Breastfeeding is hard work, for both baby and mom, and by far not as easy as most people think. Add issues, such as nipple confusion, to the equation, and you have a recipe for frustration. In this article, I will share the nipple confusion issues we had with our baby girl and how we got her back on the breast using a nipple shield and a skin-to-skin.
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Breastfeeding is hard work
The goal with both of our babies was to breastfeed them for as long as possible exclusively. Nipple confusion wasn’t a term we were familiar with three years ago. With our first child (Isabella), we quickly introduced a bottle into her feeding routine. It was a misguided attempt to help my wife with overnight feedings. We figured the delivery system wouldn’t matter as long as it was breast milk Isabella was getting.
What is nipple confusion?
What we didn’t fully realize was that getting milk out of a breast is hard work for a baby. To succeed, it takes a good latch as well as coordinated tongue and jaw movements in a sucking motion. Sucking from a bottle, however, is an entirely different motion. Without proper skills, the baby won’t be able to express milk from a breast, but almost any type of sucking motion will express milk from a bottle through the nipple. In fact, all it takes is gravity for milk to start dripping out of a bottle.
Babies are born knowing how to suck, and they’re hard-wired to nurse from their mother’s breast. But sometimes – in an effort to adapt when they’re unable to feed successfully from the breast – they develop a preference for a bottle instead. This is known as nipple preference or nipple confusion.
According to Dr. Sears, “It is easier to prevent nipple confusion than to fix it–though it is a problem that can be solved, should it occur Breastfed babies should not be given artificial nipples during the first three to four weeks when they are learning and perfecting their breastfeeding skills. Avoiding artificial nipples means avoiding pacifiers as well as bottles. Supplements, if medically necessary, can be given in ways that don’t involve artificial nipples.”
That’s good advice, but I’m not sure how we would survive without a pacifier. Besides swaddling, rocking and white noise, sucking (a pacifier) is one of the best soothing techniques in our portfolio.
Nipple confusion with baby #1
Shortly after we introduced a bottle to Isabella, she started refusing the breast. Kathy, my wife, got frustrated because she wanted to breastfeed her exclusively. Only my wife’s willpower and help from the lactation consultants at Northside Hospital helped us through this tough challenge. Ultimately Kathy brought Isabella back to the breast by doing a lot of skin-to-skin. The goal was for our baby girl to have a pleasant experience at the breast without being forced to nurse. When she nursed, we used a so-called nipple shield* to ease the transition back to the breast. It took somewhere between 7–14 days for Isabella to fully return to the breast. From that point going forward, Kathy nursed Isabella until she turned one year and three months.
More breastfeeding issues with baby #2
Having learned from past mistakes, with our second baby (Lucas), we knew better than to introduce a bottle again too soon. Unfortunately, he was born prematurely and spent 57 days in the NICU. In there, he had to be fed by bottle because my wife could not be there for every feeding to nurse him. As a result, Lucas was introduced to a bottle even earlier than Isabella, and so nipple confusion was almost pre-programmed.
When Lucas finally came home, we had to feed him by a bottle at least four times a day. For the remaining feedings, he got the breast. That was necessary so he could gain weight faster by using less energy during feedings. Bottle feeding is, after all, easier for preemies who may lack the proper coordination to breastfeed efficiently. As he gained more weight and stamina, we decreased the number of bottles he would get. But we noticed that he wouldn’t stay on the breast for very long.
When Lucas pulled away from the breast after 8–12 minutes, we got concerned because we didn’t think he got enough milk. Our pediatrician told us that some babies (those in the 8–9 lb category) could empty a breast in only a few minutes. But Lucas was a preemie, weighing merely 2 lb at birth and 7.5 lb a month after his due date.
Watching him feed well on a bottle and pulling away from the breast after only a few minutes caused major frustration on my wife’s part. So we finally decided to rent a Medela scale from Northside Hospital. Using the scale, we would weigh Lucas before and after a feeding. To our surprise, our 7.5 lb featherweight fighter could get 65–90cc of milk out of a breast in 8–15 minutes.
Fortunately, Lucas turned out to be a very efficient feeder, both with the bottle and the breast. We did, however, notice that he has a slight preference for the bottle, something we attribute to nipple confusion. We are not entirely sure how to fix that yet. With a toddler at home, time for a lot of skin-to-skin is limited.
A scale to the rescue
In retrospect, we could have prevented a lot of frustration had we gotten a scale earlier. Renting a scale at Northside Hospital costs $35 per week. That’s money well spent considering the peace of mind you get by knowing your baby is getting enough milk.
How we got our baby back on the breast
In the fog of war, you tend to be led by emotions, and that often leads to wrong conclusions. With Lucas grunting and arching during breastfeeding sessions and pulling away after 8-12 minutes, we were sure that he didn’t get enough milk. The lesson we learned is to stay calm and trust the numbers – in our case the numbers on the scale.
If you’re concerned about nipple confusion, try to delay introducing artificial nipples until your baby is 3-4 weeks old. If it’s too late already, try skin-to-skin in a relaxed environment and call your lactation consultant. You can also try the steps recommended by Dr. Sears. In our case, the combination of nipple shield and skin-to-skin did the trick. In our case, it also helped to carry Lucas a lot using a sling* or BabyBjorn baby carrier*.
What’s your experience with breastfeeding? Let us know by leaving a comment below!