Sad new mama needs help... pain, palate, pump!

[orbicular]

The situation, in a nutshell:

My little guy is one week old today. The birth wasn't pretty: my water broke and then I didn't establish contractions fast enough (given that the hospital only allows 24 hours post rupture out of fear of infection); thus followed pitocin, which brought contractions that I found unbearable despite my deep wish for an unmedicated birth; then the little fellow's head got stuck and "failed to descend" and I ended up with a c-section exactly 24 hours past my water breaking. I was in a lot of pain afterwards and have basically felt like I was hit by a bus, got up, and was then hit by a truck.

He nursed happily in the recovery room, and then we "nursed" for three days before my nipples started to crack and bleed. I had no idea that it wasn't supposed to hurt so much... I had had three different people check my latch and everyone said it looked great. Finally a LC looked at my nipple after feeding and whistled and said that no, the entire nipple was not meant to be compressed into a thin white line and that's why it was hurting so much. She stuck her finger in my son's mouth and said that he had a high palate and that we should try a nipple shield.

Over the next few days he was losing too much weight and his bilirubin levels were heading towards jaundice. We started supplementing with finger/syringe-fed formula.

Fast forward: we're now home. My nipples are still so sore that it's hard to put him to the breast, especially given that we still don't have the latch right; about 80% of the time it hurts a lot. I'm trying to pump but not getting too much. The milk, such as it is, leaks out of the bottom of the horn. I've tried 24mm and 27mm shields and it hasn't helped.

My milk "came in" in a very lackadaisical way. I get about .25 oz per pumping session out of my right breast, and about half a teaspoon out of my left breast -- seriously.

So here I am. My son is mostly formula fed and it is breaking my fricking heart. Please, please, any advice!

My main points of puzzlement:

1. Why is the left breast so far behind the right breast? It's slightly sore, too...
2. Why is my pump leaking so badly around the bottom? I've tried sealing the horns on with Lansinoh, which helps somewhat, but doesn't solve the problem. It's so frustrating to lose milk when my supply is so scanty.
3. Any suggestions for feeding with a high palate?
4. Should I keep semi-successfully pumping? Find a leather strap to bite and put him to the breast?
5. How long with the finger-feeding before his suck is ruined for the breast?

Many, many thanks for any advice. I am going nuts here.

[PatioGardener]

hang in there, Mama!

High palate often hangs out with a tongue-tie - you might want to read the tongue-tie sticky at the top of this forum to see if that's the case with your baby.

To latch with a high palate, sometimes it helps to aim the nipple straight in rather than at the roof of baby's mouth.

Are you taking anything for the pain? Can you call an IBCLC to come and see you?

[Vegan Princess]

Just wanted to offer up a hug and some moral support. I had scabs on my nipples until 6 weeks but it does get better! I did the pump around the clock thing too. I'd advise you to put some nipple butter or olive oil on your nipples and areola before you pump to help ease the discomfort from the pumping. It's very normal for you to get more from 1 breast than the other. My right breast is my dud. Also I think it takes time for your milk to fully come in so keep up with the pumping and the amount will hopefully increase. Also have you looked into herbal galactagogues such as fenugreek? A last resort would be the medication domperidone - that is really the only thing that made a difference for me. You can find plenty of info about it on here. Lastly, if you need to supplement look into doing it with a lactaid at the breast...that way you will be getting more breast stimulation and keeping baby at the breast and will be able to eliminate the finger feeding step.

Congrats on the little one and hang in there!! You're doing great.

Cindy

[2boyzmama]

Oh mama, palate issues SUCK! I have a little guy with a train wreck of a palate (several malformations) so I've felt the pain (literally!) of breastfeeding with a funky palate.

You might want to post over in the Special Needs forum, there are several of us moms over there who have breastfed our cleft-effected babies, and some of the tricks might work for you.

Speaking of clefts, when you take your baby to the ped or to an LC, ask that his palate be checked out *thoroughly*. There are lots of different kinds of cleft palates, not all of them are obvious holes in the mouth, and sometimes a high/arched/narrow palate can be a sign of a submucous cleft or maybe a soft palate dysfunction. I'm not meaning to scare you, but if your little guy does have any palate issues, it's so much better to find them sooner rather than later! It might take a visit to an ENT to be sure, but it's worth it

[GoGoGirl]

Oh wow mama, that sounds tough. Hugs!!!!!

I second the PP who said that a high palate can be related to tongue tie. I think specifically, it can be a sign of posterior tongue tie. My daughter had posterior tongue tie and a high palate. She couldn't latch right, my nipples had that thin white line, I was crying every time we breastfed, she lost weight, etc etc. It was miserable. And I wasn't trying to heal from surgery!!

Anyway, we got her tongue tie clipped and it helped immensely. Do you have someone in the area who can diagnose posterior tongue tie? It's much harder to diagnose than regular tongue tie...I would check the sticky and post in Finding Your Tribe to look for recommendations for a doctor who can diagnose and clip posterior tongue tie.

As for the pump...it can take a while to learn how to let down for a pump. When I first started pumping (about a week after birth) I couldn't get anything. It just takes practice to get the hang of it. Now I can get a bunch of ounces, no problem. Give yourself time with it, and maybe have someone check if the horns fit you correctly. Sometimes my horn leaks out the bottom (but only on the right side, I have no idea why). If I hold my breast up and hold the horn on, it doesn't leak. Maybe give that a shot?

I also have one breast that makes way more than the other one. It started because I had a plugged duct and then got mastitis on that breast. If your low supply breast is sore, I'd look into the possibility that you have a plugged duct. Check kellymom.com for more info on plugged ducts and figuring out if you have one.

Ok so I think my major advice is:
1. Call in the troops for help. If there's anyone who can come help with cooking, house stuff, some baby care so you can focus on figuring out this breastfeeding and healing from your surgery, do it.
2. Call an IBCLC to come to your house and look at the big picture of what's going on here.
3. Find someone who can diagnose posterior tongue tie and clip it. If you can't find anyone near you, I think Cathy Genna (her contact info is in the sticky) will diagnose it if you email her a picture.

Mama, I am sending you millions of hugs. We all are. Good luck!!

[LorenaAZ]

Momma, I had a similar situation, minus the c-section. Hugs!!!

#1 I don't know why one breast produced more than the other, but mine do the same thing. I was never able to pump more than 1 oz. Usually it was as you described, until I started taking Gaia's Lactate Support. In addition, my breasts hurt horribly during and after pumping. While I pumped my sipples inflated into what looked like marshmallows. I used earth momma baby angel nipple butter and it helped a bit.

#2 if your milk is leaking, you can pump facing down (facing the floor). Your milk won't leak out of the horns that way.

#3 My baby also has a high palate and I got the white line in the middle of the nipple. My nipples were full of scabs for the first 3 weeks. The pain was unbearable, but my husband was very supportive. The pain went down a lot after the first 8 weeks. I used to cry at every latch. But it gets better by the day.

#4 You should keep pumping to try to increase your supply. I pumped twice at night while baby was asleep. Don't get discouraged if you don't get much milk with the pump. Some women (myself included) do not respond well to pumps, but the breast stimulation to produce more milk still helps. Put baby to the breast as much as possible. After supplementing for almost 2 weeks I took a leap of faith and completely stopped supplementing. It was braking my heart. I chose to trust my body and baby is still EBF now at 6 months.

#5 When I was in too much pain or had lost my sanity my husband used to finger feed our baby. But instead of doing that, you may want to use an SNS which you can use while you breast feed. It's still a pain in the behind to use, but again, it stimulates your breats and does not harm the latch.



Good luck Momma!!! Trust your body! I know it's hard when your baby starts off loosing so much weight so quickly. We went through the exact same thing! Lots of hugs and encouragement. You may want to look into going to a LLL meeting if you are feeling well enough to go out. It's nice to sit among other breast feeding Mommas who can give you advice from personal experience.

[Lindsay1234]

About the leaking pump. Make sure the horn is the right size by trying different sizes out, not what the LC says. My LC told me the small which felt like my nipples were being pulled off with little milk being produced. Then I went up to the 27 and it felt better and I got double the milk!

As for the actual leak, make sure your horns are bone dry so they get a good suction. I found that if there is even one drop of water, I dont get a good suction.

Oh! and put lanolin or nipple cream on before AND after!!
Good luck!

[orbicular]

Thank you so much, everyone, for the sympathy and advice!

The events of the past two weeks:

A few days after I made that post, I ended up back in the hospital with pulmonary effusion, severe edema, high blood pressure, elevated liver enzymes and bradycardia. I felt awful! While I was in the hospital, I pumped, but never got very much.

You might guess that the hospital jaunt didn't do much for my supply... I was producing 3-4oz a DAY. Yes, all day.

I got strict with my pumping schedule (including nighttime pumps) and slowly managed to increase my supply to 6-7oz (still a DAY, sigh). I also got my paws on some domperidone, which I started on Thursday. No miracles yet, but I'm still hopeful.

Except that for some reason within the past 24 hours my supply has plummeted again.. my "good" breast kind of stopped dead in its tracks. It had gotten really sore, but with patient compresses, massage and pumping, it released whatever blockage was going on; the supply has not yet recovered, though.

And why amn't I just nursing? Because I don't think he's getting much milk and it mangles my nipples. No matter what I do he compresses them; I think he just can't/won't open his mouth wide enough. My nipples aren't the greatest, either; flattish, soft, they never look like nipples in the pictures. It's like trying to stuff a half-full water balloon into the poor kid's mouth.

Other things:

• I have ordered a SNS and am going to try and get fenugreek and blessed thistle today to add to the domperidone.
  
• A LC consult basically yielded the advice "spend lots of time skin to skin! make sure his mouth is wide open! pump a lot!" *sigh* She attempted a weigh-feed-weigh but had the scale set up wrong so it didn't work... I still have no idea what (if anything) he's able to get directly from the breast.
  
• We've got a ped appointment tomorrow and I'm going to ask about tongue tie; thanks to all the moms who suggested that.
  
• I've been able to reduce leakage by taking the good advice about making sure the horn is bone dry, pointing the bottles downwards and (my own variation) physically stuffing more of the breast into the horns! So that's improved a lot, in any case.

All in all I don't know where we're going. I still have some hope, but it's fading a bit... I'm in less of a dark place, though. After oceans of tears, my partner reminded me that I DO have something to offer this child other than my breasts and the contents thereof. I was really starting to feel like it was the only thing I had to offer and I had failed at that. I wanted to breastfeed so badly and it breaks my heart that this perfectly marvelous child has to have second best because my breasts aren't up to the job.

And that's the update. Thanks so much for all the people who have read along and offered advice!

[HappyHappyMommy]

Thinking of you

Dear orbicular,

First:

Originally Posted by orbicular

The situation, in a nutshell:

My little guy is one week old today. The birth wasn't pretty: my water broke and then I didn't establish contractions fast enough (given that the hospital only allows 24 hours post rupture out of fear of infection); thus followed pitocin, which brought contractions that I found unbearable despite my deep wish for an unmedicated birth; then the little fellow's head got stuck and "failed to descend" and I ended up with a c-section exactly 24 hours past my water breaking. I was in a lot of pain afterwards and have basically felt like I was hit by a bus, got up, and was then hit by a truck.

Congratulations on your new little one and my sympathies on your difficult birth.

Originally Posted by orbicular

The situation, in a nutshell:[*]Why is my pump leaking so badly around the bottom? I've tried sealing the horns on with Lansinoh, which helps somewhat, but doesn't solve the problem. It's so frustrating to lose milk when my supply is so scanty.

It is *so* frustrating. At one point, my very sweet dp tried to cheer me up by saying "Don't cry over spilled milk" and I burst into tears saying "You can't say that until you've worked this hard to get it." (My dp immediately apologized and kindly explained that he was hoping to make me laugh and reassured me that there really are no words for the frustration of losing something I work so hard for :-) .) In terms of the pump leaking, I would guess it's incorrect shield sizes. Initially, an LC recommended larger shields for me, but it turned out, I actually needed smaller shields (and a better LC.)

Originally Posted by orbicular

The situation, in a nutshell:[*]Any suggestions for feeding with a high palate?

I'd second the recommendation to look at a tongue-tie information.

Originally Posted by orbicular

A few days after I made that post, I ended up back in the hospital with pulmonary effusion, severe edema, high blood pressure, elevated liver enzymes and bradycardia.

How awful! I hope you are feeling better and continue to get well quickly.

Originally Posted by orbicular

I got strict with my pumping schedule (including nighttime pumps) and slowly managed to increase my supply to 6-7oz (still a DAY, sigh). I also got my paws on some domperidone, which I started on Thursday. No miracles yet, but I'm still hopeful.

What kind of pump are you using? Switching to a hospital grade pump (from a personal pump) made a big difference for me, both in terms of output and in terms of comfort.

Originally Posted by orbicular

And why amn't I just nursing? Because I don't think he's getting much milk and it mangles my nipples.

I wouldn't recommend this as a first step, but if--for whatever reason--nursing is not a possibility, it might be possible to exclusive pump. lots of people warned me that it wasn't possible to keep it up for more than a few weeks, but I'm still EPing more than a year later. it's not the easiest thing (and pumping doesn't work for everyone, even with the best of efforts), but it's often not impossible.

Originally Posted by orbicular

[*]We've got a ped appointment tomorrow and I'm going to ask about tongue tie; thanks to all the moms who suggested that.

I hope that's helpful! If your ped isn't familiar with tongue-ties, ask for a referral to an ear, nose, and throat specialist who specializes in these. You may be able to get recommendations for specialists by posting in your tribal area on this board.

Originally Posted by orbicular

[*]I've been able to reduce leakage by taking the good advice about making sure the horn is bone dry, pointing the bottles downwards and (my own variation) physically stuffing more of the breast into the horns! So that's improved a lot, in any case.

Yay!

Originally Posted by orbicular

All in all I don't know where we're going. I still have some hope, but it's fading a bit... I'm in less of a dark place, though. After oceans of tears, my partner reminded me that I DO have something to offer this child other than my breasts and the contents thereof. I was really starting to feel like it was the only thing I had to offer and I had failed at that. I wanted to breastfeed so badly and it breaks my heart that this perfectly marvelous child has to have second best because my breasts aren't up to the job.

I'm glad to hear that you're feeling a bit better. You are a wonderful mama and have so much to offer your child. He is very lucky to have you! Please remember that it's ok not to know where you are going and to just take it one day at a time. You will find the path that works for you and your child and your family. It won't be exactly the same as anyone's else (mine certainly hasn't been), but it doesn't have to be. All it has to be is right for you. :-)