Any BF experts able to please advise??

[Jergens]

I'm writing on behalf of my DSis who had her first baby yesterday I've breastfed my two children for 16 months and 9 months and counting but don't feel qualified to offer advice.
Background: Baby born at
T+4, uncomplicated preg and ventouse delivery for prolonged second stage, no pain relief other than local
for ventouse.
She is trying to BF but baby is only latching on for one minute at a time. She hasn't noticed wet, only dirty nappies. My DSis feels that there is a problem with supply. The staff on the ward have given her leaflets on donor milk and FF as they
are concerned that baby not
feeding. My DSis is really
wanting to EBF so looking for
advice. She has tried
expressing with both electric
pump and by hand and not
produced anything. I have told her that what she gets with expressing is not an indicator of how much milk is actually there. Baby is not distressed or crying. She saw a lactation consultant today. Baby is a bit mucousy so they wonder if that could be affecting feeding.
Basically, she's wondering if she can wait til tomo when she will have a midwife visit her at home who might be able to help. Or whether she needs to supplement feeding today. I should add that she is in Canada where nurses rather than midwives are on the postnatal ward. I do not know how much training they have with breastfeeding.
Any advice would be gratefully received.
Thanks

[YoniBottsBumgina]

Sorry, will probably be a bit of a list/stream of consciousness.

• 1 minute not necessarily a problem - at this stage milk will be colostrum which is literally just drops at a time however it is vvvv nutritious and filling. Baby's stomach is also extremely tiny, think the size of a marble (not one of the big ones, the normal sized ones).
  

• Baby passing only meconium and not wee is normal at this stage - it's a good sign if the meconium is passing through, it means the colostrum is getting through.
  

• Expressing not really helpful at this stage due to tiny quantities of colostrum. Hand expressing onto a clean saucer and hoovering up with a sterilised dropper is the best way to do it. Don't expect it to look like milk - it's yellowish and sticky and will taste salty, sort of like sweat or tears.
  

• Baby not distressed or crying - are they alertish when awake? Is baby listless or just content? Lack of crying can be a good or a bad sign.
  

• She needs to watch out for signs of dehydration. Sunken fontanelles is one. Also if you put gentle pressure on the baby's fingertip/nail, it should go white but spring back to pink in under a second. If it's taking longer then that is a bad sign. (Assuming baby is white - may not apply to darker skin tones)
  

What did the LC say?

[Jergens]

Thanks for the reply Yoni. I will pass on to my DSis
I should have said she was 7 lbs 7 oz at birth. At what point do you think she'd have to consider supplementing? Baby is alert, not listless or dozy.

[Jergens]

Sorry, meant to add that the LC wanted to know what their 'backup plan' was. She helped get the baby to latch on a few times for short spells but I don't think she helped much with trouble shooting. I've only had text conversations with my sis since seeing LC so she may have said more? Hoping to get sis on the phone soon,

[YoniBottsBumgina]

If the baby starts to seem listless and she can't express even enough for a dropper or cup (cups for express feeding are tiny, can use a bottle lid if she has any baby bottles - you sort of hold it so that the baby can "lap" the milk) then dropper or cup feeding formula would probably be advised, BUT I am not an expert, just a mum, ex peer supporter and an avid reader. I don't think weight makes a difference unless they are tiny. 7lb7 sounds like quite an ordinary weight.

LC sounds less than encouraging if she is asking about a back up plan!

What is happening when the baby latches? Is it coming off because of squirming/wriggling/that annoying arm flaily thing they do? Or does it seem like he can't stay latched on once he gets there?

Latch might be better if she can let the baby find it itself. Pick a time when baby is calm and lie back semi-reclined, place baby face down on mum's chest with head roughly level with or below boobs and let them "crawl" up and find the breast themself - it's amazing to watch (they can do this from a few minutes old) and it usually leads to a better latch too. Google "biological nurturing" if she wants videos to watch.

[Rummikub]

Nappies are so good nowadays that it's really difficult to tell if it's a wet nappy. Also it will take a little longer for milk to come in proper. I couldn't express anything, but my dd fed little and often for first weeks.

[YoniBottsBumgina]

Oh, or an egg cup or shot glass work well too clean well first obviously!

If baby cannot latch at all or latch is too shallow and he keeps slipping off, tongue tie may be an issue. It's hard to check for in newborns though unless you know what you are looking for.

[Rummikub]

Just to add, my dd couldn't latch on v well. Breast feeding specialist showed me different ways of holding to help latch. Latching was easier for my dd when I used to hold her like a 'rugby ball', so her legs behind me. Also, swaddling her kept her calm enough to latch on. Mixed feeding might be an acceptable compromise for your sister.

[tiktok]

It's late so will post tomorrow....but this is a baby born yesterday, and the panic button is being pressed already??? And there are worries about supply....at a day old?

And you say this is Canada, and not another planet?

She needs some people who understand about bf.

Try LLL?

[Jergens]

Thanks tiktok. That's exactly how I'm feeling inside! I thought they were being a bit alarmist. Their midwife is visiting them tomo and I think she's v informed, supportive and sensible.

[ButteryJam]

Has baby been checked for tongue tie?

[Jergens]

I think so Buttery. With tongue tie, is a baby not able to stick its tongue out far? Just asking as I saw her stuck it out quite a few times.

[MummyCoolski]

Jergens tongue ties can be in different places (tip of tongue or further back). The key thing is that if it is impairing movement in any way, it may cause trouble with latch, so baby sticking her tongue out doesn't necessarily mean no tt. My DS went undiagnosed for 5 weeks as he didn't have the heart-shaped tongue associated with a tied tip and I believed the midwives when they said it wasn't tied.

I agree that expressing (other than hand expressing) would be unhelpful at one day post-partum. You won't expect volumes of milk until the milk comes in at day three(ish). If she can get some colostrum onto her nipple, then baby will probably lick it off if she can stick out her tongue.

[MummyCoolski]

Have a look at the UNICEF tongue tie page, there should be resources for Canada on there, as well as general information.

www.unicef.org.uk/BabyFriendly/Parents/Problems/Tongue-Tie/

[sipper]

Hi Jergens I hope all is going well and mum and baby are OK. If still any probs with latching on I would try a cranial chiropractor as it is quite possible that ventouse can have impacted on head/neck meaning the baby can't quite get the position or the suckle. Some very gentle treatment could make the world of difference. Cup-feeding in the meantime is a good route to try (already mentioned by Yoni) and is recommended by UNICEF whilst establishing breastfeeding. Babycup is a make of mini cups that can be used for cup feeding newborns. Best wishes and I hope all's going well.

[Jergens]

Thanks Sipper and others.
All going well with the pair of them
She just kept offering the breast and encouraging feeding as much as poss. Didn't need to top up with any formula.
So glad breastfeeding is working for them.