I have the mother's permission to post the following situation.
    Thirty year old primip with 8 wk-old baby girl. Mom had not intendd to breastfeed. I met mom yesterday. She had a planned cesarean birth at 38 weeks due to a heart condition. Mom had planned for an epidural but was told she had to have general anesthesia just prior to birth. Mom was kept on the cardiac unit for 16 (I believe that is right) hours. She was very "out of it" until the middle of the night when she began to ask over and over for her baby. Due to "rules"--the baby cannot leave the pp unit w/o a security guard, the baby did not come for 6 1/2 more hours. Mom was told that the baby was refusing bottles and it was suggested she try to nurse the baby. Mom offered the breast, but the baby would not nurse. Over the next several days, an LC gave the mom breast shells and (I believe a peer counselor) tried to get the baby latched on. First pumping and a dropper were used (day 2), then a syringe (9 cc with 5 French) was used--first like a dropper, then on day 3 with finge!
r-feeding. On the last day, the LC
saw her again, but mom said she did not try to help latch on the baby.
    Several days after going home, mom got the baby to latch on. A visiting nurse told her how to pull the baby to her and that the baby was sucking incorrectly. Mom was experiencing extreme pain with nursing, including burning.
    Mom spoke with sevral LLLL's, all of whom agrrd that it soundd like the mom had thrush. One told her she should insist on treatment, since her OB refused to treat her. Her ped finally did treat the baby and told her to drizzle the drops on her nipples, but doubted the yeast. She also told the mom last week that she should give the baby one bottle of AIM per day to help the baby sleep at night and that it took her two months to get bf'ing right with her first, so she should just keep going. She also watched the mom nurse and told her the baby's latch looked correct.
    Mom was routinely using a pacifier and has concerns about normal infant needs for constant attachment.
    I do not belive mom has yeast.When the baby comes off the breast, the nipples are pinched, with a line across the nipple. The nipples are white and become more blanched with the baby off the breast. Then the pain becomes very severe and burning. She says that pumping feels really good and having milk on her nipples soothes them. The pain is constant, but is worse for an hour or so after nursing. She also finds using soothies helps and that after a shower, the pain becomes much worse.
    The baby does not open her mouth wide at all (taught use of mimicry). She seems to be pinching off the milk flow (mom says she never had OAMER and her supply is good) and then sucking really hard to get milk. Mom has bubbly blisters on the tips of her nipples after nursing. I finger-fed the baby and noticed that she was able to achieve a ryhthmic suckle after time with a good, steady flow of milk. She has that kind of suck where all of the work is being done by the top jaw and the bottom jaw barely plays a role. She is pretty much biting her mother.
    We tried using a starter SNS to increase milk flow, but she fed slowly. She even feeds slowly with the syringe. Mom achieved a good latch on a couple of occassions, but the baby slipped down quickly and mom was still sore.
    I referred her to a chiropractor, but she was very hesitant. I do not know if she went. I suggested she try several more times with the SNS to see if it helps.
    I suspect Raynaud's secondary to poor latch. I truly do not see this mom hanging in another month like this, so I do not see the baby working through this on her own. I told her to use heat on the breasts after nursing, to see if it helps. Baby does appear to latch well externally, but a suck assessment show it is not
    Does anyone have any other ideas?
Jennifer Tow, IBCLC, CT, USA

             ***********************************************
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