Why does my LO only latch correctly for second half of feed?

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Why does my LO only latch correctly for second half of feed?

Postby yvettep » Sun Sep 06, 2015 8:01 pm

My little one is 11 weeks old and we are still struggling to breastfeed without pain. His weight gain is absolutely fine and he is meeting his developmental milestones. But I am still in pain during every feed and while I was hoping to feed him to 12+ months, I don't think I can deal with this pain for that long (let alone when teeth come in). Please skip to the TL;DR if you don't want to read a long (somewhat self-indulgent) and a little ranty essay.

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.

Things I haven't tried, but may well do, since I'm going slowly mad with pain and getting depressed over how this bonding experience has started and stayed incredibly painful and stressful:
    - 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.
    - Formula.

The pain is ridiculous and I feel like we can't move forward in our mother-baby relationship and do things together because I'm so bound to the pump or the painkillers. I dread hearing his cry and having to feed him. The gap between how it feels on the first breast (agony) and the second breast (perfect drainage, big oxytocin release, nice calm beautiful baby) is ... upsetting. I don't know how to describe it. It's like you know how good and simple it can be, but for some reason the baby doesn't want to do the right thing from the beginning, and you can't reason with a little dude who can't talk. At nearly three months he's been fed through some of the most important weeks and had a nasty bout of flu fended off. And while I shouldn't be financially motivated for something like this I almost feel like I'm throwing good money after bad at this point if I spend any more on breastfeeding. I've spent more than $500 in hire, prescriptions, ointments, shields, pumping, not to mention losing many days of precious time together driving all over the place since it seems every LC is at least half an hour's drive away. (I know, I could live a LOT more rurally and it could be a lot worse, but more than hour round trip of driving every other day when you've only had a few hours sleep doesn't feel good, or safe.)

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?
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Re: Why does my LO only latch correctly for second half of f

Postby Esther » Sun Sep 06, 2015 10:34 pm

A quick reply.

Huge hugs for all the amazing work you have done. Feeding in pain is awful. Have you contacted the ABA Helpline at all? A trained counsellor can go through everything with you and help you work out a plan. Or plans.

Alternatively, email counselling is available to ABA members. You could paste your post into an email. The advantage of doing it this way is that you can have ongoing contact with the same counsellor if you like.

Good luck. I hope you get some info that helps you come to a decision soon.
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Re: Why does my LO only latch correctly for second half of f

Postby Mummy woo! » Sun Sep 06, 2015 10:56 pm

Also quickly because it is bedtime. What Esther said, plus get yourself along to an ABA meeting - meet some other mums, talk to a counsellor face to face. The 'local groups' section of the main website will let you find a group near you.
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Re: Why does my LO only latch correctly for second half of f

Postby Parla. » Sun Sep 06, 2015 11:02 pm

Wow. Thank you for all the detail in that. I read all of it, more than once.

Just a couple of tiny points I wanted to offer up front:

Re formula, which I noticed you listed as your last option - some mothers choose to access donor milk as another option. Only you can decide how you weigh up all your options, but you are right that both baby's and mother's health and wellbeing are factors here.

Re the palaver of pumping - I'm not sure if you know that for a healthy baby you only need to wash your pump parts once a day. "Rinse well in cold water after each use to remove surface milk. Store in a clean, closed container OR the kit can be stored unrinsed in a closed container in a fridge." And then wash properly once a day. (https://www.breastfeeding.asn.au/bf-inf ... reast-pump) Dishwashers do a superb job of washing if you have one. Flu still makes everything harder, but sometimes streamlining the equipment side of pumping can make a difference. Maybe now you're (hopefully) over the flu, going back to the bottle/breast combination could give you some relief while you try to find something that improves his latch at the beginning.

Aside from that, I can see you have tried so many things, and it sounds like some have helped to give your nipples time to heal, but nothing has really got your baby latching well from the beginning of a feed and this has been going on for 11 weeks. Prolonged breastfeeding problems can be really stressful. Some mothers find it particularly hard because only they are having this experience with their baby - partners, grandparents, and friends just see the adorable baby. You're doing a great job, your baby is thriving, you are clearly still quite sane.

The question that stands out for me is "why IS he doing this?" You say it in there a couple of times, if he can do it for the second half of a feed, it's not like he's physically incapable of latching in a way that is comfortable for you. Babies are very smart. They only need to do a couple of things, and they are so very good at making sure their carer stays nearby and making sure they get fed. So I wonder if he is doing this not because something is wrong, either there's something wrong with him you need to fix, or there is something wrong with your technique that you need to fix, but because it's what works for him.

Why would it be working for him? I've known a baby to have appalling attachment when the milk is flowing fast, which it often does at the beginning of a feed, but here your baby will happily latch properly to the second breast, which often means going back to fast flow just like the beginning of the feed on the first breast. Could it be that when he's hungry this way of latching does something that he likes or needs to happen? Did one of those LCs explain how you can tell when you're having a let down, or about changed in your baby's sucking patterns? Do you notice any difference in what's happening for your baby when he latches badly and latches well? What does the change in his latch achieve for him?
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Re: Why does my LO only latch correctly for second half of f

Postby yvettep » Mon Sep 07, 2015 5:02 pm

Hello lovely people,

Thank you so much for your replies. It means a lot just to have someone to talk to! My husband is less than interested in these details :?

@Esther & Mummy Wool -- Thank you for your support. It's so nice to know someone out there appreciates what kind of pain this is! I have been to several ABA meetings. I find them nice in that there are people there with similar stories (none quite so bad that I've met, yet!) and people have lots of good tips on pumping etc. But the Code of Ethics means that the counsellors there pretty much refuse to give any breastfeeding advice other than 'contact a Lactation Consultant or your GP'. Other mums do say what worked for them, which is useful, but I find this ethical code completely hamstrings the counsellors, and it's pretty frustrating to sit there feeding painfully and no one is 'allowed' to help. Yes, I could have telephone or email support, but then I have to spiel out this massive MASSIVE chain of events, which is hard enough to do every time I meet a new LC. At least in a forum, loads of people can see it at once. Well, now I've written it, I could copy-paste it to my local suburb leader. I'm sure she will be thrilled, hehe ;) At the meetings I have mainly verbalised my current plan at random mums and counsellors and then listen to feedback and similar stories. That has been good, at least for a feeling of solidarity.

@Parla -- Thank you for reading it in detail! Once I started writing it just all came out in a flood. I hope it's a useful story to any other mum who finds herself in similar circumstances. To address your suggestions:

    - Donor milk: Even though I read an article about it, it never crossed my mind. I am not sure why I don't like the idea. The feeling that it should be 'my way or the high way'? Hmm. I will mull over why I want to say 'no' immediately to that suggestion.
    - Pumping palaver: Don't worry, after a couple of months of pumping on and off, I'm au fait with the shortcuts! It's just too hard to manage the timing of events when you are drifting in and out of fever/chills/consciousness with flu. How long as this milk sat here for? When did I last clean this bottle? Should I get out of bed and heat this up or should I not bother? Impossible to answer when you're not really with it :) At least with hunger cues and some muscle memory it's like - OK, baby's hungry, let him feed, well that hurt, whatever, back to sleep for both of us (thank goodness he's a good sleeper!)
    - Adorable baby -- that is a really good point, thank you for exploring it! I think it's hardest with my husband -- he just gets this totally blank look when I try to explain breastfeeding problems and what my next plan is. All he sees is this cute smiley baby (ok, and occasionally grouchy whingy baby, which he does do a great job of settling, I will certainly admit!) I also get really upset by people (usually almost total strangers, like receptionists) who say 'oh he looks SO hungry, why don't you just feed him?' when I know full well it's only been an hour since his last feed, and he's crying because he's tired or overstimulated, and to try to feed him would just inflict more pain on me for nothing. Deep breaths are useful there.

Your last point is really really interesting and I have thought about it during every feed since I read it. I think you could well be right, and his behaviour might be more psychological/emotional than anything else. The fundamental thing he gets more of if he does the 'bad suck' is a lot more time on the breast, because he's much much less efficient, so I have to leave him on there for at least 10 minutes, usually as long as 15 or 20 minutes, to get anything substantial out. Whereas the 'good suck' is so efficient, it's all gone in 5 minutes, and if I'm tired and stressed or the nipple is already traumatised from the last feed (when it was the first nipple, i.e. punching bag), I don't always let him comfort suck. So I have started making a conscious effort to leave him on as long that first breast as I possibly can once he is doing a 'good suck', even if there is a bit of trauma from the first minute of poor feeding causing pain. I am even leaving him longer than 20 minutes, which was usually my cut-off time based on how awful my first few weeks breastfeeding were. And I think he is relaxing, and realising the breast isn't going anywhere, and he can stay on it as long as he likes... IF he's doing the 'good suck'. With that small change, feeding is taking quite a bit longer, BUT, he has started to get the hang of sucking properly a lot more quickly into the feed, with only a minute or so of dropping the latch, and improving faster. This is somewhat counter to all the advice I've ever read/been given, which is to end feeds or at least re-latch if you feel pain, but as long as he's doing the right thing then it's only older wounds stretching, not new ones being formed.

Another thing I'm trying at the same time, is to talk to him more -- kind of a running cooing nonsense especially for the first few minutes before he relaxes into the feed. Again, the thought being that what he wants is comfort and closeness, and that's the last sense which I can use to reassure him that I'm there. That might also be helping? Once he's in his milk zone nothing seems to disturb him and I can stop. (Which is great, because I have a yucky cough, and I can hold it for three minutes, but not twenty!)

I have already noticed some improvement (or at least a halt in the degradation) of my nipples just from doing this for the last five feeds (over about 14 hours). I'm optimistic that this trend might continue because I have never before seen more than one feed at a time of good behaviour, and now he's had ~ four in a row with reasonable behaviour. And for me, nipple trauma usually takes absolutely weeks for me to heal, not hours, so feeling the pain plateau instead of continue to get worse is huge. I have another LC appointment in a couple of days so I will keep testing this behaviour and talk it over with them.

Thank you for your replies!
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Re: Why does my LO only latch correctly for second half of f

Postby mimo » Tue Sep 08, 2015 1:52 pm

Hi,

I'm jumping in a little late here, sorry. I've probably read it all a little too quickly but I hope I understand that his latch is bad at first and then improves later in the feed/on the other breast? One thing that comes to mind is that whether he is using the bad latch in order to stimulate a let down/faster flow? I know that one of my bubs loved to pull and tug on the nipple but then after the let down tended to settle down a bit. Not the same in that it didn't usually last so long but I wonder if it would help to try and speed things along? You could try expressing a little first to get things going, or breast compressions during a feed to try and see if it is a flow thing? Some babies mess about a lot at the breast and then get the "reward" of the milk so they do the same again the next time.

Also, I found this quite interesting:

But the Code of Ethics means that the counsellors there pretty much refuse to give any breastfeeding advice other than 'contact a Lactation Consultant or your GP'. Other mums do say what worked for them, which is useful, but I find this ethical code completely hamstrings the counsellors, and it's pretty frustrating to sit there feeding painfully and no one is 'allowed' to help.


Counsellors absolutely shouldn't give medical advice and in general we're trained to give suggestions rather than actual advice and let the mothers come to their own conclusions given the available information. So they wouldn't generally say "You should do this" or "You need to try". We also wouldn't ever contradict the advice of a medical professional. We can however give breastfeeding information, assess a feed etc. Are they definitely Counsellors and not Community Educators? Community Educators cannot counsel one on one with a Mum.

I've gotta run, but I'll try to come back to this later.
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Re: Why does my LO only latch correctly for second half of f

Postby MamaMagoO? » Tue Sep 08, 2015 5:39 pm

I'm just jumping in with a couple of quick thoughts as I need to cook dinner... and I have to admit read your story quite quickly so I wonder if I missed something. But it really struck me as interesting that you say he fed really well when he finished at the breast after a bottle of ebm. Reminded me of a technique for supplemental feeding known as 'Finish at the Breast'. Its a technique that may be recommended for low-supply, which doesn't sound like an issue for you but I wondered if reading a bit about it might help: http://www.lowmilksupply.org/finishatthebreast.shtml

Another thought I had was could he simply be too hungry when he first starts feeding? You mentioned that he is very hard to calm before a feed and so I wondered if you could perhaps try feeding him a little earlier, before he gets worked up into a state? Are you familiar with early hunger signs that he might be showing, before he gets to crying?

Finally, what mimo said about the counsellors. Breastfeeding counsellors are trained to offer mother-to-mother support and suggestions but are not health professionals. The COE is there to protect everyone. You would not want to be given medical advice by someone not qualified to do so. If a Breastfeeding Counsellor is suggesting seeing a GP or LC it generally means that it seems there may be a medical issue requiring assessment from someone appropriately qualified.

Hope that helps.
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Re: Why does my LO only latch correctly for second half of f

Postby Jenbt85 » Tue Sep 08, 2015 5:57 pm

But the Code of Ethics means that the counsellors there pretty much refuse to give any breastfeeding advice other than 'contact a Lactation Consultant or your GP'. Other mums do say what worked for them, which is useful, but I find this ethical code completely hamstrings the counsellors, and it's pretty frustrating to sit there feeding painfully and no one is 'allowed' to help.


I find this really difficult too. I get why it needs to be this way, but it's frustrating.

I don't have anything to add that others haven't already said, but wanted to say congratulations for getting this far under such tough circumstances.
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Re: Why does my LO only latch correctly for second half of f

Postby Parla. » Wed Sep 09, 2015 7:34 pm

How have things been going today?
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Re: Why does my LO only latch correctly for second half of f

Postby yvettep » Tue Sep 15, 2015 12:46 pm

Hi all,

Thank you for your kind replies. I won't say anything further about the CoE because I haven't been an ABA member that long and I'm sure it was put into place for good reason, by people a lot more experienced with the organisation than I am! I just mentioned it to say why I found the ABA meetings perhaps less useful than I expected.

Last week I had another LC meeting and we went over what's been happening. It turns out I have been using too small flanges on the breast pump, so my nipples were not healing as fast as they should have been, since they were still being traumatised in a different way. Thanks to the antibiotics, the infection I had is also healing. However she didn't have much to say about the sucking behaviour except to keep focussing on positioning, and ensuring a good latch at the start of each feed. She did say to try some finger exercises like pushing down on the back of his tongue.

After that meeting I went back to pumping one side at night, not least because my nearly 3-month-old is occasionally sleeping 8pm to 4am, which is awesome, but then my boobs nearly pop without that midnight feed! And during the day I have been feeding him directly on both sides. With the new pump flanges the never-quite-healed nipple is finally improving and if he feeds well, I can go a whole couple of feeds without pain! Yay!

So I tried the finger exercises and it made me realise something. He has two different kinds of sucking: the 'correct' version you see in the videos, with an undulating tongue and some suction, and the 'incorrect' version which is more like an up-and-down chomping motion. I realised this morning that the incorrect version works on my breast in certain circumstances: mainly when the breast is 'just' ready, i.e. not overfull and engorged, nor quite drained and empty. It does NOT work in those two latter circumstances, or on the Medela Calma teat. One of my breasts tends to produce a bit more milk than the other, and the incorrect suck tends to work on that breast but not the other (the one I've been thinking of as his preferred breast).

SO! This means that if he starts on the bottle, or on the breast that doesn't respond well to the incorrect suck, he has no choice but to suck properly, or he won't get any milk. OR, if he starts off incorrectly, but I tolerate it until that first ~50% of milk has gone, he eventually gets to the point where there isn't any more milk, and sometimes he clicks into the correct suck. Once he's there, he rarely goes back to the incorrect suck, because it's so less efficient! My husband and I had even joked about putting some water in the Calma bottle so that he could get his 'bad behaviour' out of the way, but that genuinely looks like it would work. Or better, just pump a small amount of EBM and start him off with that.

@MamaMagoO? -- Thank you so much for the link! I am so glad I had always been giving him the bottle before the breast. He definitely associates the breast with feeling full and calm. He has even started rejecting the bottle about halfway through an EBM half-feed, so that helps move him back to direct feeding quite easily.

As for whether there is too much milk at the start -- I think he is quite capable of handling my moderate let-down, if he starts with the right suck. I can tell because if I start him on the slightly-less-full breast, and he does the correct suck, then when I put him on the "mega"-boob, he totally drains it quite happily and quickly, even though it has a faster let-down. On the advice of the LC, I have tried applying firm pressure halfway up half of the breast in order to reduce the flow, but it didn't have an effect.

Currently we have a fairly happy compromise situation where I tend to start him on the less-productive breast, which encourages the correct suck. Some nights I only let him on that one, after I pump and Calma the other -- that depends more on his sleeping patterns than anything else. The nipple pain is nearly gone -- it just comes back when he gets set into 'incorrect suck' mode and I have to put up with some nonsense at the start of the feed. But I am trying to encourage the good behaviour so hopefully he will eventually forget it is an option. I have also bought a more portable pump that has a battery-operated option and that is brilliant -- I can move around the house instead of having to move a massive hire pump. Psychologically that makes me feel a lot less trapped.

Thank you everyone for your helpful replies! I'll try to update again in future.
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Re: Why does my LO only latch correctly for second half of f

Postby MamaMagoO? » Wed Sep 16, 2015 1:36 pm

I'm so glad to see you have found a solution that works for you and that things are improving. Do keep us posted. I'd love to hear how you go.
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Re: Why does my LO only latch correctly for second half of f

Postby Parla. » Thu Sep 17, 2015 5:17 pm

Thanks for the detailed update! It sounds like there is some light at the end of the tunnel. I'm glad the LC picked up on the nipple flange size issue and sorry none of us thought to ask.

It's really interesting to hear what is working for you, because you've come up with an approach that is really responsive to what you're seeing with your baby, and yes this is sometimes not what conventional wisdom would suggest. Given how little it was doing for you, you're more than justified in ignoring conventional wisdom anyway ;)

Your view on the code of ethics is quite valid. Usually when a counsellor suggests a mother refer to a health professional it means we suspect there's a medical issue OR we are not sure what's going on or how to help you further. Counselling generally requires privacy, so most counsellors won't go into depth in a group conversation, but are happy to talk one-on-one. If a counsellor is really not offering any assistance, then they're not understanding the code of ethics. Breast and nipple pain is our bread and butter.
Speak to a breastfeeding counsellor anytime - 1800 686 268

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Re: Why does my LO only latch correctly for second half of f

Postby yvettep » Tue Sep 29, 2015 3:55 pm

Thanks for your support, lovely people! We have reached a milestone of two weeks of painless direct feeding, hurrah! My little one now only regresses when he's overtired or there is a lot going on around us and he can't concentrate. Now I have the more usual challenges of feeding a baby who wants to look at the world around him, and who likes to kick his legs while feeding, launching himself sideways. Those challenges are much more fun :o)

It's hard to find alone time with counsellors, at least at our group meet-ups. The meet-up is very busy, and they have older kids and commitments after the meet-up. I could definitely have asked any of them for some solo counselling time; I guess I was just a bit stressed after two hours of trying to talk past noisy toddlers running around, often with a painful feed in the middle; stress makes me want to go home. Pre-revision, it really would only have helped if they could have diagnosed the tongue tie, or at least strongly suggested I get a referral to someone who could. I already had a LOT of misdirecting advice about positioning and latching because everyone was convinced it was something I was doing wrong. In a way, three weeks of pumping, as suggested by the ABA at the time, was not at all helpful, because while it gave my nipples a rest and treated the symptom, it did nothing for the root cause. Post-revision, I think the relearning process was just something we had to work through mother-and-baby.

It helped following the Tongue Tie Facebook page and seeing other mums' stories. It's amazing how many tongue ties are missed and how many mums are out there soldiering on despite the pain -- or sadly, giving up because of a lack of support. Tongue tie wasn't even discussed in my antenatal classes, or by the midwives at the hospital. All visual inspections showed nothing. But he just couldn't move his tongue upward, and even with revision, there was so much relearning to do that in total it caused us months of pain, and there were MANY times where I contemplated giving up for good. If I could change one thing about our early days experience, it would be to have had the tongue tie picked up in the first week.

Fingers crossed for late teeth, I could do with a month or two of pleasant feeding before the next big challenge :) Thanks again for your support! Even if you've just read along, it helps me to know that you are listening.
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Re: Why does my LO only latch correctly for second half of f

Postby ClOuD_NiNe » Tue Sep 29, 2015 9:10 pm

That's wonderful things have improved! I didn't comment above but I've been reading your story. Well done for persevering and working out what was going on.
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Re: Why does my LO only latch correctly for second half of f

Postby DigDig » Fri Oct 02, 2015 1:47 pm

I wanted to congratulate you! I'm so glad that things have been going much better for you. It's a real achievement that you persevered for so long under such difficult circumstances. Well done!
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