What's going wrong?

Some background:

My friend had a baby last night 10pm. Quite a stressful birth and the baby was removed by forceps, was put on antibiotics and placed, after a brief cuddle with dad and mum, in the nursery in an oxygen crib till 5.30am this morning.

The midwives then advise for my friend to try feeding her (this is her first feed since birth). The baby sucked 2-3 times and then stopped. Didn't unattach but just wouldn't start again. They then made her express and then syringe fed her.

Fast forward to 4.30pm and she has only attempted feeding 2 times since all with the same result.

They can't work out why the baby won't suck. Any suggestions?

I told her to try and put the baby on the breast as much as she can and try skin on skin. Anything else??

She has a lactation consultant coming shortly but she doesn't think they'll say much different.

Advice please!!!

Does she have flat nipples? My DS1 would do that when i tried feeding and i never did manage to get him to latch without shields.

I do believe though thats its not totally unusual for some babies to not really feed in the first 24 hours. My sister had this happen with her second child, i think it was about 24 hours befors bub had and even semi decent feed.

Baby had a stressful birth too and needs to recover. Keep offering the breast, not expressing and syringing it in, and baby will recover soon, especially if they are allowed plenty of skin to skin and are encouraged to feed often. My DS didn't feed for the first 24 hours at all after a traumatic birth and ended up bfing for 16m, weaning only after I became radioactive for a medical procedure. I was also given no help and awful advice in hospital, despite what the nurses and midwives say, they cannot remove your baby and give formula without parental consent. Don't let them lie to your friend.

Sadly, sounds like what went wrong is the medical system. Again.

MummaT she just said the midwife has said about the shields for tomorrow because she is flat. Also she is very well blessed up top so they think it might be hard for the baby to work the breast.

CPPM: it is a big medical system fail. I feel so angry but I don't want to give her that negativity at the moment. There are so many things they have done wrong with her, I'm sure with good intentions but wrong nonetheless because the baby and her have suffered. Hopefully if she persists it will work. You give me hope.

I think babe may be exhausted by a stressful birth? Mama should keep putting her on and constantly trying. They need to just hang out together skin to skin, as you said. Just hang out like that rather than, ok now it's time to try feeding again. Let baby sleep on her (bare) chest, no swaddle etc. Enable the space and opportunity for baby to suckle in a relaxed environment.

I struggled the first few days too due to big breasts. She has to make sure she shapes the breast with her hand and guide it into babies mouth. Also with big breasts you have to keep holding and shaping the breast as you feed. The weight of the breast pulls downwards and if you don't hold it the nipple will slip and destroys the latch. Also get her to stimulate the nipples as much as possible and squeeze a bit of milk out to get the taste of the milk on baby's tongue.
That's all I can think of right now... will update when I think of more!

[QUOTE=little_O;3431560]MummaT she just said the midwife has said about the shields for tomorrow because she is flat. Also she is very well blessed up top so they think it might be hard for the baby to work the breast.


If she is flat nippled then it is still possible to feed without shields so like everyone else has said suggest she keeps putting bub to the breast. I managed to feed DS2 without shields it was just through perseverance of trying and trying til he got it.

She could also try baby lead attachment if she's game as i found that worked a treat too.

Hi little O, it sounds like your friend has had a really rough trot. For most babies, right after they are born, they experience an alert period, where they are ready and open to try feeding. Once they have a big feed, they settle down for a big sleep. Like CPPM said, they are recovering from the birth.

Sometimes, if there are things that don't go according to plan at birth, they might miss the wakeful period after birth and baby will just got into big sleep mode. And that's ok. Not ideal, but ok. They are born with fat stores to get them through.

When DS2 was born, he had a massive session at the boob after he was born, then slept for almost 12 hours. The MWs keeps asking me "has he had another feed ever?" And I'd just say "Nope, I'm not worried" and they'd back off. But it can be tough if you aren't confident that everything's ok.

Everything that the others have said is great. Remove the pressure. Lots of skin to skin, lots of rest for mum and bub. Snoozing together. Lots of time together. Use the LC - make sure she asks for an actual diagnosis as to whether she has flat/inverted nipples or not. It can be hard to tell and if you introduce shields when there isn't an actual need it can be just another hurdle to overcome. Try and keep it simple - one feed at a time, one day at a time.

Remember she can ring the ABA helpline anytime - 1800686268.

She just messaged me that the baby just fed 15 minutes either side whilst she laid down with it skin to skin.

Looks like the 24 hours was about spot on!

I will tell her about shaping her breasts and also to get the diagnosis from her LC.

I think the tough thing is that she has had so many visitors back to back she hasn't been able to just focus on the baby (a cultural things I think). I said to her she may just have to say no visitors until the baby is established.

Little O you are a great friend. :)

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Little O you are a great friend. :)

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I fully agree with this. I wish I knew you IRL

So glad hub has now had a decent feed. It will get easier from here. My experience was quite the same. Bub had no problems latching, but when on would only have a couple of sucks, then fall asleep and let go. They tried all the techniques to keep her awake, even wet cloth etc, but all it did was make her upset and in turn make it harder to get her on the breast. In terms of expressing and syringing into the mouth, I was advised to do this too. Was explained that sometimes after traumatic births (or even normal births) that bub lacks energy, especially if they don't get that first good initial feed. This then makes them too tired to drink or want to suck properly. So feeding them a small amount (we only did about 5-10ml) is getting some energy into them which hopefully will give them the pick me up and energy that they need to start feeding properly. It took around 48 hours before I was confident my dd was feeding well.

Aw thanks LL and MummaT I wish I lived near you guys then we could catch up.

On a sad note, I feel so angry.

So my friend has been trying all day to feed the baby but with little success. Apparently the have told her now not to feed the baby for 24-48 hours on her breast and they will just give her formula. The reason: the midwives have been manually expressing her nipples...hand expressing and have severely damaged her nipples so now it's too painful for her to feed.

They have instructed her to get a pump and keep pumping so her milk comes in. They are feeding the baby with a cup at least... But seriously!!!!! Now the baby stops getting colustrum because they've damaged her?????

This has all been decided with the LC as well. I'm at a loss. What do I even say?

The LC has told her to do skin to skin but no feeding for that time period so that the baby still feels comfortable.

I don't know how much to say to my friend because I'm not the professional here, but it sounds so wrong. Or am I just wrong?

So angry and frustrated and sad that this has all been mucked up for her. What's the chances of the baby taking the breast now?

:(

I didn't feed DS1 for the first 3 days for different reasons and I still managed to get him over to fully breastfed, so definitely possible.

How on earth they managed to damage her nipples by expressing I can't even begin to understand.

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I didn't feed DS1 for the first 3 days for different reasons and I still managed to get him over to fully breastfed, so definitely possible.

How on earth they managed to damage her nipples by expressing I can't even begin to understand.

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Agreed - nipples can quite easily get damaged using a pump, but hand expressing is hard to understand as is so different.

It's still early days. Her baby will feed once baby has the chance.
I wonder why are they giving formula if she's pumping? A baby this young would typically only have a very small volume of colostrum and be fine.
You can help by passing on info on normal baby stuff: so before milk comes in, 1 wet nappy per day of life, poos changing from black through to mustard after milk comes in, then 2-3 poos per day, 4-5 wet ones. This is the easiest indicator for mums to track.
Also would suggest mentioning laid-back nursing, which is a great way to harness baby's natural instincts to latch and feed, and relaxing for mum, too.

Sometimes all you can do is watch and wait and see. Unfortunately. I agree it's the medical system. I was convinced to formula top up in hospital too. Even though it didn't feel right, I still did it. There felt like there was no option. As long as she's do tuning to pump and maybe even hand express herself it will happen. Just continuing to encourage her and let her know that you have full confidence that's she can make this happen.

I don't understand how they managed to damage her either. I resent that the nurses expressed for me, when I was completely capable of doing it myself. Just because I wasn't as quick as they would have been.

You are a great friend. Just continuing to be there and support her without adding the pressure is important. Even if I'd been given different advice from friends, and I did I would have still done what they told me to. Cause it felt like I HAD to do what the professionals said. The only other thing I would suggest is to get her to call try ABA or MCH Line (if she's in Victoria) and tell the hospital staff the advice she is given from them. If she is not satisfied she could ask for the nurse manager. But it's hard to stick up for yourself when you have just given birth.

Laid back nursing has been amazing with both my girls when they were new and still sorting out attachment.

Poor mama she must feel so overwhelmed and even a little violated.

So she is finally home!

More questions though :)

She has been told to feed the baby on the shields, but she will only take about 10 minutes on each side, but the baby is constantly coming off and on and not happy about it. Apparently she suck for a bit and then just come of and then she has to put her on again. Etc. how can she encourage the baby to stay sucking?

The LC has also told her to express each feed as well, plus top up with formula. Apparently the baby needs to get 90ml with each feed. I mentioned to her that if she was solely breastfeeding that she wouldn't have a clue how much the baby was taking. When she expresses she is getting 50ml, so they completely discount the amount the baby may have gotten from the Breast and then get her to top up 40ml of formula. My friend is only offering her the formula, if the baby rejects it she lets it go.

the baby put on 90g in a day yesterday and she has lots of wet nappies (about 8) and about 6 poo nappies.

I suggested to her last night to maybe try and drop the formula today and just increase the frequency of breastfeeding to maybe every 2 hours during the day to see if that helps her. At the moment she is only feeding 4 hourly, but obviously the baby is getting a decent quantity of differing milks. Do you think that's a good idea or should she stick with the process she was doing?

The main problem is the baby not continuing to suck. I never had this problem so I am at a loss. Suggestions please.

The not sucking I'm not sure what to do, just wanted to say my DD2 did this. We don't know if there was an underlying cause (very possible with breathing issues that were picked up later) or if that was just her thing but every feed until about 8 months was on off on off on off. In the early days she was just too tired and would run out of puff (IUGR baby) but then my supply came in with full force and after awhile I knew she wasn't too tired any more, but she continued with the on off thing. So I guess I'm saying that the continual stopping might just be how it is at the moment and maybe for the time being work on other issues and see how this one pans out once baby is a bit older and stronger?

As for the formula top ups, I had to do them as a result of the IUGR and it really is the hardest thing to judge how much and when because as you say you have no idea how much they get from the breast to know how much to top up!?! So what I was doing on leaving hospital (as directed by my LC) was every feed went BF, EBM or formula top up on demand - as in I always offered the EBM/formula and she either took it or didn't, and she dictated how much she took - then expressing (in that order). Feeds were every 3 hours around the clock when still it hospital but I went back to demand feeding pretty soon after getting home and she just stuck with 2-3 hours from then on. I found after a few days at home she didn't want any top ups so I gradually stopped offering and stopped expressing.

When you say she is feeding every 4 hours is that a routine thing or baby is demanding every 4 hours? If it is a routine think I would maybe try cutting it down to 3 hours and see if that makes any difference to the top ups the baby requires.
If the baby is demanding every 4 hours I'm sitting on the fence as to what to do. When they got me to routinely wake and feed DD2 every 3 hours it felt so unnatural and her and I were both against it (!) but in hindsight it did help us through our crappy feeding start so that tells me the idea has merit (especially with a tired IUGR baby), but on the other hand I am always going to have reservations about interfering with the supply demand thing that works so well. I guess she could always give it a try (waking and feeding every 3 hours) for a few days and if it doesn't change anything go back to demand feeding with top ups?

90mL!!! That's loads!!! So the LC is assuming baby gets *nothing* at the breast?

How does your friend feel about all this? Is she wanting some other ideas? I'd suggest giving the ABA a call and/or getting a private LC in to have a chat about what's going on. She really needs one-on-one advice, because there's clearly a lot of stuff going on here.

Feeding more frequently during the day may be a great idea. Four hourly is pretty unusual, but if baby isn't asking more frequently it might be because of the formula. Whereas, if that is removed (and 40mL is quite a lot, really) then baby might simply feed more frequently to make up the difference. UNLESS, baby isn't feeding effectively at the breast. Which is something that needs to be assessed by LC and help given to mum and baby.

Skin to skin and laid back nursing may help with the sucking issue. has baby been assessed for ties? Also, she may need little extra help after traumatic birth, separation from mum and bottles early on. She probably just needs some more time. Laid-back nursing is good for this, also. And, an LC :)

It's a bit hard to offer useful info at this remove. Suggest your friend seeks more professional help. Just because an LC has said this doesn't mean another LC mightn't also have good suggestions for her.

Oh how hard for her! And baby :( Offering a breastfeed less often than 2-3 hours at this early age and considering the need for top ups seems odd to me, even 3 hours is a long time between refs if she is wanting to build supply and get a good BF relationship going. But she and babe have had such a rough trot, any number of issues or combination of issues could be causing this. Maybe another LC. Is the current one an IBCLC I wonder?

I have wondered the same thing LL!

So she is visiting the LC again today. Just spoke to her, apparently the baby is taking about 2 hours on the Breast now and still coming off screaming and wanting more. She then gives it ebm about 30ml and its happy. She said she's feeing about every 3-4 hours.

I have suggested she feed it every 2 hours at least but don't keep it on so long otherwise she will get more sore.

Guess I'll find out what the LC has said soon :)

LittleO how is your friend and her bebe?

Thanks for asking LL.

The poor thing has had more problems. She has been trying to exclusively bf the baby, but the damage was taking a while on one side so she was pumping that side and bottle feeding it every day or so to let it recover.

Then last week she ended up with mastitis on the side the baby was feeding properly on. She had a course of antibiotics, but the lump didnt go down. it actually increased.

Yesterday she had a follow up at the gp and the gp sent her to the wch. They have diagnosed her with an abscess 10cm by 12cm! (i did point out thats the size of a normal person breast haha...poor thing) so now she was in overnight while they try and get her in for it to be surgically drained.

the poor thing. she says she hates breastfeeding. She is just trying to continue because she knows its best.

They think the abscess may have been from when she was damaged by the nursing staff hand expressing. Im guessing a bug from their hands may have gotten into the damaged nipple and found its way up.

Anyway, she is having a shocking time :(

Oh the poor thing, the fact that she is still breastfeeding at all is something to be commended. Sending her lots of healing thoughts

Oh geez. She is doing an incredible job! I hated BF DD1 in the early weeks but grew to truly love it. DD2 is another matter entirely!

How rough :( I hope she can get some relief snd support soon.

this thread brought up a few thoughts when i read it all again, but probably not all relevant to her right now. I'm really sorry she has had such a rough time, and it looks like some of it was unneccesary.

Anecdotally, my 3rd child often fed for very short times (3 minutes, 5 minutes..), and i was so confused because the older kids fed for an hour or 30 mins in the first few months. i kept wondering what was wrong, but she was getting enough in that time and was happy and healthy.

Breast compressions while bub is feeding can help increase transfer of milk, and help baby if they forget to keep sucking. Nicer for mum too, to keep baby at the breast rather than putting baby down and then expressing with a pump.

It is harder for breasts to regulate if you add in expressing, and your poor friend seems to have copped that now too. When she is home, you could gently suggest nice things for mum and bub to do to reconnect. A big bath and cuddles can be lovely for mum and bub. Lots of skin and skin and checking each other out. with no pressure to breastfeed, but it might happen. Best if you have Dad or someone who can help set them up and take baby out when mum wants a solo soak or wants to get out. There are herbal bath mixes that you can buy.that are good for this.
A day or two in bed, with no visitors except close people/partner who bring food and love with plenty of skin to skin and eye gazing for mum and bub can be another way to just help her feel good with baby.

Oh that's rough! she's doing a wonderful job under extremely difficult circumstances.
It sounds like maybe baby is not feeding very effectively :/
I hope she's got lots of help and support at home.

That's exactly it otf. The baby isn't attaching well, but they don't seem to be able to improve attachment because of he size of her breast. She has literally fun out of bra sizes now, and she is only a small girl, like a size 8.

They are syringing out the pus ever day. So far she has has 100 ml on the first day and 50 ml each of the 3 times after that. They say that there appears to be a thicker type of pus in there and that's harder to remove. Also because there is no blood flow there it's harder for the antibiotics to work.

The Breast specialist has said they'll keep doing this for about 3 weeks. This is meant to be the more Breast feeding friendly option, apparently if they do the surgery like they initially wanted to its a 10c opening and they tell her it would be nearly Impossible to continue feeing because of how much would be coming out the hole.

I've been dropping off meals for her as has her mum, but the poor thing is struggling.

Yep, that is a really, really tough situation. It is incredibly difficult to continue feeding through a abscess.
She is doing a really, really great job. I hope you guys are telling her that. This is a baby who is having lots of trouble feeding and, unfortunately, the people who've been helping her haven't been able to figure out what's going on and how to fix it. And so she's come to this point. It's not her fault. It's not the baby's fault. (if anyone suggests her boobs are too big or her baby is too lazy or she's not tried hard enough, they are really just saying: I don't know why this isn't working.)
She just needs to get better now. Glad she has you guys looking out for her.