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Thread: Breastfeeding not working after tongue tie release

  1. #1

    Default Breastfeeding not working after tongue tie release

    Hello, I would love some advice. My baby is 7 weeks old. It took a while for her posterior tongue tie to be recognized and her lip tie to be recognized. For the first 4 weeks she was mostly EBF (got a little formula the first week of life due to jaundice - that's a whole other story). At week four she was diagnosed by my new IBCLC and referred to dentist, BUT at that time I had already had deep fissures in both nipples and a lot of pain so I turned to the pump to keep my supply up. My supply is not super plentiful. I make about 3-4 ounces every 3 hours. My baby eats about 3-3.5 oz from the bottle. At about 5.5 weeks we were able to get them both fixed (lip and tongue tie) and I started putting her to the breast and again it hurt and my nipples continued to come out of her mouth compressed and painful. My IBCLC gave me nipple shields and instructed me to offer the breast with the shield and then bottle feed the rest. My baby hates the shield. When she does latch with it she crinkles it at the sides and sucks on the nipple, she barely gets anything out so that wasn't really working. I have put her to the breast sporadically which she somewhat likes better. I should say she likes it only with a shallow latch. She screams if I try to get a deep latch like she doesn't like the breast at the back of the mouth, however when you put a finger back there however her gag does not seem sensitive at all. Also my nipples continue to come out compressed and painful because she will not allow me to latch her more deeply. She has recently been seen by the dentist who says her mouth looks great. Note that I can only get her to take the breast with an imperfect latch she will scream and spit out my nipple until it is where she wants it. She is sucking so much better on the bottle now, she previously could only bite the bottle. But she continues to only every get a shallow latch and chew my breast, not suck despite suck training and training her in tummy time multiple times a day like my IBCLC instructed. She is now 10 days out from her procedures. I am thinking of really just transitioning her to exclusive pumping because it is exhausting doing all these exercises, her tie stretching excercise (last ones today), putting her to the breast and then having to bottle feed and pump after to top it all off because I simply can't keep her on the entire time when she is hurting my nipples terribly. Also my husband works nights so I am alone trying to do all of this most of the time. I just don't know if I should take a break from all this exhausting business of putting her to the breast then bottle feeding, then pumping and continue uick training and try again every couple days to put her to the breast or If I should just exclusively pump. I am exhausted and saddened every time I put her to the breast and she continues to chew the base of my nipple. I feel like a terrible complainer, but I don't know what to do. I really really wanted to breastfeed and have that relationship because I work full time and sometimes 60 hour weeks, but I can't seem to make this work. I don't know if anyone else has had a similar situation or not. I don't know if anyone has had success switching to exclusive pumping and then trying to breastfeed later? I am just so tired and disheartened by all this and wondering if I should just focus on getting my supply up so I can be an exclusive pumper unless Dee wants to suddenly get it together and use her new skills to breastfeed.

  2. #2
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    Jun 2009
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    Default Re: Breastfeeding not working after tongue tie release

    Hi deesmom, I have few thoughts. Hope these help.

    First off, your IBCLC gave you a plan and that plan is not working for you. Have you gone back to the IBCLC and told her this plan is not working? Just because this is the plan this LC gave you does not mean there is no other way to do things. Exercises after tongue tie release are not universally suggested. I am not saying they are not a good idea, I am saying that if they are exhausting you, that is not working for you. If every time baby eats you are nursing, then feeding, then pumping of course that is exhausting you, and you need another plan. This is not the only way to do things!

    Your baby is obviously still not latching properly because it hurts you. My suggestion for this is to see your LC again (or a different one) and work specifically on latch and positioning to help baby get there.

    Some times a break to "just pump" can help heal. But I would suggest continue to nurse baby at least a couple times a day at least. Otherwise you risk baby never coming back to the breast. Also bottles should be given in a breastfeeding supportive way so baby does not get used to overly large, overly quick meals. Get info on paced bottle feeding if you have not already.

    When do you go back to work? Were you planning to continue to nurse after returning to work?

    Ok, milk production. Maybe I am missing something, but I see nothing wrong with you milk production.

    My supply is not super plentiful. I make about 3-4 ounces every 3 hours.
    If you pump every 3 hours that is 9 times per 24 hours. Right? Or is it 8?
    8 times 3 = 24 ounces. 8X4 = 32 ounces. These are normal pump output amounts for a mom who is exclusively pumping...and you are not exclusively pumping, as baby is also nursing.
    How much more is baby eating that you think you do not pump enough? How is baby gaining?

    What to expect at a lactation consult: http://www.cwgenna.com/lconsult.html

    Latch and positioning: Many ideas: http://feedthebabyllc.com/latch-and-positioning/

  3. #3

    Default Re: Breastfeeding not working after tongue tie release

    Thank you for your post. I had been planning on breastfeeding when I went back to work. She has been receiving only paced bottle feeding. I have been trying to put her to the breast more often in the afternoon and evening when things settle down in the house and I can pump after feedings if I have to. I have also been trying to feed in a laid back position. It is going a little better in the sense that I am not having as much discomfort, but I am not sure if that’s because I haven’t been exclusively breastfeeding. My nipples still come out misshapen. My biggest issue is that she stays on the breast for at least 15-20 minutes each side, sometimes longer and then is still hungry after feeding off both breasts. She is not sucking the entire time she is on the breast, she sucks intermittently, but I would think she should be getting more and not hungry after that amount of time. I know my pumping output is pretty consistent with what she takes by bottle. I also pumped 4 ounces 30 minutes after she finished a feeding so that is not right, she should be getting that milk out. I am going to ask my lactation consultant back because I think she needs to be weighed pre/post feed to see what is going on. I also agree and think the latch isn’t what it should be given my nipples still get pinched and blanched. I go back to work in 3 weeks so we have a little bit of time to work on things. Note, I am not bothering at all with the shield at all anymore because she hates it and it just stresses me and her out when she is crying and I am messing with the shield. So there is no shield being used that could be affecting milk transfer. She has not really had any weight gain issues as of her last doctors visit 2 weeks ago, but 2 weeks ago we were exclusively pumping.

    In regards to supply. I read about exclusive pumping and it seems like a lot of exclusive pumpers talking about having a slight oversupply. I am starting to worry that is where we are going to essentially end up, being more of in the exclusive pumping category if we cant get things fixed by the time I go back to work. My job can be pretty stressful and while I am planning on pumping while at work I would not be surprised if my yield goes down. I do a lot of breast compressions and such normally when I pump to get that yield, which I wont be able to do at work when sharing my office. I also worry my little girl will start drinking 4 ounces more consistently and then because I make 3-4 ounces (and sometimes only make 3 ounces) that on top of the stress of pumping at my job and or in the car will cause my yield to be more 3 than 4 and I really would like to have enough for her.

  4. #4
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    Default Re: Breastfeeding not working after tongue tie release

    My biggest issue is that she stays on the breast for at least 15-20 minutes each side, sometimes longer and then is still hungry after feeding off both breasts. She is not sucking the entire time she is on the breast, she sucks intermittently, but I would think she should be getting more and not hungry after that amount of time.
    You would think that, but in fact it is normal and typical for a baby to continue to nurse, sometimes for well over an hour, to nurse to sleep, to nursing in their sleep, to want to nurse 5 minutes after they are done nursing, etc, etc. Of course with nursing hurting you, YOU are finding long, frequent nursing session very uncomfortable, even painful. So it does not feel right to you. But in fact it is entirely normal for a baby to nurse this way. In other words, it does not mean baby is still hungry. It just means baby still wants to nurse. They are not the same thing.

    I also pumped 4 ounces 30 minutes after she finished a feeding so that is not right, she should be getting that milk out.
    Or, you make more milk than you thought. Or, baby was not very hungry when baby nursed that time and so what baby extracted was low. Or this was just a really good pump session for you. One thing IS for sure, if you are able to pump 4 ounces at a time, there is most likely nothing wrong with your milk production.

    I am going to ask my lactation consultant back because I think she needs to be weighed pre/post feed to see what is going on.
    I agree. You want to do as many of these as possible to see whether baby is capable of extracting 2 ounces or more over a normal nursing session of baby nursing both sides over 30- 40 minutes or so total. If you get that result right away, that would probably show baby is able to extract milk normally. If you don't, it does not mean baby cannot extract milk normally, it could be baby was just not all that interested or hungry at that one session, so you would need more before and after nursing sessions in that case to make sure there is actually a transfer issue. Of course at the same time, LC would be watching and using her observational skills to figure out if baby appears to be nursing normally or not. However, as long as nursing hurts you, no matter how it looks, something is not right. Misshapen after nursing? Eh. As long as you are not in pain or getting hurt, and baby is extracting enough milk, misshapen is probably fine. If baby is not getting enough or nursing does hurt- that is how you know something is wrong.

    In regards to supply. I read about exclusive pumping and it seems like a lot of exclusive pumpers talking about having a slight oversupply. I am starting to worry that is where we are going to essentially end up, being more of in the exclusive pumping category if we cant get things fixed by the time I go back to work. My job can be pretty stressful and while I am planning on pumping while at work I would not be surprised if my yield goes down. I do a lot of breast compressions and such normally when I pump to get that yield, which I wont be able to do at work when sharing my office. I also worry my little girl will start drinking 4 ounces more consistently and then because I make 3-4 ounces (and sometimes only make 3 ounces) that on top of the stress of pumping at my job and or in the car will cause my yield to be more 3 than 4 and I really would like to have enough for her.
    I would suggest work the current problem of getting baby nursing effectively without hurting you and leave work concerns for later. This is why I asked when you are going back. I have seen many moms who basically just stop trying to nurse because the return to work is looming and they overwhelm themselves worrying about that rather than working the current problem. But this is counterproductive. Getting baby nursing 'better' before you go back is the best way to minimize any issues you may with production or breast refusal or anything else that may crop up after you go back. If you can delay your return to work or work less hours at first, that would be a good idea to give you more breathing room, however if that is not possible it is what it is and there is no point in worrying about work yet or supply issues that may or may not occur later.

    I would suggest that if you are concerned about the amount baby is taking or will take in bottles, revisit the paced bottle feeding recommendations and videos. Done properly, paced bottle feeding should make bottles last a long time and be preventing issues in the area of too fast or too large feedings. It might be helpful to consider cup feeding instead for at least some feedings as this basically forces the caregiver and baby to slow the feeding down.

    Also do not equate your work pump times with your baby's bottles. When a mom is at work she pumps when she can, as often as she can, and as long as she can. Some days she might pump less, some more. And yes often moms who work also need to pump at least somewhat while at home on nights or weekends as well to make enough for baby to have when mom is at work.

    When baby is getting bottles when away from mom, they should be given on cue, and they should be overall frequent and small. So there is no need for pumping and bottles to "match up" so completely.

    Bottle feeding the breastfed baby (it is more than about paced bottle feeding) https://www.llli.org/docs/0000000000...astfedbaby.pdf

    Paced bottle videos- doll - https://www.youtube.com/watch?v=UH4T70OSzGs

    Baby- https://www.youtube.com/watch?v=dxpIzcitLc8

    Cup feeding: https://www.youtube.com/watch?v=R95FUa7_s84&t=43s

  5. #5

    Default Re: Breastfeeding not working after tongue tie release

    Today my IBCLC came out to the house. Thank God for IBCLCs. It was as I figured the baby is not removing any of the milk when she feeds. Her weight did not change at all from a feeding. No wonder I was able to get so much out after she had been feeding almost nonstop for 3 hours! Unfortunately her suck is bad and she doesn't create much a vacuum to get the milk going after initial let down is over. We are going to do finger feeding now. With finger feeding she demonstrated great suction. We will be finger feeding to start with then putting her to the breast once she gets going and then I will pump after and she will bottle feed if needed. I also have to hold her cheeks on the side to help her create the suction. We tried it for the first time a couple of hours ago - she took in 1.5 ounces first then was put to the breast and finished up there and then fell asleep. She must have gotten something out this time because I could hear swallows and she seemed satisfied. My mom is helping me, because this requires 3 hands to do . We will do one more feeding this way tonight and start fresh in the morning. I just don't do well without sleep, so we are going to take a break and do bottles overnight. I still will put her to the breast for comfort if she needs it overnight. I hope this works and helps her. I think part of the issue isn't so much bad latch, but she still isn't sucking right and has been biting/chewing trying to get the milk out. She is letting me use the flipple technique. I hope that this helps her figure things out and get the milk out. If not, we will just attempt breastfeeding for comfort as long as she is interested.

    As a side note, now we are looking into a nanny for the days that my family cannot watch her. It is just so challenging to get people aside from my husband and myself to perform the paced bottle feeding correctly. A lot of people are so familiar with formula that well intentioned family tries to give her larger volumes than she needs, or make her finish a bottle or thinks the milk goes bad after an hour. It is so hard to politely correct everyone.

  6. #6
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    Default Re: Breastfeeding not working after tongue tie release

    Well it sounds like you have found something that is a step in the right direction, even if it is a bit difficult to do. That is great your mom is there to help.

    It is important that you sleep, just be careful of going too long with no milk removal because the last thing you want now is to get engorged with the problems that can bring.

    It IS hard to explain paced feeding and small bottles to people who are used to gravity feeding and large bottles. It takes practice to learn and also they have to get over the false idea that the nipple must always be almost upside down so it stays full of milk or baby swallows air, as if this is some terrible thing.

    Maybe there are some simple drawings online of proper bottles positioning you can print out and tape up around the house. I know there are some in the book The Womanly Art of Breastfeeding (8th edition) so you could use that if you have it.

    Or maybe you can make a more simplified version of the bottle feeding guidelines I linked above to tape up, you could just tape that whole thing up of course, but it is long and not everyone is going to bother reading it. I would also suggest limit how many people give baby the bottle as the last thing you need right now is to have to teach multiple people how to properly bottle feed. A nanny is a good idea if that is feasible financially, but be aware she is probably going to need to learn paced feeding and about breastmilk handling as well.

    I think part of the issue isn't so much bad latch, but she still isn't sucking right and has been biting/chewing trying to get the milk out.
    This is probably true, but the root of such issues- at least most of the time- is shallow latch. A deep latch basically "triggers" or at least allows for more proper sucking and swallowing technique.

    If baby is struggling with milk extraction even when latched ok, I wonder if breast compressions might help. Did the LC show you those? More: https://www.breastfeedinginc.ca/info...t-compression/

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