disappointing meeting with LC-does this advice seem right?

efs83 · September 2012

Hi ladies! I'm hoping you can give me some insight! I was induced on Monday due to IUGR. DS#2 was born at 5lbs 12oz, quite bigger than they thought! BFing was going well in the hospital and we were released after 48hrs. My milk came in on thurs, although I never felt fully engorged or uncomfortable. On friday we had a check up with the pedi, and they were a little concerned that DS was down to 88% of his birthweight. THey suggested I contact a lactation consultant to make sure I was producing enough, and that DS had a good latch.

I found a local IBCLC, and met with her yesterday. She infomed me that I have large nipples, and since DS is so tiny, he isn' able to latch properly. We were able to get him to latch a few times properly, but he would revert back to sucking on just my nipple. She suggested we try a nipple shield to see if it would help. I had always read that nipple shields were good for flat nipples, so I thought this was odd advice. We tried it, and DS did horribly. He was very frusterated, and my milk kept leaking out of the bottom of the shield, so he was hardly getting anything. I could tell that the LC was getting frusterated and she kept making comments about how this never happens to her.

After while, DS was overtired, so she suggested I give him formula in a bottle to build up his strength so we could work on latch. I was worried about nipple confusion with the bottle, but she assured me that since I had big nipples that wouldn't be a problem?!? Doesn't that sound odd to you? I asked he about a supplemental nusring system but she said she doesn;t have them. In any case, she left, and I did end up giving DS some formula. SHe also suggested building up my supply, because it does seem quite low. I have been taking fenugreek and and pumping when I can, but I haven't noticed a big increase in supply yet.

Honestly, she spent almost 2 hours with me, and I was no better off when she left. Is it unusual for LC to not be able to get a baby to latch properly after one session? She wants to see me again, but I'm almost thinking of getting a second opinion. Were my expectations set too high? Should I stick with her and see if things get better? We are paying OOP for her services, and I really felt like the first session was a waste. I'm sorry this is so long, thanks so much!

perplexed59 · September 2012

Did she do a weighted feed to see how much he was getting without the nipple shield? How are his wet diaper counts? Are you finding feedings uncomfortable?

It is normal for babies to lose weight after being born. If you were induced and received a lot of fluids it may seem like your baby lost more weight but his birth weight may have not been as accurate because he would have been full of the extra fluids. If he is having a wet diaper for every day he has been alive (ie 4 wet diapers on day 4, 5 wet diapers on day 5) then he probably is getting enough. A good latch doesn't always look a certain way.

I would call another LC and get their opinion. They may have different advice for you.

preggersINschool25 · September 2012

I don't have much help, but just a few things to say. 1. I had to work with an LC in the hospital because LO wouldn't latch and I did have to use a nipple shield. I have flat nipples and no matter how hard the LC or I would try we couldn't get him to latch without it. It is hard in the beginning and don't have your hopes set too high. It will get easier after a few weeks.

2. It is unlikely that you aren't producing enough milk for you LO... especially if milk was flowing out the bottom of the shield like you said. But if you know that you have a low supply and want to take fenugreek - you have to make sure that you are taking enough of it... work up to 4 pills 3 times a day. If you don't smell similar to maple syrup then you aren't taking enough for it to have an effect.

ncbelle · September 2012

I would definitely see a different LC (make sure she is an IBCLC). Any LC who would advise you to use formula before discussing other options (like pumping and doing feeds through an SNS) is not giving good advice!

Since your guy is very small it may be that you need to do some SNS/dropper/etc feedings until he is a wee bigger/stronger. It sounds like you are pumping already so that could be used to supplement feeds.

I would echo the above advice to work with an LC who can do a series of weighed feedings to see how much milk your little guy is able to transfer.

Finally, what is your current nursing pattern looking like?

IBackBevo · September 2012

I have an IUGR baby (although a little smaller than yours) and he has never been able to latch properly. He was 5 lbs 1 ounce when born and his lowest weight was 4.75 lbs. His mouth is just too small to properly latch and he didn't have the strength at first to properly suck. We had 3 sessions with 2 different lactation consultants and none of them were able to get him to latch properly even with the nipple shield. I have spent countless hours working on feeding at the breast much to the frusteration of the both of us. My LO was also in in the nicu and had to be supplemented with formula due to low birth weight and low blood sugar so it didn't help he was already on the bottle...and I do think that hindered the situation..but there wasn't anything anyone could do about that. It was the hand we were dealt.

Personally,if I were you, with your LO being small and IUGR, my main priority would be being sure you got nutrition in him. A 5 pound baby doesn't have the fat supplies to loose that a 7 or 8 pound baby does.

efs83 · September 2012

Thanks for all the replies ladies! I am currently nursing every 2hrs, about 15-20 minutes each side. I have been offering a little formula afterwards if he still seems hungry usually no more than 1/2 oz. I have been tryong to pump after each feeding, but I'm only getting less than an ounce. Of course this is AFTER nursing, so it's not a great reflection of my totaL supply. Also, I'm using a 2 year old medela swing (single electric) pump, that I used with DS#1, and I don't think the suction is the best. I'm going to try and rent a hospital grade one tomorrow. We have a weight check with the pedi tomorrow, so hopefully things will go well. I will see if I can find annother LC in our area, hopefully they will have a different perspective. Thanks again for all if the suggestions!

BriDaily · September 2012

Don't go back, seriously. See if you have a local LLL group and get help from a leader.

Also, realize a NB has a stomach the size of a pea and it can take awhile for it to stretch. A NB will also lose .5 to 1 pound off their birth weight the first week. If it isn't back by the middle of week two, then worry a bit. It sounds like your BM is coming in well and this shouldn't be a huge issue.

As for latch, try to help your LO get a good latch by opening their mouth a little as they are getting up to your boob. In a couple more weeks it shouldn't be an issue!

It can be difficult to BF a baby so little, but very doable and very beneficial for their health! Keep up the good work!

hillbillysunshine · September 2012

Seems odd that she went straight to formula. Did she weigh your litle guy before and after nursing to see how much he's actually getting (these LOs can surprise you how much they actually get, and how quickly).

Also, what about pumping and a foley cup? Syring? I'd find another LC or even a LLL meeting. I'm sorry you're going through this.

As a side note, I had to use a breastshield with DD#1 b/c of cracked nipples and we used it for about a week - long enough for me to heal - and then went back to nursing without it. It took her a few times w/o it to get used to my bare breast but she did just fine and we nursed for 13+ months. I had to actually hold the edges of the nipple shield to get it to work properly - I actually had to put the nipple part between my index and middle fingers while on my breast and hold it down like that to try to be able to cover all of shield. It was trick - and my description just now of how I held it sucked - but we played around with it and finally got it to work for us.

Hang in there.

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