Jen I'm so sorry you are having such a difficult time,.....more
I'm glad you are working with an LC. I find that frequently preemies have a tough time trasitioning from the firmer stimulation of bottles, finger feeding, and/or pacifiers to the softer stimulation of the breast. This can be especially pronounced if mom has flat or retracting nipples that seem to "shrink" away from the baby. The reason for this tough transition is b/c the baby needs to feel the sensation of the nipple on the roof of the mouth back at the juncture of the hard and soft palate to stimulate a good suck and to maintain a good suck. That spot I'm talking about is very far back in the mouth, if you suck on your thumb and allow the tip of the thumb to go as far back as it can go without gagging yourself you have just found the spot I'm talking about.
The first thing I try in this situation is to have mom compress the areola close to the nipple, really almost at the spot where the baby's lips need to go, they will be touching the lip if the baby latches. I have mom hold this compression until we are sure the baby is into a good strong suck pattern for a little bit, then the mom gradually releases the compression. As the baby matures she can hold suction on the nipple and keep it against that spot on the roof of the mouth. Of course good position and latch technique are vital too and making sure the baby latches with a really wide open mouth (like a yawn) to ensure a big mouthful of breast tissue.
Another thing I do in this situation, especially if mom has a good supply, is use a nipple shield. A nipple shield is a silicone nipple that is worn over the mom's nipple during a feeding. In a way it is "tricking" the baby by providing the familiar firm feel of the bottle, pacifier or finger at the breast and seems sometimes to make the baby "automatically" suck and maintain a suck. There was a study recently published in the Journal of Human Lactation done by Paula Meier regarding the use of nipple shields with preemies and she found in her group that the babies actually got more milk with the shield. Her theory is that the stimulation helps the baby to maintain a suck and results in good milk transfer. This is something that generally is only used temporarily until the baby matures and is able to maintain good suction without it. Your LC should be able to assess if this option will work for you.
Here is information on weaning from a shield.
http://boards2.parentsplace.com/messages/get/ppbreastfeeding188/55.html
I ususally recommend starting the weaning process from the shield as soon as the baby gets pretty consistant at taking the breast with the shield and has developed trust that bf is going to work to provide food for the baby and is comfy for the baby.
Hang in there if you can, many moms with preemies have successful bf experiences after long periods with supplementing and pumping. We are here to support you as much as needed.
Warmly,
Kathy
