Yael:  I see these refusal of the breast cases fairly often.  Usually it's
after everyone else has given up and they are barely bfing or not at all.  I
tell you this because it's important to know that even in these cases, I've
never had a baby not get back on the breast (partly, because I'm so
stubborn, but also because only the most determined moms get referred to
me).

My first reaction is to spend lots of time reassuring the mom that IT IS NOT
HER FAULT.  These moms usually feel like dirt bec their babies are
"rejecting" them.  I give mom permission to NOT latch the baby on for x
period of time (depending on how frustrated she and baby are and how young
baby is).  I suggest to mom that she try the homeopathic Bach's Rescue
Remedy and maybe NSP's Distress remedy for the baby (and her if she wants to
avoid alcohol).  If supply is a problem, we might add herbs like fenugreek,
and continue pumping.

I do a full physical assessment, and frequently find that these are babies
who are hypertonic and hate being touched.  If that is the case, then we
need to work on that first.  I teach mom and dad infant massage.  These
babies generally don't start out liking it (unlike most).  We start slowly
with lots of oil and avoid the back of the head and bottom of foot
(different than usual procedure).  I "prescribe" this 3-4 times a day for
these little guys.  I also stress that mom must have lots of help.  I
investigate what is going on in the household and really try to help them
calm the whole house.  Sometimes it means  getting rid of a constant barrage
of visitors.

Then, we go to maximizing skin to skin contact.  That means sleeping
together with shirt off.  Also, Mom and baby are to bath together.  Lots of
calm, with music, maybe candles and dim light.  I don't have mom try to
latch baby yet.  They do this for as long as is comfortable and usually I
have them do it two times per day for two days before intentionally trying
to latch.  Baby lays on moms chest and usually starts licking breast.  I
always educate on the normal progression and that licking is a GREAT sign.
At this point, mom is NOT to try to latch baby.  Baby is to go to the breast
on his own.  It may take a few days of nuzzling, then licking, but they will
(maybe express a drop or two at this point to entice him).

I'm not going to say that this doesn't take time and patience.  There have
been a few cases where the bathing, carrying and massage took a week or more
to undo 4 weeks of frustration and forced shoving baby onto nipple.  In the
mean time, mom pumps and uses alternate methods of feeding.  SNS's don't
work in these cases.  For those using a regular bottle, I try to get them
over to a Haberman.  For those willing to try, a soft cup.  If they've
already been started on finger feeding and p-syringe, we'll continue that.

You might say, well maybe none of this made a difference; but it has.  The
moms feel much better and when they try to rush things, it back slides and
we see the old patterns again.  This method requires that the moms feel
comfortable trusting you and themselves, and that they can check in with you
whenever they doubt the process.  This may mean getting 2-3 calls a day for
a few days.  The emotional reward in these cases far outweighs any pay.

I hope someone finds this useful.
Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
mom, wife, educator, lactation consultant, researcher, scientist, author,
organic gardener, photographer, lapidary creator, lousy cleaner.

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html