Nipple shields won't stay on, low supply, close to giving up

[nmouse]

My son was born at 37 weeks and needed breastmilk right away to stabilize low blood sugar. He nursed on my doula and has been getting donated breast milk ever since. He wasn't able to latch on my flat, non-stretchy nipples at all, even with a nipple shield, so we used the natural flow bottle. Now at almost 3 weeks old, he nurses that bottle pretty well, though very slowly. 

Meanwhile I have low prolactin and low supply, prolactin tested repeatedly since day 8 postpartum, and I am on domperadone since about 3 days ago. My schedule with the LC includes weighing him, nursing 10-15 minutes a side, if we can get a latch, which is only occasional before he goes into a screaming red fit, then weighing to see how much breatmilk he got (under 5 ml) bottling him for 30-60 minutes until he gets enough, usually 2-3 ounces, then pumping with my hospital pump another 10 minutes, up to half an ounce comes to the pump. Then eat, snatch a half hour or so of sleep if I can manage to fall asleep, and do it again. 

To say I am not getting enough sleep would be an understatement. I cry all the time from exhaustion and discouragement. Sometimes my partner tricks me and resets the alarm so I miss some of the night-time feeding & pump dates, just so I'll sleep a little longer. He says we can't go on like this because I'm not enjoying my baby and not taking care of myself. 

The latest LC consult suggested nipple shields. I would like to do that as it might help my son latch on something similar to the bottle he is used to, but the shield will not stay on my large soft breasts and small flat nipples. I get it on, but the little flange slides all around, and as my son and I are struggling to get him latched the whole thing often comes off, or he latches only on the shield and not the areola. We do better without the shield, but still not very well. 

OKay so my question: Are there better shields than the medela? I have every size and none is working. 

I have tried reverters and the supple cup, btw. No different from when my son draws out my nipple a bit--it always flattens again during the time he and I are struggling to get him latched.

[silversparrow]

I don't know much about nipple shields so I can't help with that, but I thought of a few other things that might help.

From what I know about domperadone it is better for rebuilding previous milk supply than for increasing one that was never there. Have you tried any herbal supplements? The recommendation from Dr. Jack Newman is 3 fenugreek capsules and 3 blessed thistle capsules 3 times a day. There might be other advice on his website that could help you too: http://www.breastfeedinginc.ca/content.php?pagename=doc-HRMS

You definitely need, need, NEED to get some sleep. Can your husband feed the baby expressed milk for one night while you sleep in another room with earplugs? Sleep would likely help your hormone levels a lot. You have to take care of yourself! 

Then, if you're not already, co-sleeping with baby on your chest, skin-to-skin (baby in diaper only) as much as possible. Penny Simkin writes about it in 'The Birth Partner'. She calls it the "breastfeeding cure": mom and babe stay in bed for at least 48 hours, skin to skin, leaving only for you to use the washroom, while others take take of everything else and bring you food.

Also some things I've read about only in studies but might help:

1. eating strong tasting foods may encourage the baby to drink. In studies, babies drank longer and ingested more milk when it smelled noticeably of garlic, and after the mother had eaten ginger or beer. And yes, beer... that story you here about irish women drinking guinness to increase their milk supply? There's truth in it! Though it may increase supply directly, the flavour may interest the baby to drink more and the alcohol can relax the mother and allow for better let-down. Dark beer like Guinness has lots of nutrients too, but any beer will do. And it is safe to have one or two.

2. One study showed that women had quicker and bigger let-downs while watching clips of feel-good movies, and had corresponding higher oxytocin levels. So get out your favourite chick flicks!

I'm so sorry you're going through this, I hope something here helps!  

[nmouse]

thanks for the suggestions. I drank some beer but then stopped when I read in the Sears book that alcohol actually decreases supply. Maybe I will start again.

I've been taking Motherlove More Milk Plus and also Goat's Rue. The Milk Plus has fenugreek & blessed thistle. 

Unfortunately I can't cosleep with my son because I have sleep apnea and everything I've read says not to when you have sleep apnea. We snuggle skin on skin when I am awake and not stuck to my pump or bottle feeding him or doing something like eating. When we nurse, we do it skin to skin, but it's not a very fun time for either of us (he screams, I cry). 

I am trying to get more sleep, but when I sleep for longer and don't pump I feel guilty. Plus my partner ALSO has sleep apnea but his is poorly treated, so he needs more sleep. If he takes the nighttime feeding to let me sleep, I feel terrible when he is exhausted the next day. He has to be rested to work or we won't be able to make it. 

[Erin77]

Don't feel guilty for sleeping! Getting some sleep is very important to your supply. I also have large, soft boobs and small, flat nipples (mine were actually inverted.) I had to use the shield until my son was five months old and I felt horrible about it. One of the hardest things was even getting it centered right in the dark, God, it was horrible. Anyway, my nipples eventually popped out and it got WAY easier, and I got off the shield. Some of the things that made getting the shield on easier for me: (I also used a Medela)

Not worrying about pushing the tip halfway in to create suction on the nipple. Instead, I'd get mine a tiny bit wet- or often, it would still be damp from the last time I washed it after nursing- and just center it. As soon as my son would start to suck, it would create a vaccum and pull the nipple up in to the tip.

Nurse lying down. If you are lying on your side, you can kind of use both hands to manipulate shield, boob and baby, which makes it way easier. I had to hold my shield on with two fingers for MONTHS.

Pop the damp shield on just a second before you go to nurse and if you leak a little milk in the tip, the baby gets positive reinforcement right away. I had a really good letdown, so I'd often leak a little just putting the shield on. But this really helped my son latch, because he'd get a "hit" of milk immediately.

Try to make it fun, instead of crying as you do it. I know, it seems so horrible and like a rejection of everyhting you wanted, but remember- no matter WHAT you do, it will get better. Even if you formula feed him, chances are, he'll grow up FINE. My son went on a month long nursing strike, and I think some of it was my own stress in feeding him. Eventually I made myself lie down with him and laugh, and tease him with the boob and act like I really didn't care if he nursed or not, and THAT was what finally got him back on. He knows when you are upset and he could be associating it with the nursing- the better you can feel about it, the better he will. And finally, give yourself a break! You are a good mom and you love him. You'll do your best and it will be enough. 

[katelove]

When I used a nipple shield the LC told me to smear a little bit of EBM all around the flat part to help it stick. Just a few drops. And also to fill the nipple part with milk to give her an incentive to suck straight away.

[gemasita]

I had similar issues - low milk supply AND latch issues because of flat nipples.  It's a horrible combination.  The whole nursing/pumping/bottle-feeding thing take SO much time.  I also had about 30 minutes to catch a few winks (not really) and then do it all over.  I felt guilty if I delayed a pumping session, just like you.  I could cry right now just thinking how nightmarish the first few weeks (well, it did extend into a few months but the first few weeks were SUPER hard) were.

I agree with the pp that said to not feel guilty about getting sleep.  I did that too.  It sucks to always be looking at the clock.  And then people would suggest to me to pump every TWO hours instead of three or power pump for an HOUR (on 10 mins and off 10 mins).  And then I would feel more guilty.

Your husband is right that you simply can't go on like this.  I think it's important to prioritize.  It's really true what people say about the baby getting out milk better than the pump.  AS TIME GOES ON, work toward nursing more and pumping less.  I'm not saying to "just nurse" because obviously you can't do that - your baby is having trouble latching on.  But I felt like I made a career out of pumping...forgetting that the ultimate goal was to get the baby BREAST-feeding.  We used a nipple shield for about 4 months.  There ARE different brands...Simplesse comes to mind right away and it's shaped very differently than the Medela.  Nipple shields are a pain but they really can help.  You can wet the inside of the nipple shield to make it stick to your skin.  I didn't do that because it felt like it slipped more that way but hey, it's worth a try.  Keep at it because if you could get that to work, it might save you time pumping in the long run.  I'm trying to think of what else helped me with the nipple shield.  I had to hold them on.  Especially before your nipple is really drawn into them after a few minutes.

[gemasita]

Oh and ditto everything Erin said.

[tincia]

I didn't have time to read the other posts so i hope this isn't redundant, but have you tried pumping for a minute BEFORE you nurse? This way let down has occured so your babe gets instant gratification for sucking, and your nipple is pulled out from the pump.

[BridgetC]

Could your husband maybe help you get some lying-down nursing in? You could latch the baby lying down and let him nurse while you fall asleep if your DH sat up next to you (maybe reading a book or watching a movie on a computer with headphones) for an hour or so. This would give you the added stimulation while simultaneously getting some sleep. Even inefficient suckling helps stimulate prolactin and thus stimulates milk production. DH could remove baby after an hour and put him in his own bed- that way you get some of the cosleeping benefits without the worry about sleep apnea. Plus, you get more sleep without feeling guilty about skipping nursing sessions.

Also definitely try some other brands of shields.

Good luck! You are really strong to be working so hard at this through so many difficulties!

[gemasita]

I also wanted to just share my success story since hearing those really helped me when I was struggling and about to give up.  My nipples were sore from day 1 and then became bloody/scabbed.  My son kept losing weight and by 1 week, he was down a lb.  We syringe-fed him for about a week after nursing and then went to bottles after nursing (he did fine with the transition from breast to bottle luckily!).  In the meantime, I started pumping every 3 hours and saw various doctors about my low supply.  I started taking domperidone but didn't see much of an increase.  We took my son to get evaluated for tongue tie. It was really hard to be juggling all of the issues....talking to the LC on the phone every day, running around to doctor's offices, pumping every 3 hours, trying to nurse every 3 hours with a ton of pain, and oh, I didn't mention that we were chasing donor milk around this whole time so that we wouldn't have to do formula.  I did get on the nipple shield after the first week and that thing literally saved our nursing relationship!  I couldn't have nursed through the pain even one more day!

So that first 8 weeks was hell. I finally stopped pumping during the day at week 9 and about a week later, stopped pumping all together.  DS was still causing me pain while nursing but he was doing better.  He followed each nursing session with a bottle of donor milk.  I still struggled with pain and was in a breastfeeding pain study at my local university and then got referred to a neurologist who diagnosed me with nerve pain.  I think it was all the nipple trauma and pumping combined.

At 5 months, we were doing pretty well!  Most of my pain issues were resolved and DS loved to nurse.  I had gotten off of the nipple shield at about 4 months so the only thing we were doing "differently" was to still use donor milk after feeding during the day.

Now at 9 months, I feel like my dreams of nursing long-term are a reality!  For a while there, I wasn't sure if DS would nurse very long because of getting bottle, etc, but he really does love to nurse and I think he'll want to nurse for a long time.

Anyway, I just wanted to share this because I used to look at other nursing mothers with envy and then found out that many of them had issues early on too.  Even my LC said she didn't think she could have persevered as long as I did.  I'm glad I did what I did but I never knew if I was doing the right thing.  And even if I had had to stop bf'ing, I would have known I gave it my best shot because I was so committed to it.

[babynicholstobe]

I, too, have very flat nipples and because of it DD had a reallly, really hard time latching on. We still the shield, as it is the only way she can effectively breastfeed. To make the matters worst, my left breast for some unknown reason does not produce milk. Because of this, we really had milk supply problems. I started taking fenugreek and drinking mothers milk tea, and I did see a bit of a dfference. I also tried pumping, before and after. Finally, at 7 weeks, we are effectively breastfeeding, no supplmentation, on just one breast. Here's what I recommend so maybe (hopefully) you'll have the same success.

1. Pump for just a couple minutes before you feed. Just enough to get the nipple to protrude. If you've already tried this and it didn't work, don't waste time continuing to try to do so. Lord knows you need some sleep, so stick to what works.

2. I rinse off the shield before each use and immediately put to breast which helps it stick to my skin.  I squeeze a little milk out and put it on DDs lips, then on the tip of the shield, and cup my left hand around the shield (like a u shape, underneath her mouth) to keep the shield and latch in place.

3. Have someone check the latch after putting the shield on, making sure that the bottom lip is out. My husband stil has to sweep his finger in there to make her lips pout out. Once that happens, I hear swallowing and know that she's eating well!

4. LACTATE SUPPORT. I get mine at Whole Foods. Trust me, this stuff works. It's a little pricey, but WORTH IT. Within a day and a half of starting it, I was starting to get discouraged but then during her nighttime feeding I noticed she was squirming-she was choking on all the milk! What a wonderful problem to have!

5. Once you get him feeding off the shield to where he is satisfied, only pump when hes taking a longer nap or something-that way you keep up the supply and demand, but aren't pumping yourself silly all day long. I know how stressful that is, and how much more work it is than to just feed from the breast.

6. Don't be so hard on yourself. I KNOW how discouraging  it is- I spent many nights crying and just feeling like a failure and cursing my body for not providing to my baby what it's supposed to. But I stuck with it, and now it's still not perfect-but she breastfeeds exclusively, my nipples arent sore and I don't feel like a walking zombie. You are obviously a wonderful mom and have clearly been trying everything you know to do, so even if it doesn't work out for you-you should have the peace of mind that you did everything you could.

Wishing you tons of luck!

[E m i c h i e e]

You have already gotten wonderful advice, and I just want to add some things that come to my mind:

- Wash the shield with hot water and soap before every use because it will stick much better. I also had trouble to get it to stick.

- Fenugreek Capsules helped me best increasing my supply, it took two weeks though.

- The best way to stretch your nipples is having your baby suck, I hope you will be able to latch him for a bit once in a while, he will get old enough to pull out even the flattest nipple. 

- I also used to wear the nipple shield in my bra to have them stand out more for feedings.

I really hope you can figure something out!

Best of Luck!