Baby won't nurse and I'm about to give up

[@llli*mammal]

Hello. I have a month-old baby boy. We started out with some minor nursing issues—my nipples are big for his mouth, he didn't like it when I got engorged—but we quickly got into the swing of things in the first week. Then he started losing weight…and losing weight…and losing more weight. We also got thrush, which of course made it incredibly painful for me and I imagine for him as well to nurse. At 9 days, we ended up in the ER where he was tested for every possible infection. It turned out he had a urinary tract infection, which had decreased his appetite and made him listless. We ended up staying in the hospital for a week. At the beginning of our hospital stay, he was refusing to nurse, and we started finger-feeding him with an SNS or with a syringe and tubes. Meanwhile, I pumped about 10 times a day on the hospital's Medela Symphony.

In the hospital, it was pretty much impossible to have any skin-to-skin contact and sleeping together was out of the question. I held him as much as I could and tried to latch him on every day with no luck. I eventually decided I would just focus on keeping my supply up and get him back on the breast when we got back home and were less stressed and uncomfortable. In the hospital, I saw four different lactation consultants, who told me we had a good latch, I was doing everything right as far as laid-back breastfeeding was concerned, and there was definitely hope that he could get back on the breast eventually, but they were no more successful than I had been, even though they tried SNS feeding at the breast and a nipple shield. At this point, we were supplementing my pumped breast milk with donor milk. Eventually, one of the lactation consultants told us it was okay to switch to bottle feeding as long as we paced it and watched the flow. We were thrilled to hear that was okay because the finger feeding was so time consuming and difficult.

The day after we came home, I rented a hospital-grade pump and had an IBCLC come over. She prescribed as much skin-to-skin as possible (which was a lot—I love it), offering him the breast without expectations, and pumping eight times a day. She suggested switching back to finger feeding or trying the SNS at the breast again, but with the pumping and trying to nurse and my husband needing to get back to work, it's just really not possible. We ran out of donor milk and had to begin supplementing with formula.

It's been two weeks, and my baby still will not nurse. He will occasionally latch on and hold the nipple in his mouth but not suck, but then he ends up screaming. Most of the time, he begins screaming as soon as he even gets near the breast. Various theories have been proposed, from his lip tie (which we have an appointment to have evaluated on August 19) to flow preference to trauma from the hospital stay, but no one knows just what the problem is. Meanwhile, I've had thrush twice now and mastitis once. I'm fighting thrush right now, and I can't even hold the baby without pain in my right breast, which is also the one that had mastitis. Its supply has dwindled to almost nothing, and I'm considering just letting that side dry up.

In fact, I'm considering letting both sides dry up, but I'm grieving. I'm heartbroken and I'm crying a lot. I wanted to breastfeed so badly. But sometimes dreams don't work out. I'm spending about 5 hours a day pumping (I can't double pump because my right breast hurts so much and needs a much lower suction strength than the left side), and I'm neglecting my 15-year-old daughter, my dogs, and my husband, not to mention missing out on time with the baby. It's seeming crazier and crazier to try to keep this up. At this point, I would love if he would even nurse one time a day. I just don't want to lose that relationship entirely. But nothing is working. We've tried the SNS, the nipple shield, the skin-to-skin, offering the breast at different times of day, at different levels of sleepiness on his part, in different locations, in different positions, with different levels of pushiness. We've tried spoon and cup feeding, but I'm afraid that at this point, paced/baby-led bottle feeding is the best option for my family. I wish we had never listened to the LC who said a bottle would be okay, though.

This is my last desperate attempt to see if anyone has any idea of what I can try to get my baby to nurse even a little. I also want to know whether, at almost 5 weeks, I could just cut down to four pumping sessions a day and still maintain even a tiny bit of milk in case he can nurse when he's a little older. I don't mind combination feeding at this point—it's better than having to exclusively formula feed—but I've been getting mixed advice on whether I can keep a small milk supply with four pumping sessions a day or whether my milk would pretty much dwindle to nothing.

I can't continue the way I have been. My options right now are figuring out a way to cut down on my pumping and keep some kind of small supply in the hopes I could get him to nurse part-time in the future; giving up entirely and switching to formula; or some miracle happening and him being able to nurse for his meals. If I knew that it would take, say, two more weeks and then we'd be nursing, I could stick it out. But having no idea how long it might take makes it feel futile. The routine we have now is hurting our family and it's starting to feel very selfish. My baby is happy with formula; I'm the one who isn't.

Thanks for reading this long post. I hope it makes sense. I've gotten so much advice from so many people and I don't know if asking for more is even a good idea, but I wanted to reach out one last time before I give up.

[@llli*maddieb]

Hi, have you tried getting a LLL Leader on the phone to talk this out? I would suggest that. I will try to put my thoughts down for you but when a mom has a big decision to make, it is often very helpful to talk them out with someone who knows how to listen. You are welcome to pm me if you do not have a local group or cannot get help on the USA helpline.

First off,

and I'm neglecting my 15-year-old daughter, my dogs, and my husband,

No, you are not. You are trying to do something important for your infant's health, and your own health, something that is important not only to you but actually, provably, important, health wise and in so many ways. Your infant, whether they are breastfeeding or not, needs you much, much more than anyone else, simply because they are an infant. Your husband can take care of himself, he and your 15 year old can take care of the dogs (and you) and if your 15 year old needs her mom, she can talk with you while you pump and/or snuggle baby. You have had a very rough month, but it has only been a month. The first month of your baby's life. This is a huge, intense amount of time for your infant, (and for you) but a very short amount of time for a teenager or an adult, if that makes sense.

I also want to know whether, at almost 5 weeks, I could just cut down to four pumping sessions a day and still maintain even a tiny bit of milk in case he can nurse when he's a little older. I don't mind combination feeding at this point—it's better than having to exclusively formula feed—but I've been getting mixed advice on whether I can keep a small milk supply with four pumping sessions a day or whether my milk would pretty much dwindle to nothing.

No one can answer that for you because it is an unanswerable question. But maybe I can put it in perspective for you-

in order to have normal milk production, milk must be effectively removed from the breast a minimum of 8-10 times a day in the early weeks. After about 6 weeks, IF normal milk production has been established, (meaning, mom is pumping enough at that point to feed baby entirely) some moms find they can go down to pumping about 6-8 times a day, and later, maybe less.

But if a "full' milk production was/is never brought in, that makes the future of milk production iffy. IN the normal course of milk production, a mother's milk production increases for about the first 6 weeks of babies life. This does not mean a mothers milk production cannot be increased after that, usually it can, but it does become more difficult.

If you reduce your milk removal, you are telling your body to stop or reduce making milk. How your body will respond to this directive and how long it will continue to make milk is going to be individual, because every mothers milk production capacity AND breast storage capacity are different, and both play a role in milk production. But since no baby could nurse only 4 times a day and survive, that infrequent of milk removal would be sending a pretty strong message to your body that milk production is no longer needed.

Here is what I would suggest.
it is hard to make important decisions while feeling sick and/or in pain. So first, I would suggest, figure that out.
WHY are you and baby still getting thrush? Has it not been treated appropriately? Are you certain it IS thrush? Are you getting re-infected somehow?
What is going on with the one breast? Is there a plug, nipple injury, something else? Was there some specific cause of the mastitis you are aware of? Has this been treated appropriately?

also, it is hard to nurse if feeling poorly. Baby had a urinary tract infection at a very young age. Are you confident baby is healthy now? Is baby still on abs? Are the abs possibly causing any issues?

Then, I wonder about your milk production. It sounds as if baby was always supplemented with donor milk or formula (after the first week) Why? How much of your own milk were you able to produce?

How is weight gain now? baby is not going to be very interested in nursing if baby is full from supplemental feedings. So I wonder how much overall baby is eating now, and how often, and how much you are able to pump when you pump. Are you still using a hospital grade pump?

Some babies do, indeed, come to the breast after many, many weeks, even many months, down the road. So, if you knew you wanted to keep trying, then I would probably suggest to keep pumping with a hospital grade pump as often as you could. This would keep your milk production alive to fight another day. This is what I would suggest trying for now, at least until you are feeling a bit better. IN other words, If you have to let go of something let go of trying to nurse baby. Because at this point, your baby is not nursing at all (if I understand the situation) so not trying to nurse right now, while you regroup, is probably going to be less impactful on the current situation than not pumping, if that makes sense.

However, if you are done, you are done. And that is ok too. No one can tell you what is best in your particular situation. If you do decide to drop pump sessions, do so very slowly so you don't risk mastitis again.

It is inexcusable that you have to wait several weeks to have the liptie looked at. Any chance of moving that up? Is the person you are waiting to see likely to treat lipties due to a negative effect on breastfeeding?

[@llli*mammal]

Thank you, Meg. Let's see. I have talked to a LLL leader, and she was helpful and compassionate, but didn't really offer any ideas that the IBCLC and everyone else hadn't offered. She said situations like this are the kind that formula was made for and she has rarely seen a mother who tried harder than I have.

Well, my 15-year-old was adopted from foster care and is already having a lot of abandonment issues coming up with the new baby. She does need me right now, and I'm tied to the pump. And because I'm tied to the pump, my husband (who works at home) is having to take charge of more infant care than his work will really allow, such as pretty much all of the feedings. These two situations can't continue much longer.

I'm pumping about 20 ounces a day. I understand that pumping isn't a good metric for overall supply since the baby is more efficient than the pump, and I think that if I was nursing I might produce enough for him to get by on without supplementation, but he's eating more like 32 ounces a day. His weight gain now is good. I've tried nursing when he's hungry and when he's not and they both have the same effect: screaming. I am still using a hospital-grade pump.

I am confident he's healthy now. He's not on antibiotics anymore. We got the thrush the first time because of antibiotics I had to take after his birth, and the second time because of antibiotics I had to take for the mastitis. I think the mastitis came up because of a lack of rest, stress, and pumping in general, personally. I did have a crack in my nipple that could have been the direct route for the bacteria. The mastitis is gone now. The baby doesn't currently have thrush because he's not nursing. I have no idea why it's only in one breast this time, but I'm thankful for it. It has been diagnosed as thrush and it feels like the razor blades/broken glass/ice pick pain that I had before; the area around the nipple is red and the face of the nipple is white. I'm on Diflucan and putting Nystatin on the nipple.

The lip tie is being evaluated by the only person in town who does laser revisions. He is likely to treat it to help breastfeeding. It's a pretty severe lip tie (probably fourth degree) that goes all the way to the bottom of his gum. I may be able to see someone sooner for a more traditional revision, but my midwife recommended the laser procedure.

Thank you for explaining the concept of establishing the milk supply. What you say makes sense. But it's unfortunate. The trying to nurse takes far less time than the pumping and the pumping is what's keeping me tied down, besides the fact that it hurts like hell and I completely hate it.

[@llli*chylab15]

I am going through a similar issue with my almost 3 month old. I am having milk issues because the hospital gave me wrong info and my daughter would not latch when she was born. She's latching now, but gets mad and screams because the milk isn't instant like the bottle. I am a slave to the pump but not producing much milk... My heart is still in it, I refuse to give in just yet! Hang in there, and keep trying to get him to the boob! It can be done. Extremely maddening, but possible!!

[@llli*tclynx]

The lip tie is being evaluated by the only person in town who does laser revisions. He is likely to treat it to help breastfeeding. It's a pretty severe lip tie (probably fourth degree) that goes all the way to the bottom of his gum. I may be able to see someone sooner for a more traditional revision, but my midwife recommended the laser procedure.

Call them and ask if they can call you if there is a cancellation! That is how I managed to get my LO in to have his lip/tongue tie corrected, they didn't have an opening for weeks but I told them to call me if any opening popped up. They called me the next day and we had to rush to get there is it was a 2 hr drive for us and the opening was in 3 hours, but we did it.

As to everything else, I hear you about grieving about loosing or even the possibility of loosing the nursing relationship. I've been having supply and poor weight gain issues and my LO does have a flow preference for the bottle but trying to use the SNS all the time is hard etc..... Trying herbs and trying to get domperidone. Yesterday I saw an acupuncturist and I'm cautiously optimistic about the results.

One idea is since right now you are terribly wound up about this, you could set yourself a date as a goal and re-evaluate then. Like perhaps when baby is 6 weeks old, if you haven't found solutions you could wean yourself off the pump. Or you could start weaning yourself off the pump now with the goal of being done by 6 weeks or so depending on if you are really willing to continue or not. However, you might want to hold out till after his tongue/lip tie condition gets looked at/corrected. Keep in mind the result will probably not be instant since baby will have spent a fair amount of time learning to use those muscles in the restricted state. Get help from an IBCLC or speech therapist who knows about suck re-training and exercises/stretches to be done to get that mouth ready for possible nursing again.

Your heroic efforts have given your baby your breast milk at least this long so you have done a wonderful job there. EPing I couldn't do it, I don't respond well enough to the pump (most I ever pumped in a single session was 2 oz and normally I'm excited when I pump 1 oz.)

[@llli*maddieb]

Hi, so I had to run before and posted without completing one of my thoughts. What I was going to add was that, even if you can only pump 4 times a day, or even less, one thing you can know for sure is that will be better for milk production than not pumping/nursing at all. In other words, if that is what you can do, do that, and your baby will certainly get more of your breastmilk, for longer, than if you did not do that.

Ok, so I understand your situation is unique with your 15 year old. Every situation is. My point was, even in the best of circumstances, newborn babies require lots and lots of time and energy. Way more than anyone will tell you, way more than anyone can imagine prior to having a baby, or remember later. I have had three children, and every time, I am amazed again at how incredibly time consuming and exhausting newborn care is. And most siblings, while they survive the experience, experience jealousy of and resentment about a new sibling.

Lots of new moms have older kids, older kids with special needs, important jobs, aging parents, ill spouses, etc etc... I would never say they neglected their families because they focused their attention on their newborns. So I will not agree that you are neglecting anyone. That was my point.

There are many ways to make pumping more manageable, but I don't know if you want those suggestions or not. If you do, it would help to know what your current pumping routine is now, including how much you pump and how long you pump for. what kind of pump it is.

Pumping should not hurt. So if it is hurting, and the pain is not due entirely to thrush, something else is wrong. It may be your pump, or how you pump, it may be something else. And pain inhibits letdown, so if you are having any issues there, it may be due to the pain.

Thrush is a complicated condition and often a difficult diagnosis. If the issue is thrush, it will likely clear up rapidly with diflucan, which is usually very effective if mom is taking the correct dosage. I would not agree baby cannot have thrush if they are not nursing, as bottle fed babies also get thrush. But of course, if baby is not nursing, you are not going to be directly cross contaminating each other via nursing. But cross contamination can occur with pump parts, bottles, clothing, and from other family members. I once read about a case of recurring thrush that cleared up when the family dog was discovered to have yeast and was treated.

I certainly agree see the specialist that will revise due to breastfeeding issues. I really do not know if waiting for laser is important or not, that is well beyond my expertise. I do wonder if they understand the urgency of your situation, I am just frustrated for you that they cannot see you sooner.

For ideas on bringing baby to the breast, it would help to know mor about how often bayb is being fed, how much each time, how the bottle feedings are going, etc.

[@llli*tclynx]

I am going through a similar issue with my almost 3 month old. I am having milk issues because the hospital gave me wrong info and my daughter would not latch when she was born. She's latching now, but gets mad and screams because the milk isn't instant like the bottle. I am a slave to the pump but not producing much milk... My heart is still in it, I refuse to give in just yet! Hang in there, and keep trying to get him to the boob! It can be done. Extremely maddening, but possible!!

I find the SNS can be helpful in dealing with the "instant gratification" issue as long as you are not having huge problems with her latch.
I have a 4 1/2 month old and am still struggling but I think acupuncture may be helping some with my "flow rate" and supply.