Going back to breastfeeding... Help please

[msq]

How can I go about returning to breastfeeding? My baby has been having mostly formula from a bottle for the last 4 days. She is 9 days old today. I haven't nursed at all in 3 days and my boobs are not as full of milk. I suspect I will have to pump to bring my supply back up and I will have to supplement with formula but how do I do this? How often to pump and when? Offer bottle or breast first? I feel like I'd have to feed her at least an ounce or so before offering the breast otherwise she will be too hungry and frantic. Advice from ladies with experience with this would be great I also have nipple damage on one side. Should I use a shield on that side?

 

[Kiwiberry]

With my daughter I spent 8+ hours a day in the NICU for 3 months before I was able to take her home. Even though we did breastfeed, she still preferred bottles at first when we brought her home. So what I did was, I would use a nipple shield first thing. They are relatively cheap to get. This will help her with the transition process. I would try and feed her every 2-3 hours depending on how sleep she is at the time. You can pump in-between her nursing sessions to get your milk supply up. You can do power pump sessions where you pump on and off 5-10 minutes at a time for an hour. I can't quite remember the exact minutes I did it at because it was awhile ago for me lol. Now when it came to nursing, I would offer her the breast first and if she did not want to after many attempts with the shield and without I would feed her a bottle. I did this for 2-3 weeks and she was more and more comfortable with breastfeeding. After that she no longer wanted bottles and actually preferred to EBF. Hope my experiences help at least a little.

 

[noon_child]

Shields aren't designed to protect your nipple from pain or damage (infact a badly fitting one can cause damage, and if your baby struggles to get a wide open mouth they can make it harder to get a deep latch) BUT if you find a good fit and it does help with pain then obviously you can choose to use it this way.

Have you got any access to a board certified lactation consultant? In the UK, LLL, ABM, NCT etc all offer free advice, some free home visits, and are really the best people to talk to about how to get back to breastfeeding.

If baby is frantic with hunger at breast, then calming her with a small amount of formula or pumped milk may be a good start (try half an ounce maybe?). However you can also try introducing baby to your breast before she gets really really hungry. She may not take loads at first but you are creating the connection in her head that this is where milk comes from while she is nice and calm.

Re the damage, if it is still there at 3 days and not healing you should get a swab for infection. If it is healing but you are afraid of opening it up again, then you need to find the root cause of the damage. Is she uncomfortable lying on one side (common in forceps babies - can be helped by osteopathy etc.), can you try different positions to mimic feeding from the other breasts, or just to give damaged parts of your nipple a rest (I fed in all sorts of angles just to move the pain around to a new part of my breast!). I think I have recommended laid back breastfeeding/bio nurturing before but it really can help get baby back to their natural breastfeeding instincts and latch can be deeper and less painful because baby is always tummy to tummy with their chin meeting the breast first.

Re pumping. If you feed any formula, you should try to pump an equivalent bit of breastmilk (it is hard to say how much because they aren't equivalent substances - a breastfed baby eats less breastmilk than a formula fed baby eats formula) to tell your body how much baby needs. Feeding/pumping regularly at night is important for keeping your supply up too, if you think you can face it for a short period. When I was supplementing and pumping the aim was to pump of feed baby directly from breast every 2hrs or less if she asked but that was cos my Los weight was low. An LC really is the best person to talk to if you can.

 

[Kiwiberry]

I used a nipple shield for almost 3 months and NEVER had any damage to my nipples. In fact, a nipple shield makes it EASIER for a baby to latch. I am sorry but I was really offended by your post. I feel like you are undermining what I said as if I did something wrong and I KNOW I did everything right.

 

[noon_child]

I used a nipple shield for almost 3 months and NEVER had any damage to my nipples. In fact, a nipple shield makes it EASIER for a baby to latch. I am sorry but I was really offended by your post. I feel like you are undermining what I said as if I did something wrong and I KNOW I did everything right.

So sorry if you are offended by my reply, but I hadn't actually seen your post, was just replying to OPs question about whether she should use a shield.

I tried to make its clear in my post that she could as a parent choose to use a nipple shield if it helped her, but I feel strongly that she needed to be aware that they can cause issues because they are not a product designed for nipple damage. Sorry if you felt this was me saying no-one should use nipple sheilds - I dont think that. However a lot of people feel intense panic and feelings of failure when nipple shields don't fix their issues, as if it is proof that they can't breastfeed, whereas I feel it is important to be aware that if they have the wrong size shield or baby can't take enough breast tissue due to tongue tie etc. then pain and damage can persist even with shields.

It isn't for anyone else to say whether you did the right thing for your child - if you were happy with your choices then you did the right thing. Now that I've read your post I can see that nipple shields were part of a transition from bottle preference back to boob, which is a great result! I don't know if OPs baby has bottle preference but now she has two perspectives - one from someone who found shields to be a lifesaver, one whose own baby couldn't latch on to shields.

 

[ElmaWG]

I can't comment on the nipple shield issue, but I did have severely cracked nipples with my first baby and low supply that I worked hard to increase (ended up with a huge oversupply!). Regarding your one injured nipple, I would suggest you might try pumping more on that side and nursing more from your non painful nipple. That's assuming the pump doesn't hurt as much as baby's suckling at this point. For me pumping hurt much less. Ideally you'd be trying to get roughly the same amount of milk on both sides (though you have to guess a bit how much baby is drinking). This might allow that nipple the break it needs to get started healing while you figure out or fix whatever issue is causing the problem in the first place.