I saw a mother & baby today and would like some help from this list.  Mother 
gave permission to post.  

First baby, spontaneous labor @ term.  Ten hour first stage and 1 hour second 
stage labor.  Epidural anesthesia from 6cm.  No forceps nor vacuum 
extraction.  Birth wt 8-4, discharge wt 7-15 .  Weights during follow up visits 
at pedi office were 7-10 a couple of day after discharge  and 7-6 @ 1 week.  
Then, baby began gaining and now, at 4 wks old weighs 8-13.   

Mother is reporting pain with feeds.  Sometimes it is mild then increases as the 
feeding progresses; sometimes it is constant throughout the feeding.  
Exteriorly, the latch looks fine (wide open mouth,chin planted well into the 
breast,  good jaw excursions, audible swallows)  When the nipple comes out of 
his mouth, it is slightly flattened.  Adjusting the positioning to tilt the baby's 
head doesn't seem to help.  Mother also reports itching after feeds and a 
history of Raynaud's before the pregnancy.  No obvious sign of yeast (nipple is 
not pink/red/shiney) Occasionally, the nipple will look slightly purple after a 
feeding.  Her pedi has suggested nifedipine but mother's doctor did not agree.  
Mother would like not to go back on nifedipine.  Mother has some mild pain 
when pumping but it may be due to using the wrong size flange.  We gave her 
a larger flange to trial.  

When examining the baby, there is no lingual frenulum.  But, the posterior 
aspect of the tongue has a groove similar (but not exactly) to the photo on 
page 231 (figure 9-7) in Supporting Sucking Skills in Breastfeeding Infants by 
Catherine Watson Genna.  Suck assessment reveals some biting/clamping and 
occasionally an uncoordinated tongue wave.  I also think I see some mild 
asymmetry in the face and the tongue when the baby opens his mouth to cry 
or yawn.  

Could this be a posterior tongue tie?  Could that be causing the pain?  Should 
I pursue the Raynaud's issue?  Anything I am missing?

Thanks for your help.
Debbie

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