I have a few thoughts on your case.
Nipple trauma: I think baby should have someone evaluate the oral cavity to
rule out anything that could be contributing to the trauma.
Also, mother should be seen by a doctor of breastfeeding medicine or if you
don't have access to one in your area, then an MD that is also IBCLC,
especially since she is reporting same pain during pregnancy.
Latch: I know you say you explained how it should look and feel, but did you
show her? I know many on this list prefer the hands off approach, but given
the language barrier a demo could go a long way. If there is no problem with
the baby's anatomy, then it probably is latch related, and should be worked
on. Although I find that 3 month old babies don't like anyone telling them
how they should latch. How long has she had the crescent shaped injury? Is
it recent or has it been there from the beginning?
Baby's behavior after feeds: Here I have to disagree with you. I think it is
a supply issue. There are so many clues in what you wrote that lead me to
say this:
* Mother didn't bf for 3 days before you saw her. Unless she expressed milk,
a mother under normal circumstances would be not able to go 3 days w/o
expressing, her breasts would be too full, and would probably end up in a
lot of trouble.
*Baby is bf 2-3 x day. (mom not expressing)
* Baby is getting 75- 80% ABM. With a full supply, that would not be happening.
* Baby is crying soon after feeds, and calms down as soon as she gets a bottle.
* Baby didn't gain properly and needed to be supplemented.
I think a full medical history is in order to try and understand what is
going on. How was initial lactation (onset of lactogenesis II)
what was baby's birth weight, d/c weight and all other weights since birth.
You said she can express 3 oz. a few hours after she feeds the baby. It is
important to know how many hours after. 2-3 hours or 5-6 hours?
I asked about the look of her breasts because some particular breast's shape
can indicate a possible issue with milk supply. (Please refer to the
Breastfeeding Atlas by Kay Hoover and Barbara Wilson- Clay. They have
pictures of breasts that could present milk supply issues.)
Now you say that this mother can't / won't express milk at work. I have seen
some mothers that were able to nurse their babies before and after work
successfully, w/o expressing during the work day. However, every mother's
system is different. There is no way to tell how a mother's supply will be
affected by this routine, and how quickly it will decrease, or if baby will
be willing to continue this particular pattern.
She can start taking some herbs to help with supply. ( I think she might be
familiar with fenugreek since she is originally from India).
It seems like there are many obstacles in her way: her upcoming travel to
India, nipple and breast pain, perceived low supply (real or imagined). She
should look for support while away, or she might find it very hard to continue.
Best of luck with this case.
Ayelet
Ayelet Kaznelson, CLC, IBCLC
Los Angeles, CA.
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