Another case of major latch issues

[NolasMom]

I have really appreciated reading the thread below about latch issues. Rather than hijacking that thread, I'll start another with my questions. I am so frustrated with trying to latch my daughter, and have vacillated many times already between optimism and teary despair.

Nola is 10 weeks old today, and was born at 37 weeks gestation. I had pre-eclampsia and had to be induced. The induction process and the labour took almost 4 days. She wouldn't latch at the hospital, despite numerous attempts by nurses and lactation consultants. After she lost some weight, we started finger feeding with formula, since my milk didn't come in for about 5 days. After about 10 days, the lactation consultant said we should switch to a slow-flow bottle, since she still wouldn't latch onto my breast. At 2 weeks, another lactation consultant suggested a nipple shield, since my nipples are smallish and somewhat flat. That was a real breakthrough, and she started latching a bit sometimes. I offered the breast at every feeding before the bottle. At best, she would nurse intermittently for a half hour with the nipple shield, but she soon started crying horribly at the breast. After two weeks, she refused the nipple shield at all.
I was reading everything I could, and found the suggestion to spend time with her in the bath. We had a breakthrough with that at about 6 weeks. In week 8, she was nursing straight from the breast quite often, as much as 40 minutes at a stretch. She always needed a top-up from the bottle, though, and it was always a struggle to get her to latch. She just doesn't seem to understand how to attach every time, and how to keep sucking and deal with differences in the speed of the flow.
Now, in the past week, she's started to cry when she is even put in front of my breast at all, and can only be coaxed to latch on for a minute or two, maybe once a day. I spend as much skin-to-skin time with her as possible, and have started co-sleeping with her, despite nervousness about SIDS.

Oh, and I should add that she seems to have reflux (occasional projectile vomiting (not pyloric stenosis), lots of spitting up, fussy feeding). She's been on Zantac for a week now, but I'm not sure how much it's helping.

HELP! What can I try? :confused:
Should I refuse the bottle cold turkey? Won't she just go hungry and cry if I do that?
Should I give her a break from the breast for a while? If so, for how long?
Should I hook myself up to an SNS? I don't see how that would help, since I have lots of milk and she would still somehow have to latch on.

It's just so frustrating and all-consuming to deal with this all the time. I'm not depressed, but I am discouraged that my experience with her is so dominated by this issue. When I was trying to conceive and when I was pregnant, I imagined a wonderful, rewarding time with my baby at the breast.

Any suggestions are welcome! I do see lactation consultants at a breastfeeding support group once a week, but would particularly like to hear the voices of experience here.

[gobucks1013]

I'm sorry your having trouble, too. Your latch problems sound a little different than mine. Your baby latches correctly when she does latch?

If I were you I would continue to offer the breast first and offer it often. If she is still having trouble latching due to flat nipples, etc, you can try pumping for 2-3 min before offering her your breast. The pump will help pull your nipples out and should improve her effort to latch. Try not to wait until she is frantically hungry to offer the breast. She is more likely to get frustrated at that time. That may mean giving her a little EBM via a slow flow bottle or finger feeding to stave of her hunger a little. It will help to keep her a bit more patient with your continued efforts to get her to latch.

I'm sure some of the other wiser, more experienced ladies will chime in here at some point with their excellent advice. I hope you get it all sorted out soon. In the mean time, keep trying and remember to take time to enjoy your little one! Don't let this issue get in the way of enjoying your relationship with your babe. :hug:

[NolasMom]

Gobucks, thanks for your reply! Yes, Nola does seem to latch correctly sometimes, but it takes a bit before the latch goes from shallow to deep. So you think I should keep offering her the breast?

I didn't want to overload my previous post, but I have tried to pump a little before offering her the breast, have offered her the breast at the slightest peep or gesture of hunger, and also offer her the breast an hour after pumping so that it is still a little soft. Frankly, I think I may have tried too hard and added to her negative response, which seems to have become more intense.

[DecemberBaby]

First, it sounds like you are really trying... pat yourself on the back! Second, GoBucks gave really go advice so I have nothing to add to it. I second to pump for a few minutes prior to BF to help with your letdown. Once you have letdown she will not have to work as hard at first. Also, baby knows if you are upset...maybe this is why she is crying. I had a little different latch issue which was not totally resolved until around 3-3.5 months. So do not give up.

[klynnw]

I sympathize with you!!! I know this really sucks when it just doesn't work like it's supposed to. And don't you find yourself so jealous of women who never have to struggle to make it work? Well, I do. But anyways.......when you bottlefeed her, do you feed her in the same position which you breastfeed in? When I was having trouble getting ds to even attempt to latch, that seemed to help (albeit, very slowly). I wonder as well if your latch is correct when she does get latched on. Can you feel her really sucking (pulling your nipple out) when she latches on? Perhaps she isn't sucking effectively, or has a weak suck and that's why you need to top her off with the bottle.

When ds was crying at the breast, I took a couple of days off, then tried again. It seemed to help, although maybe it just helped me, not him. Where we're at now, is he would happily stay latched on forever if I let him, but he hurts me, so I try to correct the latch, and he only has the patience to be relatched like 3 times at the most. If he is freaking out, I don't even try b/c he won't do it and then I just end up frustrated and feeling rejected.

I know I'm not any help and I certainly haven't been able to fix my own problems here, but I want you to know that although your problem is different than mine, you're not alone in the struggle!

[RedheadbyChoice]

I don't understand, if she's nursing, why the top off with the bottle? If she's still hungry after nursing both sides, you can just give her the first breast you used again, AKA The Third Boob, according to Farmer Red, my DH. :D No need to wait for the breasts to 'fill up' again, as they're never empty.

Along with the possible flat nipples issue, I'm seeing a possible nipple preference. If you have to supplement, I'd suggest using something else, other than a bottle. If she's crying when she's put at the breast, that's often it; being used to the faster flow of a bottle (even if it's a slow flow bottle) And then now she's getting used to the bottle after she nurses, too.

If you have flat nipples, though, like gobucks said, pump just a bit to draw them out, and then latch babe. When you do that, how does she nurse?

Does babe take a pacifier? If so, I'd suggest cutting that out now; let all sucking be at the breast until things are a bit more stable.

A few other things to think about: do you consume a lot of dairy? That can also be a reason for a fussy or spitty baby. When you spoke of reflux with the doctor, was your diet ever discussed?

Oh, and The Happiest Baby on the Block book, that's a good one. Explains a lot of newborn behavior, not to mention swaddling. Not all babies are happy little creatures when they first get out into the non-uterine world. It's quite an adjustment for them, too. Babies also have a big need to suck, it's an instinct. Babe could be wanting to suck more after a nursing session, rather than being hungry; again, offering the breast, rather than a bottle or a binkie, can help with that.

And yes, there is a way to cut out those bottles, absolutely. Don't offer them, just the breast. Sounds simple, eh? It is. But.......you need to watch babe, which you will. As long as babe is giving you the diapers (at least 6 in 24 hours) then you're making enough milk and babe is getting enough milk. Though it's not QUITE the same situation, check out this linky: weaning from formula supplements (http://www.kellymom.com/bf/supply/decrease-formula.html)

[NolasMom]

It's so good to hear from all of you. Klynnw, yes, I'm definitely jealous of people who get it right, straight out of the gate! About baby's latch: no, most of the time, it isn't quite right. She doesn't suck hard enough to really pull out the nipple, although she CAN do it sometimes. I struggle with the right balance of insisting she try again, but giving her a break when she's too upset.

December, thanks for weighing in. It's good to hear about success stories. The suggestion to pump before BF is good, but sometimes the timing is tricky. I need to feed her before she starts really crying, or there's no hope of a latch. I think pumping first helps a little, but I'm not really sure, since the latch is so sporadic anyway.

RedHead, much of the time, she really doesn't latch on at all. When she does, she stays on for usually a few minutes before pulling off and crying like crazy, even if the milk is dripping out in a steady stream when she pulls off. It's rare that we get a longer nursing session, although it was going well in week 8, as I wrote. This week, if I didn't give her the bottle or some other source, she would go hungry. I guess I could try not giving her the bottle at all, but I would anticipate days of desperate crying and losing weight. I read the link on weaning from formula, but will that work if it is a latch issue - that she simply hasn't learned to latch properly?

About the pacifier - she doesn't get one, although she would love it, I'm sure. I give her my pinky to calm her. Adjusting my diet is still a possibility. I have cut down on dairy, but still have a little milk in my daily cup of coffee and use butter for some things.
I've heard about the Happiest Baby book, and should really go and pick it up soon.

Today's update is that she did take the breast for about 4-5 minutes per side in the bathtub last night before giving up, but she didn't have a really deep latch.

I'll keep you posted, and would welcome any and all feedback!

[RedheadbyChoice]

I'd definitely see an LC, momma. I'm sorry, it sounded like she would be latching on well, every now and again, but if that's not the case, I'd definitely get seen and evaluated.

[Nipple_nectar]

I absolutely agree with Red, it sounds like nipple confusion (http://www.breastfeeding.com/all_about/all_about_confusion.html). I would immediately stop all bottles indefinitely. Your baby sounds like she cannot transition from bottle to breast and back again.

This requires a change in latch and it sounds like she is not doing this. You mentioned a finger feeder, that is an excellant BFing friendly feeding alternative. I used one for 5 weeks while my DD practiced and perfected her latch.

DO NOT TAKE A BREAK FROM THE BREAST~ you are in danger of losing her completely from latching on cooperatively, the more you use bottles, the more she is going to resist going to the breast.

How often are you pumping? Does she gasp or gulp when she is latched on the breast? The only other culprit may be over active letdown. Does your other breast spray milk while she is nursing from the other?

[NolasMom]

Well, I totally agree that it's nipple confusion. For the first while, I was finger feeding using a syringe and little plastic tubes that they gave us at the hospital. That's pretty awkward and labour intensive, so the LC suggested switching to the slow-flow bottle (Playtex natural latch) after a couple of weeks. You think I should switch back?

I don't think that I have OALD, but don't know for sure. My other breast drips, but doesn't SPRAY. She does gulp and gasp when the speed of flow changes, though.

I'll talk to two LCs again on Wednesday and see what they recommend. So far, they've been encouraging me to stay the course, and just offer the breast at every feeding before the bottle.

Thanks again for your input!

[RedheadbyChoice]

I'll talk to two LCs again on Wednesday and see what they recommend. So far, they've been encouraging me to stay the course, and just offer the breast at every feeding before the bottle.

Thanks again for your input!

But that's not really helping matters, is it? Personally, I'd go back to finger feeding if you need to supplement, and absolutely no bottles, at all.

[DecemberBaby]

Does she open her mouth wide on the bottle or is it shallow as well? If you use a bottle do not let her just suck on the nipple. I used the natural latch for a bit with him but the little bugger would not open wide and just take the nipple sort of like on me! Try to make her open wide each time if you are going to or have to use a bottle.

[NolasMom]

Hmm.... I will consider going back to finger feeding later this week or next week when I have a couple of days to devote the extra time to it. Filling the syringe over and over again will be quite a production.

December, she does have the wide, flanged lips when she is drinking from the bottle, but she doesn't open wide when she grabs on. I've occasionally tried unsuccessfully to get her to do that.

Right now, while I do some unavoidable work during my maternity leave, baby is sleeping adorably in the sling with her hand on her heart. Aww.

[RedheadbyChoice]

Labor intensive, yes, but if it will help fix the problem? ;)

[DecemberBaby]

If you supplement... via finger or bottle I would try and have her open her mouth wide first.... this might help with your problem too? Do you rub her cheek to get her to open wide?

P.S. I love my sling too!

[Nipple_nectar]

Hmm.... I will consider going back to finger feeding later this week or next week when I have a couple of days to devote the extra time to it. Filling the syringe over and over again will be quite a production.<snip

I have a finger feeder that holds up to 3 oz. at a time, perhaps you can get a bigger one from your LC visit. I got mine from www.medela.com