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  1. #1
    acmom is offline Emerald level (3000+ posts)
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    Default Anyone here a lactation consultant? Could use some advice...

    With baby #3 on the way, I have been thinking about my plan for feeding this time around. With my last 2, I had all sorts of breastfeeding issues and ended up exclusively pumping for both for several months then needing to supplement or switch to formula. I'm not sure if I should just give it a try and see what happens this time around or if I should probably prepare myself that I will have similar issues. Here is the laundry list of what I dealt with in the past (sorry in advance for the TMI!)...

    1) I have inverted nipples which made it hard for both kids to latch.

    2) Both kids were early and little and didn't have a strong enough suck/latch to draw out the nipple.

    3) With DD, I had significant supply issues.

    4) With DS, I had ok supply, but got mastitis repeatedly.

    Obviously, the inverted nipples will still be an issue to contend with and I will most likely have an early/small baby again. We are in a new city this time around and I'm trying to figure out if I need to explore renting a hospital grade pump again (last time, there was a lactation center right in the hospital that arranged all that for me, but I don't think here has that set up). I'm also trying to figure out what bottles and other supplies I would need right at the start. Obviously, no one can predict exactly how it will go but I am trying to think about ways to be somewhat prepared so we aren't scrambling. While I would love to breastfeed in some way, I also know that the issues last time just got to be so challenging that it was consuming family time at the expense of all of us (I was pumping round the clock separate from feedings, visiting pediatrician and lactation consultants very frequently, making me feel miserable and guilty, etc.). I know with 2 older ones to keep up with, that just can't happen this time for the sake of the whole family's well being! So I want to be prepared to possibly give it the best shot I can at the beginning, but also know that I might have to be open to options!

    Anyone have any advice??

  2. #2
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    Just keep an open mind and try again. If it works, awesome; if not, don't beat yourself up. Arm yourself with resources. Find a good local LC (get recommendations) and arrange visits on day 1 and again after your milk comes in, find the local LLL meetings and other breastfeeding meetings. Good news is that your supply generally increases with each subsequent child.
    DD (3/06)
    DS1 (7/09)
    DS2 (8/13)

  3. #3
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    Not a lactation consultant, but wanted to chime in about the mastitis. Lecithin supplements can help with that and plugged ducts. You can read about it on Kellymom. I've had recurring plugged ducts and mastitis, and the lecithin did make a difference. That and rest (which is sometimes really hard to come by, I know). I would get mastitis if I was getting too run down.

    Good luck!

  4. #4
    SnuggleBuggles is online now Black Diamond level (25,000+ posts)
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    Quote Originally Posted by sweet_pea View Post
    Not a lactation consultant, but wanted to chime in about the mastitis. Lecithin supplements can help with that and plugged ducts. You can read about it on Kellymom. I've had recurring plugged ducts and mastitis, and the lecithin did make a difference. That and rest (which is sometimes really hard to come by, I know). I would get mastitis if I was getting too run down.

    Good luck!
    Yes on the lecithin. It helped a bunch! That and realizing certain undergarments caused plugged ducts.



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  5. #5
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    Not an LC, but I've been breastfeeding for a hundred years. Okay, only 7. I started with one inverted nipple, and the terrible LC at the hospital where I had my first told me not to bother trying. Whatever, lady. It was no longer inverted by about 6 mos of nursing. I didn't do anything other than nurse. You could see an LC and/or attend an LLL meeting (call or email and tell them what help you're seeking first) before birth. More suggestions here: http://www.llli.org/faq/flat.html

  6. #6
    ArizonaGirl is online now Sapphire level (2000+ posts)
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    Quote Originally Posted by acmom View Post
    With baby #3 on the way, I have been thinking about my plan for feeding this time around. With my last 2, I had all sorts of breastfeeding issues and ended up exclusively pumping for both for several months then needing to supplement or switch to formula. I'm not sure if I should just give it a try and see what happens this time around or if I should probably prepare myself that I will have similar issues. Here is the laundry list of what I dealt with in the past (sorry in advance for the TMI!)...

    1) I have inverted nipples which made it hard for both kids to latch.

    2) Both kids were early and little and didn't have a strong enough suck/latch to draw out the nipple.

    3) With DD, I had significant supply issues.

    4) With DS, I had ok supply, but got mastitis repeatedly.

    Obviously, the inverted nipples will still be an issue to contend with and I will most likely have an early/small baby again. We are in a new city this time around and I'm trying to figure out if I need to explore renting a hospital grade pump again (last time, there was a lactation center right in the hospital that arranged all that for me, but I don't think here has that set up). I'm also trying to figure out what bottles and other supplies I would need right at the start. Obviously, no one can predict exactly how it will go but I am trying to think about ways to be somewhat prepared so we aren't scrambling. While I would love to breastfeed in some way, I also know that the issues last time just got to be so challenging that it was consuming family time at the expense of all of us (I was pumping round the clock separate from feedings, visiting pediatrician and lactation consultants very frequently, making me feel miserable and guilty, etc.). I know with 2 older ones to keep up with, that just can't happen this time for the sake of the whole family's well being! So I want to be prepared to possibly give it the best shot I can at the beginning, but also know that I might have to be open to options!

    Anyone have any advice??
    1) I don't have inverted nipples, so I can't comment on that...

    2) My first was early and until he got older and had a strong enough suck and latch I pumped and then I transitioned to the breast

    3) Mother's Milk Tea and if you are able to actually nurse as opposed to pump this problem might become a non-issue.

    4) The mastitis issue may also be a non-issue if you aren't pumping because I found that my LO were much more efficient at emptying the breast than the pump and I didn't go as long between feedings as I did with pumping so I wasn't as "full" as often.

    HTH
    Lindsey

    Married to DH June 2005 gave birth to Shawn December 2008 and Lilian August 2012




  7. #7
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    Not a LC, but I had lots of bf issues to overcome, including flat nipples. For me, I had to use nipple shields often in the beginning (for a few weeks, I think...) with my DDs. I also used nipple shells around the clock to give my nipples time without contact with anything. I had to use APNO with both of my girls for quite awhile as well. FWIW, I exclusively pumped with DS1 for a few months before switching to formula & had mastitis many times, so I have been there. ouch. good luck!!

  8. #8
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    I took the coursework to become an IBCLC but then I got pg with #2 and was never able to finish the internship hours (over 2000 hours since I am not an RN). I would definitely seek out a good LC in your area because hands on help is so much better than online/phone. A good LC can make tiny little adjustments that will make a world of difference in how well the baby empties the breast, which can make or break your nursing experience. I would caution you to not rely on the hospital staff LC (if there is one). When I did my training there were many post partum and L/D nurses there taking the course. At most hospitals the LC position is a prime job and thus some nurses who have little personal interest in helping breastfeeding moms will take the coursework simply to get the better hours and pay bump. Nurses are required to do far fewer (far FAR fewer!!) hands on training hours for certification, and L/D or post partum nurses can just "write off" a lot of their hours by virtue of their current job (on the assumption that they have helped moms learn to nurse as part of their regular job). The instructors (all of whom were also nurses) admitted as much and called out the staff nurses who were there. Several were honest in admitting that was their motivation and they had not even attempted to nurse their own babies. Obviously not ALL are this way and I do believe that it isn't necessary to have nursed your own child in order to successfully help new mamas, BUT I think your chances of success are much higher with an IBCLC who has a personal conviction to help moms be successful in difficult situations (if that is what the mom wants).

    That said, it is hard to predict if you will have problems again or not. It's a good idea to be prepared for it, but don't defeat yourself before you've seen what this new baby is able to do. You can start wearing nipple shields towards the end of our pregnancy (I wouldn't wear all day, just a few hours here and there) to help put pressure on the areola and pop the nipple out. Did your previous LC have you use a pump just prior to nursing in order to draw the nipple out and make latch easier for baby? If not, this could be a technique to try.

    For the supply and mastitis issues, I agree with previous posts that if you can get baby to nurse that alone will help supply issues tremendously. That will also help with mastitis and plugged ducts. To get off on the right start, be sure you are drinking a lot of water. If you feel the *slightest* twinge of a plug forming immediately start using warm compresses (as hot as you can tolerate without pain) over the spot while nursing/pumping and massage a bit. It is likely to make your toes curl but I always had luck loosening plugs this way and was able to ward off brewing mastitis on a few occasions (I got plugs often when I was pumping for DS1 during work). Lechethin caps do also help keep things flowing. Mothers milk tea is a mild galactogogue. Fenugreek is a bit stronger and can be all some women need. I used it often when pumping. Oats and brewers yeast can also help boost supply. There are more heavy duty meds that can be used but I wouldn't worry about those unless the other methods don't work. Another plug control method is to vary your position for nursing or pumping position. Football hold can be helpful for outer edge plugs. For pumping, try leaning over so gravity can help drain all the lobes more evenly. Be careful about underwires, purse straps, slings- anything that puts pressure on or near your breast.

    I have not kept up on the various pumps. I do know the one that most insurance companies provide is pretty awful and weak. For supplementing supplies, if you're hoping to start off nursing and just supplement with pumped milk or formula as needed you could consider some alternative feeding methods to the bottle so you aren't fighting an uphill battle trying to get baby to latch appropriately. This is an *awesome* video on how to use some alternative supplement feeding methods https://www.youtube.com/watch?v=vrrrC5NyNnQ For bottles, there really isn't any research I'm aware of that says one type of nipple is better than another because it really is such a different set of behaviors/muscle movements. The general thinking, however, is the longer nipples are better because they encourage a wide "latch" on the bottle and get the baby used to having the nipple far back in the mouth like they should be with a good nursing latch. Something like Avent. There's a bottle called Breastflow that seems like it would be great for promoting proper latch but I haven't used the personally so I can't say for sure. They look awesome though. The biggest issue with artificial nipples is the way they collapse on themselves so encourage a biting motion rather than compression/suction motions of BFing. The 2-part nipple system looks like it would prevent that issue and help avoid nipple confusion.

    Sorry if this is rambling or too much info! Just tossing out what I can think of to give you some starting points and things to consider. That is all I can think off the top of my head. If you have specific questions feel free to PM me. I'm not on this subforum much- I saw the title from the preview on the main forum page- so am not likely to see replies here.

    Good luck! If you want to nurse there is no reason not to try this time, you might be pleasantly surprised. I can't stress enough find a good LC locally BEFORE baby comes. With the right help you have a much better chance at being successful.

    ETA - woke up thinking about this and can't believe I didn't mention initially. Did the LC have you do anything to draw out the nipple prior to latch? I mentioned a pump above but another less cumbersome and more portable method is an inverted 10 or 20ml syringe. Here's a paper that explains the method. http://www.ncbi.nlm.nih.gov/pmc/arti...255362/?page=1
    You use just prior to nursing to draw nipple forward so baby can latch. As PPs have said, if you can get baby latching from the start you can usually stop using these things after a few weeks because baby can either do it herself or the nipple stays more drawn out on its own.

    When I was googling to find a drawing of the syringe method I ran across a product by avent called the "nipplette" that wasn't around when I was doing my training. It is fairly pricey for what it is ($45-50) but might be useful. They are small cups that can be worn to draw the nipple forward during pregnancy and before the milk fully comes in.

    Also wanted to add that if you decide none of this is worth it, that's ok too! You sound like you'd like to give it a go if possible, so I'm tossing out things that might help, but please don't think I'm pressuring you to try every possible thing!
    Last edited by calebsmama03; 01-29-2016 at 09:41 AM.

  9. #9
    Simon is offline Ruby level (4000+ posts)
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    As someone who has BTDT, I would try to nurse Dc3, but if for some reason Dc cannot nurse well, then give yourself permission to not pump at all, pump for a limited time, or only pump part-time and supplement from the start. I have nursed successfully and also had to exclusively pump for my babies. They were each so very, very different. My first two were early like yours and too small or tired or uncoordinated to nurse. I worked for 6 months to get Ds1 nursing but by 6 weeks I was exclusively pumping with Ds2 (eventually we had to supplement then switch to formula). I have no regrets and know that Ds2 would really never have learned to nurse so I was glad that I hadn't made us crazy trying. That said, pumping full time is hard and time consuming. I knew that I wanted to avoid that if I could.
    My third was full term and that made a HUGE difference in his nursing abilities. He was by far the easiest to nurse. I did need help from the LC at the hospital but that was enough. I had decided ahead of Ds3 that I would try to nurse with the following limits: try for up to 4 weeks and with up to 3 LC visits, then I gave myself permission to just let go. If nursing didn't work or needed more support that that, I planned to pump part-time for 3 months but not feel guilty over formula if we needed to supplement sooner. At 3 months I would re-evaluate if pumping was working for me/our family, how formula was working, etc.
    Ds1 (2006). Ds2 (2010). Ds3 (2012).

  10. #10
    acmom is offline Emerald level (3000+ posts)
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    Thank you all for your advice and insights- that all helps a lot!

    calebsmama03- is there a good way to find a good lactation consultant who is not hospital based? I actually found just what you said to be true...my experiences in the hospital were not good last time but when I went to a women's center months later for help, the LC there was extremely helpful and I wished I had found her at the beginning! Unfortunately now we live in a different state so I have to search again.


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