Hi All,

 

I saw a 42 yr old first time mom yesterday.  She had a natural, identical
twin, pregnancy and carried to 37.5 wks.  DOB – 4-17-07 Due date was
5-03-07.  Babies are (hella cute!) small but look good – weight gain is
great.  They are currently 26 days old.  

 

Mom had a C-sec.  – babies never got to breast well from day one.  Hosp LC
gave her a 16mm shield telling her she had tiny, tiny nipples.  Babies try
to latch but don’t do much other than lick and snuggle.  Moms’ milk supply
never really came in – just sort of piddled in gradually.  She started
pumping within the first 24 hours – but didn’t get anything more than drops
for the first week or so.  Last week Hosp LC started her on Domperidone.
Her milk supply is coming up slowly.  There is no visual appearance of
Insufficient Glandular Tissue – no history of hormonal issues – no
infertility – no family history of risk factors – nothing.  We don’t know
why she doesn’t have enough milk – she barely makes enough milk for one
baby…  I suggested she have blood work done (thyroid, iron levels, etc) and
to talk to OB about possible retained placenta (taking a leap there…).

 

On to the more frustrating issue for me:  Parents were NOT given important
information about specific things like appropriate and safe handling of ABM.
They were using it unsafely and did not even know they were putting babies
at serious risk (they were mixing it up before bedtime and leaving an 8 oz
bottle on the nightstand to feed the babies with at night when they woke up
so they wouldn’t have to go out to the kitchen every 2-3 hours…meaning it
sat out all night and was going back and forth between the babies with all
that wonderful saliva backwash in there…).  They were NOT encouraging the
babies to open for the bottle – which now means they get to teach the babies
how to do this.  Babies currently open like little birds…and slurp the
bottle nipple in because that is what they were told to go ahead and do –
just feed the babies.  Mom’s breasts are soft and squishy.  That 16mm nipple
shield – omg!  This mom does NOT have tiny little nipples – and the 16mm one
turned her nipple WHITE from the pressure.  I do not understand the logic of
using a 16mm shield that compresses the nipple so tightly it causes mom
discomfort and does not allow the milk to flow.  Baby A refused to latch
with the 16mm.  We switched out to a 24mm – much more comfortable for mom
and baby latched much better.  Both babies are completely nipple confused –
they have no clue what to do with the breast even with milk dripping, and
they get frustrated.  So nipple shield is the only way, at this moment, to
get babies on the breast for any length of time.  This was also the first
time both had latched and stayed latched for more than 1 minute…

 

Here is the main issue:  Both babies latch to the 24mm shield.  NEITHER can
get a deep enough latch to do anything other than suck and be happy to suck
– when they attempt to latch (with about ½ the open mouth they need) they
simply press the shield into that soft breast.  We tossed an SNS in there
and baby B got her meal – but the latch sucked (no pun intended).  She was
very happy (mom too) but obviously we need to improve that situation.

 

So – as it stands right now – mom will be using the SNS under the nipple
shield.  She will be pumping after nursing.  She will continue with the
domperidone and decided to add herbs (More Milk Plus) on top of that to give
herself every chance to up that milk supply.  She is using a hospital grade
pump.  Babies are well fed.  They know how to encourage wide open mouths,
mom knows proper positioning, we covered the basics.  Now for me:  How do
you get that deep latch on a soft breast that squishes in when baby tries to
latch with a nipple shield?  I know we have to wait for ‘grow time’ with
these babies as it is, and until they can open wider.  But, I have had this
issue before with the soft squishy breast that just sinks in with the nipple
shield when baby ties to latch.  Even with the asymmetrical latch…I just
bang my head against the wall trying to figure out how to give some
stability to the breast so baby can get on there nice and deep.

 

Any suggestions on this will help.  I must just be really tired ‘cause I am
not coming up with anything, and usually, I can…help?

 

Thank you!  And Happy Mother’s Day!

 

Warmly,

Jaye

 

 

 


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