Help! Why can’t me and my baby breastfeed? When your newborn doesn’t latch!

What do you do when your newborn doesn’t latch! Breastfeeding is a skill that needs to be learnt by mothers and babies. It is the normal way of feeding a baby but that does not mean that it comes easily to all babies! It is natural to get upset, frustrated and disheartened when your baby refuses to latch or does not stay on the breast long enough to feed. Your baby is not refusing or rejecting you or your milk, in fact you are the only person your baby wants in these early weeks. The important thing is to stay calm, be patient and remember that most reluctant babies will be latched on and feeding by 4-8 weeks (Bonyata, 2018).

Why won’t my baby latch?

Possible reasons your baby is finding it hard to latch include;

  • A difficult labour or delivery, including caesarean section – baby may be sore and uncomfortable in a nursing position or when opening their mouth wide.
  • Medication and drugs within labour may affect baby’s sucking reflex, for example pethidine, synthetic oxytocin and some epidural medications are known to reduce babies sucking and rooting behaviours (Jordan et al, 2009).
  • Baby was separated from you after birth for example for observations or you needed medical attention.
  • Some deliveries do result in birth injuries – forceps or suction deliveries can cause bruising and headaches which may cause pain as baby tries to feed.
  • Excess mucus or meconium at birth and suctioning of their mouth may make your baby feel sore, congested, or full – hence less likely to feed.
  • A hurried or forced first experience at the breast before baby is ready to feed – may result in a reluctant feeder.
  • Using breastfeeding as a comfort during blood tests or heel pricks in the first few days – may mean baby has negative associations with breastfeeding.

 2 really important factors – feed your baby and establish your milk supply!

How do I establish my milk supply?

It is important that you stimulate your breasts frequently within these first few days as this will determine your future milk supply, especially if this is your first baby. This is due to the hormone prolactin and the receptors within your breast tissue. Do not worry if you do not see any colostrum at first – this will come and babies in the first few days need little amounts.

Hand expressing is the easiest, gentlest and most effective way of stimulating your breasts and providing vital colostrum for your baby. Ask for experienced support with doing this if you have not done it before. Make sure any colostrum you produce is given to your baby, even if they are not with you (unless it is medically contra-indicated – in this instance ask for help with storing it).

If baby has not fed start hand-expressing within 6 hours of your baby being born. Collect the colostrum in a syringe to begin with and a cup if you are producing a large amount. In the first 24 hours after delivery aim to hand express every 2 hours. After this hand express at least 8 times in 24 hours, and make sure some of this is overnight. After 2-3 days an electric pump may make expressing easier. Make sure you have it on a gentle setting, and consider hand expressing after the milk has stopped flowing, to encourage your body to make more milk.

It is importance to have support available to you over this time, your partner and/or supportive other can change baby, you bring food and drinks and cuddle baby as necessary so you can rest in between expressing. If it is safe to do so, sleeping and resting with your baby skin-to-skin at this time will establish feeding quicker than baby sleeping alone.

How do I then feed my baby?

If your baby has not fed by 12 hours, then offer any expressed colostrum via syringe and stay calm. Unless your baby has risk factors for low blood sugar levels, then stay patient, skin-to-skin and offer colostrum every 2-3 hours.

Ideally your baby would receive your colostrum, donor milk (if available) and then formula as a last option. If your baby receives formula milk then do not stop trying to breastfeed, consider it a step towards establishing exclusive breastfeeding over the next few weeks. The important thing is to establish and maintain your own milk supply so that your baby can feed when they are ready.

When giving small amounts of colostrum, it is advised to use a syringe due to low volumes. For larger feeds when baby is 2-3days old, a cup or at-breast supplementary system may be suitable. This is personal choice and if you are home from hospital contacting your local breastfeeding support group is a wise idea!

If neither of the above options are suitable then using a paced bottle-feeding technique with expressed breastmilk, donor milk or formula milk will ensure that your baby has the calories they need. Ask for support to show you a paced-feeding technique to ensure that your baby does not become used to receiving large volumes of milk and a faster pace than they would receive at the breast. If you are offering a whole feed via bottle then placing a sock over the bottle whilst feeding, helps you focus on your baby’s satiety (fullness) cues rather than focusing on the amount they have drunk. Remember that your baby will suck at a bottle as a natural reflex and will swallow as a protective mechanism regardless of how full they are. A baby who drinks a bottle of milk quickly does not necessarily mean they are hungry rather they have no choice. Learn your baby’s cues and needs and try not to use a dummy in these early stages.

If you are using formula, always use a first milk which is suitable to be prepared above 70 degrees C, and prepare each feed as you need them using freshly boiled water.

Ok – I am expressing regularly and my baby is fed! Now what?

The aim now is to support your baby to feed from the breast exclusively.

Your baby may have medical or anatomical reasons for not being able to latch and stay latched, therefore it is important that you get experienced breastfeeding support and manage any underlying problems. This leaflet is aimed at supporting newborn babies to latch and feed well at the breast.

The following are some suggestions you could try to encourage your baby to the breast;

  • Lots and lots of skin-to-skin – there are many simple and easy feeding tops, slings and baby-carrying.
  • Offer the baby to breast frequently, not just when he wants a feed, offer when sleepy, when just waking, in the bath, in bed for example.
  • Consider offering a small top-up before a breastfeed, then drop some milk onto your nipples and baby’s top-lip whilst baby is at the breast., to encourage them to suck.
  • Don’t try to force your baby to the breast. If you and or baby are getting cross and frustrated at the breast, stop and take time out. Offer a small feed and then start again. If this is not tolerated by baby – then offer all of feed by a different method.
  • Allow your baby to comfort nurse at the breast – even if there is minimal milk transfer – this helps build supply and allows baby to nurse without pressure to take a proper feed.
  • Make sure your baby is held comfortably for both of you in a supported position, get skilled breastfeeding support for position and attachment and rule out any underlying medical or anatomical problems which may be affecting feeding.
  • Look at where our baby is sleeping – follow safe sleep advice and consider safe co-sleeping to help with overnight feeds. Milk supply is greater at night and baby is sleepier – this may make feeding easier. Consider overnight skin-to-skin if co-sleeping is safe for your family.
  • Keep baby with you during the day – watch for early feeding cues and offer a feed as soon as baby stirs.
  • Do skin-to-skin after a bottle feed- not just when baby is ‘due’ a feed – allow yourself and baby to enjoy cuddles at the breast and enjoy feeding-free time.
  • Express – hand or pump – until let-down and then attach your baby, this will give your baby an ‘instant’ reward of milk flow.
  • Use breast-compressions when your baby slows sucking to help milk transfer and speed up the feed before he gets tired.
  • Dribble expressed breast milk or formula onto nipple as latching to encourage your baby to suck.
  • Consider careful short-term use of a nipple shield if baby has become used to bottles to help them transition to the breast, seek experienced breastfeeding help.
  • Consider an at-breast supplementary system to aid milk flow as baby is sucking at the breast.

 Congratulations you are now establishing exclusive breastfeeding.

Can you observe your let-down – is it fast or slow – consider how will this affect baby when you achieve full breastfeeding?

If you have used a nipple shield, then access some skilled support to help your baby nurse without it.

Consider how to reduce expressing so that your breasts adjust slowly to what your baby needs.

If you have used formula, then gradually reduce this amount as your baby feeds better at the breast.

Monitor your baby’s feeding by his behaviour, nappy output and weight gain.

Other sources of support…

National Breastfeeding Helpline 0300 100 0212 (9.30am – 9.30pm).

ABM helpline 0300 330 5453 (9.30am -10.30pm)

Local breastfeeding support group

Midwifery and health visiting teams

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions 

References

Bonyata. K (2018) Help me baby won’t nurse. [webpage] Accessed at: https://kellymom.com/ages/newborn/nb-challenges/back-to-breast/

Jordan. S, Emery. S, Watkins. A, Evans. J, Storey. M and Morgan. G (2009) Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. British Journal of Obstetrics and Gynaecology 116(12) pp1622-1630. Accessed at: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2009.02256.x

La Leche League GB (2019) My Baby Won’t Breastfeed [webpage] Accessed at: https://www.laleche.org.uk/my-baby-wont-breastfeed/

So how do you cope with the really bad days?

We all have them, days when we have had very little sleep, days when everything takes ages, days when everyone says ‘no’, days when we just want to be left alone! This Thursday is World Mental Health Day , and this year they are focusing on suicide prevention. This may seem dramatic for a blog focusing mainly on parenting and sleep deprivation but many of us have had days where we feel we just can’t carry on. We have all heard the suggestions for improving our mental well being, such as a healthy diet, exercise, ‘me time’ ( what’s that?), warm baths and doing something enjoyable. These are very valid solutions and do help in the longer term. However, what do you do when you are at your wits end, everyone is crying, the kids are fighting and you haven’t had a minute to either shop or prepare lunch?

First – stop and breathe! How bad is the problem?

Let’s scale the problem! Sometimes a hug from a loved one at the end of a tiring day is enough and sometimes we are at breaking point. How bad is your problem right now?

  • Reassurance and encouragement – we all feel better when sometime we care about and respect tells us we are doing a great job. It is normal to find parenting really hard work, especially with today’s pressures and lack of time. Accept your hug and take a breath – this phase will pass!
  • Ok hugs aren’t cutting it! Do you have any practical help available to you? Can you call a friend or family member for some back up? What tasks/chores etc can you ignore for today so you can all get through until bedtime? Do the bare minimum and congratulate yourself for still being upright!
  • Do you need to some simple sleep and parenting tips to help with each day? Simple tweaks such as an earlier bedtime or a cuddle nap in front of the TV can make all the difference. Try some active outside time for the children and if the weather is ok take a simple picnic for their dinner. Regular meals, exercise and naps for little ones do make a huge improvement to nighttime sleep.
  • Are you at crisis point right now ? Are you ‘touched out’ by a baby needing to be held and fed constantly or a toddler clinging to your leg, and fed up of managing everyone else’s emotions? Sometimes reassurance and hugs are just not enough!

What can I do right now to help me cope?

Stop – whatever chaos is ensuing – just stop. And take 1-2 minutes to breathe. Our minds and our stress responses  are designed to be in-tune with our breathing – this has evolutionary advantages and is described as Polyvagal theory. When you have  time – this is a great link to check out. Right now breathe in, hold and breathe out slowly – repeat 5 times if possible!

Give yourself a hug – we can release our own oxytocin by a firm self-hug, or pressing on our chest just above and between the breasts, there is also a pressure point between the thumb and forefinger in the fleshy bit just before the joint.

Now put on some uplifting music that you like, start by swaying and humming and then really dance out that stress and tension. Young children love this to and it may be enough to distract them from whinging.

Ok – now write down some of those feelings and thoughts any old way!

Consider some aromatherapy – try out scents for yourself – patchouli, frankincense, and clary sage are great for mood and hormone balancing but anything which you like will help!

Simple mindfulness techniques can also help – breathe in the smell of your little ones head as you cuddle them. Really look at your older kids and note what you adore about them. Look around your home and remember occasions when good things happened!

Now look at what you may have written down and see if you can re-frame it to be slightly more positive. You can change the internal voice that says everything is rubbish – see if you can find a little bit of calm and happiness within the mayhem.

How do I cope with my children today?

This blog post is aimed at those of us with no social support to call on – perhaps family are not available or not interested, perhaps you’re a single parent or partner works long tiring hours? If you have someone to call on – do it – now! There is no shame in asking for help! When you do – tell your cavalry what you want them to do! This is your choice – not theirs! Sometimes we want an hour away from the kids and sometimes we don’t – let them know!

For those with no-one available right now – first make sure the kids are safe. Now make sure everyone is fed – you first – hot drink and snack first and then everyone else – it doesn’t have to be healthy right now !! It can be healthy later on today or tomorrow or on an easier day!

What do you need to do now to feel better?

If you need to yell – go into the next room and yell into a pillow! Will your child wonder what’s going on? Yes – but this is ok, they are safe and loved and you are not yelling at them!

If you need to have 5 minutes away – then go and lie down to breathe or cry – will your child wonder where you are for 5 minutes – probably but this will not harm them and may save you!

If you need to just hug a fractious baby rather than feed for the hundredth time that day – then do so – again this will not harm them – its ok!

If you feel you have not slept for days then its ok to ask someone else to have the kids for 5 hours. Did you know that a stretch of 5 hours unbroken sleep will work miracles – this does not have to be at night. If you are breastfeeding, most babies can cope with a big cuddle from dad or gran and an occasional one-off will not affect your milk supply or relationship with your baby.

We all know that responsive parenting is best, that being emotionally available for your children helps them grow and thrive, that modelling your emotions teaches them how to regulate theirs.

But we were not designed to do this by ourselves! Your children are loved and cared for ! You may try these suggestions above just once or you made need to use them more.

I feel guilty!

I think parental guilt is delivered alongside the placenta (please note there is no evidence for this!) We all want to do our very best for our children! Guess what? You are the best for your children! You are the one there for them, comforting them and loving them – no-one else can do that better than you!

Do you remember everything little thing about your early years? Your children will not look back and remember the times you needed to just ‘pop into my room’ to cry or ‘just going to the toilet’ to hide and yell into the hand towel! They will remember running to you for comfort, having a dance and laugh, sharing a treat! They don’t need perfection – they just need you – warts and all!

When this crisis has passed look at ways that you could make life easier! Look at just doing one niggling chore first thing in the morning then its done. Look at not multitasking – take enjoyment from the mundane and focus on one thing at a time. Ask for help or hire it in if you can. Aim to get outside each day for some fresh air. Look at swapping a couple of ‘reach for and grab’  foods for something more healthy.

Look at parenting or feeding support if needed! A couple of bad days do not mean you’re a bad parent! But sometimes a lack of sleep can exacerbate our stress and tension the following day which inevitably the kids pick up on. Try an earlier bedtime and a calming wind down period for everybody before bed.

Longer term support can be found through your GP, health visitor or charities such as Mind or Pandas

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions