Hello Everyone!

I received a call from a mom today that has left me stumped.  She is 8 days
pp with a term male, first child.  12+ hr. labor, epidural, forceps
delivery, did not bf well in the first 12 hrs of life, but has done well per
mom since then.  Was seen by the hospital LC and according to her all is
well except for what I will explain.  Her milk "came in"  (really don't like
that term - any other ideas?) on day 3 with no difficulties noticed then.
Presently he is nursing every 2-3 hrs round the clock, wetting 8+/stooling
most every feed.  On day 6 mom noticed no change in feeding pattern or his
health, but he began to get extremely agitated when put to breast no matter
when feed occured in relationship to last one or whether he woke on his own
to eat or she woke him.  He roots "like crazy" per mom and fusses for about
10 minutes before calming and finally latching and getting down to a normal
feed.  If he nurses on the other breast mid feed, he latches fine and
continues with no problems.  This is just in the beginning of feeds.

According to the hospital LC her nipples are fine, MER is fine, supply is
terrific and when he is latched all is well til the end.  The hospital LC
recommended yesterday that she express about 1oz. prior to latch, but that
has made no difference.  The history is benign except for the labor & birth
- epi, forceps.  Mom is very committed to bfing - she is acting
appropriately, not frantic or anything like that.  This is very important to
me, as she is one of *my* home health nurses - and a super one at that!

I wonder if the forceps delivery is related to this?  Could it relate to his
sucking action and possible pain?  The fact that it is a week later leaves
me stumped.  I suggested a calm, gentle environment, good support with
positioning, trying different positions (she already tried - no luck), and
head elevation with feeds.  She had been using mostly sidelying.  I also
recommended a calming bath pre-feed - nurse in the bath too.  Finally I
suggested she try waking him closer to every 2 rather than every 3 hrs.  Any
other ideas?

Mom cannot think of any possible cause, and she is very knowledgable and
thorough, plus very caring, so I trust her judgment.  Thanks so much!!

Debbie Shinskie RN CES IBCLC
Private practice/home health/education