I have been reluctant to post, partly because this is my first time and partly because I feel like I should be able to figure this out. Yet this mother needs a solution, so here goes...

I'm seeing this as a latch problem, with a compicating factor of mom having been sexually abused as a child.  She desperately wants to breastfeed (having educated herself on how important it is for the child), and realizes that though she has done a lot of emotional healing, there is a lot of difficulty in having a baby at the breast.  Though there have been maybe 3 times in 2 1/2 months that she has achieved a good latch (one that she "can't feel"), all other attempts are either just emotionally bearable (early in the a.m. when her breasts are more full - does that make any sense?!) or not at all, due to too much nipple stimulation (which really shouldn't be happening anyway with a proper latch...).  Double pumping has been workable for her, and baby has gained 4.5 pounds in his 2.5 months of life (BW 9lb 9oz).

Mom has large, yet not flacid, breasts with areolar tissue that is non-distictive and small, everted nipples.  Baby's oral structures appear to be in the normal range with good grooving of tongue and slight protrusion over bottom gum.  He goes to breast eagerly with relatively open mouth (maybe 90 degree angle), but after a few suckles mom takes him off and nipple is creased in the middle and flattened along the length of the bottom. He tends to suck in his top lip (it is very difficult to pull out). She sometimes has a crease on the areola near the nipple base where baby's lower gum has clenched.

Mom has researched assymetrical latch, and understands the concept. She says that sometimes she has to almost stuff the nipple in at the top of his mouth, as she has it aimed at the roof of his mouth and her areolar tissue is not firm and the nipple is small. Somewhere she read that the open mouth angle needed is more like 140 degrees, but we can't get the baby to open that widely. ( I've just gathered tips from the archives on getting a wide gape, such as using a light tickle on the underside of baby's nose, yet I think that there may be more going on as this has been a struggle for a while and mom has tried a lot of ideas.

I first saw her at 2 wks pp; her nipples were healing after having been "torn up" at 1 wk.  Mom reported clicking and dimpling (not enough breast in mouth & inadequate seal).   Baby had been off the breast for a week at this point to allow mom to heal up, and was taking EBM.  Short frenulum was suspect, and there was some distant family history, but tongue could extend over lower lip and cup my gloved finger, and mobility was OK. Tried a nipple shield to see if it would provide a bigger "handle" for baby to grasp; mother couldn't tolerate, as baby would slip down onto shield nipple and she would feel it.

Mom & dad finger-fed baby for a couple of weeks to avoid bottle, but it became too labor-intensive to continue.  So baby has been on bottle, lately with a "breastfeeding" nipple, and mom is working on baby's gape by putting the bottle into his mouth further.

Mom would like to have more children on down the line and nurse them, but if she can't get this little guy onto the breast, she's thinking she will probably just write off  breastfeeding.  Neither of us want this!

(oh, just fyi:  both have also been treated (by another consultant)  for thrush (this was at 6wks for baby), mom with Diflucan, but for only 4 days,  for deep breast pain; is getting back on, for a 2 wk treatment, as is still experiencing twinges of deep pain)
(and I have given her some of Kathleen Kendall Tackett's articles on SAS & BF).

Thanks for any insights you can pass on!

-Kathy Freeman,  IBCLC
Fayetteville, AR



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