I have a case I would like input on (mom gave permission). I met mom at about
8 days pp. Her nipples were in terrible pain throughout feedings, but she was
nursing exclusively. Baby was gaining b/c she was at breast truly non-stop.
Even so, mom's milk was beginning to wane. The baby was pinching the nipples
severely--leaving them white and w/ a horizontal ridge. Mom has somewhat
large nipples--in length and diameter. Birth was traumatic, including drugs
and vacuum. Latch was shallow and
baby did not draw in nipple well, nor sustain suckle and she was obviously
"chewing" or "clamping" on the nipples. Mom had burning, shooting pain and
history suggesting high risk for yeast. During the next week and a half, mom
treated with gentian violet for 3 days (definate improvement) and took the
baby for CST (2X, I believe). The baby did improve her ability to open and
there was better jaw excursion. The nipples were less compressed. Mom began
to use a sling and has been co-sleeping. As her milk decreased further, she
used MoreMilk Plus. She tried co-bathing and pain meds for possible secondary
Reynauds. She used breast compression, w/ some improvement--baby was sleepy
at breast.
Over time, it became clear that the baby did best with a stimulation of
MER prior to latch on. Mom did this and found the suck was less aggressive
and more sustained. At 4 week weight check, baby had gained an avg 5.5 oz per
week, which ped did not like--she suggested AIM, but mom resisted, saying she
wanted to do everything else first. Also, mom's MER has been better since she
is in less pain, so baby has longer periods of good latch and suckle.
I also have some concern about the baby's tongue, as it does come beyond
lips, but makes a definate tiny heart shape when it does. Mom asked ped, who
said tongue was normal, so I am having a hard time with this angle. We have
tried every position and baby really is certainly better at latch. Mom was
given antibiotics by OB, for which I saw no valid reason, so I am concerned
about recurrent yeast.
I saw them tonight. Baby doesn't like to open as wide as we would like,
but is better. Mom leaks and baby gulps when on well. Mom bought a pump, but
the flange is too small and really hurting her nipples. She will get the
larger flange. Due to past pain, she has a difficult time with MER, esp with
the pump. She has used rescue remedy as well.
Mom is seeing the CST Saturday for herself and will check on the baby as
well. She is going to order the flange and a supplementer, so she can
stimulate a greater supply and supplement at the breast if needed.
I hope I am remembering most things. She is a fabulous mom--very
intuitive and connected to her baby. Any other ideas on the
clamping/pain/suckle?
Jennifer Tow, IBCLC, CT, USA
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