Dear Friends,

Please help, I have the mother's permission to post. 

I recently saw a mother of a one month old who has been suffering since the first time she breastfed her baby.  Mother's positioning is great and baby looks well latched on but when he comes off, the mother's nipple is severely pinched with the worst compression line I have ever seen. (see figure 148 in the Breastfeeding Atlas - 3rd ed. and imagine it much worse)
While the baby was eating the mother described the pain as coming from the baby's upper gums.  She also felt that the baby was "really eating"  since she felt such a strong pull,  though it was obvious to me that he was getting very little milk.  He very quickly got frustrated from lack of flow.She says that the pain starts after a few minutes of nursing and is less when her breasts are fuller.  Her milk supply is obviously down. She complained of a burning sensation after the feed.  Baby sucked strongly on my finger.  Oral anatomy and tongue movement seemed normal.  

The baby was born very fast, labour was 4 hours start to finish.  Mother was very shaky following the birth but nursed him soon after.  The nipples were compressed from the beginning.  Mother continued to breastfeed in hospital but baby was supplemented as well.  According to mom, "he was just very hungry".  He ended up jaundiced and stayed in the hospital for a week under the lights, nursing and bottle-feeding.  Mother pumped as well.

Mother began almost exclusive breastfeeding at home with the exception of one bottle a night.  Baby's out put is good and gained 660 grams in the first two weeks and 220 grams in the next 2 weeks. Mother had a breast infection at about 3 weeks and took antibiotics.  He does not come off of the breast alone and does not fall asleep on the breast.  Mother has to rock him, wear him or otherwise get him to sleep.  She is a single mom so this is extra difficult.

We changed the positioning a little to get baby's bottom jaw a bit further from the nipple and the pain was a bit less severe.  Compression helped keep the baby on the breast but didn't help much with the pain.  In side lying the latched looked worse from the outside but the nipple was far less compressed.  

We discussed the mother's need to build up her milk supply.  She is taking 30 mg motilium 3 times a day, using compression and  pumping with a Lactina.  She is using an APNO like cream that we use here in Israel and the burning has gone away.

I suggested CST (can I admit that)  She is well aware of CST and took the baby right away, however, the practitioner, who is not the one I usually recommend, told her that she can't see anything wrong with the baby and does not think that he needs any treatments.  Mom said that she gave him a kind of mini treatment.  She couldn't tell if there was a difference but now she is left with no options and has given herself a two week deadline which is quickly approaching.  I found a post in the archives from Jean Kotterman which sounded like a very familiar case  in which the CST did help. 

Does anyone have any ideas what could be causing this kind of pinching and what can be done to fix it?

Thank you so much for any help,

Chayn Fogelman IBCLC Israel

 








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