posting with permission.   Huge props to whomever taught this mom in
prenatal breastfeeding classes in Orlando.  You did a fabulous job!!!

Hey all,

It's been months since i've been on lactnet, maybe even a year or two.
 Just to recap, I'm Katherine Morrison and am in Atlanta, GA.  At one
time I apprenticed with a homebirth midwife here (on hiatus since the
birth of my first child 8y ago) and have since been deeply involved in
labor and lactation support.   Lactation support is certainly my
passion.

At the preschool picnic, a dear friend and client (who has four
children all breastfed for 1-2y) came to me about her SIL who was hear
visiting for awhile.  She was very concerned about the baby who at 5.5
weeks old, either nursed or cried constantly and who had gained just 8
ounces  in 3.5 weeks.

I gathered together my favorite Jack Newman handouts so I'd be
prepared to work on latch (which ime can *always* be improved, mostly
by a lot), milk transfer to the baby by breast compression....and even
 handouts on 'how to tell if your baby is getting enough" just in case
it was really just a fussy baby who was getting enough and she needed
to get everyone off her back.  Grabbed something on tongue tie and
some info on domperidone and herbs.

I wasn't prepared for what I saw.....it was so, well, wonderful.
There wasn't a single improvement to be made wrt latch.  Not one.
You'd think she worked alongside Jack Newman himself <vbg> her whole
adult life.   It was a deep full assymetrical BEAUTIFUL latch that
could be improved in no way.  Mom used breast compression
automatically and properly.  Not even the remotest possibility of a
tongue tie.   No anatomical issues that might make nursing more
challenging (no notable jaw recess, no high arched palate)...with mom,
no issues of swelling, unusually firm/not pliable breast tissue,
larger than typical nipples etc.

Immediately obvious was the significant space between the breasts,
their tubular shape and the dramatic difference in size (probably a/b
and C).    I don't let that worry me though in the absence of other
factors as I know many women with this structure who nurse with no
supply problems.

But, in light of the other things observed it was readily apparent
that Insufficient Glandular Tissue/Structure was the issue.   The baby
nursed beautifully....got one letdown after about six minutes and
managed 7 big swallows from it, then back to work.  We started super
switching and managed a full three letdowns with 7-10 swallows each.
In.  An.  Hour.

After talking about options for supplementing that could be done right
then, they did try a cup and a bottle.  Baby did well with the bottle
and dad was an eager student of how to properly use a bottle.    Both
mom and dad were most interested in using a supplementer at breast -
something I am always most encouraging of.  And in this situation,
something I felt would work really beautifully b/c of mom's
unflappable nature, the baby's eagerness to nurse and ability to latch
so well.  Dad is also extremely supportive and wants mom to be able to
feed the baby (even supplements) b/c it's very very important to her.

After considering the supplementation the baby took yesterday and
today, it's likely that mom is producing around 1/2 to2/3 of baby's
caloric needs.   Mom and baby took beautifully to the supplementer
(the short term hosp handout sns, which i really don't like) and a
lact-aid is on the way.   They ordered it yesterday as soon as they
learned that is was easier for longer term supplementation.

After sharing some info on the Mexico study and some anecdotes about
moms who later have gone on to fully nurse other babies, the parents
are thankful that this is all that's 'wrong'.   Mom's still sad, but
relieved.  She had wanted to nurse fully so her mom can see that not
'every baby needs a supplement after nursing....just and ounce'.
But considering some things that her friends have been through with
ulcerated/bleeding nipples, non-latching babies she's just very very
happy that her baby nurses, nurses well and that this problem has a
breastfeeding solution.  And that over time (short and long term) will
be less of an issue and maybe not an issue at all at some point in
time.

The one thing that initially led them to believe that the baby was
getting enough was that the weight gain was 'just' barely sufficient
in the first 2 weeks.  Eventually, information came out from other
present family members that the grandma had been giving the baby
'top-up' feeds every so often through the day when the mom was
sleeping.  It was 'just' enough to bump the weight gain up out of the
zone of concern, but not so much as to keep the baby from nursing
frequently.

Anyway,  it was such a great experience with them (not over yet!
they're here for another 5-6 days) and I just had to share.   I was
grateful to be able to quickly cull the lactnet archives for more
information to share with them and came up with the helpful Mexico
study and the info on Goat's Rue.

Of course, mom will continue to feed frequently on cue, she'll be
taking domperidone, using the supplementer at breast, and taking
Goat's Rue and other possibly helpful herbs.

If you're teaching breastfeeding classes in orlando, stand up and take
a bow.  You have a standing ovation coming:)

In fact, everyone stand up and take a bow!:)  You've all got the ovation.
katherine in atlanta

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