Alice writes:

"Baby boy born at home with a mid-wife Wed. ll/26/08, weighing 6 lbs 4 
oz. Described as a sleepy baby. Had a couple of good feeds apparently 
but evidently never really learned to latch and nurse. I was not able 
to determine why not. Mother began to pump with a Pump in Style. 
Attempted to supplement at the breast with a tube, as per advice in 
Jack Newman's book, however baby did not latch long enough for them to 
get started. "


A homebirth does not assure that the baby has experiencd no trauma. 
What excatly does the baby do when offered the breast, a finger-feed, a 
bottle? Has nayone tried a nipple shield? Have you referred them for 
CST (preferably to someone who works with breastfeeding babies)?


"Mother called and requested home visit, saying that she did not have 
enough milk. In early morning she can express 1 oz but then amount 
dwindles during day. She fed what she could express by bottle. No 
formula given. What she is pumping now is not satisfying baby."

IMO, it is a metter of extrme urgency when a baby is placed at risk by 
being fed AIM, The mother needs galactogogues as well as pumping--any 
delay in a full supply is a significant risks to the baby's well-being.

"No BM since Sunday although there have been about 6 wet diapers per 
day.
Baby’s tongue does not appear to be tied. Mother’s nipples are not 
sore. Breasts appear normal. Mo
ther concerned that engorgement came and 
subsided very rapidly. "

Do you feel confident in your assessment of posterior tongue-tie? I 
have found many PPTTs that experienced LC's have missed. I used to miss 
them all fo the time too until I met Betty Coryllos. Lots of babies 
with PPTTs cause no pain to mom.

"While I was there the baby’s pediatrician arrived. Knowledgeable and 
supportive. Plan worked out is:
 1. mother rent a hospital grade pump.
    2. Mother pump and feed what she has by medicine spoon.
     3. Supplement with formula by spoon until baby is content but not 
overly full so that he will feed frequently.
     4. Mother to offer breast at end of feeding, as well as at other 
times, in hope that he will latch for comfort sucking. "

IMO, this plan takes too much of a wait and see approach. I woulf make 
a referral for CST/chiro/Pt/DO,  get mom onto galactogogues, initiate 
co-bathing using at least rescue remedy in the bath water, lots of STS, 
have a second opinion for TT and try feeding methods that might teach 
baby to latch like shield or finger-feeding, depending on his current 
behaviour. Good luck!

Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC

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