(2) Second case (unrelated) is of a 3 week old baby whose mom of 2
successfully bf previous children called me 9 days postpartum after two
other LCs had "given up on her" (mom's words, not mine). Mom dx'd with
postpartum hypertension as well. The baby exhibited classic nipple
confusion from birth even before being given any artificial nipples.
Previous LCs had mom pumping and using a Hazelbaker finger feeder (but mom
didn't know she had to clean or replace the tubing and had been using it
since discharge 4 days earlier--tubing was clotted shut with milk when I
examined). One LC had mom using a nipple shield after dx'ing high arch
bubble pal. (I did not agree with high arch). Shield didn't stim suck
either. Second child was tongue tied--this baby has a slightly tight
fren--but not bad. Baby was receiving pacifier from 2 days on.
Mom described baby as "a good baby" (ah oh) that sleeps a lot but who hated
nursing. At 7 days, when I first examined, baby attempted latch but would
just sit there not knowing what to do and eventually got frustrated and
hysterical. Mom has slightly flat nipples and I demonstrated "nipple
sandwich" plus techniques to make nipple more erect (remember she nursed two
previous kids). I showed mom breast compression--mom leaks tons of milk
right into baby's mouth. Baby sucks a few times and gets very upset. As I
do with all reluctant nursers, I demonstrated infant massage, but baby was
not receptive. BTW, I use massage as a two-fold diagnostic and to teach
parents a very useful technique. This baby clearly had something going on
with its neck, but I couldn't identify what. (Ped said baby was normal.)
First I attempted to stimulate suck--which required signif stim with finger
pad. Showed mom how to do this before latching and had mom stim let down.
Baby not at all receptive and appearing to be in pain. At this point I
introduced Distress Remedy (a homeopathic similar to Bach's Rescue Remedy
but not in alcohol) for both mom and baby.
We tried cup feeding--unsuccessfully--mom's patience not great. After a 3
hour consult, I gave mom the option of more tubing for finger feeding or a
Haberman bottle until we could work this baby back to the breast. Mom chose
Haberman and I demonstrated proper use (apparently not common with some of
the practitioners handing these out here) as well as training baby to open
wide and stim suck (also took baby off pacifier). I put the mom on my usual
reluctant nurser protocol of backing off the breast to undo some of the
negative association...had mom do lots of skin to skin contact, massage if
possible, sleep with baby with mom's shirt off, bath with baby, use Distress
Remedy, attempt latch only during baby's light sleep stage and watch for
signs of readiness (licking the breast, nuzzling, etc). We worked this for
a couple of days with baby showing more interest, but still acting in pain
and not actively sucking. Normally, I would then take the baby through
LLL's no breast, no bottle routine as described in the Breastfeeding Ans
Book, but I didn't feel as though either baby or mom were ready.
After a week of this "holding back" approach the mom was describing her
labor to me and said that there was this immensely loud "POPPING" sound as
the baby's head crowned but no one could find anything wrong with her (the
mom). At that point, I knew we had a clavicle issue and referred mom to a
very competant, gentle chiropractor, experienced in newborns. The
chiropractor, who uses only soft tissue work with babies, said that "yes,
indeed this baby had an anterior clavicle subluxation" and fixed it. Baby
latched on and nursed the best she had since birth and mom was ecstatic.
I thought our problems were solved at that point, but the next day the
clavicle popped out again (audibly) and baby was hysterical. (Ironically, I
had just recovered from bronchitis where I had been coughing so violently
that I too had clavicle pain and jaw pain to the point where I couldn't open
wide). So, back to baby, this baby went back to the DC's to be adjusted and
the same scenario resulted. This has now happened several times and baby is
now at the point where it will only nurse 1-2 minutes--seeming to have a
very negative association with bf and the pain that results when opening
mouth wide.
This is a mom who really wants to breastfeed but also has two other young
kids (ages 2 and 5) and not much time. She's been dutifully pumping and
using the Haberman, and is willing to try "anything" that might work. I'm
bringing a loaner sling to her tomorrow in the hopes that having this baby
in the sling while nursing will decrease pressure on any one part of the
body and also be in a position not associated with negative pain.
Sorry for the long post, but I thought you all needed detail in order to
help. Please if anyone has any ideas, I'd be delighted to entertain them.
I'm nomail so please email me privately as well as to list. TIA!
Warmly,
Chris
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC [log in to unmask]
mom, wife, active UU church member, educator, lactation consultant,
homeschool mom, researcher, scientist, author, organic gardener,
photographer, wilderness adventurer, lapidary creator, lousy cleaner;)
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