Thanks to everyone who privately emailed me notes of encouragement last week.  You inspired me to hang in there.  Well I did and today I finally got paid for a lactation visit.  It isn't an easy case and I need your help.

The mom is a 29 year old.  This is her first baby.  He was 37 weeks, weighing in at 6lb 10oz.Vaginal delivery, no epidural.  Some painkiller intraveniously right before delivery.
Latch on problems from the very beginning.  Mom has large breasts and flat nipples.  Baby has a normal size mouth, but the tongue appears to be short.  Tongue will extend over bottom gum, but I don't know if it will stick out of his mouth.  Didn't check the frenulum.  This is not my area of expertise and I don't feel confident to make diagnosis myself.  Would like to check it out tomorrow and then make a fairly intellegent recommendation to the doctor.

Baby is 8 days old.  Had bottles and latex nipple shield in the hospital. (AHHHHH!)  Baby came home jaundiced.  Bilirubin peaked at 20.5.  This was day 5 and on day 6 the Dr. took baby off of breastmilk for 2 days and put him on formula.  Mother had support counselor inform her, so she at least pumped and kept up her supply.  Baby falls asleep quickly even with a bottle.

Mom has milk.  Baby can't form a seal.  Would latch for a few sucks, then let go and fuss.  After trying several positions, pillows, etc.  for 20 minutes,  tried a silicone nipple shield.  Baby latched on and nursed like a champ for 15 minutes.  He then fell asleep (with that drunken baby look).
Recommended that mom use shield and then pump.  Use alternative method (syringe or dropper) if unable to get baby to latch.  Gave her permission to use the bottle should she need.  Also recommended feeding frequently and use breast compression.

Mom has not had much luck this evening and is pumping and feeding with the bottle.

Also thought maybe baby has high palate and would only keep sucking if nipple touched.  This would happen with the bottle and the shield, but not with mom.

Any suggestions on what to look for or recommendations to make to mom ?  She feels pretty down right now.  She doesn't feel normal, even though we know this kind of stuff happens all the time.

Any help is appreciated.  TIA.

Susan Kappel, BS, IBCLC
All About Breastfeeding
Earleville, MD