Help! Flat nipples, pumping problems, nipple shields, nipple pain - so many problems nursing my...

[DrBrockBaca]

My baby is almost 4 weeks old, and we are having lots of problems breastfeeding. I've been to a lactation clinic multiple times and talked to a LLL leader, but we are still having tons of issues. My nipples are somewhat flat (not completely, they just don't project very much and are kind of soft), and the LC's think that may be one reason why my baby doesn't latch on or nurse well. She falls asleep every time we try to nurse, even if she's really hungry. We were forced to start giving her pumped breastmilk in a bottle when she was 5 days old because she was very jaundiced and losing a lot of weight. She is still nursing every few hours except early in the morning when she is really sleepy, but she doesn't get enough milk that way and always wakes up hungry a little while later, so we have to give her more in a bottle. She is finally back on track with her weight gain though. Last week the LC's gave me a nipple shield to help her latch and stimulate her to keep sucking when she is nursing, and she is nursing longer now, but still in her sleep. I do everything I can to stimulate her, but it's not enough to keep her sucking hard and rhythmically, so she doesn't get very much while she's breastfeeding (about half an ounce to an ounce per HOUR). 

When my baby does nurse now, I try to take off the nipple shield in the middle of a feeding, but she usually won't latch back on. I'm really afraid we are not going to be able to stop using it. I really hate it. I think it may have also made my supply go down (it wasn't great to start with since she was never a good nurser, but I rented a hospital grade pump and I'm making enough for her and some extra). Anybody have experience with this? Any advice?

Another problem is that I have extreme nipple pain, especially on the breast in which the nipple is flatter. The pain is there regardless of whether I am nursing or pumping. It's worse at the beginning of a nursing or pumping session, and fades away (or maybe I just get used to it). I have read that flat nipples are caused by adhesions inside the nipple, and the pain is from those adhesions being pulled and stretched. I've also read that pumping can help pull out the nipples permanently by breaking/stretching those adhesions. Is this true? Anybody else with this problem?

I'm also having trouble figuring out which size breast shields to use on the pump. I have the Medela Freestyle and have rented the Medela Symphony, and they both use the same type of shields. I have every size shield between medium and XXL. The problem is that because my nipples are flat and soft, they just conform to whichever size shield I use while I'm pumping. I'm thinking now that the large is the right size because I'm getting more milk using them without having to press the shields into my breasts really hard, but I'm not sure. Any suggestions?

Finally, I'm really struggling to balance nursing and pumping. I'm supposed to be pumping every 2 hours during the day and 3-4 hours at night for 20 minutes at a time, in addition to nursing my baby who takes FOREVER to nurse. I can't actually do this - it's all I can do to pump 8 times a day. This still leaves me almost no time to do anything else - I've been wanting to post on this blog for the last 3 weeks and I just haven't had time. I can barely eat, and usually only because DH feeds me or brings me something I can eat one-handed while I'm nursing.

Please tell me it gets easier! 

[Erin77]

I totally sympathize with what you're going through! I, too, had flat nipples and used a shield to start. In fact, I didn't really get rid of the shield until my son was almost 6 months old. I also had questions about the "horn" size pumps: the diagram showed the nipple not touching the sides of the horn, but because my nipples were soft and flat, they would puff out to whatever size horn I used. My son is now almost 11 months old and I used ended up using the L size. Just go with whatever the size is that gives you the most output. 

Regarding the shield, I felt all paranoid about it and I was worried it would destroy my supply, but if you pump more than your baby needs, I wouldn't worry about it. My son went on a nursing strike for a full month, and I exclusively pumped and got more than he needed. The shield never ruined my supply and I was eventually able to get rid of it, after he was big enough the latch on well. 

Re: nursing pain. It hurt some when he would first latch on without the shield, but it went away within a month. My nipples have turned out now, too, so I guess the adhesions went away?

Re: pumping and nursing. Do what you can, and don't beat yourself up. I think if you're getting him to latch, 6-8 times a day for pumping is a LOT. I think your baby will get better at it, and you will too, and you'll have plenty of milk. Good luck!

[rducky]

I have the exact same situation as you except that my DD is 12 days old.

Large breasts, flattish nipples. They come out a bit with pumping, but like you they will take the shape of whatever size shield I use on the pump. When I use the larger one, it seems that part of my areola gets shaped into "nipple", but with the smaller one I pump less...

We have been supplementing with a syringe and a little tube at almost every feeding. She will fall asleep at the breast, so you think she's full but as soon as I move her she's rooting again.

I can sorta get her to latch with the shield, but it still feels like she's just sucking on the nipple and not grasping more breast.

My LC has told me that the adhesions will release with time and that pumping is effective at releasing them. Latching the baby on will also work, probably even better. I have been told that it may also improve as her mouth grows because now it seems that she has trouble fitting more than just the nipple in her mouth.
I have been told to pump a bit just before nursing to evert the nipple.

Hopefully someone else will chime in with advice!

[mt_gooseberry]

I had a similar situation and here is how it all worked out....

My nipples were flat.  I ended up using a nipple shield for 5 months and had no drop in supply (even though my DD was also a very sleepy eater).  I did eventually get rid of it for other reasons (constant blocked ducts, mastitis, thrush, annoying to use).  When you do feel ready to take the plunge and dump the shield, ask around on MDC for advice and check out www.kellymom.com.  Some time between birth and weaning (I didn't pay attention) my nipples did change to the pointy-out form for good.  Even when "relaxed," they don't go flat and puffy like they used to.  However, I didn't do a whole lot of pumping, so mine were popped out by direct nursing.  Not sure if the shield helped with this or not (like I said, I didn't pay attention).

As mentioned earlier, my DD was a sleepy eater.  I did all the little tricks (taking off her clothes, constantly poking and prodding and tickling her, changing sides frequently during the nursing session, etc.)  Part of the problem was the nipple shield.  Sometimes she would take over an hour to nurse just on one side.  I pretty much just constantly nursed for weeks.  She got better as she got older, and she cut her time in half when we finally got rid of the shield.

I had a lot of pain too, which at first was from your basic sensitive nipples/bad latch issues, but at 1mo pp, I was diagnosed with thrush.  Definitely look into that diagnosis--I would have saved myself a lot of agony if I had gotten that taken care of from the start.

I don't have much advice on pumping.  I only ever used the little Isis hand pump I got from WIC, which are pretty much one-size-fits-all.  My nipples just kind of ballooned into the funnel, but I still got really good at getting lots of milk, so maybe it doesn't matter.

I hate to say this, but those first few months of nursing were basically just misery for me.  I'm actually looking forward to nursing this time around, because I have so much experience with all the BAD that I now feel I can deal with whatever is thrown at me this time!  And please, check out www.kellymom.com, it saved my boobs!  Good luck, and don't give up.  I pushed through all these problems and more to nurse for over a year, and I wouldn't change that for anything!

[DrBrockBaca]

Erin77 and mt_gooseberry, your stories give me hope! I know it has to get better. I'm not going to give up, even though many people are suggesting that I should. 

We have been supplementing with a syringe and a little tube at almost every feeding. She will fall asleep at the breast, so you think she's full but as soon as I move her she's rooting again.

Do you have a supplemental nursing system?

We were using a syringe to start with, but my baby just started waking up and laying there with her mouth open and waiting for us to drop the milk in. We thought that was worse than giving her a bottle, and the LC's agreed because she would at least have to suck on the bottle. So we started using the First Years Breastflow bottles to supplement instead of the syringe, and it doesn't seem to have interfered with her breastfeeding. 

I can sorta get her to latch with the shield, but it still feels like she's just sucking on the nipple and not grasping more breast.

That's how I felt too, but I think it's just because of the shape of the nipple shield. I went back to the LC and asked about it, and they looked at it and said her latch was fine. After she nurses for a few minutes, some of my areola gets pulled into the nipple shield into her mouth. So I guess it's ok. I just hope she doesn't get used to not opening her mouth quite as wide, especially her lower jaw.

 had a lot of pain too, which at first was from your basic sensitive nipples/bad latch issues, but at 1mo pp, I was diagnosed with thrush.  Definitely look into that diagnosis--I would have saved myself a lot of agony if I had gotten that taken care of from the start.

I have read about this, but I don't think my symptoms fit that diagnosis. I've also had the pain since day 1, and it's consistent with the flat nipples being pulled out. But I will definitely continue to monitor it. 

Does anybody have any advice for getting rid of the nipple shield? Did it work for you to let your baby latch with it on and suck for a few minutes, and then take it off and re-latch the baby without it?

[mt_gooseberry]

I finally buckled down and got rid of the nipple shield around 5mo.  I don't know if it was wise to wait that long or if it would have been better to get rid of it during the newborn stage.  I feel like it really got me through those first weeks.  I certainly had no lasting problems with latch or supply because of it, but it did cause other problems.  In any case, I wouldn't stress about getting rid of it as fast as you can.  I would wait until you get all your other issues resolved first, and then work on the nipple shield.  Keep in mind that I'm not an expert, just someone who has been there and done that.

When you do decide to work on getting rid of the nipple shield, I can't recommend enough the articles on www.kellymom.com.  I know I keep plugging that site, but that's how I did it.  DD didn't want to nurse without the shield, so basically I had to teach her to nurse without it, just like you have to teach a newborn to latch.  I tried different things: going cold turkey, beginning the nursing session with it and slipping it off in the middle, using it on one side and not the second, etc.  It took about 3 days, and once DD caught on, she refused to nurse WITH the shield.  It was an immediate, AHA! kind of moment.

Anyway, I'll see if I can find the specific links to the most helpful articles, but right now it's naptime....

[mt_gooseberry]

Here's a specific article on nipple shields and weaning ( http://www.kellymom.com/bf/concerns/baby/wean-shield.html) and then here's a bunch of others it can help to look at.  I wasn't just taking the nipple shield away, I was teaching her how to latch on properly, so I read all of the articles about latching.  You will also find info on pumping and pain, too.  http://www.kellymom.com/bf/sitemap.html   Hope this helps.

[Erin77]

One of the things that helped us get rid of the shield was for me to dry off my nipple. My son got used to the feel of the shield, I guess, and the warm wet nipple feel was not "right" to him at first. So I'd let him use the shield at first, so my nipple would point up and I'd have something to work with, then I'd dry it off really quick with a paper towel and then re-latch him. It took a while, like a few weeks, before he would tolerate it for a full feeding, so be patient! It's so worth it now, not to have to dig that stupid shield out and fear losing it all the time.

[rducky]

Yes, it's a supplemental nursing system for finger feeding. She has to suck to get the milk. You put a finger in her mouth with the tiny tube and she pulls the milk from the syringe.

This weekend I figured out why she was "falling asleep" at the breast. I noticed that milk was spraying out in jets. She was being overwhelmed and stopped sucking to try to stop the flow. Maybe this is happening to you too since your supply has increased with the double pump? I haven't used the shield since figuring this out and the nipple pain has decreased a lot. She was chewing the tip of the nipple through the shield.

It helps to pump briefly before feeding to draw out the nipple and then try to latch without the shield.

[Heba]

Have you tried Laid-back nursing positions (to facilitate an effective latch) and breast compressions (to maximize milk transfer)? Just a couple of "tools" you might like to consider.
Details at www.biologicalnurturing.com and http://www.breastfeedinginc.ca/content.php?pagename=doc-BC respectively.

[rducky]

How are you doing? I hope you're seeing some progress.

[SweetSilver]

I had no grasp on just how bad my nursing problems were with dd1 until dd2 latched on that first time and.....YIKES!  She was a nursing powerhouse.  My flat nipples did change shape in the 1.5 years I nursed my oldest, but clearly half of the trouble was with her ineffective sucking.  I still see a bit of an overbite at 6.5 and her jaws just seemed to get tired.  Add to that a monster let down (then allergies, but that's a whole other story.)  The "nipple sandwich" worked very well for us those early months before my nipples took some shape.  She, too, would fall asleep because her suckling was so weak it took forever to get a letdown.  (Then WHOOSH!)  I learned to let her stay latched on for as long as I had patience for. suck suck.  wait. suck suck.  suck. wait.  (I'm not even sure I'm still addressing your troubles!  But good luck!)

[DrBrockBaca]

Have you tried Laid-back nursing positions (to facilitate an effective latch) and breast compressions (to maximize milk transfer)?

I always do breast compressions, which does help her keep sucking because she gets more milk. I keep trying the laid-back nursing position, but I just can't get it to work. I think my breasts are too large. 

How are you doing? I hope you're seeing some progress.

We have made a LOT of progress in the last week! Baby is latching a lot better, and we have completely ditched the nipple shield, first on the less-flat nipple, and then on the flatter side too. I still have a lot of nipple pain, but I think it is getting a little better (or else I'm just getting habituated to it). I am just using the size L shields on the pump because I get the most milk that way and they seem to fit the best in the areola. I have noticed that I get pretty bad nipple blanching when I pump though. I read that nipple blanching is caused by a poor latch, but I don't know what about the pump would be causing it. I always try to make sure the shields are centered properly. 

Baby is nursing ALL THE TIME now! Which is kind of good - we rarely have to give her pumped milk in a bottle - but also so tiring! She nurses for 8-10 hours a day! We have a digital food scale that I use to weigh her before and after she eats, and it takes her 45 minutes to an hour to get 3 ounces. I hope she gets more effective soon - I don't know how long I can keep this up. It's so much faster to pump and give her the milk in a bottle, but that is such a hassle, and I really want the breastfeeding relationship. I literally spend my whole day nursing her or pumping. I have watched virtually every halfway-decent movie that you can stream on Netflix, and I am getting bored! Plus I start back to work full-time (from home, mostly) tomorrow. We did get a wireless mouse for my laptop so I can use my free hand (that I'm not using to hold my breast) to do some things on the computer, but I can't type while I'm nursing. Hopefully soon she will get better at nursing and maybe I won't have to hold my breast for her?

Rducky, how is your situation?

[rducky]

Things are much better here too. I ditched the shield cuz I realized that she was doing more damage with it (chewing the tip of the nipple). I do notice that the nipples are getting more shape, still going quite flat between feedings but easier for her to latch on to. I guess the adhesions are getting worked out?

I am no longer pumping but I still have a fast letdown with milk spraying everywhere. She gets frustrated while we wait for the excess to flow into a receiving blanket, but it's better than before. I have to be careful because she will also clamp down on the nipple if the milk is coming too fast which causes cracks. The right breast seems to be worse than the left. She usually only eats from 1 breast per feeding.

It is such a relief to get away from the pump!

Feeding times range from 10 minutes to 1 hour so sometimes it feels like all I do is nurse, but it seems that you're really tied down at 8-10 hours a day. Also some days she wants to eat every 2 hours but other times it's 4-5 hours.

I also have not had much success with laid-back nursing, I agree that it may be large breast size, or I just need a better demonstration...