Dear Melissa, I have a few suggestions for this mother.  First, I would
offer her lots of verbal support.  I also am sick to DEATH of getting the
train wreck situations after others have already done their screw up jobs.
It is frustrating, and borders on malpractice in my opinion. Here is your
note, with my suggestions. Take what works for you.

"Hi, all

I just came from a most frustrating consult. I got a call earlier today from
one of the doctors here that I have been trying to get to begin referring to
me. He had a mom in his office who was having problems getting the baby
latched on, had plenty of milk, and the health dept had just given her ABM."

****A copy of the WHO CODE on formula would be a place to start with this
particular person at the health dept. ALso, keep them informed of your
progress, by letter..formally, so that they can learn a bit....I find that
slipping copies of things into my report often helps..as I am not out to
make enemies, but to instruct ( MOST OF THE TIME< anyhow.) : )


"He was appalled that they would give her ABM when she desperately wants to
nurse and had so much milk. He said the baby looked good and was obviously
getting enough to eat."

"I went to see the mom this afternoon. This is her first baby, delivered by
C-section after 9 hours of intense labor. Mom had an epidural and Stadol,
which according to her "threw her for a loop." She was out for 4 hours
before being awake enough to see her son. In the meantime he was deep
suctioned because of breathing difficulties at birth.

She nursed a few times before her mature milk came in. The nurses would take
the baby to the nursery for baths and occasionally to let mom get some
sleep. Baby would come back from the nursery and spit up clear fluid--mom
said she was pretty sure it was water, meaning the nurses had given him
bottles of sugar water while in the nursery."

*****Melissa, I have seen babies spit up clear fluid after breastmilk...this
I saw on my own babies......so this may not be a conclusion that you can
jump to.

"When her milk came in her nipples all but disappeared. The hospital has no
breast pump."

****I would suggest, via letter, that this hospital get a few pumps.  They
may even get them donated by a pump company. They should explore the
options, and you should start documenting the consequences of NOT having
one....ie to any baby you hear about.  Put it in terms of lost breastfeeding
relationship..which can then result in possible diabetes, Crohn"s, etc.
SHoot from the hip, nicely though.

"The nurses were no help and basically told her they didn't know
what to suggest. Someone from the health dept came and tried to help but
couldn't do anything either.

So baby is 8 days old, and getting most milk from a bottle. Mom has been
using a small electric pump that takes an hour and she gets 6 ounces which
baby downs in one feeding. She leaks and has a strong letdown that
frustrates the baby.

***Try , when she has an electric pump, pumping a little off so it doesn't
spray in baby's face.

I watched them try to nurse, and also tried finger feeding baby to calm him
to the point of going to the breast without pitching a fit. Baby has a
slightly recessed chin, and a relatively high palate, and while I finger fed
him he would move his tongue back inside his mouth and clamp down on my
finger more or less rhythmically."

***Sounds like he is doing ok stuff with his tongue. I would suggest that
you do a multifaceted thing with her..a set of interventions...which I will
put down later. I find that the high palate and short nipple thing is a
rreal challenge. However, I have had success with a nipple shield that is
silicone.

We tried football holds, cradle, cross cradle, prone postions and couldn't
seem to find one that would compensate for the recessed chin and relatively
flat nipples. She tried one of the inverted syringes to draw her nipples
out, which worked but only for short periods.

She had been given nipple shields by somebody. They were useless (something
other than the clear Medela variety. She was using a NUK nipple on the
bottle and discovered that she could use that on her nipples as a shield and
it would work some. She had also been given an SNS but I couldn't see the
point in adding that to what she was doing since he wouldn't latch on to
begin with and her milk supply is fine--too good, if anything.

Tomorrow I will bring her a Medela Classic pump to at least make pumping
more bearable. But beyond that, I don't know what to do with this mom. I am
not a miracle worker and it frustrates me no end the kind of "help" she got
from the hospital. (I've been trying for a year now to convince the hospital
that they need to hire me part time to work with the moms IN the hospital,
rather than waiting until things are so messed up. )

Monday I plan to go in and talk with the doctor who referred her since he
seems pretty receptive. I'm not sure how far to push things with him, though."

Melissa,------I would call the Doctor today, Saturday.  I often beep people,
as I feel that what I have to say is important, and I have had good response
with this. Keep everyone up to date.

My interventions in cases like this have been:

1. Lots of encouragement, and daily phone calls.
2. Provide her with a good quality silicone nipple shield asap. I am not a
fan of these, but in cases like you mention, I have had excellent luck.
They make it possible for something to touch the baby's palate..between the
hard and soft, often triggering the latch. Has worked for me before. Most
recently 2 weeks ago.
3. Twice weekly weight checks
4. DOCUMENT up the wazoo...to everyone, including the head nurse and dept
chair of Pediatrics...at the hospital. They need to be aware that their
interventions have cause, and that you are dealing with the effect.
5. Support mom's supply with hospital grade pump, pumping 8 times a day
6. Heat before pumping, nursing
7. Finger feed at breast with syringe or supplemental feeding system on
finger, at breast. Give mom guidelines for amounts to feed, and have her
keep an I/O chart
8. Tell her that she can expect about as long to get OUT of the problem as
it took to get in there..and that if her baby has ever nursed, he knows how,
and her faith in him will help get him back there....faith is the key, I find.


I guess for me, the nipple shield route has really helped when you get a
baby with a high palate, and a mother with a big soft breast and no nipple.

Been there with the train wreck thing.

Kathleen

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,Corgi-L,TLC, Indep. Consultant
http://together.net/~kbruce/kbbhome.html (PLEASE VISIT!  I have a counter
now!!!)
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