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Thread: Breastfeeding problems

  1. #1

    Default Breastfeeding problems

    Posting for my wife because English is not her primary language. This is a long post

    She has had some problems breastfeeding and the lactation nurse says we have been doing the correct things but she still feels guilty that she hasn't been able to breastfeed exclusively.

    Some background first. The baby is now a week old. Wife was in labor for 31 hours after her water broke. No complications. Umbilical cord fell off after 30 hours. Pediatrician said it was very rare but it looked fine and gave us some things to watch out for. She was in the hospital for 48 hours after the baby came out then discharged.

    In the hospital, the first day, the baby breastfed the first 4 times easily. The Pediatrician noticed the tongue needs to be cut underneath (very common in my family tree) so they cut it. My wife is hand expressing perfectly. During the night the baby has some problems latching. Baby has about 8 bowl movements.

    The second day the lactation nurse comes in and helps her. Baby is doing fine and within normal weightloss. Bilirubin test shows she is in the high-intermediate range so she is very sleepy and lethargic. Breastfeeding is touch and go. Sometimes she latches and feeds. Other times she latches then falls asleep immediately.

    Discharge day, lactation nurse comes in and spends 2 hours with wife. Baby latches like a pro. We get home and baby refuses to latch. Either she falls asleep or shoves her own head off the breast. This continues until 2am at night she starts crying and is clearly frustrated. Wife is expressing milk just fine but the baby is refusing to latch more than 5 seconds. Babies cries are getting louder and louder so my mom gives her formula. Wife is really upset at this because she didn't want to give her any formula ever. In her country they breastfeed up to 3 years. She feels she is failing as a mother.

    Day four, baby starts the day latching and feeding just fine. Baby goes in for bilirubin test again, still high-intermediate. Rest of the day the baby feeds just fine. Wife uses breastpump a few times and saves it just in case we need it. Nighttime comes and baby does it again. Refuses to latch. This time we have breastmilk saved so we use that.

    Day five, baby refuses to latch more than 5 minutes all day until the afternoon when we visit the lactation nurse. She feeds for 45 minutes perfectly. Next feeding baby refuses to latch again.

    Day six, baby alternates from feeding for 15 minutes just fine to refusing and crying. Wife is producing 90ml breastmilk each time she pumps so a majority of feedings are breastmilk. Her nipples have been getting sore and the underside of her breasts are itching.

    She sees the lactation nurse tomorrow again. I will bring up the nipple and itching to them. (as it could be thrush, mastitis, clogged duct)

    1) Wife is never the one to give the bottle. I am. Sometimes when she is trying to breastfeed I will use a small injector to put a little breastmilk into the baby's mouth to stimulate feeding.

    2) We always try breastfeeding first. If she doesn't latch after 10 minutes and/or becomes clearly frustrated then we feed pumped breastmilk and/or formula. In 8 feedings half or more are just breastmilk. She has tried every position and tried with and without her "My breast friend" pillow.

    3)All bottle nipples are slow flow newborn types.

    4) Her bilirubin is now low but she is still slightly under birthweight (3560g birth, 3325g now)

    5) Bowl movements have all been normal and very frequent (7-9 times a day).

    My personal views are that if breastfeeding is not working then 1) use pumped milk and 2) if there is no pumped milk then to use formula. If baby finishes pumped milk then use formula if she is still hungry.

    As a man I did as much looking around and listening as I could, which is why I am posting here(always more info out there). If anyone has any tips then please share them. I do want my wife to breastfeed. However, it wouldn't be the end of the world if she had to just resort to pumping and feeding, would it?

  2. #2
    Join Date
    May 2006
    Posts
    24,794

    Default Re: Breastfeeding problems

    Welcome to the forum and congratulations on the new baby!

    First, please tell your wife that she isn't failing. Breastfeeding is natural but that doesn't mean that it is easy. Plenty of moms struggle, especially in the early days.

    The first thing I suggest is for mom to try the laid back/biological nurturing position, see http://www.llli.org/btissue5pg04. This position is especially helpful for babies who latch only very briefly and then pull off the breast because it enlists gravity to hold the baby's head on the breast, instead of allows gravity to pull the baby's head off the breast or to drag the breast out of the baby's mouth.

    Mom may also want to try a nipple shield. Shields have some drawbacks, and are best used cautiously and with guidance from a lactation consultant, but they can be very useful for babies who are reluctant to latch.

    If the baby requires supplemental feedings, then it is important that supplements are in appropriate amounts and that they are delivered in a breastfeeding-supportive way. For a newborn, 2 oz is a complete feeding so supplements should be 2 oz or less. small supplements mean that the baby should still desire to eat at a normal newborn frequency, which is about 10-12 times a day. This is a useful link on how to bottlefeed the breastfed baby: http://kellymom.com/bf/pumpingmoms/f...ottle-feeding/. and this one is about alternative methods of supplementing: http://kellymom.com/ages/newborn/new...ative-feeding/

    Some more things to try, with a baby who becomes easily frustrated with nursing:
    - Instant reward: express some milk onto the skin of the nipple or drip some onto the nipple before latching the baby on. When the baby gets the taste of milk in her mouth, she is more likely to be triggered to continue to nurse,
    - Time the supplements in different ways. Many parents try to nurse first and then finish with a bottle when the baby becomes frustrated or sleepy at the breast. It may help to offer a small supplement- 1 oz or less- and then offer the breast. The baby will have the edge taken off his hunger and that may allow for a more calm latching experience.
    - Try to get the baby to the breast at the very earliest hunger cues, or even before the baby is acting hungry. Hunger cues can rapidly escalate into frantic head-bobbing and latching/unlatching, so the quicker you get the baby to the breast, the better.
    - If the baby is refusing to latch or is unlatching and crying, try offering him your pinky finger to suck on, with nail held down towards his tongue rather than up towards the delicate roof of the mouth. A few seconds of sucking on a pinky can calm the baby enough to enable a repeat latch attempt.

  3. #3
    Join Date
    Jun 2009
    Posts
    10,754

    Default Re: Breastfeeding problems

    Hi and welcome. Your wife is lucky to have a supportive husband.

    However, it wouldn't be the end of the world if she had to just resort to pumping and feeding, would it?
    No, but it would be the end of the breastfeeding relationship. Nursing one's baby is about so much more than what substance is going into baby. There are other medical/ "factual" reasons bottle feeding is not as beneficial to a baby as nursing at the breast, and why pumping and feeding is very difficult to maintain long term, but given that your wife wants to nurse baby, (and you can be assured that your baby wants to nurse) I think there is no reason to go into all that.

    Here is what I am hearing. Weight gain and poops are within normal and jaundice is clearing. So right now, baby is getting enough to eat. Great!
    Baby had a tongue tie and this has been treated early. Great!
    What your wife is able to pump each time indicates a normal or even high milk production. Great!
    So many issues that nursing pairs are still dealing with at this age, and in fact for many weeks in many cases (poor gain, untreated physical issues, low milk production) have already been taken care of or are normal. All before baby is a week old! So it is very, very premature to be throwing in the towel.
    Here is the one issue you are having- Baby can nurse, as he has proven, but is clearly having some difficulties with latch. A poor latch in the early weeks is THE most common breastfeeding issue (the other is low milk production, much less common) and a poor latch is almost ALWAYS something that can be fixed.
    Many babies who nurse well early on find it more difficult to nurse once moms milk is more abundant (has "come in.") The timeline of the difficulties would suggest that is part of the problem. What do you think?
    Yes thrush causes pain and itchiness. But it is fairly unusual for a mother and baby to have thrush so early. Thrush does not itch UNDER the breasts, typically. Itchiness like that is also a normal response to the physical changes when the breast start producing milk(lactating) as well as the sweaty realities of having given birth, nursing, and pumping around the clock.
    Since we know baby has trouble latching, I think that baby's poor latch may well be the root of nipple pain, rather than thrush. Since pumps cause injury as well, Be very sure that mom is pumping at a comfortable setting and that the pump flange fits correctly.

    I question whether any formula is needed. Since mom is pumping so much. How much are you trying to feed baby at a time? A complete feeding for a one week old baby would be about 2 ounces TOTAL- or less.
    Since babies this young need to eat so often and take so little at a time, a syringe, cup or spoon is often an acceptable alternative for supplemental feedings and are considered more supportive of breastfeeding than bottles. If you must bottle feed, try paced bottle feeding and upright positioning (of baby) and horizontal positioning (of bottle.)

    A fussy baby will have a harder time latching. This is helped two ways: 1) Have mom hold baby most of the time, snuggled on her chest, skin to skin or at least with very easy access to the breasts. This way as soon as baby cues, baby can seek and find the breast. Of course, it is fine (and very important if baby is unusually sleepy) to rouse baby and offer to nurse as much as needed as well.
    a small amount of expressed breastmilk dribbled on the nipple may get baby going where he needs to go. Or mom can express milk so it beads on her nipple.
    a small amount of expressed breastmilk (half ounce or less) given when baby is getting fussy may calm baby and allow baby to have the energy to try nursing again.

    The LC is coming tomorrow, and latch issues are almost always best helped by in person assistance. So I don't want to get too far into latch ideas here except to give you a few links.
    Positioning baby is a big part of getting at good latch.

    Several wonderful breastfeeding videos with multiple language options: http://globalhealthmedia.org/videos/breastfeeding/

    Description of a professional lactation consultation: http://cwgenna.com/lconsult.html
    Weak such post frenotomy: http://cwgenna.com/postfren.html
    Good overall latch and positioning article: http://feedthebabyllc.com/latch-and-positioning/

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