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My baby only latched properly at 4 months old

I had an emergency c-section. After the birth it wasn't possible to have skin-to-skin, and my baby was too sleepy to breastfeed, so a midwife hand expressed colostrum for us to syringe feed the next day. When the breastfeeding specialist came in, she tried to get baby to latch but his mouth simply wouldn't open. I have flat nipples which probably wasn't helping. We syringe and cup fed him a mixture of expressed milk and formula for three days. I didn't want him to have a bottle as I was concerned about nipple confusion, but after the third day, when the doctor came to discharge him, we were told he had lost too much weight so could not be discharged. We then used the bottle and he took a lot more that way. All the while we kept trying to get him to latch on, but he would just keep crying. We did get occasional latches which lasted about 1 minute each, always with someone else helping to force his mouth open. I wasn't allowed to pump until my milk came in, but I found it very difficult to hand express. At five days baby was admitted to SCBU as he had lost too much weight and had severe reflux. I was so worried my milk had disappeared, because when I was using the pump nothing was coming out. A friend with an older baby said she also had trouble with latching her baby due to her c-section and that in the early days it took her at least 10 minutes to get the milk to flow with the pump. This helped immensely as I was really worried my milk had dried up. I finally got my milk flowing and when my baby was five days old, I got about 40ml out of one side and 30ml from the other. Our baby got discharged at 7 days old and we took him home. 

I continued on and on and on with pumping, still not quite up to the amount my baby was taking but slowly increasing. I did this by pumping six times per day. I was advised to pump in the night but only did this about twice as it was so tiring to get up to pump. I always pumped for a minimum of 15 minutes, until the milk flow stopped. Sometimes at the end of the 15 minutes when I was about to stop, the milk flow would start again and I would get another 30ml or so. I would also use breast compression while pumping which worked well.   

At 2 ½  weeks we had a breakthrough. Our baby started crying for food but we had no sterilised bottles. While my husband went to get them sterilised, I held him and said to him there isn't anything available apart from my breast, so if you're really hungry just have the milk from there. And then he latched on (whilst crying)! (He latched on as in, I stuffed my breast in his open crying mouth and he started feeding.) I couldn't believe it. Then at the next (night) feed, I fed him again. It was on and off after this, each and every time I offered him on the breast his mouth would never open, he would refuse with lots of hysterical crying so I would have to offer the bottle which he would never refuse. The only way I was breastfeeding him was when he was crying for food and then stuffing my breast in his mouth. I was still pumping alongside this. It appeared that he wasn't eating enough as he kept falling asleep at the breast and when we gave him the bottle he finished it totally. 

Then at about five weeks, I decided to totally breastfeed him and see how it went. His nappies were really light, he kept falling asleep at the breast and then waking when I moved him and wanting more milk. I knew by my nipple shape (lipstick shaped) that he wasn't latching on properly but he still refused to properly open his mouth, I always had to wait for him to cry. I felt I had no choice but to return to exclusively expressing and then feeding him from the bottle as the thought of him being readmitted to SCBU really scared me. That was a huge mistake, as then at six weeks he started refusing the breast again. I tried and tried and tried so many times. At 12 weeks there was one solitary occasion where he latched on but that was never repeated. I resigned myself to exclusively expressing full-time and had such a large supply I had a freezer full of milk (we stopped needing to use formula at five weeks and by six weeks I started to make more than he needed so could freeze some). My pumping schedule from about four weeks was 8 am, 12 pm, 4 pm, and 10 pm. In hindsight, I shouldn't have been so worried about my milk supply decreasing if I tried to totally breastfeed him, but instead concentrate on getting him to feed, and if he didn't feed, then feed him expressed milk or formula and then express for the next feed. 

At 19 weeks, we had another breakthrough. I hadn't done my usual 10 pm express due to having gone out for a meal. Baby woke at 12.30 am (very unusual time for him to wake for food). Usually my 10 pm express would provide his milk for the night, as it was convenient to leave it in the room rather than in the fridge where it would need heating. Because we didn't have any warm milk, I just held him while he was crying while hubby went to heat his milk. He was getting really upset waiting to feed so I held him to the breast, hoping this would comfort him. To my absolute shock and surprise, this time, he didn't fuss, he didn't cry, he just turned his head sideways to look at me and flash this beautiful smile and then went straight to it!!!! I was so determined not to lose him again. Every time he woke he would accept the breast, mouth wasn't wide but I was able to tuck my breast in. And this time the shape was good and I didn’t need him to cry for him to latch on. I tried feeding him whilst wide awake but he wouldn't accept that.  

Then five days after the initial latch I thought let's try again with the wide awake feed, and he accepted it! The next day I took him to be weighed. I managed an entire week exclusively breastfeeding, then weighed him again. He had lost a small amount of weight and the health visitor said to offer him an extra bottle in the evening and did I have a low milk supply? I said no, I've got stacks in the freezer but we'll try offering him an extra bottle. Joanne at the Baby Cafe said that could be the difference between a wet or dry nappy and to keep at breastfeeding as his latch was now perfect. For the next week, I decided to feed him from the breast through the night and morning, and expressed milk from the bottle in the afternoon through to evening. I pumped and pumped like mad at the same time he fed in the late afternoon/evenings. I found out that I initially was able to express one less feed than he was taking. By the end of the week I had only 20ml less. We got him weighed again and this time he had put on loads of weight. I stopped pumping at 21 weeks and we could physically see that he had put weight on. He was happy to switch from breast to breast; his mouth would open really wide in readiness for the breast. I still smile at how wide his mouth opens; it's such a contrast to how he used to be. 

I was going to stop pumping at six months and use up the frozen stock till about seven months but now I can keep giving him my milk whenever he wants it. He is now almost nine months and has become a totally breastfed baby in every way, including preferring the breast to the bottle. 

What motivated me to pump initially was the hope he would breastfeed and the need to keep my milk going. What motivated me to pump when he wouldn't feed was that I had all this milk and just because he wouldn't breastfeed why should he miss out on it. I had a lot of encouragement from friends and family with pumping and also to not stop putting him to the breast. I always hoped he would lactate but by the time we got to 10 weeks I had given up, but still didn't stop trying. One friend in particular always encouraged me and said that babies get smarter as they get older, they work things out. I'm sure she didn't expect him to latch by 4 ½ months, but her comments and others like these really helped. 

I would say to anyone who is having trouble with your baby breastfeeding, the most important thing is to first make sure your baby is fed, and then second to that, try to keep your milk supply up through pumping, and keep on trying your baby at the breast. I would pump so often in the day there wasn't a need to pump through the night, although I was often advised that it was important to in the early weeks. If you can give him one day of expressed milk, one week, one month, that is all better than him not having any. Just make sure you are totally relaxed when you go to express. When I was emotional or crying (lots in the early days) I would never get any milk out. I took it a week at a time, and then when I got to three months I knew I could go to six. Who knows if he hadn't gone on the breast whether or not I would have kept expressing beyond six months? I found that as you got to your goal, you would make another goal and before you know it you've gone far longer than you would ever have dreamed.  

A mums view of Breastfeeding following Breast Reduction Surgery

Carla’s  Story

I had  breast reduction surgery about thirteen years before I became pregnant with my first child. I was told breastfeeding should still be possible but didn’t really give it much thought at the time and it wasn’t until I became pregnant that I realised that I dearly wanted to breastfeed

At last my daughter was born and the midwife tried to help me put her to the breast. Luckily my baby latched on and I hoped everything would be all right.

All that night my baby cried but I was told to just keep on feeding her. I could see there was yellow colostrum coming from my nipple and she even possetted up some so I was absolutely elated.

I went home, overjoyed that I was able to produce milk for my baby. I was in heaven for a day or two, I thought breastfeeding was beautiful even though my nipples were beginning to get a bit sore. My midwife helped me with latching on and checked I was producing milk by hand expressing some. On one side it was slow but the other side seemed to be okay, and I even got quite engorged at one point which was rather uncomfortable.

My baby seemed to come off the breast satisfied and was content between feeds. It did not occur to me that she might not be getting enough milk until when she was weighed at 6 days and lost 10% of her birth weight . The midwife said she was allowed to lose that much and helped me with positioning and latching the baby on. Wow! my nipples stopped hurting immediately!

I thought things would get better then but three days later she had lost another 10%. I fell to pieces at this point, and sat and cried my eyes out whilst I fed her some formula. I was told I should stop breastfeeding and was heartbroken.

A few days later a friend suggested I just keep putting my baby to the breast anyway. I was so wanting to, but was afraid of what the health professionals might say. I’m so glad I did this in between bottles as it kept things going, then I hired a hospital grade electric breast pump to carry on with. I was able to produce milk, usually about 15 mls but once I got 20mls.

Pumping, breastfeeding and bottle feeding was exhausting but my baby was gaining weight at last. After a couple of months she began to prefer the bottles and I was distraught that she no longer wanted to feed from me. This was a really emotional time but then I found a website for women in my position with lots of helpful information and support (bfar stands for Breastfeeding after Reduction).

As soon as I went onto this website I realised I needed a special feeding device called a lact-aid so I could supplement my baby with extra milk whilst she was breastfeeding. A lact-aid is a bottle or ‘reservoir’ a mother can hang around her neck with fine tubing running from it.

This can be filled with either expressed breast milk, donor milk or formula. Fine tubes lead out of it and the mother tapes the end of the tubing so that it lies alongside of her nipple. In this way the baby carries on breastfeeding but at the same time is drinking the milk out of the reservoir bottle. The baby is encouraged to stay on the breast (the bottle can be squeezed to increase the flow) and all the time they feed they are stimulating the mother’s breast to produce more milk. My baby took to this straight away, and three months later I was making more milk than previously.

I plucked up courage to go and see a Breastfeeding Counsellor, I found she knew about ‘bfar’ and supplemental nursing systems and also about galactagogues (medicines or herbal remedies that can increase milk production)

Talking openly about having had the reduction surgery was very traumatic as I didn’t really want to discuss it, but it did help me come to terms with it. She said being able to express 20mls was really good, which made me feel quite proud.

I am hoping when I have another child  that more of my milk ducts will have ‘re-canalised’ or grown back together so I will have a better supply. At least I am better prepared this time !


Further Information

Breastfeeding following breast reduction surgery depends on the way the surgery was carried out, surgery can involve severing of ducts and nerves to the nipple.

Damage to the ducts

Research has shown that women have a different amount of ducts in each breast if you have 9 ducts then losing 2 will not impinge on the supply as much as a women who has 4. Research also shows that ducts can repair themselves, that a mother with an incomplete supply with the first baby may find that she has more milk with her second.

Damage to the nerve supply to the nipple

When this occurs the nipple can lose sensation.  If the nipples are numb the mother is unable to feel the baby at the breast and the hormone response to eject the milk form the breast is not triggered. Fortunately nerves can regenerate and reconnect over time and is separate from lactation.

Helpful hints 

  • Have a full discussion with your surgeon, before surgery to allow minimum risk to future breastfeeding.
  • Discuss your operation with your surgeon ante-natally as to how the surgery was undertaken, to help you prepare for breastfeeding.
  • Feeding/ expressing getting as much milk from the breast as possible in the first 3 weeks, to maximise your milk supply
  • Seek help and support from your nearest Baby Café/Drop-in as soon as possible, preferably antenatally

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