Breast of both worlds?
January 27, 2012 10:05 AM   Subscribe

Breastfeeding woes: is there any way to battle nipple confusion without cutting out artificial nipples completely?

When baby litnerd was born about 5 1/2 weeks ago, his latch was horrendous for various reasons that no amount of lactation consultations would resolve. I continued to feed him from the breast for a few days after we came home, but soon turned to exclusively pumping instead. It's been working fine for us up until now; my supply has been able to come up with his demand, and he's gaining weight like a champ. But at his most recent checkup, his pediatrician strongly urged trying the breast again. In the few days since then, I've managed to get him latched on and feeding a few times, and whether his latch has really improved or the pump has simply toughened up my nipples, we have another problem that remains--getting him to get on the breast and stay on is a challenge.

I've tried starting when he's just starting to show signs of hunger, but it doesn't make a difference--as soon as I get him into position (cross cradle hold), he starts screaming. As soon as I try to get him to take the nipple, he goes into hysterics. He might latch on for a while, then pull off. It really is very stressful and frustrating for both of us, but I do want to make it work since feeding directly is a heck of a lot easier than pumping and everything that comes along with it. I suppose it's a nipple confusion problem, but I'm resistant to the idea of cutting out bottles entirely, since I'd like to feed him calmly and quietly at the very least at nighttime, when my husband is trying to get some sleep before going to work the next day. And I really hate the idea of trying to syringe or cup feed him at this age, especially since he's eating about 4oz at a time.

How do I handle this? Do I give up on him happily taking the breast? Or is there a middle ground to be found here between the breast and the bottle?
posted by litnerd to Health & Fitness (18 answers total) 3 users marked this as a favorite
Have you checked out Kellymom at all? It's a great resource for all things breastfeeding related. There's this page on getting baby back to the breast. In particular, check out the "instant reward techniques" they suggest. With a bottle, baby gets milk instantaneously, but with nursing they have to wait for letdown. This may be one of the reasons your little one is preferring bottles right now. The techniques they suggest can help with that problem.
posted by sanitycheck at 10:28 AM on January 27, 2012 [5 favorites]

Quick clarifying question: did you see a IBCLC lactation consultant? I had terrible experiences with THREE completely not-helpful lactation consultants before I found an excellent, board certified lactation consultant who completely turned our borderline-unsuccessful breastfeeding relationship around. NOT ALL LACTATION CONSULTANTS ARE CREATED EQUAL. I actually found my lactation consultant by asking for recommendations here on AskMe, so I'm not sure what the best web resource for finding a good one would be. This search page might help, it looks like there are a few IBCLCs in your area -- hopefully these aren't the ones you've already consulted.
posted by rabbitrabbit at 10:28 AM on January 27, 2012 [2 favorites]


This is what they do!

This is one of the issues they work on specifically!

They can give you tips!

In the meantime, one suggestion I have would be to use some pumped breastmilk in some type of supplemental nursing system. I'm betting one of the reasons he doesn't stay on is because with the bottle, the milk has a steady flow, whereas with the breast, it's more stop and go, stop and go. So if you use an SNS and latch him with that on, he'll start to get milk before you let down and will begin associating the boob with milk.

One other suggestion is, when he is not hungry, like right after he's eaten, try putting him on for comfort nursing. Do as much skin to skin as you can and let him nuzzle and find his way some on his own. And as long as you are bottle feeding him, do that skin to skin and as close to your breast as possible.

For what it's worth, I belong to one messageboard where someone is going through much of this, too, and a lot of people have chimed in to say that many of them had similar issues and their babies finally figured out latching at 9, 10, even 12 and 15 weeks. It's far from too late.

But definitely pick up your phone and find an IBCLC to help you.
posted by zizzle at 10:39 AM on January 27, 2012 [1 favorite]

I have almost the opposite problem (see my posting history) - so I can't speak from experience with your specific scenario. I do know exactly how frustrating feeding issues and newborns can be, and I am in awe of your determination to keep the pumping/bottle feeding going. You are awesome!

I second the suggestion to shop around for a lactation consultant. If there are local moms groups/email lists in your area they might be a good source. I had a lot of mixed results with people I talked to as I got breastfeeding established. Do not be afraid to keep looking.

A friend had trouble introducing the bottle at all (to get ready for daycare when nursing was not possible), and wound up being able to do it when the baby was tired and ready to sleep. If it's the letdown issue could you pump to get your milk going and then pop him on?
posted by handful of rain at 10:45 AM on January 27, 2012 [1 favorite]

Yeah, I did about 6 weeks of SNS and nipple shields before baby Cocoa #1 latched happily directly to the breast while we were sitting on a bench in Central Park. Go figure. A few things to try:
- Pump past your let-down and then get baby onto your breast. He won't have to work as hard initially and then you can phase out that interim step.
- Nurse when baby is really sleepy or relaxed. I nursed some in the tub, and I think the novelty and warm water helped.
- Start with a bottle for a few minutes each feeding to take the edge off, and then transition to breast.
- Alternatively, my IBLBC recommended 10 minutes first of direct latch each feeding no matter what baby's reaction*.
- Nipple shield: sounds like the best of both worlds for what Baby litnerd is doing now, but be aware you then need to transition off of that eventually.
- I guess an SNS is worth a try. I found it added yet another step to pumping and feeding during the already-massively-sleep-deprived early days. I don't look back on those first six weeks fondly.

* I found the crying unbearable with #1. I had other nursing issues with #2 (tongue-tied, which we had snipped) and I found I was definitely dispassionate about letting him cry and nurse on the breast after the procedure. My attitude was a loving "It's happening this way or not at all, Bud."

posted by cocoagirl at 10:55 AM on January 27, 2012 [2 favorites]

My wife the volunteer breastfeeding counselor concurs with the idea that there may a problem with the delay factor. She says you can manually express the milk before latching the baby on so that the milk is already there. Perhaps the Kellymom's page sanitycheck refers to explains this. She also mentioned you might want to try a nipple shield, which can protect you and make it easier for the baby to latch on. Finally, she says you can also try doing a partial feeding with the bottle then latching him own.

On a different note, she wants to mention that it's not really a medical issue, and you should ask yourself why the pediatrician is strongly urging you to do this. The most important thing is to feed the baby in the way that's best for both you and the baby.
posted by mollweide at 10:56 AM on January 27, 2012

I also want to recommend kellymom and suggest that in addition to pumping/hand expressing to trigger let down before latching him on you also try hand compressions (squeeze the breast moving towards the nipple) while he is nursing. This will increase the flow he is getting to closer mimic the bottle experience. I also suggest lots of skin to skin time. Offering the breast when he's not hungry as a comfort thing. Also try taking a warm bath together. The water and the nakedness really triggers the desire to latch.

If you want to message me I am happy to encourage or coach anytime. I am a volunteer breastfeeding buddy for my regional health unit and I help new moms establish happy breastfeeding relationships.
posted by saradarlin at 11:28 AM on January 27, 2012

Lots of fantastic advice here already, almost everything I was going to say has already been said (pump or express first to get letdown going, try a small bottle to take the edge off, etc), but also, make sure the nipples on your baby bottles are slow. If you use medium or fast nipples, then baby Litnerd will be annoyed that your breast is slower than the bottle, and complain. Also, bottles don't require any work, whereas breastfeeding requires him to actually suck to get milk, so he may just be outraged at this :)

Seconding an IBCLC, and don't be afraid to look for someone who is a good personality fit for you. I went through the same struggle with my first, and it really is a struggle. If you can stick with it, then you can do this! I managed to do the whole thing while also continuing to bottle feed and pump as well, ready for going back to work. You don't have to quit the bottle feeding, in fact trying to go 100% on the breastfeeding would probably be a terrible idea, you need to make sure he gets fed, and you don't go insane.

I agree with your pediatrician that its good to make this transition purely for the convenience of not being tied to the pump. Pumped milk is effectively just as good as directly fed, but the convenience and sanity of not HAVING to pump is priceless.
posted by Joh at 11:34 AM on January 27, 2012 [1 favorite]

Just checking -- how long is the 'while' that he latches on? 10 seconds? 2 minutes?

He sounds young for this, but I recall my little ones being able to empty a breast and ready to switch to the next after only 4-5 minutes . . .

(Don't actually think this is your issue, but wanted to throw it out there just in case . . .)
posted by MeiraV at 12:00 PM on January 27, 2012

Thank you everyone for your answers and suggestions so far! I'm hesitant to reach out to another LC since it's another expense, but I might look into it and see if there are any economical options. In terms of how long he latches, it's sometimes for as short as just a few sucks, but sometimes he'll stay on for a bit, longer than a couple minutes, and start complaining again. He'll pull off my breast and scream, and I'll have milk going everywhere--so I can't imagine that the flow is an issue. I do try to do breast compressions and help things along with his initial latch, but maybe I need to manual-pump for a few minutes before attempting a latch, period.

I do have an SNS kit from the hospital--do you ladies have any tricks to working it alone? Quite a few of little one's feedings happen when my husband is either at work or asleep, so I don't have anyone to help me hold the bottle up or feed the tube into baby's mouth.
posted by litnerd at 12:09 PM on January 27, 2012

He'll pull off my breast and scream, and I'll have milk going everywhere

Depending exactly what you mean by this, it might be that your letdown is extremely forceful, in which case it might be too much for him to cope with. In this case, pumping or expressing first will help because it gets past the initial fire-hose bit, and then when you latch him on the stream has calmed down to a more manageable rate. But I am just reading into one sentence you wrote :)
posted by Joh at 12:15 PM on January 27, 2012 [4 favorites]

any tricks to working it alone?

I used to go topless, wear a baseball cap, clip the SNS "bottle" to that, and use medical tape to hold the tubing in place. There is a picture of me in this get-up that will never see the light of day.
posted by cocoagirl at 12:30 PM on January 27, 2012

I wanted to echo nipple shield. Without one I would not be nursing the 8 month old little scientist as I type, as we used one for about 3 months when intially faced with similar problems. Something my LC suggested was pumping with the shield on, to fill it up with milk, so there was instant gratification. I also went to a weekly nursing support group, which I strongly advise if there is one near you. Not only did it give me a destination out of the house, but it gave me access to nursing experts familiar with our problem, so every week we could refine the solution of the previous week. Good luck, and you are doing a fabulous job!
posted by girl scientist at 12:52 PM on January 27, 2012

A nipple shield is a really truly awesome invention. My daughter had the same problem, but the nipple shield helped her immensely.

I'd even massage milk till it filled the shield and offered it to her that way. When I figured that out, I would have to pull her off to switch sides.

I was worried about how I'd wean her from the shield, but she did it on her own after a few months.

Good luck and I hope it works for you!

P.s. to keep the nipple shield on, you can use a bit of nipple cream on the outter edges to help it stick.
posted by Sweetmag at 2:34 PM on January 27, 2012

I had problems latching with my first: I used a nipple shield for a couple of weeks and then slowly transitioned him to feeding without it. It can slow down the flow (the baby doesn't get as immediate a response from the breast) but that sounds like for you it might actually help.

In getting him to latch directly to the breast, I used different positions like nursing him in the football hold (pillows under him to prop him up) and nursing lying down. I too tried nursing in the bathtub, since it's warm and relaxing for you and often for the baby too. I also would do things like stand up while trying to latch him on and then once he was, rocking back and forth up in the air or swaying gently to keep him distracted/soothed enough to stay on.

I found pinching the areola flat between thumb and forefinger, trying to get the baby to open his mouth really wide, and pushing the nipple as far in as I could get; then holding his head pretty firmly for a few seconds while swaying and/or making a lot of shush noises helped with giving him the idea. I do this kind of bouncy up-and-down to keep the baby distracted. Also stimulating letdown first by squeezing the breast so there's already some milk at the nipple when trying to latch on.

I think to be successful you do have to be insistent and persistent. Can you try the "go to bed and hang out skin-to-skin with no bottles all day" thing, maybe on a weekend? The baby *will* learn that if they refuse the breast long enough, they get a bottle; and that can torpedo efforts to breastfeed. However, it *is* unfamiliar to them, and you have to balance it out with getting them fed of course. I feel for you! Establishing breastfeeding is not smooth sailing for me either even though I totally know what I'm doing now (I've had five times the practice). Those first few weeks are rough. Feel free to MeMail me if you want some personal breastfeeding encouragement or troubleshooting (that goes for anyone reading who needs it - my mail is open anytime).
posted by flex at 2:46 PM on January 27, 2012

Another idea - maybe he doesn't like the cradle position? My daughter doesn't; I seem to have what they call a 'forceful letdown'. You might want to check out laid-back nursing (pdf). It worked for us...
Good luck!!!
posted by The Toad at 3:08 PM on January 27, 2012

There's a nipple made by Medela for use with bottles that is supposed to simulate how babies eat at the breast. We've been using that and our baby seems to still be breast feeding fine - however we started doing this after she was used to breast feeding and had a good latch. If litnerd has to work at the bottle and not get his milk so easily, he may be more willing to eat at the breast. It may be worth a shot as I don't remember paying all that much for it (less than $20).
posted by any portmanteau in a storm at 3:17 PM on January 27, 2012

I'm an IBCLC LC (and a pediatric RN, NP grad student). I'd be happy to help you for the mefi mom rate (free) over email or phone. Memail me.

In general, some very nice advice here (mefi has really gotten sharp with the breastfeeding). You've described more of a flow preference versus nipple confusion. In addition to stimulating your let-down before latch, there are a few ways you can frustrate flow during bottle feeds to wean baby to the breast rate. Typically, a combination of starting the baby with a faster flow at the breast and a more frustrating flow at the bottle gets the majority of babies on the breast eventually. And it's fine to be laid back about the time frame--I've worked with getting babies from the bottle to the breast post 3-4-5 months just fine.

One easy to employ method to frustrate bottle flow is to hold baby at a near sitting up position and offer the bottle at a 90 degree angle to the mouth so that the milk only half fills the nipple. It's true baby will swallow lots of air, as well, but that's just fine (really) just burp well. This frustrates bottle flow pretty quickly and after a (well-burped) feed like that and then an offer of a breast that has been primed (to the point of dripping) with hand expression, baby will start to catch on that the breast is worth it because the bottle and its feel has become frustrating.
posted by rumposinc at 4:28 PM on January 27, 2012 [6 favorites]

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