What to do?

[minimatron]

Hi, just more of a vent and hoping for some suggestions thrown in!

A while back I posted about getting help for bf dd3. Great suggestions came in and after that I hired a LC and we wrote up a birth plan. I saw the LC on the day I came home with dd3 and have had very regular contact with her via phone since then. I have also seen a midwife who does baby reflexology/massage and she stayed with me for 3 hours and helped me with feeding.

Ok since birth dd3 hasnt latched on properly. She had her tongue tie snipped prior to going home. Every feed I express a bit out and rub it on my nipple, some under her nose. I offer her the boob and she will open her mouth and attempt to take it. She gets on and has 2-4 sucks and comes off. This goes on for ages and she either gets frustrated or falls asleep. I offer both sides but shes never had a full feed from me. I now give her a time limit of 5 minutes each side as she either gets too upset or I could be sitting with her for hours on end trying and not feeding. So every feed I have to give her ebm. She requires at least 75mls to satisfy her and even at just over 2 weeks old she has had up to 125mls!

We have loads of skin to skin time, I have tried the nipple shield, various holds, hot packs on my boobs, offering boob before ebm and after, giving boob inbetween meals. She just doesnt suck hard enough to drain me for a feed and she just doesnt seem to want to stay on.

I have hired a medela lactina from the hospital which is due back tomorrow, although I can extend it for another 4 weeks. I'm not sure if I want to hire it for longer or get a pump off ebay. She will happily suck from a bottle and maybe she finds the boob too hard to do? I have no choice but to top her up because she just wont latch on. Im at a loss.... this happened with my other 2dds. I lasted 6 weeks and 3 weeks with them. I have tried so hard this time around and Im not sure if I am ready to give up yet, but the past few days I have spent in tears and on the couch as its such a big job to offer boob, then give ebm then express. I hate expressing... why cant I be one of those ladies who just chucks them on the boob and off I go?

The other thing about all of this is my other girls are really missing out on me. They have been so very good for me but I can see if I keep going they are going to get frustrated with it all. At the moment they spend so much time infront of the tv just so I can get this done. And I am so exhauseted that I fall asleep during the day on the couch feeding and they are always trying to wake me up.

Anyway this is more of a vent. Im not too sure what to do, if I should hire the pump for a few moe weeks, if I should buy my own, if I should continue trying and for how long, or if I should just count my losses and switch over to formula.... I dont know!

[Kmn]

I'm sorry that despite all your prep-work you are having difficulties. What follows is a bit of a brain-splat, but hopefully some of it is useful.

When you express, do you have some idea of how your let-down behaves? Does it take a minute for there to be any milk at all, or does it come in an instant rush, or does it take a while and then rush? If it is "slow", then pre-preparing byhand expressing a bit before you try to attach may help. If it is very fast then feeding bub lying down, with you both lying on your sides and with bub lying on a towel may help her handle the firehose effect. In both cases a bigger baby will just cope - so if it is a let-down based issue then it will go away with time.

Can you attach her when she is apparently not hungry - i.e. any time she is awake and happyish give it a go.

Have you tried giving her a little bit of EBM and then the breast??

Suggested tactic: express partly so that everything is ready to go and dribbly. Then try and attach her. If that doesn't work then give her some of what you have expressed via bottle and then attach again.

Keep the hire pump for another few weeks if you can - it will do a much faster job of expressing than anything other than an expensive bought pump. Can you borrow a second set of attachments and see how you go pumping both sides at once -it may save you some time.

You also can just put milky pump bits back into the fridge between uses - and only wash them once a day, which saves a bit of time too.

Have you seen the LC again - this sort of breast refusal can be quite tricky, and they have lots of tricks to overcome it.

As to "how long to continue for" - I think that you should see the LC first.

In the future, if you maintain some sort of breastmilk supply then you have options. And attaching usually gets easier as bub grows. I would really encourage you to keep pumping (not necessarily full-time if it is driving you batty) for a few months at least. See FionaS's thread for an example of how attachment can improve with time!

All the best.
Kate

[MantaRay]

Oh hun, that must be so tiring and time consuming for you All that time spent trying to attach, as well as expressing and feeding the EBM. No wonder you are in tears. You are doing such an amazing job to persist through all of that, especially when you have two other DDs to keep you busy as well.

Only you know whether it's worth persisting or not. The fact that you have been so determined and seem sad at the thought of not continuing suggests to me that you would prefer to get this working if you can. Hopefully with the right support you will get there and all this effort will seem well worth it. I wonder how you feel about the LC you are seeing? Are you comfortable with her and confident that she understands your situation? One option might be to see another LC to see if she has any other ideas that you haven't tried yet. IBCLC qualified LC's are the most highly trained and are pretty good at spotting things that are unusual. If you would like to look up an IBCLC in your area, you can do that here - Australian Lactation Consultants Association Ltd - ALCA - Find a Consultant.

There are a few things that could be going on and it's so hard to know without spending some time talking to you more. It could be that your DD has a high palate which can make attaching more difficult - this is more common in babies with tongue ties. Or it could be something else anatomical, or perhaps something else altogether. Have you tried Baby Led Attachment at all? A lot of mums have success with this when nothing else is working. If you haven't tried it yet, it might be worthwhile. Usually mums find it works best when they are sitting comfortably in a reclined position and when their baby is calm they place her on their chest between the bresats. The baby will sooner or later start to move to one breast - either by lunging, or bobbing her head. At this stage you gently support her as she moves, and allow her to find the nipple and attach herself with little or no assistance. There is more information here - Australian Breastfeeding Association - Baby-led attachment and a great little video clip here - Biological Nurturing sample scenario.

If at any time you would like someone to talk through a feed with you, or give you some support over the phone, you can call the ABA helpline on 1800 mum 2 mum (1800 686 2 686, drop the last 6 for VOIP). SOmetimes just hearing a friendly voice who understands what you are going through can help get you through.

And of course we are all here in BB land holding your hand You are an amazingly strong woman hun and you are doing such a wonderful job for your DD.

[minimatron]

Thanks girls for your reply

I had such a bad day when I posted and I think this journey will see me go up and down until it sorts itself out.

Kmn- I will try and answer all your questions.... My let down, well when I pump it takes a few seconds and then sprays out. I have tried all different positions to feed, she seems to and so do I , prefer the football hold. I have tried to feed her at all times, hungry sleepy, awake, pre ebm and post ebm. All these times she has not attached well. I have rehired the pump for 4 weeks so that will give me time to sort it out! I have lots of milk again now so am a few bottles ahead for each feed And feeling heaps more relaxed that I am ahead! As for my LC... shes a nice lady but I dont feel like I am getting any further with her..... which leads me to ....

MR- thanks for your lovely message. As with everything at the moment, it made me tear up! I took your advice and called the number you PMd me. She also suggested high palate issues and is going to get back to me with some names of LCs that she recommends. I really need someone who knows what they are looking for. Its quite hectic in this house at the moment so I am keen to get on top of it all sooner rather than later and am really would like to do this as its my last baby and would love the experience at least once! I have looked at those web sites and have tried them, and although shes not great at it, we still do it quite a few times a day to get practice in.

Oh and I have booked in for osteo.... has this helped any one I wonder?

Anyway, once again than you for helping out. I am realy appreciative if it all

[Kmn]

It does sound as though she is attaching, having a few sucks and then getting put off by the force of the let down a bit. Hang in there - that will get better as she gets bigger (as in over the next few weeks rather than when she is 2!). And sorting it out any other issues with the very best LC you can find is also an excellent idea!
Give attaching after you have expressed and when she isn't hungry a go - that way your letdown will be pretty weak, and she may be able to practise without all the milk getting in the way (almost using you as a dummy). If she attaches when you are empty then the let down is part of the issue - and feeding lying down is one way to reduce the impact of that.

Being ahead does make a huge difference - you can try and attach and then get the EBM out without having to express with a grumpy baby demanding her dinner. My son got to the point of finding breast pump noises soothing....

I have huge admiration for anyone who does all this with other kids - it was enough "fun" for a couple of months with a first baby (who did eventually get the hang of actually staying awake long enough to feed). You can cannibalize an old bra by cutting holes where the pump bits should go, and then you have hands-free-ish expressing, which might allow you to draw or read or do other stationary things with your older kids and feel a bit better about them not getting as much of your time. Pop over to the exclusive expressers thread and get some tips from the expert expressers.

[minimatron]

Quick update.... Things are looking somewhat better.... Shes started to suck a bit better and at times has had up to 30ish sucks in a row! Better than the 2-4 she started with. Shes still taking about 100mls ebm top up so hasnt had an exclusive feed from me... I suppose that will take some time. I saw the health nurse who happened to be a LC as well... she commented that my nipples are large and Amy doesnt have a huge mouth, so she thought that she should be right in a few weeks. Also she checked out her palet for me and said she didnt think it was very high. She gave me reassurance that what I was doing was very positive. Also Amy has put on just under half a kg in 2 weeks so shes being fed ok and that the bigger she gets the better she will get on the boob. The only thing thats bothering me now is my nipples are stinging. I think its from a combination of all the expressing as it does sting when I put it on coz my nipples touch the sides and also that Amy is trying so hard to have a feed and latch on.... Any suggestions or comments? I am feeling really good about it. Oh and the other thing is I have no idea about breastfeeding in a sense like.... how do I know when shes had enough? How long do I let her feed for? Its so different to the formula journey!

[Lenny]

Hi Melissa,
Well done on getting this far through all this. It's so good to hear things are getting a bit better and DD3 is gaining weight. You'll know when she's had enough because she'll stop feeding from the breast. You don't necessarily know how long this will be - try to let her actions tell you. The ABA says to feed frequently whenever your baby cries or seems hungry and let baby finish the first breast before offering the second breast.
All the best

[Kmn]

THat one is an easy fix - I am assuming that you have a Medela hire pump?
Get the bigger nipple attachment (costs abour $10 or so) and that will fix that.
Comes from MothersDirect/ABA or probably also from chemists or even the hospital.
WEll done!

[minimatron]

So my girlfriend came over yesterday with her 3 month old son and I was trying to feed Amy and the first thing shes says to my is that my nipples are huge! So 2 people this week have made comment about how big they are. So I had a look at hers and yes... mine are large! Hers are the like a crayon in diameter and mine are like a big chalk! Now I have a nopple obsession! No wonder the girls havent had a good time getting on my boob! Amy is my biggest baby and she struggles so it would have been harder for the other 2! So I am assuming that its only a matter of time that her mouth will get bigger and she will be able to take my nipple and aerola in as well..... gives me greater hope! Shes starting to feed better too. She always looks for my boob and has a go with gusto!

[Lenny]

She always looks for my boob and has a go with gusto!

Awesome!
I laughed at the nipple obsession!

[Kmn]

Big-nipple-little-mouth will fix itself over the next few weeks. You're doing really well!

[minimatron]

Yes... I like to hear that big nipple little mouth will fix itself over the next few weeks.... if only someone suggested that with my first 2 I may have had a longer go. Its funny because I thought mine were a normal size! But I suppose what is normal?

[Kmn]

There's such a huge variety - both in nipples and in baby mouths.
The other thing that will change hugely over the next few weeks is DDs strength and endurance - so she will be better able to cope as well.

As for how will you know when she's had enough - initially you should find that she has less of her top-up bottle. When that's down to say 50ml then you have the option of not giving some of the topups and adding extra attachment feeds instead. For your own peace of mind keep up with weekly or fortnightly weighs as you drop the top-ups - that way if things go off-track a bit they will be caught early, and you can always add a top-up in again or an extra feed.
Most BF bubs ask to be fed - they winge a bit and are then happy when they get their boob. The timing of this can be very irregular. For example my DS at 3 months was feeding at 7am, midday (because he went back to sleep after 7), 2,4,6,8,9,10,11,12 midnight. As long as DD is weeing, pooing at least once a day (which may back off once she is a few months old) and growing then all is well.

[minimatron]

Ok so my next question..... how do I get her off the bottle and onto full time boob? Shes starting to drink properly from me as I can hear her gulping, but she regularly falls asleep and she also requires top up after each meal. I tried yesterday to feed mostly from me but it ended up in tears from all the girl in this house because I spent all day on the couch with her and she was so fussy and wouldnt sleep and wanted to feed constantly. So even though it was a crap day it was kind of heading in the right direction..... or should this be a whole other thread ?

[Lenny]

Melissa, Maybe you could start a new thread and put something like "how do we finish with the top-ups" or something like that. The subject title is important and maybe you might get a few more responses.
There are lots of lovely BBers who have gone from top-up feeds to full time breastfeeding so i'm sure there is a wealth of great advice out there. Also, Barb Glare is our amazing expert and you might catch her eye too.

But you are heading in the right direction. It is difficult (I had my DH at home and no other children when i did it). You do need to offer the breast A LOT. The more she takes, the more you will make so you will have a few days of lots and lots of feeds until you can both get in sync.

All the best