Greeting,
My client has given me permission to post, so any suggestions are greatly
appreciated.
Yesterday I saw my client and her 13 day old daughter in their home. Birth
resulted from a spontaneous 13 hour labor, no PROM, anterior presentation,
1 hour pushing, 8 hour epidural. Her birth weight was 6 lb. 4 oz. Baby
latched in the first hour after birth and appeared to nurse well, nursing
about every 2 hours for the first few days. Mother developed sore nipples
around the 3rd day. On the 4th day her weight dropped to 5 lb. 10 oz. and
her doctor was concerned about jaundice and the amount of time baby was
spending at the breast, so a bottle was introduced with the instructions to
nurse 5 minutes on each side and then give 2 oz. via bottle. Baby is now 6
lb. 8 oz. and mother is eager to get baby back to exclusive breastfeeding.
Mother had been breastfeeding every 3 hours. Feedings would last for an
hour or two and end with supplementing via bottle.
When baby showed feeding cues,we undressed her down to diaper and put her
to the breast. Mother has large breasts with well everted nipples. We were
able to achieve a good asymmetrical latch. Mother was pleased that she was
experiencing no pain. Baby suckled for a short time and then would either
pull off and fuss or pull off and latch more shallowly and then doze and do
an occasional non-nutritive suck or just hold the breast contentedly in her
mouth. Breast compression was ineffective. Because baby may have become
used to the faster flow of the bottle and mom's supply was on the low side,
we tried using a supplemental nursing system. With a lot of coaxing, we
were able to get her to take an ounce via the supplementer at the breast,
but then she was unwilling to do more, so we finished the feed via bottle.
Her parents said that she was slow feeding via bottle also. She appeared to
be having trouble coordinating suck and swallow with bottle, so I showed
her parents the Kassing bottle-feeding method, which dad thought she was
handling better. We later tried nursing again using other holds and also
lying down with no better results.
I did a suck assessment after the feed. Her tongue appeared to cup
appropriately, but her suck felt weak and she did not make a tight seal
around my finger, however her parents assured me that she usually does so.
When laid on her back, baby would not keep her head straight but
continually turned her head to the side. She could turn to either side, but
not in a smooth motion.
I have encouraged the mom to pump to increase her supply, hoping that
faster flow will keep the baby more interested. I also suggested they seek
an evaluation from someone trained in CranioSacral or pediatric
chiropractic techniques, but don't think the parents are convinced.
Any other suggestions are greatly appreciated.
Sincerely,
Kathleen Fallon Pasakarnis, M.Ed., IBCLC, RLC
Nurturing Family Lactation and Parenting Services
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