PTP = permission to post
I was called  to see a mother and her 5 day old baby today. Mom was
concerned that she was pumping and not getting anything.  Mom and baby
discharged 2 days ago after 3 days in hospital, c-sec delivery, first baby.
 Baby never latched until today!
Mom has a small Evenflo SimplyGo electric pump and was getting a few ounces
a day until today. Her breasts are very engorged.   Feeding 2 ounces of ebm
or abm every 3 hours.
 Baby weighed 8lbs 4 oz at birth and dropped to 7lbs 14 oz.at 2 days and
was 8lbs 1 oz at discharge.
 Mom also told me over the phone that she has flat nipples.  So I brought a
 Medela medium Contact nipple sheild and went to see her and the babe.
Mom' s nipples did look a little flat to me ( I am a CLS in hopes of
sitting for IBCLC exam in 2013 or 2014, hard to get hours).  Baby's tongue
and palate look good although I don't know if I could detect a posterior
tongue tie.
  I showed mom how to apply the nipple shield and do "breast taco".    Baby
was very fussy at her breast - rooting, gaping but no latch. Tried
different positions, including laid back and skin to skin. At one point
there were a few drops of milk inside shield and the nipple was drawn
slightly into the shield.  Finally gave baby 1/2 oz of abm by bottle to
calm her before trying again.
Tried putting baby to the breast without nipple shield and she latched!
 She stayed on for about 5 min. with several swallows per min.  Mom's
breast was not appreciably softer though so I am not sure if there was much
milk transferred.
Baby seemed happy!
I then wanted to evaluate her pump, flange fit, etc.  The flange seems a
little big, but I am not sure if that is just because her nipples don't
protrude much at this point ( no pun intended).  This pump has only one
size flange.  She pumped 2 oz from the side the baby had not nursed on and
1/2 oz from the side the baby nursed on.  Mom senses no MER and none was
noted by me.
I advised mom to soften breasts before feeding by using manual expressing
or pumping a small amount, and to feed baby more frequently so that
feedings are calmer.
 I also offered some suggestions to try to elicit a MER - warm compresses,
gentle massage, thoughts/images of her beautiful newborn.  She responed " I
'm not supposed to watch the pump the whole time?"
Baby seemed fussy again.  We tried to latch the baby to the breast again
without success, then tried the bottle, she was not interested either.
I am going back tomorrow and will teach reverse pressure softening and try
to convince mom to try spoon feeding.
I feel like I am all over the map with this mom, but we were both thrilled
with baby' first latch at the breast today!

Helen Hoctor, BS,RN,CLS

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome