Well I landed in MA at 5pm and was at my DIL's side by 8pm. Things  
are not good I fear. I was able to diagnose
a tongue tie in little Alexander.  I almost missed it as the little  
guy is able to stick his tongue out past his lower gum
but he can't elevate it and when really trying to stick it out you  
can see the classic heart shape. He "plays" with
his tongue a lot. I did a sweep and met up with the frenulum. So that  
is one issue.  Next upon observation of my
DIL's breasts I think she is at risk for a low supply as well. Her  
breasts are widely spaced and conical shaped.
I'm so worried.  I'm finding it VERY difficult to be the one to tell  
her she may have insufficient glandular tissue!
Basically I just asked her if she could fit her hands width between  
her breasts to which she replied yes, then I
gently said that was sometimes associated with a lower milk supply.  
Now she's really thinking she's a failure.

Alexander hasn't gained at all since discharge, he is 7days old and  
still 7lb 10.2oz as of last night. I did wind up
bringing a scale and doing a pre/post wt. It was late in day and .8  
oz transferred
after a so so feed where he kept falling asleep. He's not adverse to  
being at breast
but sucks vigorously for several minutes (suck/swallow ratio is off  
just a bit and you can see/hear some swallows but
not what I'd expect at day 7) and then rests/sleeps.  Breast  
compressions keep him interested for a little longer but the
whole feed / breast is not more than maybe 8 min at which point with  
baby off the breast, I only saw dribbles of milk when
compression was done.  Interestingly even with the tongue tie he is  
able to appear to latch well, looks deep, nice flange, large
amount of areola taken in AND mom's nipple is not uncomfortable nor  
lipstick shaped when released.

One point of confusion is he seems to be peeing and pooping  
appropriately (although I haven't seen the poops yet myself).

They both seem to be in denial. When my son said "am I missing the  
gravity of the situation?" as he sat there calmly while
his wife was crying. I said YES!  I told them he needs either pumped  
milk, donor milk or formula to supplement breastfeeds.
While they didn't agree to the donor milk outright my son also said  
"I'm not comfortable with formula". So I will buy them
some donor milk today. Also going to try to get the frenulum clipped  
today. While I'm sure it won't solve everything
I'm sure it will help the little guy swallow better and be more  
comfortable. I've got her set up with an electric pump
and I hope she'll use it but they both have a lot of other stressors  
in their life right now too and my DIL is sad and
frustrated, Her words, " I did everything to keep you healthy and now  
look".  I've told them nothing is irrepairable at
this point but the baby needs to get fed. Dealing with a lactation  
aid may put her over the edge so I told her using
a bottle is OK and left a finger feeder with her as well.

YIKES..why is it LC families often meet up with so many challenges!   
I'm too close to the situation and I'd love for
another more experienced LC to try to help them through this. All  
suggestions and offers of help accepted!

Ilene Fabisch, IBCLC
Brockton, MA




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