The long story:
For the first three weeks he would appear to be latching on properly but the pain for me was absolutely excruciating. Six midwives, two LCs and a child health nurse observed my latch and said he was fine, and I must just have an infection, or be so traumatised from day 0 of newborn nonsense that even a good latch was continuing to damage the tissue. They all recommended I cease breastfeeding and pump-and-bottle instead, so that's what I did for weeks 2 to 4, until my nipples had healed enough to put him back on.
Immediately, the pain was right there again, and new cracks formed, even though to all observers he seemed to be latching fine. He also started to develop a really loud clicking noise on one breast, and over his 5-week birthday weekend, this transitioned into a complete loss of suction on every suck. It turns out that he had an undiagnosed posterior tongue tie which was only fixed at 6 weeks of age.
After the tie was fixed (using the scissor-snip method) the latch was if anything worse, with his tongue now flopping around inside his mouth. I persisted with feeding for weeks 7-9 and managed to deal with the pain with shedloads of ibuprofen and occasional nipple shield use. This left one nipple a mass of tiny hairline cracks and the other with a single large fissure, which got infected, and after 6 weeks of it hanging around, it's finally healing using antibiotics and medi-honey. On seeing another LC, I was recommended again to pump and bottle until the nipples had healed and then go back to feeding directly, working on my positioning etc. What I found was that with a bottle he wouldn't settle, but if I gave him the bottle (using a Medela Calma teat) to replace the nipple which was most excruciating, and then fed him directly with the other breast, he'd get enough milk, I'd avoid 80% of the pain, and he'd settle afterwards. Despite starting on the bottle, he'd feed perfectly well on the breast, with no apparent problem transitioning from one to the other. After spending all of week 9 doing this, and with most of the damage healed, I have gone back to feeding him directly on both breasts. (I actually would have been happy to keep going for another week, but I caught the flu, and suddenly couldn't get out of bed to do all of the annoying washing-up/refrigeration/reheating that pumping involves.)
At first, when I replaced the bottle with the breast that had been worst off, I thought he was only able to feed properly on the breast I had been feeding him directly on. But after a few days of settling in and getting my supply back to normal levels (pumping had increased it) and going back to the rotating method, it seems that whichever breast he starts on, he does an absolutely horrible job, and either latches poorly (on the right) or with the old-style tongue-tie losing-vacuum-every-suck (on the left). Uuuusually toward the end of that breast, he'll get a tolerable latch, but I'm usually in teeth-gritting pain at that point, so it's hard to leave him on for the usual 'comfort/hind milk' suck. So I'm rotating between breasts in the traditional way, and every feed I have to deal with 10-20 minutes of increasing pain, before switching sides, and then ~75% of the time he latches on perfectly well, the feed is painless (beyond the existing trauma) and the second breast is drained in less than 5 minutes! He is nearly three months old, after all, and has a really powerful suck. I can leave him on for 5-10 minutes of comfort/hind milk sucking if he wants, or until he falls asleep.
Things I have tried:
- - Always offering him the same breast to start with -- I've had to do this in order to avoid the worst pain when he has particularly damaged one of the nipples. It generally seems to leave him even worse at latching on to that breast when I resume rotating.
- Rotating quickly between breasts over a feed -- absolutely excruciating and awful. No good latching at all. Stressful and painful for both of us.
- Nipple shields -- these vaguely helped with the pain back when he was a tiny newborn, but now his suck is so powerful that he pulls the nipple all the way to the top of the shield and I end up with tiny circular raised bumps at the top of the nipple, which I'm sure would blister if I let him keep going. I do not want to find out.
- "Improving the latch" -- If anyone directs me to another bloody list of latching techniques I will either scream incoherently or cry. I have gone through 100 of these. I have tried the sandwich. The taco. The flipple. Baby-led attachment. His nose is level with my nipple and his chin touches the breast first, and he gets a good mouthful. It's just that on the left, he sucks as if he still has tongue tie, and on the right, he chews me as if he's on a bottle, or lets his tongue flop around like a fish. So the very first letdown sucks and attachment are GREAT, and then the first deep suck he immediately ruins the latch. If I have him in a perfect position then he 're-latches' with not-horrible amounts of pain, and if anything is off then I have to correct it immediately, because feeding would be impossible if he re-latched himself in an awful position. Which brings me to...
- Positioning -- my worst LC appointment was with an LC who had me try five different positions in a single feed. This was at 5 weeks, before his tongue tie was diagnosed and fixed, and I was in absolute sweating, crying agony. From week 9 onward (so 3 weeks post-revision) I have tried at least 6 different positions, but at 11 weeks, he is only just getting the head control necessary for some of them. Off the top of my head, I have tried reclining, very locked-in cradle (favourite of one LC), cross-cradle/transition using the other hand to support but not swap, so as not to dislodge the baby (favourite of another), football, baby-led which ended up in a semi-reclined diagonal hold, and standing while rocking (favourite of another LC). Not a single thing helps. I am not horrible at positioning; I have even been used as a model in an ABA demo class! The only good thing about some of these positions is that when he inevitably loses suction, he immediately regains some kind of latch afterwards because his head can't move, so if I get it exactly 100% right, he can re-latch with not-horrible amounts of pain, as I said above. And I can't be consistently bad at positioning for ten minutes, and then good at it *after* I'm in pain and even more stressed, right?
- Finger exercises -- I have not been given much guidance on these, but I let him suck on my largest finger, with the nail down, and I tilt the finger so that there is pressure on the rear of his tongue, to force it downward and outward. I tried doing this before every feed for a while, or after the first minute of torture, or in between breasts. Doesn't seem to help.
- Mimicry -- I was told it could take 'a couple of weeks' for post-revision latching to improve, and that if I stuck my tongue out, he would learn to use his new mobility faster. So we play the 'can you stick your tongue out?' game every single nappy change, so ~10-12 times per day. Yes, he can stick his tongue out. Yes, I give him a big cuddle and grin afterwards. Does it help him latch? I am not sure.
- Changing nappy before or during the feed -- normally I change him if he needs changing, but I have tried to see if there is a pattern to whether he behaves better with a completely dry nappy. Not that I can tell. Particularly long gaps between breasts seem to 'reset' his behaviour back to 'awful', so generally changing him first is better, but he seems to tolerate a short gap fine.
- "Getting the baby completely calm" -- I swear, I have an uncalmable baby. Those inspirational videos with the lovely placid pale babies are very cute. Oh, they cry a little and mum sings to the baby, and ohhh look at them calm right down. "Now put the baby to the breast." Easy for you to say. If I do that, I have a screaming upset tomato-face with fists in his mouth and tears and saliva pouring everywhere. If he's awake and he's due a feed, and gets hungry, I whack him on *immediately*, at the very first hunger cue. But sometimes he wakes up and is hungry. NOW. So I either feed him immediately, and sometimes try to deal with massive amounts of squirming due to a nappy that needs changing, which is excruciating given his horrible 'latch', or change him, and then feed a somewhat upset baby. Attempts to calm the baby when he is hungry eventually result in him completely and utterly exhausting himself crying. I just cannot bring myself to let him get to that point. It's too soul-destroying. He knows what will calm him down -- being fed! Very occasionally he has woken from a nap without a sopping nappy, and I have tried the 'feeding the barely awake ultra-calm baby' method. Awful, awful, awful. I didn't think a latch could get any shallower but apparently it can.
- Room temperature: Especially for baby-led attachment, I have tried feeding in a really warm room, with very little clothing on either of us. Nope, no difference.
- - Physiotherapy -- I was considering this, because at first I thought that he just had a very strong nursing preference for one side. But I've found it's more that the first 10 minutes of nursing are awful and the last 10 minutes are fine, regardless of side. So how can that be muscle tightness?
- Osteopathy / Chiropractic / cranio-sacral therapy -- all seem like a bunch of alternative medicine nonsense, and chiropractors in particular scare me since I respect science journalists like Ben Goldacre and by all accounts, the evidence for the practice doesn't seem to stack up, and may even be harmful. There have also been a couple of infant deaths from CST (google, I'm not linking, it's horrible). I couldn't bear to risk anything like that unless I was recommended by a health care professional that I trust, but none of the LCs I've met with "could comment on the efficacy" of any of those options.
- Giving up and pumping exclusively for a couple of weeks -- I've now bought a pump since I've been haemorrhaging money on hire almost since he was born, so I could just pump for ... well, as long as it takes for his mouth to change shape like it did at 5 weeks? Or I could go back to my old method of one bottle - one breast, which is annoying and hassly but at least it settles him.
- Feeding in the bath -- I have the flu. It's winter. Our house is not centrally heated. Our bath is a 70s angular nightmare of protruding taps which we never used at all until the baby was born. Honestly, this doesn't sound like the best idea. But I'm running out of ideas...
- Feeding only on one breast -- I honestly have no idea how to transition to this. I don't really care about being lopsided but I have no idea how to feed him enough to keep him happy. Surely there will be a couple of days of hunger while my supply readjusts? Sounds horrible. And what if he just ends up being really horrible on that breast and never latching properly at all? Then I would have made a massive change for nothing.
So far I am proud that he has been 100% exclusively breastfed but it still makes me cry to think that it will be this way until the day he weans.
TL;DR: The short story:
I have an 11-week old baby who has a horrible latch on whichever breast he starts on, so the feed takes forever and is very painful, but he usually (80% of the time) improves a little after ~10 minutes on that breast, and then usually (~70% of the time) latches fine on the other one and proceeds to drain it perfectly.
Does anyone in this forum have any suggestions I could add to my 'to try' list, or any comments on (or links to posts which discuss) the pros and cons of the options I've already listed?