BF & attachment with premature babies

DD has been in NICU/SCN since June after arriving at 25+6 gestation. Her corrected age is 39 weeks and over the last few weeks I have been putting her to the breast to get her suck feeds established with the goal of bringing her home fully breastfed, with EBM top ups if necessary.

We are having some difficulties getting attachment right and its not doing my nipples any favours so I need some tips and hints from people who might have been through similar. She is a great feeder - she wakes for feeds, roots around a lot and searches for the boob and knows the nipple is there when I position her. She coordinates her suck, breath, swallow routine very well and stays at the breast for a reasonable amount of time.

I believe a lot of the problems relate to her size - she is still only 2.3kg and I know that with time & growth her mouth will get bigger, but I am struggling to get enough boob into her mouth and hence coming out with a pinched nipple and soreness. I've got lots of support from the LCs and nurses in SCN and they're are working through it with me. Today we tried the football hold and it seems to have made a bit of difference but not alot.

I'm sort of wondering if I'm actually trying to hard IYKWIM? You know, the whole shape the breast, position her chin & nose in the right spot etc. etc. its confusing! Maybe I'm intefering with the whole process so I'm going to do a bit of a search for some baby-led attachment stuff now. But today when I just put her near my boob and let her get on herself she just grabbed the end of the nipple and sucked away OUCHIES!

Any suggestions? I know time and growth will help us, but I don't want ruined nipples in the meantime. I am very prone to nipple trauma for some reason - it was my downfall with DS - and I don't want the same experience again.

TIA

I had similar issues with dd2, she was 34 weeks and had a cute but very small mouth, it took forever for her to put enough of my nipple in her mouth.

I used the football hold and a nipple shield until she got better at it. Lanisol cream was a godsend too for easing the pain in-between feeds.

I hope you can work something out.

i had 30 weekers and same problem as they were too small to get a good amount of boob
nipple sheilds helped- but get the ones for premmies!
i highly recommend using a Lactation consultant!! Wished i had have- would have saved me trying to second guess myself all the time!
take care and you are doing an awesome job!!

Thanks black_rose & *det*

They suggested a nipple shield to me today so I'm going to give it a go tomorrow. They said it can help in the early stages when they can't quite get enough boob in and hopefully reduces the nipple damage. Did the sheilds make a difference for you? When I was trying to b/f DS (who was a perfectly normal term baby) I avoided shields - scared off by unhelpful midwives telling me my supply would dwindle (which I know can happen but I wished I'd tried it.) I ended up giving up with him because my nipples were so battered.

*det* a lot of the senior nurses in SCN are LCs and I'm finding them very supportive and encouraging. I've put them on high alert that we NEED support and help to get this right. I have a tendency to just get on with things and not ask for help :redface: but we really need it to make this work. I did see a private LC a few weeks ago but she wasn't real helpful I must admit.

The shields were great for us, eventually I just forgot to put it on one day and we worked it out. Using a pillow to position her head helped to. I used a medela brand shield I tried an avent one but it was too big.

we used the nipple shields for dd1 but didnt need them for dd2 (both prems)

We just went through similar (DS was 36 weeks & 2.8kgs so tiny little mouth as well).

I'm definately another one to suggest the shield... I struggled hugely with cracked/bleeding nipples as he was only grabbing the end of the nipple and pinching... ouchies!!

When I left the hospital, I was using the shileds, but otherwise we were having no other issues.
Make sure you get the premmie size though - I used the avent one, theres a normal size & a prem size. Apparently the prem ones are hard to get but if you have any issues PM me & I can post you ours... I bought a few sets ;)

FWIW I had to use shields with both my DS1 (he was just lazy, lol) & DS2 - only in the beginning with both... and it made absolutely no difference with my supply.
It wasn't a hard task to wean off the shield as DS2 got bigger either... didn't take long at all.

Good luck & you sound like you're doing fabulously :D

My DD was born at 34 weeks and was 2.405kg born and 2.165kg on discharge from hospital on day 15. We left hospital on full suck feeds from the breast but I could tell attachment wasn't great (ouchy woah waa) I did a lot of baby led attachment with her and contacted the ABA for advice and we are happily continuing our breastfeeding now at almost 14 months.

I too was worried about using nipple shields because of the supply issue but I recently read (or maybe it was a midwife that told me, I cant remember) that its more of an issue if your supply isnt established yet. With DD1 I used a shield from the very start in hospital because she just couldnt attach at all. This may be easier said than done, but once she gets the hang of feeding on the shield and her mouth is a bit bigger, you could try taking it off during a feed and see how she goes.

We had a lot of trouble as well, DD was similar to your DD, she would hunt around for the boob, she knew it and would have a suck/play, she was 2.1kg when we started BF'ing so similar size to Miss H and she really did struggle, we tried for 6-7 days without a shield and my BB's were too big and her mouth too small. We then tried a nipple shield and I can recommend the Medela ones (which have a half moon shape cut out of them) so that Heidi's nose etc can still touch the breast.

We used nipple shields until she was 10 weeks old and I weaned her off them, I did how ever experience pain everytime she fed until she was 5-51/2 months, I had seen a LC numerous times and her attachment was right, she just wasn't big enough in the mouth. I got a bout of mastitis when I weaned her off the shield and would often have blocked ducts, but it just meant rotation feeding, so I would switch from cradle hold, to football hold and even to a partially sitting up position so that she would drain the whole boob as she wasn't big enough to really draw out for a majority of the ducts in one position alone.

I was on Motilium for supply issues, but I had to be on it the whole time, I just didn't have a good supply with BF'ing, and expressing, with and without the shields, so I would say that in my case they didn't not affect the supply.

It was truely amamazing to see how much more content DD was after a feed with the shields, she didn't have to work so hard, she could have pauses in her feeding (she didn't have a lot of energy due to jaundice that lasted 3 months) and not lose the boob and have to go through the whole reattachment.

We made it to 15 months when my supply disspppeared after I weaned off the Motilium, but it was a LOT longer than even my LC thought we would get :D

Well I'm pleased to say that I tried the shield today and achieved my FIRST EVER pain-free breastfeed. Yes, first ever. Even with DS everything was painful. I am so grateful to all of you for your advice & support. DD took a minute to realise and get her mouth open but once the milk started flowing there was no stopping her. Great big gulps and she lasted a good 10-12 minutes. I'm so so happy, I was starting to get increasingly anxious about it all, the pain I experienced trying to feed DS is something I never want to re-visit. I had never even contemplated a shield but it seems (based on this thread plus my own research) that its a really common strategy to help prems attach. And if it works, then YAY. Thankfully my supply is well established due to expressing for such a long time so I doubt it will create too many problems there.

Beema, the hossy use the Medela shields with the half moon shape which is great. Very comfortable. Sounds like DD was much like Nakita - she can get on ok at the start but just gradually slips back as the feed continues which was causing the pain.

Hollybolly - I wonder if the ones the hossy have given me are the prem shields? It had no size indicator on it so I'm unsure. It would be bizarre if they weren't though given the majority of the bubs would be prem? I dunno. Thank you so much for the offer to post yours over - I will get in touch if I need.

I feel very relieved. When I posted last night I was starting to spiral a bit, very concerned that I'd end up failing this whole b/f caper again, but I have renewed hope after the feed today. Thank you all again.

:leap: :hooray: :hooray: :leap:
that is all :D

:leap: OMG *Infinity* :leap:

Wooooo Hooooooo!!!!!!! :dance:

I am so so so happy for you, I so understand what that feeling is like to see that shield filling up with milk and my precious little one enjoying all that yummy BM :D

WTG Heidi :excited:

fantastic news!!!

:hooray: :loveshower: :hooray:

Fantastic!!!!! Well done!!!!
Strangely enough, the hospital gave me the normal size, not the prem size :lol:

The prem size are realistically more like the size of a real nipple, (quite thin & pointy), the bigger ones are a lot fatter... If that makes sense :rofl:

Another pain-free feed this morning with DD which was great. Such a weight has lifted for me, its unbelievable. Instead of sitting there, hunched over, trying my hardest to attach her and getting very anxious in the process, I just relax back and put her on and away she goes. Just beautiful. And I used the shield on my slower side today and didn't really phase her too much either - still lots of sucks & swallows which is great.

Holly - the size on the shield is 24mm - how does that compare with yours? She seems to be going ok with them.

I can't see anywhere with a mm measurement, but on the avent ones, down one end is the avent logo, and down the other it hass CE. (I have no idea what this is :rofl:)

On the bigger one, it has the number 16, on the prem size one it has a 3.

I have no idea if this has helped, sorry!!!! ;)