BF the second time around - how to avoid the same early problems

[Samuel's Mom]

Hi everyone,
As I am getting close to the end of my second pregnancy, I am getting more anxious about how to avoid the BF problems I had the first time around.  So I thought I would see if anyone had any ideas to help in case the same thing happens again with my second.  So here is what happened the first time around....

Samuel was born on a tues night at 9 pm, I BF soon after and again around 11 or so.  He had a good sleep until 1 and then was up for the next few hours hungry, but always falling asleep after a few minutes.  So I would put him on, he would fall asleep after 5 min, so I would put him in his bassinette, he would wake up, etc...  The nurse suggested undressing him, doing the hand rubbing, etc to keep him awake for a feed but none of it really worked because by the time I got him dressed he was awake, crying and rooting again.  The nurse took him at 4 am so I could sleep, but I could hear a few babies crying in the nursery from my room so I didn't really sleep, but when they brought him back at 6 he was out for a bit.  THe day time was busy, but had longer feeds.  That night he did the same thing.  Woke up at 1 am (I was exhausted by this time, shared a room with a jaundiced baby under the lights) and asked the nurse what to do and her response was to just keep feeding and that it would bring my milk in sooner.  At 4 I asked them to take him, they brought him back 20 min later saying he was hungry.  So I just let him fall asleep on my chest.  The nurse came in at 5 and woke us up to say "that's not safe' and bundled him up in bassinette, and yes he woke up again.  I went home that day exhausted...

That night, my nipples were so sore and cracked (not bleeding yet) and I could barely get myself to allow him to latch on.  My hubby went out at midnight to buy formula (I already had a breast pump with bottles - Avent) and Samuel took the formula with no problems and slept for a few hours (YAY).  So for the next week, we did both bottle and bf - but I was still very sore. I couldn't get into the lactation consultant for another week.  The doctor completely freaked me out, telling me that most babies that have both breast and bottle this early end up rejecting the breast - so not to be upset if this happens.  Thankfully it didn't, but I was very stressed and felt guilty everytime he had a bottle (which my husband loved to do, so was not very supportive on the exclusive bf).

Anyways, enough rambling.  I ended up bf very successfully (lactation consultant helped with getting let down sooner and with latch) for 8 months.

So, any ideas for what to do those first few days.  I know my positioning will be better this time around, but I just want to avoid the nightime stretches.  Part of me thinks to go the bottle route again during those nightime periods (since my milk wasn't in and he was 8 pds, 4oz - maybe he was hungry) or is that just asking for trouble? 

Thanks
Nicole
PS Hi Samuel's Mum!!  If I am remembering you right your little Samuel is the same age as my Samuel. 

[lisi's mum]

sorry this is just a quick reply - I'm surprised the nurse insisted on you putting Samuel in a basinette - my hospital encouraged us to co-sleep meaning I could feed and doze at the same time which saved my life. I remember those first days where it seemed like Lisi just wanted to nurse the whole time.
Would it be an idea to arrange an appointment with a LC to come visit you asap after your lo is born? Get help from the start instead of waiting for things to go wrong.

And if you are allowed to co sleep in the hospital do it - it makes everything so much easier (and the cuddles are quite nice too)

[Erin M]

Hi Nicole--
I just had my second just over two weeks ago, and I had a few thoughts reading your post. 
The first is that I think you will be better off the second time around just because you know what to look for in terms of positioning -- that being said, make sure you brush up on your nursing positions - it's amazing how much you forget - I found myself looking up kellymom.com in the hospital for a refresher.  Also, lanolin is helping me a lot in the early days - I know some people say that if the latch is right, it's never supposed to hurt, but I have pretty sensitive skin, and I'm sure of my latch so I think it just takes some people a short time to get used to it.  There's a great FAQ on the FAQ board about sore nipples actually that's worth looking at. 

PP's idea about a lactation consultant coming to see you too is a great one.  DD2 nursed quite a bit in the early days, I think it's normal for them to want to suck quite a bit (being born must be a very traumatizing event) -- really, they don't even need to eat all that much in the early days and whatever small amounts your baby gets from you is fine.  Actually, this time around, my milk didn't come in until 4 days after DD was born -- she was down to 7 pounds 5 ounces from her birth weight of 8 pounds at the hospital -- just over a week later, she was up to 8 pounds, 12 ounces, so all that early nursing really made my milk come in strong, so it really does have a purpose despite how hard it is in the beginning. 

I had my LO nursing every two hours during the day the first few days, more towards evening as she demanded it and then let her set the pace at night.  She's now moved her feeds apart a bit -- we're closer to every 3 hours now, though sometimes every 2.5 -- she also tends to cluster feed at night, so sometimes every hour.

Anyway, I'm rambling -- the point is, I think if you get your latch correct, there's really no harm in your new baby nursing frequently in the beginning.  I usually do a diaper change halfway through a feeding too if she's fallen asleep.  Newborns are just SO sleepy, it is hard to keep them up when they want to be asleep. 

I'm sure you'll get some other great advice.  Good luck!

[Samuel's mum]

Hi there
I recognised you immediately and thought 'hello!!!!!!!!!!!!!'

Congratulations on the pregnancy!

And remember you did get there in the end.. for 8 months!

First know that jaundiced babies are sleepier babies which is why he kept falling asleep perhaps before he'd fed. I also had a sleepy baby in the first 24 hrs (due to the pain relief medication I'd had during birth - I wouldn't do the same again) and my midwife advised me to pump to make sure my milk supply got the stimulation it needed and syringe feed him the colostrum when I got the chance. So I'd offer the boob, he'd be unconvinced (we'd had the first feed OK but then he was not so good over the next 12 hours or so) and I'd drip feed the colostrum (didn't use a bottle at all). After 2-3 days he was feeding fine and we didn't look back.

They really don't take much those first few days but it's about practise and getting your supply stimulated.

My to-do list would be:

Think about your birth plan and find out about the different pain relief and the effect that might have on the baby.
Try and talk to an LC now and tell her your story and see what she says and try and get her to come to hospital. If he was feeding for a few minutes but wasn't satisifed it might have been a latch problem (which would partly explain your nipple although I do agree some discomfort is common). Colostrum feeding really doesn't take long. It does happen frequently. It sounds as though the environment really wasn't helping your calm and that possibly had a knock-on effect and might have even effected your letdown reflex.
Consider your hospital stay carefully - how long do you really have to be there (obviously you can't say now for sure), have some ear plugs so you will still be able to hear baby but nursery noises will be drowned out, bring an eye mask if by some fluke you have the lights again, Get yourself a walkman thingie with calming music - really kit yourself out as if the situation was going to repeat itself (and then it probably won't).
See if they have sleepers for baby which can be put next to your bed. In my hospital in London we were given official leaflet (made by UNICEF) about how co-sleeping benefits early breastfeeding and advice on safety. That first night I remember I took Sam's plastic cot-thing and put it in the bed with me (we were against a wall!). If I was doing it again I would probably take my own moses basket or one of these to the hospital:
http://www.thefirstyears.com/products/product.asp?pValue=3171
I'm basically saying consider safe and comfortable ways to sleep nearer to baby in the hospital. You were working against the odds last time but 'rooming in' is proven to help early breastfeeding success. If you are able to reach over and stroke/touch and make contact you may find there is less of the waking up and being unsettled. There was a recent study about how baby sleeps in hospital after delivery (Ball H, Ward-Platt M, Heslop E, Brown K. Infant sleep location on the post-natal ward 2006) and it concluded that the use of side-car cribes is an effective means of enhancing breastfeeding and allows for infant safety.
I would really try and stay away from bottles in those first few hours and days if you can. You were lucky last time with flow/nipple confusion but you'll find your milk just won't transition properly if you don't get that stimulation. Even those few minutes before he fell asleep would have been making a difference. Consider the pumping/syringe option or pumping/cup feeding if things go really pear-shaped but I'm sure they won't. I've given all these suggestions as if every baby is the same. It will be a completely different experience I'm sure but you will be prepared!

[Samuel's Mom]

Thanks for your responses!!

I hadn't thought about requesting that he stay in the bed with me - we didn't do it too much with Samuel becuase my husband is such a deep sleeper, a pillow could easily end up on the baby and so I don't sleep well.  We had a cradle right beside the bed at home.  But that is a great idea to do it in the hospital. 

I also did have an epidural, which may have made him sleepier too.  I know part of it is just the newborn pattern that I think the first time around shocked me, plus I was in a room with another mom and baby so didn't want to keep them up (although they kept me up with the lights and such).  Oh well.  We'll see.  I'm trying for a private room this time and I'm due right before Xmas so maybe they'll let me leave earlier this time.  I am going to look into the lactation consultant too.

Thanks
Nicole

[Petunia]

Umm...it's my understanding that the medicine from an epidural does not get to the baby.  I had two babies with epidurals and they were very active after birth.  They had great apgar scores, latched right on, and were happy nursers.  They both did have a sleepy period about 4 hours after birth, but I was told that's totally normal for any baby.

With my second, to help keep my nipples from becoming dime-sized bleeding scabs like they did with my first, I watched the clock.  My second, like my first, would have stayed latched on for 40 minutes out of every hour if I had let her.  But that's why my nipples ended up sore the first time.  There was nothing wrong with the latch, with either baby, but I still ended up with sore nipples.  It's just that the second time around I avoided bleeding nipples.  I did this by following that little chart that Tracy gave in her book.  Here it is again:
 
Breastfeeding: The First Four Days

When babies are six pounds or more at birth, I usually give their mums a chart like this to guide them through the first few feeds.

                                                     Left Breast   Right Breast
First day: feed all day, whenever baby wants   5 minutes   5 minutes
Second day: feed every 2 hours               10 minutes   10 minutes
Third day: feed every 2 ½ hours                15 minutes   15 minutes
Fourth day: Begin single side feeding and your E.A.S.Y routine   40 min max, every 2½ to 3 hours, switching breasts each feed   

I think I was a little more lax during the second 24 hours (the second day) and let her eat as often as every 1.5 hours if she needed it.  But by day 3, I was not having her suck any more often than every two hours.  When she wanted to suck, but had just finished eating, I just gave her a paci.

Also, if it was nightime hours (between 7pm and 7am) I let her go as long as five hours of sleeping between feeds.  It's normal for newborns to go for four or five hour stretches at some point during the day.  I, of course, wanted to encourage this at nighttime.  But just one stretch of this length.  The rest of the time I didn't let her go longer than three hours.  Not that I really ever had to wake her.  But I was mindful of the time in case she should go past.  That first four hour break, less than 24 hours after she was born, was a big help to my nipples.

My second was jaundiced too, but my ped was not worried about it.  She said it's normal for breastfed babies to be more jaundiced and for a longer period than formula fed babies.  She left it at that.

Hope some of that helped.

[Samuel's Mom]

Thanks!!  I didn't realize Tracy had that schedule in her book - I'll have to look at it again.

Questions
Did you break the latch and stop after the 5 min and then give her a paci or was she okay just to stop at that time?  Did she end up getting addicted to the paci?  I never even brought it to the hospital the first time around and was going to bring it this time, but didn't really want to use it this time around. 

[lisi's mum]

you could use a finger instead of a paci if you wanted

[Samuel's mum]

I would just caution a little bit with using a paci for such a young baby. Obviously this is just my opinion but it is also the opinion of some fairly distinguished breastfeeding experts that you are taking a bit of a risk.
Very early introduction of a paci can lead to problems with a weak suck (this is from my LLL breastfeeding answer book which I referred to on another recent thread where a mother suspects weak suck).
It is also true that occasionally it might mean a mother misses out on hunger cues - the suck reflex is bound up so much with hunger that a very young baby might be satisfied with a paci and simply miss out on calories and your milk supply may not get the stimulation it needs.
A young/sleepy baby can also expend a lot of energy sucking on a paci and lack the required 'oomph' when it comes to the feed as breastfeeding takes a lot of effort. In those first few days this important new skill of breastfeeding is being learnt by baby and it's a lot to ask that they be able to switch sucking techniques.
I know many people do introduce a paci and have no problems but some do. I have a ton of respect for Petunia's breastfeeding knowledge and I think she's such an asset to the board but on this subject we'll have to agree to differ.
I think when the first few days are passed, breastfeeding is pretty much established and you feel a paci is necessary for you to get through the day then that's a slightly different story. Although some LCs will even say think weeks not days! Dr Jack Newman goes against the LLL in that he feels pacifiers can have a useful role in babies with heavy sucking need but even from his 'pro' position he says 'make sure the baby is breastfeeding well and gaining well before you start the pacifier' (The Ultimate Book of Breastfeeding Answers. P.383). I personally don't think you can be confident of this while still in hospital!
I would just suggest you talk to a few more people and speak to an LC to get a bit more information if you are considering taking one. Organisations such as the LLL and the ABM in the UK have no reason to be anti-paci for the sake of it - they just feel it can jeopardize successful breastfeeding if they are introduced too early on.

[Petunia]

I Dr Jack Newman goes against the LLL in that he feels pacifiers can have a useful role in babies with heavy sucking need but even from his 'pro' position he says 'make sure the baby is breastfeeding well and gaining well before you start the pacifier' (The Ultimate Book of Breastfeeding Answers. P.383).

I do agree with this.  For me, it was a matter of not being the human pacifier.  Both of mine, literally, would have stayed attached ALL THE TIME if I did not have a paci.  TBH, I really didn't need it much until the second day and then just for about 48 hours.  In fact, I remember having to find the pacis when she got about two weeks old because I hadn't needed them for at least a week.  But I did use it some in the hospital, like I said, because otherwise she never would have come off.  The nurses checked her every 4 hours, and kept a record of how often she fed, and commented that she fed very often, and for long periods, even for a newborn.  She had lots and lots of heavily wet and soiled diapers.  So my case, I feel, warranted a paci.  So use your common sense and decide for yourself what is going to work in your best interest.

[Samuel's Mom]

Thanks!!

I was going to avoid the paci.  I remember the nurses mentioning to the girl in the room with me and realizing that I never even brought one to the hospital.  I will have it, but as a last resort.

Thanks again

[heartforall260]

Oh, I had such problems myself... long story... anyway, my LC ended up giving me these gel patches that fit right over your nipple and they encourage moist healing.  They saved my life.  You can order them online, but I think WalMart carries them (Gerber I think) in the baby section by breast feeding stuff.  They don't last long but I wish I would have had them for the first week while my nipples were getting used to being sucked on so hard.

Bless you!
~ Joy

[heartforall260]

  one more thing... my LC said that when you do pick out a pacci to get one that looks round like a nipple and not those slightly flattened ones (they're a little harder to find).  My DD was trying to flatten my nipple into the shape of her pacci until I switched pacci shapes (very painful!).  My Eva wanted to suckle all the time, my nips were cracked and bleeding within the first two days.  I wasn't going to use a pacci either but now I think whoever invented them was a genius!

~ Joy

[Erin (redstarfalling)]

Great advice already.  I'd second the suggestions of co-sleeping in hospital, if you can do it safely and comfortably.  Also, use as much skin to skin contact as possible in the early days to encourage a good latch.  I found changing diapers between breasts worked great to get fuller feeds with a sleepy baby.  I'd avoid bottles in hospital, if you can though - the more the baby nurses, the quicker and fuller your milk will come in - you might find it comes in faster with the second baby - mine certainly did!  Finally, I really encourage the suggestion to wait until you're sure the latch is good and the weight gain is good before introducing a paci.  I know the book suggests those nursing times of 5 min at first, etc, but each baby is different, so watch your baby.  Look for swallowing and proper sucking rather than the clock.  When the baby stops having those long sucks that indicate actual feeding and moves to the butterfly quick sucks of comfort sucking, that would be the time to break the latch and not before.

And relax and enjoy!