Trying To Get Away From Pumping

[@llli*splotchgc]

My little guy is 9 days old. I've struggled to feed him by breast since day 1, despite the aid of my midwife, a local LLL leader (by phone), a breastfeeding warm line consultant, and my sister (who has an 11 week old right now, her 4th).

I'm certain it's a positioning issue, because I've had plenty of milk up to now. My supply does seem to be getting smaller, but I'm hoping that's because it's adjusting to his actual needs. I've had a huge surplus until yesterday.

He doesn't latch very easily--probably due to my incompetence in positioning him correctly--so I've put up with the pain brought on by cracked and sore nipples when I can get him to latch, but I keep reading (and am told) that it's NOT normal for it to hurt like this. Last night he latched on and it hurt so much that I had to pull him off entirely. I haven't tried to breast feed him since.

I'm pumping every couple of hours but I really would like to just feed him by breast. I'm lucky to have a good supply, but I want him to get it straight from me. Waking up and having to pump is more than a little inconvenient, especially since I'm still recovering from birth; a trial all its own.

I've tried the cradle, cross cradle, football clutch and lying down positions. We have the best luck with lying down, although it still hurts. Is there something obvious I could be doing wrong? He does have a tendency to suck in his lower lip, but we work very hard to correct this (even when he's using a bottle or doing it in his sleep). Thanks in advance for any advice.

[@llli*mammaof2]

Has your lo been checked for tongue tie?

[@llli*splotchgc]

He hasn't been checked for a tongue tie, no.

My sister has breast fed him a couple times to make sure he hasn't forgotten how (nipple confusion and all that), and he latches on just fine for her.

I did get him to latch a couple hours ago, but it eventually started making my nipple ache again.

We'll take a look at his tongue and see what we find.

[@llli*mommal]

I would go and see a lactation consultant ASAP, preferably one who is an IBCLC. There's no substitute for hands-on help! The LC should be able to pick up on any tongue tie situation, and can also help you with positioning.

A few questions for you, that might help us figure out what's going on:
- What are your nipples like, normally? Are they inverted, flat or semi-flat?
- When the baby comes off the breast, what are your nipples shaped like? Are they more like pencil erasers (elongated and symmetrical) or like new lipsticks (elongated and asymmetrical)?
- Breast size- larger than average, smaller than average, or about average?
- Do you ever feel like the baby "slips up" on the nipple- in other words, starts out with a good deep latch but loses it as the feeding progresses?
- When do you experience pain, at the beginning of the feeding, throughout the feeding, at certain points during the feeding, or after the feeding is over?
- Does the baby ever choke, cough, or splutter during feedings?
- Where are your cracks? Are they radiating all over the nipple/areola or are they concentrated in one spot?
- In addition to the cracks, do you notice any changes in the skin of your nipples/areolas- changes like redness, flaking, or white patches?
- Are you experiencing any itching or burning sensations?

[@llli*aprilsmagic]

Originally Posted by @llli*splotchgc

My sister has breast fed him a couple times to make sure he hasn't forgotten how (nipple confusion and all that), and he latches on just fine for her.

I did get him to latch a couple hours ago, but it eventually started making my nipple ache again.

I find the first part interesting. Does your sister say it hurts her to nurse your baby at any point? BTW, I think that's awesome that she can help you like that. I grew up in a family where my mom and her sisters nursed each other's babies all the time

So when you tried again, it was OK and then started to hurt as time went on? Is that correct?

Something that might or might not help you .. . a wise mama told me about the 60 Second Sizzle when I first started nursing. It should only hurt for the first 30-60 seconds, and if it hurts after that, then it's thrush or the latch. Take the baby off and start over.

Originally Posted by @llli*mommal

I would go and see a lactation consultant ASAP, preferably one who is an IBCLC. There's no substitute for hands-on help! The LC should be able to pick up on any tongue tie situation, and can also help you with positioning.

A few questions for you, that might help us figure out what's going on:
- What are your nipples like, normally? Are they inverted, flat or semi-flat?
- When the baby comes off the breast, what are your nipples shaped like? Are they more like pencil erasers (elongated and symmetrical) or like new lipsticks (elongated and asymmetrical)?
- Breast size- larger than average, smaller than average, or about average?
- Do you ever feel like the baby "slips up" on the nipple- in other words, starts out with a good deep latch but loses it as the feeding progresses?
- When do you experience pain, at the beginning of the feeding, throughout the feeding, at certain points during the feeding, or after the feeding is over?
- Does the baby ever choke, cough, or splutter during feedings?
- Where are your cracks? Are they radiating all over the nipple/areola or are they concentrated in one spot?
- In addition to the cracks, do you notice any changes in the skin of your nipples/areolas- changes like redness, flaking, or white patches?
- Are you experiencing any itching or burning sensations?

and . You can get through this!

[@llli*splotchgc]

Originally Posted by @llli*mommal

I would go and see a lactation consultant ASAP, preferably one who is an IBCLC. There's no substitute for hands-on help! The LC should be able to pick up on any tongue tie situation, and can also help you with positioning.

A few questions for you, that might help us figure out what's going on:
- What are your nipples like, normally? Are they inverted, flat or semi-flat?
- When the baby comes off the breast, what are your nipples shaped like? Are they more like pencil erasers (elongated and symmetrical) or like new lipsticks (elongated and asymmetrical)?
- Breast size- larger than average, smaller than average, or about average?
- Do you ever feel like the baby "slips up" on the nipple- in other words, starts out with a good deep latch but loses it as the feeding progresses?
- When do you experience pain, at the beginning of the feeding, throughout the feeding, at certain points during the feeding, or after the feeding is over?
- Does the baby ever choke, cough, or splutter during feedings?
- Where are your cracks? Are they radiating all over the nipple/areola or are they concentrated in one spot?
- In addition to the cracks, do you notice any changes in the skin of your nipples/areolas- changes like redness, flaking, or white patches?
- Are you experiencing any itching or burning sensations?

My right nipple lies flatter than my left--whether this is the cause or result of his only taking to the left side, I don't know.

My nipples don't come out eraser-like, they're usually asymmetrical once he's done with me.

My breasts are larger than average. Milk has made them almost unbearably large. I have to hold it back to keep from smothering him during feeding.

I don't think he slips up. He'll latch on and let go after just a few sucks sometimes, but during "successful" feedings he maintains the latch until he falls asleep or gets full.

The pain is throughout the feeding, and sometimes continues afterward (last night it didn't).

He's never choked while on the breast, but he does sometimes while I'm bottle feeding him.

The cracks are just on the nipple itself, starting at it's peak and going upwards (the underside of the nipple doesn't seem to be cracked).

There is a tiny bit of flaking around the cracks themselves, no redness or itchiness though.

I'm starting to think he has a shallow latch... I'm just not sure what to do about it.

[@llli*splotchgc]

Also, my sister hasn't had any problems with him. She said his suck is much gentler than her daugther's, but he doesn't cause her any pain.

[@llli*mommal]

My right nipple lies flatter than my left--whether this is the cause or result of his only taking to the left side, I don't know.

Sometimes it's really hard for babies to latch onto flat or semi-flat nipples. And they can be bad for mom, too, because it's much harder to get a short nipple to land in the sweet zone on the back of the tongue. Often a flat/short nipple lands too shallow in the mouth, and gets compressed between the hard palate and the moving tongue.

My nipples don't come out eraser-like, they're usually asymmetrical once he's done with me.

This also suggests a shallow latch. Lipstick nipples mean that there's compression going on. If the latch was perfect, your nipples would be more likely to come out symmetrical.

My breasts are larger than average. Milk has made them almost unbearably large. I have to hold it back to keep from smothering him during feeding.

This definitely makes positioning a challenge! I also had the most luck with the side-lying position, so I'm glad you're using that.

I don't think he slips up. He'll latch on and let go after just a few sucks sometimes, but during "successful" feedings he maintains the latch until he falls asleep or gets full.

That's good! Sometimes babies have trouble holding onto the heavy breast using just their mouths, and over the course of the feeding they let a lot of breast fall out of their mouths. Then they end up latched onto just the nipple, and that is more likely to be a shallow, painful latch.

The pain is throughout the feeding, and sometimes continues afterward (last night it didn't).

Ouch! Once again, this is saying shallow latch to me. If it was thrush, you'd probably be having more pain after feedings.

He's never choked while on the breast, but he does sometimes while I'm bottle feeding him.

That's good news. Sometimes choking/coughing/spluttering at the breast indicates overactive/fast letdown, which causes some babies to clamp down on the nipple in order to control milk flow.

The cracks are just on the nipple itself, starting at it's peak and going upwards (the underside of the nipple doesn't seem to be cracked).

Ouch ouch ouch. Are there multiple cracks per nipple, or just one major one? (With thrush, you'd likely see multiple radiating cracks. With a shallow latch, you're more likely to have fewer cracks, and they'll be in the same spot consistently, the spot where the baby's mouth is landing each and every time.)

There is a tiny bit of flaking around the cracks themselves, no redness or itchiness though.

That's good news. If thrush was a problem, you'd probably see more redness and itchiness.

I'm starting to think he has a shallow latch... I'm just not sure what to do about it.

See a lactation consultant! Seriously, I saw 2 IBCLCs, and each one had slightly different tricks for helping me improve my baby's horrible shallow latch. Also, hang in there and give this time. As the baby's mouth grows, he's going to be more able to latch on much deeper. Once that happens, your nipples will start landing in the sweet zone even if they are somewhat flat. And flat nipples do tend to correct themselves with time: mine used to be flat to the skin except on very cold days, but after 3 years of nursing they are a normal length.

[@llli*sarahekd]

Mommal, you are awesome.
Am I allowed to at "mine used to be flat to the skin except on very cold days"? Because that's awesome.

Just wanted to add my 2 cents... ok, maybe more like 25 cents:
I had tons of trouble with positioning and latch in the beginning, and I think it was a combo of large breasts (it was ridiculous, really) and slightly flatter nipples. I also had a lot of pain, cracks, etc.

Football hold made the large size more manageable for my little guy, but he tended to get lost under there...
Once you *have* cracks, the rule about not having any pain may not be too accurate. It will be hard to tell from pain alone if you're latching correctly if you already have cracks. You'll have to pay attention to the shape of your nipple and your baby's mouth while they're latched. My breathing techniques from birth helped a lot while my cracks were healing...

I eventually got a breast infection without any plugged ducts due to the cracks too. It did NOT help with the pain. I pumped a lot in the beginning to help with the pain, but it didn't help with the supply. Oversupply + infection + cracks = no fun. Make sure you're sterilizing your pumping stuff and washing your bras in hot water. I used vinegar vinegar in the wash too. You're probably more on top of this than my lazy self was but just something to keep in mind if you have open wounds.

It took us a while to get off the pump/bottle, but after I found a dr that knew how to treat infections properly and the thrush from the poor use of antibiotics was treated, we were fine! I haven't even pumped since my little guy was about 3months. You can do it!

I also agree about seeing an LC. I talked to an IBCLC over the phone, and it helped a lot. Going to LLL meetings is really what helped me learn how to latch! There is nothing that compares to hands on help and watching other people nurse!

[@llli*splotchgc]

Here's an update on the situation:

I went into a lactation consultant yesterday. She suggested the football hold for a deeper latch, and we worked on getting him on the right breast with little success. When we tried the left breast (with a nipple shield) the pain was so excruciating that it was unbearable. The crack runs right along the top edge of my nipple.

She suggested pumping until the crack has time to heal, using gentian violet twice a day (each morning and night) to prevent possible infection, and using a nipple shield to help with my flat nipples. She noted that normally she does not like the use of nipple shields, so I guess my case is worse than I thought.

My pump is dying (it's from Wal-Mart, what did we expect?) and it's about $60 per month to rent one from the hospital. I called WIC's breastfeeding line and they are allowing me to borrow a Medina Lactina double pump for two weeks. There are conditions, of course. They want him feeding more frequently, not using a bottle, and I have to track and report how often I pump and how much is pumped. This is explained further below:

I've had conflicting advice and standards given to me regarding Rylan's weight:

The lactation consultant called me up after I had left and said Rylan is underweight for a 2 week old-- 3 ounces more than his birth weight. Supposedly he should be gaining an ounce a day from day 5 on. She feels I need to feed him more.

The WIC breast feeding consultant was concerned that he had gained anything over his birth weight at 2 weeks-- He should just have gained back to birth weight and as far as she is concerned, Rylan is over-eating.

Considering his stomach is visibly large when he breathes and he takes 3-5 ounce bottles every 3-4 hours, I'm leaning towards the latter being accurate. We've weaned him down to 2 ounces at each feeding and try to spoon feed him every 90 minutes to 2 hours.

We've only been doing this a little over 24 hours now. He is eating more frequently and we've got spoon feeding down to an art, but I'm ready to put a drill bit through my head from lack of sleep and a migraine. Waking up every 2 hours to pump at night is ridiculous; I get maybe an hour of sleep between pumpings. The Lactina takes 2-3 times as long to gather half as much milk as the other pump. On the other hand, it's much gentler on my nipples.

I need to start trying him on my right breast in the next day or two because it's less damaged and the sooner I get this down, the better. In the meanwhile my sister has fed him a couple times today and found that his latch is perfect, once he gets on. She isn't fond of the football hold but has used it for my sake so he's used to it when I finally gather the courage to try again.

More on conflicting information: The WIC specialist said Rylan should take no more than 18 oz of milk per day. What I've read on kellymom.com tells me that 18 oz is a minimum. I don't know what source to rely on anymore.

This would be a complete non-issue if he was just feeding from the breast, and I feel incompetent as a mother for not getting this right to start. It's been torture having any kind of "feeding schedule," because I feel like I should just be able to follow his cues, but weaning him down has required us to let him feel unsatisfied for a couple meals. His sucking needs are also unfulfilled. His dad and grandma are both willing to have him suck on their finger, but I'm scared to death of hurting him.

Sorry this is so long. I'm extremely discouraged at this point. I had no idea it would be this hard to feed my baby.