Dear Mellanie!

I have read your mail and all the answers and thought to share some ideas 
and some experience.

You wrote that this is mothers 4th baby and she had problems with the 
breastfeeding with the baby number 3 also. What about the first two babies? 
Did they breastfeed normally? Can there be any hints for the reasons of this 
problem?

What if the reason is not only with the baby but with the mother also? I am 
thinking for example the elasticity or the size of the nipples? I have had a 
couple of cases where the main reason behind milk transfering problems were 
the nipples that were too large for the babies to suckle efficiently. The 
latest case was from this summer. The mother had not been able to nurse her 
both children for the first 3-4 weeks because her nipples were too large for 
the baby even to take them into her mouth. The mother expressed her milk and 
fed it from the bottle to the both babies and then gradually babies switched 
to the breastfeeding. I worked with the mother with the second baby, they 
did not discover the reason with the first baby. The mother thought the 
reason with the first baby was because the first baby had infection right 
after birth and was bottlefed at the childrens unit but it was not the only 
reason as it turned out the second time. This mothers nipples were so big 
that we could not even try the nipple shields we have here in Finland.

The second thought was the nipple shield, have you tried it? Sometimes it 
helps the baby to breastfeed better when the oral motor functioning is 
ineffective or compromised.

I have had one mother baby dyad where the reason was babys ineffective 
sucking technique. This mother was able to improve the nursing by better 
latching technique and very short intervals between feedings and the weight 
gain normalized. But the mother was not able to breastfeed all the time for 
months since she had older child, too (normal breastfeeding, no problems 
with sucking or weight gain) and the weight gain slowed. I suggested 
supplementation or solids according Dr Newman and pediatrician or speech 
specialist assesment but the mother chose not to do so (baby was 3 months 
old). One month later the baby was referred to the pediatrician and admitted 
to the hospital due to slow weigth gain and of course the breastfeeding got 
the blame. They switched the baby (about 4-5 months old) to the bottle and 
EBM. The mother was able to express twice the amount of milk that the baby 
took at a feeding according to the test weighting. The baby continued to 
have feeding problems. A couple months later a speech specialist diagnosed 
oral motor function problems as the baby had problems with solids and 
bottlefeeding also. It was so frustrating and sad how too often the 
breastfeeding is considered to be the problem when it is not.

Your clients baby bottlefed slowly, too. Maybe the baby still is having 
problems with sucking or is still learning to nurse as others has suggested. 
In any way she is doing excellent work by expressing the milk.

Best wishes,
Pia Ruohotie, RN, breastfeeding counsellor, mother-to-mother bf support 
group leader
From Helsinki, Finland, Europe 

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