flat nipples, nipple shield and painful feedings??(long)

[doulawoman]

A brief history as I need help and ideas ASAP

I had a c-section three weeks ago after planning a homebirth. It was fairly tarumatic for me and the baby and I hadn't really slept for days beforehand due to a very long labour. We had midwifery care and our midwife remained with us in the operating room.

first issue is that my nipples are flat and we could not get the baby latched on my breast with a nurse, lactation consultant, the midwives etc. We ended up using a nipple shield which seemed to help, but due to all the stress I had no more than a drop of colostrum whether I was pumping or using shield or hand expressing. So we ended up cup feeding our daughter formula and friend's milk when we could get it...I pumped and continued trying to latch her on and my milk came in a few days later...at which point she screamed a great deal but finally seemed to latch on and things went fairly smoothly for two weeks. She gained back the weight she lost very quickly and I have an abundant supply of milk.

At two weeks I started having pain with feedings and it got so bad I couldn't stand to latch her on at all...in retrospect I think her suck got stronger and I didn't have a breastfeeding pillow so she'd often start off ina good position and we'd both relax and we would end up with her putting pressure in the wrong areas or my nipple slipping in the shield...I didn't correct it at first because I thought it was the "normal pain" of her drawing out my flat nipples that I'd heard about. I had no real symptoms of thrush and neither does she other than the pain. The midwives suggested I take a break and pump for 48 hours and cup feed her expressed milk. We did this but she screamed the entire time and it was extremely stressful for us all. So we all evenbtaully and begurdgingly agreed to try a slow flow bottle that was as similar to breast as we could find. At our next appt. the midwives helped me with my latch and we even got her latched onto my breast without the shield for the first time -but only after she had used the shield for several minutes to get my nipple out (pumping doesn't get it out long enough to get her to stay on even if I pump for 20 minutes, neither does ice or just pinching) it was very painful since my nipple was already so cracked and scabbed. The midwife suggested I just continue with the shield for now.

We gradually added in more and more breastfeeds again until pumping and bottle feeding only at night, then the last couple days (a week later) we have cut out the bottle altogether, and I am back where I started. My nipples are very cracked and so sore I need to bite something when I feed her. My let down seems to be really strong...she chokes and sputters and pulls off, she also clamps down on my nipple with her gums which hurts a lot, and she makes a smacking sound with her tongue. She has been spitting up a lot more too the last couple days.

I am using Jack Newman's nipple cream... I really don't want to give up but I am in so much pain she has trouble opening her mouth very wide and tries to suck the nipple in, but we are working hard not to let her. still with already sore bleeding nipples, just one or two clamps with her gumds are enough to keep me in pain for several feedings. I feel that the nipple shield may be causing more problems than it solves but it is very difficult to latch her on without it.


please help. The midwives think I may have raynaurds syndrome, I am not so sure. I just really need this to get better and easier. I never wanted to do any shields or bottles ever...

[littlemizflava]

oh i feel your pain....
i will try to give some advice and lots of hope. i was in your place twice. i bf my dd for 18 months and my ds for 28 months.

first time was the worse with my dd. when she was born both of my nipples were in. when breastfeeding my dd i would stomp my foot, bite my lip, hold my breath and cry every time. for the first month. i had cracked, scabbed, bleeding nipples. it was bad. i only gave her one bottle of formula when she was 2 days old and she threw it all up. so i went ok bm only for you. what i did was no nipple sheilds. i did use a sheild that allowed air to touch the brest but not the clothing. http://www.toysrus.com/product/index...ductId=3758529i would bathe in very hot water and soak my breasts in the water. this was a lifesaver it calmed me, soothed pain and loosened the scabs that had formed. i would walk around topless all the time. i breastfed on demand never used bottles or soothers because of changing their sucking habits. when the pain would become to much i would just stick my finger in the side of her mouth to release my breast then relatch her again. i stopped using the nipple cream at home. i felt that it blocked air flow. i only used it if i was going out i would put it on so that my nipple would not stick to the breastpad. In the begining i could pump and still not get my nipples to come out the only thing that worked was BFing. as time passed it became better and then i breastfed pain free till they selfweaned

[PatioGardener]

There are a couple of tricks that may help with the latch. Do you have access to a good IBCLC? That would REALLY help! So much better to get advice in person!

For the fast flow, baby is probably clamping down and that is causing pain. If you can nurse in a reclined position (laying back), with baby sitting up facing you, that may help to slow the flow.

Having baby checked (by someone in the know) for tongue-tie would be useful too. A good IBCLC should be able to do this.

Painkillers for the nipple pain should also help. There are also treatments for vasospasm if that is the issue: http://www.nbci.ca/index.php?option=...tion&Itemid=17

Newman has some great videos that are worth watching: www.drjacknewman.com - it may help if baby can self latch.

This article may help too: http://www.nbci.ca/index.php?option=...tion&Itemid=17

Good luck, Mama, and hang in there! This all sounds like you and baby will be abel to work through it.

[HappyMommy2]

Hugs mama. You are doing great!!! My nipples are pretty flat too. But they get sucked out once DD latches.

With my first, an unecessarian, I breastfed for 2 weeks with bloody painful nipples, and then exclusively pumped. I later learned that c/s can interfere with bf'ing.

With my 2nd, a homebirth, I was bound and determined to breastfeed. And WHOA did it hurt. I had to hear from the mw and believe that nipple shields are not the devil!!! They helped me hang in there when BF'ing totally sucked (pun intended!). :-)

DD is now 2.5 and still nursing ... we didn't need the shield forever. Once you are not in pain you can worry about weaning off of that. (by switching sides every other time, using it and then not using it)


Are you using lanolin? That helps a lot. Also running around topless. Also - try other positions, like hanging over your baby (her on her back in bed, you on your hands and knees) ... her on top ... some weird positions helped us until we found on that worked! It only takes one!!

I agree with popping her off and relatching when it hurts. Also, I found that if I lifted up & supported my giant boobies and kind of did the C with my fingers helped.

Good luck mama!

[feest]

Oh i was in your shoes minus the shields justa few weeks ago. I tried lanolin... didn't help, then i tried covering with milk and air drying... made things worse As dd would suck the scabs would tear and my cracks/ wounds would get deeper and bigger. I eventually resorted to using hydrogel pads and nipple butter. It was a life saver. Moist healing was the only thing that helped and even then healing has been slow (still not finished and it's been lil over a month)

The odd thing is DD's my 4th, my nipples used to be much flatter and unresponsive yet i never had problems like this. Ds 2 had a crap latch and i'd eventually settle for it, still no probs... The only difference i can see is this is my first girl......Hormones?? idk what the prob was/is?? Her latch is great but i still ended up with bleeding cracked scabby nipples

It really puts a huge damper on the happy babymoon. I swear all i did for two weeks was dread having to feed her and once it came time to latch it was such a terrible sinking bite the bullet feeling The pain made made me resent feeding her i felt like an awful mother. Had she been my first and i'd not understood the bond breastfeeding creates i woulda soooooo thrown in the towel.

I really applaud you for sticking with it mama, U'll find something that works for you

[Shanny2032]

I second the suggestion to seek out additional help from an LC. I found them more helpful than my midwives at some point because it was ALL they do. I also wanted to say that I used the nipple shield for 5 months solid, never went anywhere without it. I really wasn't even very good at bothering to try without it. At 5 months and a few days it fell off and she just kept going. She is 15 months now and still nursing like a champ. I wouldnt change a thing and love that the shield got us to where it did. If you need it use it! Good luck you are doing a great job and I applaud all of your work to keep going .

[ewe+lamb]

the technique for flat nipples and getting them to extend is quite a simple one actually, go to the pharmacy and buy a syringe, the wide part i.e. the body part of the syringe has to be large enough to cover the nipple, so I think the size is from 20/25ml.
Then take the needle part off and discard.
Take the inserted part of the syringe out and put aside.
Then with a sharp knife cut off the end of the syringe that would hold the needle so that it is just a long tube.
Then take the insert and put it back into the body but starting at the end that you have just cut off, the nice smooth part should go over your nipple.
Then firmly but gently pull the inserted part back so that your nipple extends, then once you feel it's at a size/extension that you think baby can handle, get baby to latch on and see if that makes a difference.

ITA with Patio Gardener that going to see a IBCLC would help especially to rule out tongue tie, but also to go to a LLL meeting where you'll get lots of support and information.

It sounds as if, to top it all, you have a strong ejection and your baby is having difficultly swallowing quickly enough, I too second the sitting up position for nursing so that gravity can help, you could also let her nurse until the let-down comes and then take her off the breast until it's not so strong and then put her back on when you feel that she can cope with the flow, look out for sore gassy tummy lower down in the intestine and keep an eye on the colour of her stools, keep posting to let us know how you are getting on.

[sahmmie]

Medela makes a product called Nipplette for drawing out flat nipples. It's similar to the syringe thing explained by the pp. It didn't really work for me but I think it's worth a try.

http://www.motheringfromtheheart.com/catalog/20.html

[MindfulBirth]

Try to find another IBCLC. As a postpartum doula, I know that there area a couple of IBCLCs in my state that give very bad advice. Even if the first LC you saw was a good one, it may just help to have another perspective on the issue.

One way you can try to nurse is this: Make sure baby is in the cradle hold position (not cross-cradle). Use the free hand to push your breast BACK towards your chest. By pushing back, it can cause the nipple to protrude.

You might want to ask the LC about using breast SHELLS briefly during the day to draw out the nipples as oppossed to using nipple sheilds that can a) cause a huge drop in your milk supply and b) be hard to wean your baby from.

[texmati]

I know lansinoh also makes a product called latch assist. (it's available at walmart).

I had the same problem as you (but only on one side.). The nipple shield, and having someone else sandwich the nipple helped alot.

But what helped the most was the IBCLC. I would try posting on FYT for recommendations.