July 17, 2015 at 8:13 pm #5319
This is going to be long, I apologize. I think the background is important to my situation.
I have two daughters and both were born with physical impediments to nursing successfully. My first had an underdeveloped larynx. I started pumping and supplementing formula at day 6 when we realized she wasn’t actually getting anything. By week 11, with every galactagogue I could take and pumping 10-12 times a day and taking Domperidone, I was making enough milk that 1/3 of her diet was breastmilk. At max, I only was able to pump an oz per breast, but usually less. I started getting recurring mastitis from the pump flange that abscessed and had to be drained repeatedly. I also hadn’t really held my baby, since pumping was so intense. I decided it was best to stop at 12 weeks.
I was so ready and ahead of things with baby #2. She was born in a baby-friendly hospital, a natural birth, my OB was amazing, I had postpartum doulas and LCs and a CST lined up if I needed them. Baby would latch beautifully, then suck a few times and fall asleep. Repeat. I started pumping right away but life was pretty crazy and stressful and I was only able to pump 6-8 times a day. I got a max of an ounce per session, usually less. After a month, my husband left town for a job and pumping became impossible. I’ve been able to keep it up 2x a day, but my supply is pretty low, I get about 20ml a session. Sometimes I am able to pump 4x a day and get about 20ml each extra session, so when I can pump more, there is more milk.
I think I don’t respond well to the pump, there seems to never be a real letdown, but milk trickling out. I don’t think I ever empty. I THINK if I had a baby who could nurse, I would produce more. It’s hard to know.
Fast forward to present day. I have a 17 week old. Baby still latched and nursed at night wakings until about 2 weeks ago when she started to refuse. She had begun refusing daytime nursing gradually over the month before.
She’s been on the bottle since 4 weeks (we finger/syringe fed her up until then) except for those night nursings. She isn’t very effective at the breast when there. She also had a very difficult time with the bottle, she very rarely has made a seal. She was very gassy. Up until a month ago, we fed her about 20x a day (no exaggeration) because she would get tired after 1/2 an oz or an oz. She was diagnosed with a class IV upper lip tie and a posterior tongue tie two weeks ago. I went two days ago to the dentist and had them revised by laser. Baby is pretty uncomfortable, still, but her bottle latch is much better. Her upper lip flanges out and I can actually see her tongue extending and pushing on the bottom of the nipple.
I want to lure her back to the breast. She’s easily distracted, but also loves to nuzzle. I just want her to get what she can from me, I don’t expect her to be exclusively breast fed. I am seeking advice on this, is it possible to get her interested again? She arches and cries when I try, it breaks my heart. I don’t want to force anything that isn’t meant to be, but I also want to take advantage of this window before it closes (if there is one). Thank you.July 18, 2015 at 10:03 am #5320SylviaFounder
Hi Sweet Pea! Wow, it sounds like you’ve gone through a lot with both your daughters. You’ve been such a great an engaged mom! This situation sounds pretty complicated and tough; it may be difficult to answer your question on a forum. Have you spoken to an IBCLC (Lactation Consultant)? The details of your situation make talking to a person a great option for you. At MilkOnTap, we’re launching our ability to do a video consult on September 1st, but we may be to set up a visit with one of our Lactation Consultants before then, if you are interested.
Until then, may I simplify your question to the following?
When a mom tries to relactate, is it normal for the baby to arch and refuse the breast at first? If so, how can you get the baby to return to the breast?July 18, 2015 at 2:18 pm #5321
Thanks, sorry for the long story. Yes, your simplified question works.
I have spoken to several IBCLC’s in person and otherwise from the beginning. Two recently. One did give me some literature about reintroducing the breast and I am going to try what it suggests, but I was hoping to find someone who has had success with babies this old, and who could offer strategy.
She acts like I am poisoning her when I try to get her to latch. I do worry that it might be too late.July 19, 2015 at 10:54 am #5322July 20, 2015 at 10:48 am #5343Michelle L. RothIBCLC
When she had her revision for the lip tie / tongue tie, did they provide you with suck exercises to do? You can learn more here: http://drghaheri.squarespace.com/aftercare
A nipple shield may be helpful for you since your baby has had lots of bottles.
Spend lots of time skin to skin – even at this age it might help.
Continue to offer the breast when your baby is sleepy or drowsy, slowly building on those successful feedings.
Some moms with low supply do much better with hand expression of milk than with a pump. You could also try pumping after every at breast feeding for 5-10 minutes, just to give your body some extra stimulation.
While stress doesn’t affect every woman’s milk supply, some women are more susceptible to the effects of stress. Try relaxation – especially when pumping. Cover the bottles so you’re not watching them and worrying about how much you’re making. Try “hands on pumping” (http://newborns.stanford.edu/Breastfeeding/MaxProduction.html).
Keep up the good work – every drop of your milk your baby gets is a wonderful gift!
MichelleJuly 21, 2015 at 6:53 pm #5382Sonya MylesIBCLC
Sorry for the delay in responding to this post, I was away in Indy and only had a phone on which to communicate, and I knew I needed a keyboard for my lengthy answer 🙂
These babies are tricky. Part of the equation here is that we have taught baby that food comes easier from the bottle and not very much from the breast, so a hungry baby has no interest in breastfeeding, and will argue their case with arching and crying.
Remember, all of your baby’s actions are ways she communicates. As adults who don’t speak baby, it is up to us to try and figure out what she is saying and then work with that information.
So, when I am dealing with a baby who has a breast aversion, I do things backwards 🙂 I first offer full feed from the bottle, then I offer skin to skin time with mom with no pressure to breastfeed at all. Lesson number one needs to be that the breast is a safe place to be with no expectations, for mom or baby. This way moms and babies can start to enjoy each other again, the pressure to feed baby is gone and babies love cuddles.
Once we have a baby who is happy to come to the breast and just hang out in a breastfeeding position, we can either decrease the amount in the bottle and then offer baby breast to have the last bit of milk from breast, or we can try and go cold turkey to offering breast first. It depends a lot on mom and baby. In this case, your little one has been on the bottle for a long time, so I would probably start to decrease the amount in the bottle by 1/2 ounce, bottle feed then offer breast and see if she latches. If she starts to cry or fuss, bring her up, cuddle and give her the rest of the bottle and then bring her back for cuddles but no latching. Often these babies will start to calm down about breastfeeding and will start to latch. I find a biological nurturing position works better here, allowing baby to set the pace. Biologicalnurturing.com has more information. I believe Nancy Mohrbacher has an article on this approach, but nothing on her website yet.
Copious amounts of skin to skin can help trigger baby’s basic instincts to breastfeed as well, and trying to bath with baby often helps as well, maybe it takes them back to being in utero? 🙂
Ok, so now lets dig a bit further. We know your milk supply is probably low, and you are doing everything you know of to increase it, but part of the problem may also be that your baby may not be able to transfer milk well. So lets start off with problem solving your baby a bit. We know there was a tongue tie that was revised, were you given exercises to help improve her tongue function after the release? If not, you should start those as soon as possible.
Here are the ones I generally tell moms to do (these are a combination of exercises picked up over the years from various conferences, mainly Catherine Genna Watson’s work):
1. Touch baby on the lower lip, gently pulling the lip down, also touch the lower gum gently. This should encourage your baby to start sticking out her tongue. Baby’s also mimic very well, so spend some time sticking out your tongue at her and she will start to copy you. This exercise is to improve her ability to maintain tongue extension, essential for good breastfeeding.
2. On her lower gum, where her teeth will one day be. Take your pointer finger, put it in the center of her lower gum ridge and slide it along the top of the gums to the back where her molars will one day be. Lift and repeat 3 times in each direction, 3 to the left and 3 to the right.
3. Let baby suck on your finger, make sure your (obviously clean finger with short nail) is inserted all the way to the second joint. Place the pad up towards the roof of her mouth and gently straighten your finger, this places pressure from your nail bed on to the back of her tongue helping her to maintain tongue extension. Once you feel a good wave like motion, slowly pull your finger out of her mouth allowing her to suck it back in. This helps strengthen her suck, while the pressure helps correct tongue motion to a more wave like motion.
4. Dr Martin Kaplan (who also recommends the above, although I have been as well for years, even before I heard him speak) has a last exercise that involves letting baby suck on your finger and then using the other hand to help flange baby’s lips around your finger so that she has nice “fishy lips”
5. If your baby does not open her mouth wide, running a finger lightly around the outside of her mouth should encourage her to open and stretch, as will mimicking.
These exercises should be done 4 to 6 times a day and never when baby is crying, always in happy moments.
I am going to assume you were given post frenectomy exercises, if not, let me know and I will post them here as well.
Sometimes a nipple shield can work in getting a baby back to the breast, but they can be a 2 edged sword. The bonus of a nipple shield is that it pushes down on the tongue, helping baby maintain extension, but it is a crutch for these babies and may not be teaching them how to do this by themselves. The other thing a shield can do is make baby think she is on the breast because it feels like a bottle, so she may be more inclined to latch and suck. However, we need to tread with care here. If she does latch and she sucks and she gets very little reward in the way of milk, she has now learned that the shield on the breast is also not a way to get food. I would recommend using a lactation aid at the breast under the shield if you wanted to do this, so baby is rewarded with milk even with the first few sucks. This process is fiddly and will require another post if you wish to find out more. I think if you let me know, I will post on this, but I also don’t want to overwhelm you with too much information…. I know, too late!! 🙂
A lactation aid might also work here, but again, we need a latching baby for this. Lastly, the bottle you use is key. I am very fussy about bottles, and I have to admit, I only like one so far. I like a soft walled bottle (so a drop in liner) with a wide based nipple which is softer rather than harder. A soft nipple is more like the breast than the harder nipples. A drop in liner gives us the ability to play with pressure dynamics. If you want to know how and why, ask a new question and I will post on that topic, or maybe I will write an article 🙂
Ok, I am overwhelmed and all this stuff is already in my head! Here is your homework: bottle first, breast for cuddles only for now, lots of skin to skin and baths with your baby. Do the exercises with her. And lastly, read through the other information and decide which approach you want to take. If you need more information, ask questions and I will answer as quickly as I can. Once you have decided which approach feels right in your heart, lets get into more details.
Last thing, consider osteopathy and reiki for baby, and maybe even for you, moms need looking after as well!
Oh, and @sylvia, I think I over answered (like an over active milk ejection reflex 🙂 ) The simple answer is yes, with a lot of hard workJuly 22, 2015 at 7:09 am #5395
Thank you! This is just the kind of info I was hoping for! Hands full at the moment, but thank you, thank you, thank you.
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