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Date: | Thu, 27 Jan 2005 12:17:48 EST |
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I have permission to post. I am working with a mom (P1, G1) and her baby,
born 3 Jan. Baby was TXFR for surgery at birth to repair an imperforate anus.
Surgery was uncomplicated and baby was discharged home at one week of age.
Mom had a C/S and so was unable to see baby until she was d/c'd. Mom was
able to breastfeed baby but nursing staff pushed formula and baby received
numerous bottles while hospitalized.
Mom contacted me day 10 of life. Baby is gaining well, stooling frequently
and hydrated. Mom is in a lot of pain while nursing. I saw her on a home
visit. Extreme pain while latching, but mom could tolerate the later
discomfort after initial latch and has been "nursing through the pain". Nipple was
compressed. Worked on a deep asymmetrical latch and mom was able to latch and
nurse without pain. Nursed in cross cradle and lying down with baby flat on
mom's stomach (mom had C/S and incision was opening again). Both worked well.
Saw mom a few days later and left nipple is now open and baby drew blood
with one quick latch on and off. Mom has not nursed on that side since and has
pumped with PIS, milk supply is going down. Nursing on right still leaves
compressed nipple and now (10 days after initial consult) has opened a wound.
Oral digital exam is normal, tongue protrudes well past bottom lip, palate
seems normal, baby sucks with tongue under finger and does not bit or mash often
(I think when she realizes my purple gloves don't have milk!!).
Several days ago I did another home visit and mom was able to nurse well in
side lying position and cross-cradle. Baby seemed to have thrush although
mom had asked PEDI at appt. 48 hours prior about it and he said it was "milk
residue". Advised mom to start Nystatin.
Yesterday contacted mom and she said that right nipple now is VERY painful
and she is to the point of not being able to nurse without extreme pain on
either side, she is also starting to feel the yeast on her breasts (has started
Nystatin for her as well). I reluctantly suggested that we try nipple
shields to attempt to give her nipples a chance to heal while not removing baby
from breast completely. Mom came to my house with shields. Baby does not like
the shield and although she nursed well at my house she refused to nurse with
them last night.
Also advised mom to start gentian violet and if no relief for her and/or
baby in 24 hours to get RX for Diflucan.
She started fenugreek yesterday to increase milk supply on left. She is
insurance pumping with shields.
Even when the latch was deep and comfortable for mom the nipple still
emerged compressed; both in cross cradle and football. Ensured baby's hips were
flexed and a few times I put baby onto the breast as mom is hesitant to pull
baby on firmly due to pain with most latch attempts.
I am feeling at a loss as to what to do for this mom and baby at this point.
I am concerned about the open skin on the nipple and have suggested that
she get a RX for Newman's all purpose nipple ointment. She is getting Newman's
book and I think that may help convince her to be a bit more aggressive with
this. I am concerned about the yeast getting worse and mastitis.
Through all this the baby is happy (while latched and after a good feed) and
gaining. Mom is really determined to get this right. She and her husband
will be moving in April and I would like her to feel REALLY good about
breastfeeding prior to moving (actually, I would like her to feel good about it
today...)
Any suggestions or things I have missed or misadvised...feeling out of sorts
about this one.
Thanks in advance.
Christie Pillado
El Paso, TX
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