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/