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Re: feeding problems small full-term baby

Posted: Sun Jan 23, 2011 02:52 pm
by glimmer
Hi Jules - how are you getting on? 4-5h of pumping a day must be exhausting.
Did they not offer you are lactation stimulant? I second the above - you must do what's right for you, but
formula is really an excellent choice if extracting BM is that time-consuming. Playing's just as important?!
Congratulations on the great weight gain!

Re: feeding problems small full-term baby

Posted: Fri Jan 21, 2011 10:48 am
by milesymommy
Don't know if you saw this... a recent article on Posterior Tongue Tie ... tongue-tie
Trouble Breastfeeding? Could be Rare Type of Tongue Tie
News by Stand and Deliver
(January 04, 2011) in Health / Women's Health
In last week's post A Proactive Approach to Breastfeeding, I briefly mentioned tongue tie as a possible culprit for breastfeeding problems. Cassandra wrote in about her daughter's posterior tongue tie:
My 3 month old recently had a posterior tongue tie fixed after being told by three different IBCLC, my midwife and a pediatrician that nothing was wrong with her. She got clipped and like magic latched for the very first time. I'm doing what I can to spread the word about this rare but severely underdiagnosed problem since if I hadn't been extremely stubborn and kept at it, this problem would never have been taken care of. Here is a very in depth and fantastic resource for diagnosing tongue tie of every type:

I wanted so very badly to breastfeed, I seriously almost killed myself over not being able to (yay hormones, it's incredibly frustrating that it was a problem that could have been fixed, but nobody caught what was actually a pretty obvious tongue tie. I don't want to see any other moms go through the same thing.

Yesterday, Shannon shared her story of posterior tongue tie at the Motherwear Breastfeeding Blog. Shannon was an IBCLC and still did not pick up on the tongue tie! It wasn't until she was in a room full of IBCLCs (most of whom misdiagnosed the problem as well) that she met one woman experienced with posterior tongue tie. Like Cassandra's story, as soon as Shannon took her baby in to have the tongue tie clipped, the baby latched on perfectly for the first time. Here are a few excerpts from her story:
After the birth of my first son Aidan, I was so excited to nurse. After spending so many years teaching breastfeeding, I was finally going to experience it myself. In the labor and delivery room when I nursed him for the first time, I was surprised at how painful it was. I knew I was latching him correctly; after all, I was the expert! When he came off, my nipple was misshaped, smashed into a slant, like a new tube of lipstick. I looked at his tongue and he could stick it out, so I thought it was not tongue tie. By the next day, my nipples were cracked and bleeding. The agony was too much, and I had to pump and bottle feed most of the time to give my nipples a break. I was devastated and thought I might have to change careers.

I was ashamed that as an IBCLC I couldn't get this right, and the only person I could be honest with was my husband. When friends and colleagues would ask how things were going, I was not fully honest about how terrible I was feeling. When Aidan nursed, it was more than just a pinching or biting feeling. It was irritating, like sand paper on my nipple. His sucking was choppy, and he was having a hard time maintaining latch. Feedings were 45-60 minutes long....

Then there was one IBCLC, Debra Page, who saw him stick out his tongue and said I think he is tongue tied. I asked her to explain because when I worked in the hospital, the babies I saw who were tongue tied could not stick out their tongue past their gums, and if they did, it was heart-shaped on the tip. She said there were different types of tongue tie, the obvious ones are type 1 or type 2, and it looked like Aidan had a type 3 posterior tongue tie. I had never heard of this. She explained that he couldn't elevate or lateralize his tongue, and when he did stick it out, it was duck bill shaped, not pointed.

The surgeon we went to, Dr. Elizabeth Coryllos, explained that she would do the frenotomy in the office and she would numb him under his tongue. I began to cry. She assured me it would not be painful to him and he would be able to nurse right away. I told her that was not why I was crying. I explained to her I was upset that I was not able to solve this on my own, that as a professional and as a mom I felt like a failure. Then she gave me the best advice I have ever heard as a mom. She said even if I was the best race car driver in the world and I had the best car ever built I could not win the race if a tree fell across the track. Someone would have to remove the barrier so my car and I could continue on our journey. It was not my fault that nursing was not going well. I had the best baby in the world and I was the best mom for him; we just needed to remove the barrier to continue on our journey.

In an AAP newsletter on breastfeeding, the article Congenital Tongue-Tie and its Impact on Breastfeeding (PDF) explains the four types of tongue tie and how they can affect breastfeeding.
Types 1 and 2, considered “classical” tongue-tie, are the most common and obvious tongue-ties, and probably account for 75% of incidence. Types 3 and 4 are less common, and since they are more difficult to visualize are the most likely to go untreated. Type 4 is most likely to cause difficulty with bolus handling and swallowing, resulting in more significant symptoms for mother and infant.

An infant can obtain milk from a bottle without the wide gape and consistent suction needed for a good breast latch. If the tongue-tied infant cannot maintain the tongue over the lower gum during sucking, the “phasic bite reflex” (chewing) is triggered. This chewing motion is ufficient to transfer milk from the bottle, but is clearly problematic at breast. Bottle feeding allows milk to drip into the mouth without effort, thus requiring less tongue muscle effort (such as tongue grooving, cupping and depression) than needed for breastfeeding. Breastfeeding requires well-defined peristalsis from the front to the back of the tongue as well as tongue–palate synchronization. Some tongue-tied infants cannot even manage a bottle.

Even more simple forms of tongue tie can be overlooked. In Totally Tongue-Tied, Sheila, an experienced breastfeeding mom, describes her difficulties nursing her third baby. She had expressed concern to her pediatrician about possible tongue-tie, and he told her that " there was nothing wrong with Kyle's tongue since he could extend it out past his lips." But it turns out her baby was tongue-tied. His latch improved somewhat after the frenotomy, but he still had to learn how to latch, to drink, and to extend his tongue properly. She writes:
I was frustrated that it was taking so much work to train him to suck, but the lactation consultant reminded me, "He hasn't been able to move his tongue out of his mouth for 9 months. It's going to take more than a few days to teach him to use it properly to nurse." The next day, I noticed Kyle was actually sucking and swallowing while at the breast, so I started massaging the breast while he was nursing to encourage the milk out and his swallowing per suck ratio increased dramatically. He was still requiring about an ounce of additional expressed human milk after nursing most of the time, but this was major progress. At three months, Kyle is now nursing totally independent of any supplements, and only occasionally requires adjustment of his sucking.

I never expected my third child to be the most difficult to breastfeed. I feel very fortunate to have an extensive network of support from friends and family. I am eternally grateful for a loving and supportive husband who feels as strongly about the importance of mother's milk as I do. I am also thankful for the support and encouragement I have received from my La Leche League friends. Without them, I feel I may not have been able to provide my son with the best nutrition available to him, his mommy's milk.

Re: feeding problems small full-term baby

Posted: Fri Jan 21, 2011 10:40 am
by milesymommy
Personally, I think I'd have the 'tie' clipped. I really think you'll see improvement.

I completely understand about the time it takes to pump and feed - hence why I only BF DS2 for 3 months. It's exhausting.

I think the BF community pushes too hard. I understand that 20-30 years ago, BFing was looked down on, and the formula companies pushed very hard to sell their stuff, including deals with hospitals to get the infants on formula as soon as possible. This still happens in many countries. But here, BFing is over-encouraged, to the point it makes moms who don't BF feel looked down on or like they aren't doing 'whats best' for the baby, or uneducated or ... Random strangers judge a woman for not BFing when they don't know why the woman isn't BFing. I hate it. I really beat myself up over having to supplement with DS1. I've learned a lot since then, and become more 'open' about formula.

Formula is not evil, or unhealthy (besides the ones in China). You can't tell the difference between a formula fed baby and a breast fed baby in the US. Formula may not have the immunities that BM contains, but thats most important for the first few weeks - and you're beyond that. Yes, BM is 'best', but formula is darn close. So don't beat yourself up if you switch to formula!

I'm not saying don't keep trying... I'm saying if you decide not to contune, don't beat yourself up. Your baby will be just fine drinking formula. Almost all of us aged 25-50 were formula fed and we turned out fine. Drinking formula didn't impair my brain development or growth or health, and I know I was formula baby.

Re: feeding problems small full-term baby

Posted: Fri Jan 21, 2011 07:04 am
by jules2
thanks for all the advice.

i have seen a lactation consultant - she does have posterior tongue tie but her tongue mobility was still good overall. has anyone had sucha tnogue tie cut and seen improvement? - still wondering about that?

i now spend 4-5 hours a day pumping for her to top up after some of her breast feeds (on top of b feeding about 10-12 times daily, sterilising, cooking, housework etc etc it is a punishing schedule). good news she is now 7lb 14oz @ 5 weeks today (born 6lb 8oz but dropped to 5lb 13 oz by 2 weeks which worried me - now back up to the 10th centile she was born on after dropping to 2nd. lactation consultant basically felt she is just a very inefficient feeder.

i am concerned that i get liittle time to interact / play with her given all the pumping etc & beginning to wonder whether breast milk is really worth it - but i so wanted her to get the best start in life possible? would she pefer i give her more time and formula though? or should i just keep going a bit longer and think about giving up in another month when she really does start to want to play perhaps?

my parents can' help (dad dead, mum severely disabled) and no other familt to ask for advice so i would be grateful for anyone's views

thanks x

Re: feeding problems small full-term baby

Posted: Thu Jan 13, 2011 02:47 pm
by milesymommy
My first DS was born at 36 weeks. He did not feed well, my milk took forever coming in, he had to be hospitalized due to juandice because I didn't know he wasn't getting enough. Ultimately, I pumped (and pumped and pumped) and supplemented with formula for the first 3 weeks until I was sure how much I was producing. I started with a manual pump but ended up with an automatic one. I never did produce enough and always had to supplement. Don't beat yourself up - formula is safe and healthy, and if you are at least getting her some of the 'good stuff' she'll get the immunities and all the natural goodness. I pumped for almost a year. He's a happy healthy soon to be 4 year old.
With DS#2, my milk came in too fast for him - he would literally choke when he would try to nurse. So initially I pumped and bottle fed, but with 2 kids, finding time to pump and then bottle feed is hard. So I only did that for the first 3 months, then switched to formula.
A friend of mine's son had a tongue issue- some babies are born with too much of their tongue attached to the bottom of the mouth so they have a hard time latching on. I think its called tongue tied... have her checked out for that too because the symptoms sound like it. It was easily corrected in him and he was able to breast feed. Look at ... aby-a78730
Good luck!

Re: feeding problems small full-term baby

Posted: Sun Jan 02, 2011 11:47 pm
by tree
Jules, I hope you have found something that helps. I had major supply issues (they run in my family and HELLP doesn't help), and I only breastfed for four months. I had planned to breastfeed for at least a year. I also had a lazy/slow feeder. She ate plenty, but very very slowly at first. We would nurse 10 min/side, feed the few mL I could pump, then have a bottle of formula, then pump, then do it over again. I had a hospital pump and a high-end Medela home pump, and both worked about the same. I can't imagine doing that much pumping with a manual pump. I had repetitive stress pain just from holding the bottles! You must be in major pain. A pump might help you a lot.
I think I could have breastfed successfully if I had done a few things earlier than I did. Can you see you midwives or a lactation consultant in person really soon? First, try to get them to weigh the baby before and after a feeding to determine if you have a supply problem or a pump problem. If you have a supply problem, you might want to ask if there is a chance of retained placenta. I had it, and I was too stubborn to ask my doctor about bleeding until my six week check up. Definitely ask your docs about it if you have any symptoms and a supply problem. I thought it couldn't happen after a c-section, wrong... Then, I had thrush, which I blamed on a bad latch for a few weeks. Treating that helped a lot. Check the baby's mouth for thrush symptoms if you are worried about it. They will turn away from feedings because thrush is painful for everyone involved. My doctor also put me on medication (they use Reglan in the US, other drugs are available elsewhere) to increase my supply. I think that would have helped if I hadn't waited so long to start it and had it kick in while the thrush was peaking. Bad combo... I started on the meds with the encouragement of our local LLL leader. She was amazing, and their focus on mother to mother support can be incredibly valuable if you find a good group. I don't think it has to be someone from LLL, but having someone knowledgeable to provide support can be really valuable. You could get that from a lactation consultant, but I wasn't able to. I needed encouragement to go to my doctor and ask for help. My doctor was pretty supportive, but she was a little too ready to recommend that I give it up.
I know this is really, really hard. Whatever you do will be right for you and your baby, but that doesn't always make it easier to accept. I have heard of women successfully breastfeeding after having supply problems, and I really hope you are one of them. It is possible.

Re: feeding problems small full-term baby

Posted: Sun Jan 02, 2011 10:55 pm
by tracym
Slow letdown on a pump doesn't necessarily mean slow letdown on the breast. She could be burning more calories than she is eating if it's taking that long. When ds was small (born 5lb 14oz at 37 weeks and was a month old before he hit 6lbs...even now he's only 55lbs and he turns 10 in a month) I was told to limit feeds to no more than 10 mins each side then top him off with a bottle of ebm. I did this on demand but no less than every 3 hours during the day and 4 hours at night, pumping after each feed. It took 2-3 weeks to get him on a consistent gain and by then my supply was well established and I was able to feed completely from the breast on demand.

Good luck :)

Re: feeding problems small full-term baby

Posted: Sun Jan 02, 2011 04:44 pm
by glimmer
Oh, I am glad that normal life will return again.
I am sorry if I come across as a little pushy. It's just that I have seen both, the UK and the US system
(I am German by the way...) and they are soooo different. There is so much more help in the US (at a cost certainly...).
I wish you the very best. It sounds like you are doing just the right thing for little Rachel.

Re: feeding problems small full-term baby

Posted: Sat Jan 01, 2011 05:05 pm
by trish
I don't know how to make let down start faster but you could pump first and then when you feel let down start let her latch on. Then she won't have to do the work of getting let down to start & won't tire as easily. Hang in there!!

Re: feeding problems small full-term baby

Posted: Sat Jan 01, 2011 02:26 pm
by jules2

Thanks again everyone.

I've realised from pumping more that it can take ages (20-30 minutes of vigorous pumping) for me to get a let down, and wonder if its taking me that long and that much effort if it might be the same for DD and that is why she is taking up to 2 hours to feed and not gaining weight? Sometimes she does seem to get impatient and roll off.

Does this seem plausible and does anyone have any suggestions as to how to get the let down to happen faster?

Thanks again