuring or painful.

    What are you doing for nipple care to promote healing?

    for milk production issues I suggest the book making more milk. Milk production is not static, so yes, it is certainly possible to increase milk production at any time.

    Week 7- Sunday morning LO flipped out at the breast and refused to even try to latch. All through the day she would wail and refuse to nurse-- not even attempting. Monday (yesterday) I talked to the LC and she said she thinks LO has developed a bottle preference and to try a nipple shield but if that didn't work I'd probably have to EP or use a SNS
    eping no, I can see why you would want to avoid going that route, but why not an sns? (or other at the breast supplementer) these can work pretty well, although, are not for everyone. Are you concerned this would be forever rather than temporary?
    Last edited by @llli*lllmeg; July 1st, 2014 at 04:44 PM.

  5. #5
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    Default Re: I need help/suggestions/encouragement

    you might want to read my long post in this thread, post number 6. I try to explain what happens with supplements, bottle confusion, and nursing. It might help explain some of baby's behavior. http://forums.llli.org/showthread.ph...om-the-breasts

    and here is article explaining sns use and how it can save a little work for mom http://cwgenna.com/smartnothard.html

    she has an interesting article about nipple care as well http://cwgenna.com/nhygiene.html
    Last edited by @llli*lllmeg; July 1st, 2014 at 04:43 PM.

  6. #6
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    Default Re: I need help/suggestions/encouragement

    If nursing is getting less painful and the pump is painful, then I would say if you can get her to nurse, the nurse as much as possible.

    The SNS might be a good idea for temporary since it kinda saves you a step since you get to supplement at the same time as breastfeeding and you are still getting the stimulation at the same time so it isn't quite as imperative that you have to pump ALL the time when you are using it. However if supply is low then pumping and nursing often are the only really sure ways to increase it.

    Of course if the pump is hurting or causing injury then that is NOT good.

    Now I'm definitely no expert here but if the pump hurts (which I've experienced this problem before) I'd be more likely to take a day or so off from the pump if you are able to get her to latch. (For me I've never responded to the pump well so I've had to supplement some with formula, I'd never make it EPing.)

  7. #7

    Default Re: I need help/suggestions/encouragement

    I could/should maybe look into a different LC. I did ask my midwife for her suggestions of LCs and she gave me two, but neither of them accept insurance (and having just paid for the lip/tongue tie procedure out of pocket, I'm not sure we can start paying out of pocket for LCs as well). I feel like at this point baby and pump are re-injuring me to about the same degree, which is why I am now considering just BF for every feed. Pumping does hurt a little bit, but just at the start like nursing. I have the pump turned down to the lowest setting to start, but it still hurts when I turn it on (and I do believe I'm using the right size pieces, from the pictures I've looked at online). I was just sort of thinking it through because that is new-- when she fights me she does hurt me more. Today was a great nursing day-- ended up nursing her 3 times so far without a fight. Yesterday was a bad day and she fought all day (and the day before she refused entirely. But the day before that she was fine). Every day is new it seems. Regarding promoting healing, I try to express a little breast milk and put that on my nipples and let it air dry if I have time after nursing or pumping, then once it is dry I put on the prescription all purpose nipple ointment and use cloth breast pads because they are softer than my bra.

    My concerns with the SNS are several. First I want to encourage LO to take as much breast milk as possible before offering formula. Currently she doesn't always take formula after the breast (or pump milk), so I don't want to give her formula when she doesn't want/need it. Also nursing is already difficult for me because I have large breasts I have to sort of hold up and LO is squirmy so it takes everything I have to get her positioned correctly and latched on, I'm worried adding an extra tube there is going to make me even more awkward. Third it just seems like something else to wash/worry about. I'll look up your links/book rec tomorrow when LO naps! Thanks

  8. #8
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    Default Re: I need help/suggestions/encouragement

    Quote Originally Posted by @llli*clerksgrl View Post
    My concerns with the SNS are several. First I want to encourage LO to take as much breast milk as possible before offering formula. Currently she doesn't always take formula after the breast (or pump milk), so I don't want to give her formula when she doesn't want/need it. Also nursing is already difficult for me because I have large breasts I have to sort of hold up and LO is squirmy so it takes everything I have to get her positioned correctly and latched on, I'm worried adding an extra tube there is going to make me even more awkward. Third it just seems like something else to wash/worry about. I'll look up your links/book rec tomorrow when LO naps! Thanks
    I agree that the SNS can be quite fiddly to deal with, especially if baby is squirmy. I find that most of the time when I use it I have to do football hold. But a benefit is you don't necessarily have open up the tubes at the start of the feeding or you can close them off for a large part of the feeding and only open them up if you think baby is going to want more and you don't really have to warm the milk being served up this way so if what is in it doesn't get finished off I usually feel better about putting it in the fridge and offering it again at the next feeding while I'm less comfortable doing that with a bottle several times.

    That said, I'm usually only using the SNS for 2-3 feedings in the afternoons and then also giving 1-2 very small bottles per day. At one point I was down to only giving 4-5 oz of supplement per day and I was able to pump that much but then we had a setback and he was getting alot of supplement and wasn't taking as much from me, I'm now working hard to get back to him getting most from me again. It is grueling to keep this up for long, here is wishing us both strength to carry on another day, and another..........

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