Help with nipple shield & latching a 1 week old

[ck1]

Help me! I'm a new Mom to a 1 week old boy. I have flat nipples (though not so much now that my milk came in). The hospital LC gave me nipple shields to use because DS couldn’t latch. Still, DS wasn't getting enough milk and lost weight, enough for concern. We supplemented at the hospital with formula, and when we got home we used breast milk and formula. LC came to the house and helped get DS latched and not supplementing at all, but the nursing was long.

Since then DS has been nursing longer and longer… he’s getting enough as indicated by the number of dirty diapers, but 2 - 3 hours of nibbling, trying to put him to bed only to fuss because he’s still hungry, and have to put him back on the breast and try again is too much for him and me. I’ve decided the nipple shield is the problem.

I've tried a couple times to get him off the nipple shield and it's worked, but not always. I noticed when I was able to get him off the shield my breasts became softer, unlike with the shield, so I know he's getting milk, but he won’t latch without the nipple shield 90% of the time.

I don’t know what to do. The first attempts to get him off the nipple shield were a success, and then it was back to the nipple shield. I feel like I frustrated the little guy by expecting him to be off of it; there have been times when the cried, balled his fist, looked angry, and hit me. I felt terrible and decided that’s not good for him so I’m not forcing him… if he fusses I put the shield back on and calm him. My problem is he’s not getting anything with the nipple shield, it just hurts my nipples, and I get engorged.

We've started giving a bottle of breast milk, and that's been good. We give him a little bit of pumped milk before (1/2 oz), then on the breast with the shield and trying without. Then in the end we give him milk – all together about 2 – 2 ½ oz.

A concern is that today he took a 5 hour nap with no hunger cues. We woke him at 3 ½ hours but he was out like a light and wouldn’t suck – I think because we’d spent hours before feeding and he was just tired. Is that okay? The next feeding was 3 hours later, and the next one will be in 3 – 3 ½ hours.

I’m considering just pumping and forgoing the breast feeding all together, which part of me says is fine, he’s getting breast milk, and DH can feed him, too, but there’s a feeling of loss that I don’t understand and makes me kind of sad… those hormones!

I have an appointment with an LC on Tuesday and hope to get him re-latched, but I wish someone were available to help now because the longer it goes on I’m creating bad habits.

Does anyone have a similar experience to share that would make me feel better? Or offer a suggestion? I’ve watched all those YouTube latching videos and they just don’t work and I don’t know why. With the nipple shield he gets a poor latch, and without the nipple shield he’ll get a good latch but won’t stay on; so frustrating. Help!

[PatioGardener]

Some quick ideas:

Have you tried breast compressions when you first latch him? that gets the milk flowing faster and he may stay interested.

Also, some babies will latch and nurse witht he nipple shield at first, and then agree to have it removed and latch right to the breast 1/2 way through a feed.

Can you supplement without the bottle? The artificial nipple and faster flow will be replicating what you are trying to get away from with the shield. Your LC may be able to help you supplement at the breast with a tiny feeding tube. That will encourage baby to learn to breastfeed.

How are you putting on the shield? It should fit right to your nipples (you sort of flip it inside out to get a good fit - hard to describe in writing!) and draw them out as baby feeds. Is baby getting a lot of breast in his mouth when he uses the shield or does he just 'spaghetti suck' the tip? Getting that good mouth full of breast tissue is rally important for milk transfer.

Hang in there. Watch diapers (by now there should be 6 heavy wet ones in 24 hours and 3-4 good poops a day) and weight gain too (baby should be starting to gain weight when you see the LC on Tuesday.) You guys got a rough start, but it sounds like you are doing everything right to get baby back to the breast without the shield. The LC's visit on tuesday will really help too I bet.

Have you looked at Jack Newman's videos? He talks over them and there may be something there that will click for you: www.drjacknewman.com

[heidirk]

He's probably popping off when you nurse w/o the sheild because nursing is hard work. Even if you decide to pump for the milk, you can have him nurse/experiment with latching after you've pumped and your breasts are softer.

I used a nipple sheild for both my boys, and then weaned them of of it after about 4 weeks or so. I would just keep doing what you're doing, keep offering the breast, and he will get stronger and be able to latch on.
And what the PP sadi about compressing the breast to get the milk flowing is a good idea. I also think maybe pulling your nipple out a bit between your thumb and forefinger will make it stand up a bit, so he can latch on better.

Hang in there!

[alegna]

I would stop the shields and stop the bottles. Nursing will not get better with both of those in the mix.

-Angela

[mom2tig99Nroo03]

i agree w the pp about getting off the bottles- the fake nipples won't show how much better the real deal is. you can supplement either at the breast, or w cup or a spoonfeeder. the latter is available thru medela

my son took almost 6 months to learn to nurse because of nipple confusion/prefernce.

[ktmama]

Some encouragement:
1. Don't worry about the sleeping unless your LC recommends that you feed due to weight concerns. He's tired from working at nursing and you need a well-rested baby for more hard work.

2. My dd1 nursed with a shield for six months before she latched on. Continuing bfing is SO WORTH IT! Keep at it - the light will go on soon.

3. I have flat nipples (hence the shield) and my next two kiddos have had NO problems latching, probably due to the fact that dd1 nursed for two years. So, when you get discouraged, try to continue not only for the baby you have now, but for the one/s you may have in the future.

Hang in there mama!

[flower16]

I ended up on the shield for 5 months, and my Dd weaned herself from it. I thought it was the end of the world at the time, and now I look back and give thanks for the darn shield. For whatever reason, and I went to LC'c all over town, and they all said my baby just needed the shield, they could't get a good latch without it. So a few times a week, I would just try without it, sometimes more, sometimes less. But one big thing I noticed is it made my Dd very frustrated when we would try without, and I did not want that frustration to be associated with BFing, so I gently weaned her from it. Then at about 5 months she just latched on one day while I was busy trying to get the nipple shield off, and lo and behold that was the end of my journey with the shield. So, if you do end up needing one for whatever reason, it is not the end of the world.

[Megan73]

I hope you're doing well – I know how hard it is to have breastfeeding hurdles to overcome when your babe is still so new
It WILL get better.
Let us know what the LC says. We may be able to help.

[ck1]

Hi! Thank you for the replies!

I took DS to the LC on Monday and that LC wasn't very good. She said he's fine, he's just little so keep using the nipple shield; she kept poking him to keep him sucking and constantly readjusted him, it was so painful for my nipples! The problem is an hour later he took only an ounce of milk, if that, and the LC saw nothing wrong with that.

I paid out of pocket to see another LC on Tuesday and it was soooo worth it! They really helped to get my son latched without the nipple shield, but my breasts were making it hard to latch so pumping or hand expressing before was needed. Still, the nipple shield was needed but come to find out the one I had is too small. The new one I got fitted for is a lot better and one I can live with it, and helps him latch better.

The LC had an oral therapist look at him as well, becuase we spent a long time nursing with and without the shield and still he barely took a 1/2 oz.

The conclusion is he's not a good sucker; he nibbles and bites and can't make the milk transfer, and they didn't want him to nurse so long that he burns more calories than he takes in. They gave me some exercises to do with the soothie pacifier and my finger, and if I can get my insurance to pay I could take him to a couple oral therapy sessions, which they said is all he'll probably need.

That day I worked with him on sucking and when we went to the breast I could hear lots of "cu" sounds from swallowing that I'd never heard before! And instead of taking 2 - 2 1/2 oz of milk afterwards he only took 1 1/2, that's progress.

I'm still frustrated because we've only had success a couple of times, and a couple times it was back to 2 oz bottles. But again, it's been when I couldn't work with him on his sucking because he was passed out asleep and was hungry right from waking.

Anyway, I'm really hoping I can see someone about getting him to transfer the milk more efficiently (has anyone else's little one had that problem and been able to overcome it?). If he is able to do that then I'll work on removing the nipple shield. I am working with him on not using it, but it's not my main priority as just getting him to nurse efficiently.

I appreciate all of the support, I definitely need it.

[Megan73]

That's great!
I think you're smart to get some suck therapy and he will probably get better as he gets bigger and stronger.
Did either LC suggest that maybe supplementing with bottles isn't the best thing? Other options include cup or syringe feeding, finger feeding or using an at-the-breast supplementer, such as a Medela SNS or Lact-Aid.

[Beaner96]

It sounds like things are getting better. I know you still have a ways to go but you ARE making progress. I have to agree that maybe you should stop the bottles and supplement another way. My baby had a hard time latching due to my inverted nipples and basically his laziness or fatigue. But we used a little feeding tube and syringe, and a nipple shield. The firts two weeks nursing was a 3-person job. I would hold him and support my breast. My mom would sit there with a wet wash cloth and stimulate his feet, etc. to keep him from falling asleep and also controlling his arms from flailing all over the place, and my husband would hold a syringe full of formula or pumped milk if I had enough, with the tube running down and into his mouth through the corner. When baby would latch, DH would squirt some extra milk into his mouth. That worked great! He got all the milk he needed and it was all from the breast as far as he could tell. Gradually as my milk supply increased and he got better at latching we were able to stop the tube feeding. Then it was just BFing with the shield for 6 weeks, and then I weened him off the sheild. He's almost 5 months and I'm still BFing!

I agree that you shouldn't worry about the nipple shield right now. If it is helping then that is great and there is no harm done. Once BFing is going well you can wean him from that.

Hang in there! Stick with it and I'm sure you'll be glad you did. Honestly the first 6 weeks were really hard for me and I often thought of giving up. But now that all is going well I'm SO glad and I love it.

Keep up the good work! You should be proud of yourself for trying so hard. I know you must be tired and hormonal, etc. Good work mama!!

[heidirk]

Try to remember ANY sucess is a step in the right direction!

Yes, I had milk moving issues, but really, if he nurses with the sheild, he's learning to get his tongue down and out over his bottom jaw, which is how to get a good open latch and move milk. My DS2 had a huge increase in milk moving suddenly, and I'm sure it was because his mouth grew.

I would keep with the finger excersizes, and just keep trying every now and again to latch w/o the sheild. If you keep offering the bare nipple, he will eventually get it.

I'm so glad you got a properly fitting sheild! I can't imagine how badly that must have hurt!