DD learning to BF - need encouragement - ANOTHER UPDATE

[justincase]

ETA: Final (I hope! :)) great update in post #29...
ETA: Baffling yet positive update in post #18...

So we are now just over one week into The Plan to try to get DD to learn to BF, and I think I am going out of my mind.

A quick recap: In the hospital she didn’t latch on well. LC and ped agreed that she had weak to no suction and was not putting her tongue far enough forward. She seemed to do "okay" with a shield on as it gave her more "feedback". We went home using the shield and supplementing with a cup feeding at night (EBM), when her sucking seemed to be poorer and she still seemed hungry after attempting to BF. Initially things were better during the day. Sometime during week 2 of life, she started seeming hungry after daytime feedings as well. We were referred to an SLP to make sure there was nothing physically wrong. SLP confirmed poor suction (but good compression) and tongue not coming far enough forward, also said she has immature breathing pattern while trying to eat, but ruled out anything physically wrong and said she should be able to learn with two to three weeks’ maturity and practice. In the meantime we should go to a bottle after each BF attempt to ensure that she was getting enough into her; she was not gaining as fast as everyone would like. Two LC’s (one from hospital over phone and one I know personally) blessed this plan and said the most important thing to do was to get food into her and that she “should be able to learn” to BF.

So for just over a week we have been following this cycle of BF attempt, bottle of EBM (she takes about 3 oz hungrily regardless of whether my assessment of the BF attempt was fair or poor), pump, repeat at least every 3 hours during the day with one little bit of a longer stretch of sleep for me at night when DH gives a bottle without waking me. It is working from the perspective that DD seems satisfied after feedings and her weight gain is now good. My supply does not seem to be an issue for now – I get anywhere from 4-14 oz each time I pump, 6-7 times a day. But here is the problem – actually two – (1) I feel like I am going out of my mind with how long this routine takes and the fact that by the time it is done it is practically time to start again and could use a little encouragement from those of you who have BTDT and (2) I don’t feel like the BF-ing is going any better. Is she really going to “learn” if she keeps getting the bottle? I know it is only one week in but I don’t know, I thought I’d see some change in her BF-ing by now.

[jenny]

Hugs to you Jessica. I've been there. I cried the first week home b/c DD didn't latch on very well. She wasn't taking my nipple far enough back and was hungry all the time, even after I put her to my breasts for 1 hour!! Because she wasn't drawing enough milk out, it impacted my supply. I went to see an LC and she said we needed to put our finger in DD's mouth so she'd get used to sucking and taking the nipple far back without gagging.

The LC suggested we use Playtex dropins b/c they're most like a mom's nipple and has the slowest drip and will force DD to take the whole nipple into her mouth so she doesn't get nipple confusion. She wasn't gaining weight in the beginning, so we had to supplement with formula until I got my milk supply up enough. I was pumping every 3 hours, waking up at 4 a.m. to pump while DH and DD were sound asleep.

I don't know if it was b/c DH and I were lazy or what, but we just kept giving DD the bottle of EBM b/c she really didn't latch on and i was going back to work anyway by that time and I was just spent.

I know some moms have a better experience with getting their baby to latch on and some have said that breastfeeding doesn't really become natural for both mom and baby until at least 3 months. I don't know since I've never been there.

I've been exclusively pumping for 9 months and it's seriously a big pain in the butt. But just wanted to encourage you that I know it's tough. Try not to beat yourself up about it. I know I've looked with jealousy at moms who can easily pop out their breast and feed baby wherever and whenever while I have to find places to pump. It can be trying on your spirit.

So do whatever you need to do. Formula isn't evil. I know I cried over giving formula in the beginning too (which is weird b/c I was a formula-only fed baby). It's just that expectation I had I guess that I'd be able to breastfeed with ease.

Enjoy your time with your baby and know this too shall pass. Whatever you decide to do, do what's right for your baby and you.

[egoldber]

I am sorry you're dealing with this. I think it's an amazing thing that you are doing though.

Amy was in the NICU and came home on bottles (EBM) and also on the nipple shield. I had to do the "triple feed thing" (nurse, then bottle, then pump) for about a month after she was born and I seriously thought I would lose my mind. It was so.incredibly.freaking.hard. I can honestly say I have never done anything harder in my life. And she was also on a nipple shield, so I had to keep track of those and clean those (I ended up with like 10 of them so I didn't have to wash the same one every time.) Like you say, by the time you finish the cycle, I would pee and wolf down a snack and it was time to start all over.

But after about a month, she got it and started gaining just on breastfeeding. It took a few weeks after that to wean her from the shield, but that happened too. At times I was not sure it would happen, but it did and it was so worth it. I got told so many times to give up and move on and I was just too stubborn. :)

It really did help that DH was 100% behind me and did his part to make things happen, washing bottles and pump parts and getting the pump all set up so that I didn't have to think about that. My MIL also took care of my older DD so that I could just focus and concentrate on what I needed to do for Amy.

I just wonder if perhaps you might want to consult the LC and/or the SLP again and see how things are going. What is the plan for weaning off the supplements? If she always gets 3 ounces after nursing, then she may learn to "wait" and not really nurse and wait for the bottle. So at some point, I think you need to have a plan for how to do that. What we did was drop a supplement every day over a week and then seeing how her weight gain was at that point. Since it was fine, we stopped the supplementing. But there are other ways. You could reduce the supplement to 2 ounces and then 1 ounce and then see if the weight gain is still there.

But :hug:it is so hard and so many people just don't get why you would work that hard.

[pastrygirl]

SLP confirmed poor suction (but good compression) and tongue not coming far enough forward, also said she has immature breathing pattern while trying to eat, but ruled out anything physically wrong and said she should be able to learn with two to three weeks’ maturity and practice.Has anyone checked her out for posterior tongue tie? There aren't too many physicians that are familiar with it. In my case, 3 pediatricians and 1 ENT all said my son did NOT have tongue tie. My LC was persistent with her suspicions, and referred me to a specialist in NY. Got it clipped at around 8 weeks, and things finally turned around. I was able to wean him off the shield at the same time, and by 20 weeks, he was nursing normally.

For those first few months, my son nursed for 45 mins, then break for 15, then back for 45, break for 15, all day long (with the shield). It was crazy, but thankfully my story had a good ending.

[kcandz]

FWIW DC did not have these challenges with latch etc but still took a full 6 weeks to "get it" and even at 8-9 weeks there was nipple confusion - resulting in pain for me while DC tried paci/bottle sucking on my breast.

You may want to look into the tongue-tie - my friend had that issue with her DC - it was cut, which freaked her out in theory but in practice was not a big deal - and it went much much better after that. I can't remember her DC age but it was within the first couple months.

[justincase]

Thank you so much for the encouragement. It helps to hear that others have been through similar things and just to be told again that this too shall pass. Hearing your stories gives me motivation. Jenny, I am totally inspired that you have been pumping for 9 months! I hope for the dedication to keep doing that. And if one more IRL friend says something to the effect of "You are crazy, this cannot be what is best for all of you, just give up and put her on formula" I will scream.


Has anyone checked her out for posterior tongue tie? There aren't too many physicians that are familiar with it. In my case, 3 pediatricians and 1 ENT all said my son did NOT have tongue tie. My LC was persistent with her suspicions


You may want to look into the tongue-tie - my friend had that issue with her DC - it was cut, which freaked her out in theory but in practice was not a big deal - and it went much much better after that.

Two LC's, ped, and SLP all say she is not tongue-tied. After advice I received in another thread, I brought it up to all of them and they all said no. It kind of freaks me out, pastrygirl, that so many people told you no, too. Interesting also that when I brought it up to SLP she said no and then added "and the current thinking is that doctors really do not do the 'snip' these days unless it is so severe that the tongue is heart-shaped; it is better to do without it" -- which seems contrary to what I have read from so many people here.

OK, off to pump again. No kidding!

[justincase]

But after about a month, she got it and started gaining just on breastfeeding.
So here is my question: How exactly did you realize that she got it? As I said in my original post, one of my concerns is that whether the session seems good or bad to me (as judged by how well she stays on the breast or how much sucking I feel) she is equally hungry afterwards. How do I know she is getting it?


I just wonder if perhaps you might want to consult the LC and/or the SLP again and see how things are going. What is the plan for weaning off the supplements? If she always gets 3 ounces after nursing, then she may learn to "wait" and not really nurse and wait for the bottle. So at some point, I think you need to have a plan for how to do that. What we did was drop a supplement every day over a week and then seeing how her weight gain was at that point.
Yeah, the SLP brought this up at our original visit. Basically she outlined the same plan you used, dropping one supplement a day. But we wouldn't do that until we got to the end of the 2-3 week trial period. The fear that she is somehow learning to "wait" for the bottle is what is driving my concern right now -- like we are really teaching her to wait instead of teaching her to BF.

Anyway, thanks again. Please know how much better you made me feel!

[egoldber]

So here is my question: How exactly did you realize that she got it?

Well it was a bit of a trial. Once I confident she was healthy and gaining weight (she had been in NICU and was only 36 weeks gestation at discharge), then we started trying without the supplement. I went to a nursing support group at the hospital that had a digital scale so I could make sure she was still gaining week to week. If she had stopped gaining we would have gone back on the supplements, but it was fine.

Then after we got off the supplements, I started trying to wean her off the shield. That was another slow process. But we go there. :)


And if one more IRL friend says something to the effect of "You are crazy, this cannot be what is best for all of you, just give up and put her on formula" I will scream.

People honestly think they are being helpful. But when breastfeeding is important to you, I don't think they get how demoralizing and unhelpful that response is.

[Nooknookmom]

I don't have too much to add as far as technique, I just wanted to give you some encouragement. You CAN do it!!!

It does seem like you are bfing ALL day when they are learning to feed. I think DD was simply attached to me 24/7. DD had reflux to boot and she would scream during feeding b/c of the reflux pain but then she wanted to comfort nurse b/c nursing helped to ease the pain *while* nursing. I know confusing.

I always had her on the boob. I also had supply issues and had to pump after each feeding. She refused to be put down in any contraption so I would have to let her scream while I pumped. It was a crazy cycle and I wasn't sure I would make it through. We were nursing every 1.5-3 hrs round the clock for the first 3-4 months. I was sleeeepy.

I was still pumping a little bit when she was over a year. Just to maintain supply and get a break if I had to leave the house. She was also MSPI and started refusing to drink the rice-milk so BM was IT, lol.

Keep your chin up you & the baby will get the hang of it.

My DD will be 2 in a few short weeks and we're slooooowly weaning. I am sad because it is coming to an end. I grew to love it and wouldn't have traded it for anything in the whole world!!!! :)

ETA it is way too cute when she comes up and says "Mommy, b-o-o-b-i-e!"

[pastrygirl]

Two LC's, ped, and SLP all say she is not tongue-tied. After advice I received in another thread, I brought it up to all of them and they all said no. It kind of freaks me out, pastrygirl, that so many people told you no, too. Interesting also that when I brought it up to SLP she said no and then added "and the current thinking is that doctors really do not do the 'snip' these days unless it is so severe that the tongue is heart-shaped; it is better to do without it" -- which seems contrary to what I have read from so many people here.I did get a comment like that from the ENT -- that maybe my son was tongue-tied, but it wasn't in a way that interfered with ANYTHING except breastfeeding... so I guess that meant it wasn't really "important."

Posterior tongue tie (type IV) doesn't keep your tongue down or give you that heart shape; that's why it's so hard to diagnose. Pediatricians aren't learning about it. There used to be an article on the internet about it but I can't find it now -- the link I have is broken. It was written by Dr. Coryllos, a pediatrician who specializes in that kind of tongue tie. I took my son to her in NY (Long Island) since no one near me thought anything was wrong. My symptoms, according to my LC, were inability to latch, insufficient milk transfer, poor suck, and high palette. If you're anywhere near NY, it might be worth trying to get in touch with her. I was able to e-mail her photos of Toby crying (mouth wide open) and she diagnosed it on the spot.

ETA: Just found this (http://breastfeeding.suite101.com/article.cfm/diagnosing_tonguetie_in_a_breastfed_baby) article on the types of tongue tie, in case it helps...

[justincase]

My symptoms, according to my LC, were inability to latch, insufficient milk transfer, poor suck, and high palette. If you're anywhere near NY, it might be worth trying to get in touch with her. I was able to e-mail her photos of Toby crying (mouth wide open) and she diagnosed it on the spot.

ETA: Just found this (http://breastfeeding.suite101.com/article.cfm/diagnosing_tonguetie_in_a_breastfed_baby) article on the types of tongue tie, in case it helps...

Thank you so much for this. Your symptoms sound identical to mine: inability to latch, non-nutritive suck, high palette. And the list of symptoms in the article are also spot-on. I am seeing ped tomorrow and can call LC again at any time. I am in CT so this might be do-able. I think I will keep the camera handy and try to snap some open-mouth photos as well.

[pastrygirl]

Thank you so much for this. Your symptoms sound identical to mine: inability to latch, non-nutritive suck, high palette. And the list of symptoms in the article are also spot-on. I am seeing ped tomorrow and can call LC again at any time. I am in CT so this might be do-able. I think I will keep the camera handy and try to snap some open-mouth photos as well.Oh! I just found out about a ped in CT that was trained by Dr. Coryllos! I'll PM you his info.

[mmsmom]

DS was just too small when he was born to nurse. I pumped exclusively & he got bottles. I started out trying at least once a day to get him to latch but as the weeks went on I only tried every few days. Then when he was 8 weeks old he suddenly got it & I successfully BF until he was 8 months. So hang in there, it can be done!

[HIU8]

DS and DD were both pretty severly tongue tied. Even so, No doctor would touch them until they were older. DD was 10 months and DS was 8 months when they each had their surgeries. Neither one of them could lift their tongues off the floor of their mouthes. DD's was so severe that we were told by 3 doctors that she would have a pretty bad speech impediment and would need the surgery done by age 5 anyway, so might as well do it before she really starts talking.

[mm123]

Big HUGS to you! Reading your post made me feel like I was reading about my first month with DD (which now is somewhat of a blur), except because she was having so much trouble gaining weight, we were waking her every TWO hours to feed- day and night, and at the beginning, she was just too small to latch at all. Our routine was: try to latch, pump, bottle-feed, clean up, repeat...for a whole month.

I can honestly say it was THE most difficult thing I did in my life, but the help of two amazing, supportive LC's, and an amazingly helpful DH got us through. At one month, DD finally latched (despite being bottle-fed for a month), and has been EBF since. SO worth it, even though MANY people told me I should just give up. Now, looking back, I see how our persistance paid off...you CAN do it!!!

[natness]

Oh this brings me back, too!

A couple of things that helped me:
We did the nurse-bottle-pump thing for two months. One thing I learned about the bottle is that DS would ALWAYS take it hungrily, no matter what. The LC said this is because babies will continue to suck on a bottle nipple because there is no way for them to "comfort suck" on the bottle like they can on your breast. She suggested pulling the bottle away every 12-15 sucks to give him a chance to indicate he'd had enough. If he gave hunger signs (rooting, screaming in anger,etc) I gave it back for another 12-15 sucks. Sometimes he would just play with the nipple, which indicated he was done. Sometimes I would put him back on the breast for comfort nursing. I think she called this "paced bottle feeding."

I second the recommendation for the drop-ins natural latch slow nipple. We're 8 months over here, and still using slow 0-3 month. DS switches between breast and nipple easily.

Don't beat yourself up over formula! We had supply issues, and in the beginning DS was getting 24 ounces of formula a day to make up for my shortages. It is so easy to be hard on yourself-- but you're using formula as a supplement and that's all it is. We got to 100% EBF within two months. It takes work, but all three of you (you, DH and DC) are doing your jobs to make it happen.

I could have quit so easily at any time. Like the other posters said, learning to breastfeed is the hardest thing I've ever done. Harder than childbirth, even. I kept telling myself I wasn't going to quit at my darkest hour, and somehow I got through. You will too! In the words of my ped, "When he's one and flipping up your shirt for self-serve, all this will be a distant memory."
:grouphug:

[deenass]

I did get a comment like that from the ENT -- that maybe my son was tongue-tied, but it wasn't in a way that interfered with ANYTHING except breastfeeding... so I guess that meant it wasn't really "important."

Posterior tongue tie (type IV) doesn't keep your tongue down or give you that heart shape; that's why it's so hard to diagnose. Pediatricians aren't learning about it. There used to be an article on the internet about it but I can't find it now -- the link I have is broken. It was written by Dr. Coryllos, a pediatrician who specializes in that kind of tongue tie. I took my son to her in NY (Long Island) since no one near me thought anything was wrong. My symptoms, according to my LC, were inability to latch, insufficient milk transfer, poor suck, and high palette. If you're anywhere near NY, it might be worth trying to get in touch with her. I was able to e-mail her photos of Toby crying (mouth wide open) and she diagnosed it on the spot.

ETA: Just found this (http://breastfeeding.suite101.com/article.cfm/diagnosing_tonguetie_in_a_breastfed_baby) article on the types of tongue tie, in case it helps...

I knew from the beginning that DS2 latch was NOT right, despite being toldby multiple LC that it was fine. I had nursed my 1st so I knew somehting was wrong, but not WHAT. FINALLY my LC suggested posterior tongue tie and called Dr. Coryllos (same dr that pastrygirl mentioned). We wnet to see her when DS was 2 1/2 weeks old, she confirmed the diagnosis and clipped the tongue tie. The first time I nursed him after that was like nurisng a different baby.

Tongue ties CAN cause problems other than BF, (such as speech delays) as well as preventing the palette to develop properly so it shouldn't be disregarded as "only" affecting BF (um, hello, not being able to EAT seems like a pretty big problem for a baby!!!!)

[justincase]

So I just got back from ped (who BTW is very pro-BF, not sure if I've mentioned that before).

Chapter 1: DD weighs in at 8#4 after being 7#6 on the same scale one week ago (at 2wo) and 7#10 at birth. Hooray, right?!

Chapter 2: Ped hears my whole tale of woe, all my concerns from my original post. I ask about the posterior tongue tie and she tells me pretty definitively that she does not think that is the problem. I wasn't ready to let that go just yet, but I leave it aside for a moment and continue with my concerns. When I get to the part about feeling like DD is just as hungry for the bottle after a relatively "good" session as a "poor" one, ped expresses concern that the shield, although helping DD latch sometimes, is decreasing the amount of milk she is getting. She asks to see DD try to latch on without the shield. (This is after I have just, while waiting for ped to come into the room, attempted to get DD on with the shield as usual, with the result being DD's scratching my breast, fighting the latch, biting the shield, finally knocking the shield onto the floor of the exam room, and then eagerly taking a 3 oz bottle of EBM when I've had enough of the battle.) So I say, well, she has never really successfully done that in her life and she just sucked down 3 oz but sure, but let's give it a shot. DD proceeds to latch on *without the shield* BEAUTIFULLY -- a textbook latch -- as if she has been doing this her whole life instead of, I don't know, never?! She proceeds to nurse. And nurse. And nurse. With ped sitting there watching, smiling at me in between leaning in to listen carefully for swallows. Until DD falls away totally limp and satiated and I swear, smiling, after about 20 minutes. And my breast is soft and tiny for the first time in her life.

Chapter 3: I exit the ped's office with my lopsided boobs, feeling cautiously optimistic for the first time in three weeks, with ped's blessing to start decreasing the bottles slowly by whatever plan feels best and an appointment for a weight check in another week. Can this be happening? :)

New question: So now how often do I pump? Still after every feeding? Only if we give a bottle? I do not want to jeopardize my supply... I should have asked ped but didn't even think of it, of course...

[deenass]

Thank you so much for this. Your symptoms sound identical to mine: inability to latch, non-nutritive suck, high palette. And the list of symptoms in the article are also spot-on. I am seeing ped tomorrow and can call LC again at any time. I am in CT so this might be do-able. I think I will keep the camera handy and try to snap some open-mouth photos as well.

I think I even have Dr's Coryllos phone #s - we drove down to see her - PM me if you need info. I also have the number of the LC who I worked with.
I beleive Dr. Smilie in New Haven can diagnose and correct some posterior tongue ties.

[egoldber]

What a GREAT update!!!!!!!!!!!!!!!!!!!!!!!!! :bighand:

Good for you and your ped!! And having that supportive ped is so important.

[pastrygirl]

Great update! I hope it continues to go uphill!!

[AngelaS]

If she's draining you after a feeding, she's going to do plenty of stimulating and you should be able to give up the pumping. WTG mama! Sounds like you're going to do just fine!

[Sweetum]

Yay to you!! I'm so happy for you (certainly hoping that your DC will stick with it). Wish mine came back to me. I've started a thread asking for suggestions "back to BF" - hoping to get some advice...

-SunshineAndMe

[Melbel]

Congratulations!!! We have had more than our fair share of nursing woes with thrush and I have been fed up with unsupportive friends. Way to stick with it! :bighand:

[kijip]

Yay! That is wonderful.

It really does get better, it sounds like she is gaining nicely. Way to go baby and mama!

[natness]

I'm so happy for you! :bighand: What a relief! I don't think you need to pump after each feeding, but I would consider pumping 1-2 times a day to build a freezer stash and to have a bottle for DH to give in the middle of the night. We never regretted starting DS on a bottle so early-- he never got "confused" and it saved us some grief down the road.

[missym]

What a little stinker! :love-retry: I guess she needed an audience. Glad to hear things are improving and hoping they continue to get better!!

[justincase]

What a little stinker! :love-retry: I guess she needed an audience.

Yeah, my ped has been affectionately calling her "Pest" since birth because of all this, so we were joking that she performed so that she wouldn't get called names anymore! :)

Mixed results with the latch today but we'll keep at it. Thanks again for everyone's encouragement and support!

[justincase]

THANK YOU so much to all of you for your support and encouragement and PM's and love. Sending a big :grouphug: back your way! There really must be some kind of BBB mojo because as soon as I posted, things started to turn around.

We saw my favorite LC yesterday (this is the one who had been on vacation this whole time and so had not seen DD in person, just talked to me on the phone). She is very familiar with the posterior tongue tie and definitively ruled it out. She even showed me photos in a book of what it looks like. I am ready to let that suspicion drop now, finally.

DD latched on really well a few times yesterday and the day before and this morning. The LC gave me two tiny little positioning changes to make that would make DD more comfy at the breast -- a good reminder for me that there is always something new to learn even if you've done this before. LC also has her own theory of what caused some of the early issues -- I repeated an off-hand remark one of the nurses made to me in the hospital about "how much" fluid was in DD's belly and "how much" they had to suction her. LC said over-aggressive suctioning can hurt a baby's throat and make them refuse to latch on. Now my heart is breaking that DD could have been in pain, but I really do believe we have turned the corner now!

Thank you all so much again...

[pastrygirl]

That's great! I'm glad your LC was about to rule out tongue tie. Hopefully your daughter just needed some time and growth! :)

[deenass]

Thanks for the update and good work keeping up with what is I know, overwhelming and exhausting and stressful.

Glad the LC could help with positioning and ruling out a tongue tie.

Keep up the good work!