Complicated Problematic History

[linting]

My 3-month old DS has been refusing to nurse for over three weeks now. We have had a long, complicated breastfeeding relationship up until this point but I'm sad that he won't even comfort nurse anymore. I'm at a cross-roads to accept that he's at least getting 100% breastmilk (from a bottle) or to continue the struggle with perhaps the assistance of a nipple shield (to get him back to the breast) and SNS (to avoid further nipple confusion). Here is a summary of our history. Any advice you may have, I would greatly appreciate. Thank you!

Born on 8/15/2009

2 weeks

Me
Cracked nipples, extremely painful upon latch. Told latch looks good by LC at hospital. He nurses almost nonstop (sleepily, not always actively), not sleeping but for a couple of minutes, then wakes up to nurse again, cries more and more, seems exhausted but can't sleep (too hungry?). I have trouble breaking him off (clamping down with jaw instead of suction?).

LC
says he’s taking in too little milk for all the work he’s putting in to it. Seems to have a suck/swallow/breathe issue. Makes whooping noise while nursing. Suggests pumping after nursing and giving 1 oz from bottle with each feeding to help get him stronger.

Ped
he’s still under his birth weight. Recommends nursing for no more than 40 minutes then giving him formula in bottle (concerned about how little I got from pumping). He takes about 2 oz. after every feeding. For the first time seems full and can finally sleep for a couple of hours.

Me
hard to work pumping in on top of such frequent and long feedings.

LC
most important is to get milk supply up and my inefficient nurser is not doing it. Focus on pumping.

Me
in order to get pumping in (7 to 9 times a day), I only nurse a couple of times a day. I only pump about 10 oz./day and must supplement with formula.


6 weeks

Me
milk supply is up.

LC
still not transferring much milk when nursing. Suggests ENT – posterior tongue tie?

ENT
confirms posterior tongue-tie, clips.

Me
latch seems good and he actively nursed right away but he’s hungry shortly after. I continue practicing with him, especially at night and try “nursing days” (no pumping so I'll be full and no bottles) which sometimes lasted until 4pm – when he would cry and drink a large bottle while I pump off large amount- seems to me he’s still not efficient. Must continue pumping to protect milk supply.

Me
completely off formula. Pump about 25-30 oz./day. Still nurse at least 1 time per day for a few minutes, until he comes off or cries.


8 weeks

Me
Clicking noise starts (while drinking from bottle, nursing, and even when not feeding).


10 weeks

Me
Believe he is teething.
milk supply is holding steady and has not needed formula for 4 weeks. Pumping routine is exhausting and keeps me house-bound. Decide to cut back to 5-6 times a day and check to make sure milk supply holds. Breastfeeding is more like once or twice every other day while checking milk supply.


11 weeks

Me
DS is refusing to nurse. He won’t even try to latch on – seems angry at the suggestion and cries until I give him a bottle. He’s okay when in cradle hold and with his cheek up against my skin but if I offer my nipple to him, he turns away and cries. Or takes it and bites down.


LC
treat it like a nursing strike – woo him back


LC2
treat it like a nursing strike – perhaps nipple shield.

14 Weeks (Present)

Me
tried napping together, bottle feeding against breast, warm baths, nursing upon waking, in middle of night, while sleeping, nipple shield. Maybe twice he has opened his mouth to my nipple and sucked very lightly, several times he would just bite down like he does on anything else that goes into his mouth lately (teething?). My fear is that it’s nipple confusion (bottle preference) in which case all the counsel is to get rid of the bottles. Since he is now three months old and has been supplemented by bottle since 2 weeks, I’m not sure if it’s too late to introduce another method of supplementing with breastmilk. Can nipple confusion begin so late in the game (at 3 months?) And even if I could get him to nurse again, I worry that he is still an inefficient nurser and will need to continue with supplementing. I guess right now I’d just be happy to get back to some nursing and worry about whether or not he can breastfeed exclusively later.

[Nurseliz]

Wow. Where to start?
I sure wish you had been introduced to a SNS instead of the bottle early on. Or better yet, introduced to ways to empty more effecively. But that is neither here nor there...
#1 if your baby can effectively empty a bottle, he can effectively empty your breast. If he had a anatomical problem then bottle feeds would be difficult as well.
He is not nipple confused. He is bottle spoiled.
He has simply associated feedings with bottles because they are super easy. Nursing takes time and effort on both your parts.
In my opinion there is no easy answer for you. But here is my answer.
1. Get your supply up to where you are making what he is taking.
2. While you are working on supply find a LC or la leche league leader who is experienced with relactating. I would suggest someone who has worked with adoptive moms or someone who relacted from a baby who was bottle fed. May take some researching.
3. Get with the above support person for your first breast feed. Be prepared to use an SNS (supplemental nurser) and Maybe a nipple shield. Be prepared for an irritated baby but be persistent and DO NOT GIVE IN AND GIVE A BOTTLE. Keep offering the breast until he takes it.
4. Plan on spending a 48 hour period doing nothing but resting, cuddling and nursing your baby. Resist the temptation to bottle feed. He may very well want to eat every hour while adjusting to getting back on the breast. This is ok. This 2 day period is your nursing holiday.
5. Stay in contact with your support buddy during this time, log on here for support, you are not in this alone.
It can be done, it will not be easy, you will have to work really hard and you must be totally committed.
Remember, if you keep doing what you are doing, you'll keep getting what your getting.
Right?
So if you want him to be back on the breast, you must stop the bottles, Totally.
You can do it!
Liz Pevytoe, RN, IBCLC
www.askthelactationconsultant.com
P.S. Marta, if you have a better answer or something to add, please add to this thread....thanks.

[linting]

Thank you so much for your advice. I was under the impression that he may not be capable of nursing well enough because of his low weight gain when he was EBFed. My milk supply is no longer a problem. I pump more than he needs every day. My husband is willling to help me and he wants to go cold turkey on the bottles but I am afraid this will make DS dislike nursing.

[Nurseliz]

He is going to be mad at first, breastfeeding will be more work for him to get the same amount of food. But in the long run, you will both be happier at the breast. Much less work for you, and more beneficial for him suckling. (antibodies dont respond to a pump but they do to a baby suckling)
And on the low weight gain, all newborns lose weight, they should be at or near their birth weight by 2 weeks. Some take a little longer.
Remember, his pattern is going to be totally different going back to the breast. So do not compare his patterns on the bottle to when you go to the breast. Basically, you are starting over. Clean slate. Back to learning the basics.
I am so glad your husband is on board, you are going to really need his support. That is awesome.
Liz Pevytoe, RN, IBCLC
www.askthelactationconsultant.com