Dear Lactnetters,
I've sworn to myself I wouldn't post with problem situations, but here goes
anyway.
Mom had her first baby via c-section (baby in bad position) after 20+ hours
of labor.  Baby was 8'12", healthy, good apgars, was deep suctioned in the
nursery because he was "juicy".  Baby latched within first hour in recovery.
Lips flanged, tounge coming forward.  Not tons of sucking, but some, stayed
latched and drifted off to sleep.  Mom and baby hospitalized for four days
following the birth.  Practiced rooming in.  I saw them (as a doula with
breastfeeding experience, not as an LC) 24 hours after the birth.  Baby was
still accepting the breast, but with some reluctance, had not yet pooped but
was peeing.  Baby is now 8 days old.  Had lost down to 8'0" 3 days
postpartum.

Mom has hypothyroidism.  She did not take her meds for five days during the
birth and hospital stay.  She is home and taking them again now (past four
days).  As I understand it hypothyroidism can contribute to low milk supply,
but with meds it should not be an issue.  She reports that her milk came in
(experienced the only really good feed at the breast he's had) but then
reports her milk dissapated within the next 24 hours.  Over the next few
days they saw four different hospital LCs.  Baby was finger fed both EBM and
ABM because he became more and more fussy at the breast and has now began to
refuse the breast all together.  Apparently one nurse gave him 90 cc's of
fourmula all at once and then his stomach had to be pumped.

He is at home and being bottle fed EBM when it is available.  They are using
an long teat with a wide base and letting the baby draw the nipple in with
several sucking motions.  Mom is pumping to increase/preserve her milk
supply, drinking to thirst, very good nutrition, resting and taking
fenugreek.  I have not been able to observe his behavior at the breast (will
see them again tomorrow for this) but parents describe it as fighting the
breast away.  Baby becomes very upset, arches his back, pushes away with his
hands, shakes his head from side to side. Occassionally will allow the
nipple in his mouth but won't seal and suck.   She gets very little (1 oz at
a time) pumping with a PIS.  She switched to a Classic and is getting
slightly better results.  I suggested she continue pumping every two hours
for the stimulation and not to worry much about volumn.

I have encouraged them to see one of the excellent IBCLCs in our area, for
some reason they seem reluctant to do so.  I plan to continue this
suggestion, especially since I feel I've reached the limits of my
resourcefulness.  I have suggested:  pumping prior to attempting a latch to
facillitate immediate gratification, breast compressions with baby at the
breast, feeding an ounce prior to attempting to latch, offering the breast
often but not to continue if baby becomes upset, offering when he is just
waking and falling off to sleep, offering in a warm bath,  spending lots of
skin to skin time letting baby lick and nuzzle.  Mom has had some recent
success offering breast mid feed, baby will go back and forth, but won't
actually suck on the breast.  Her nipples protrude well and she is not
engorged, reports not feeling her let down, no pacifier use.  She has never
had breast surgery or trauma (I have not asked specifically about sexual
abuse, but don't pick up on any of those vibes).  Mom verbalizes wanting to
breastfeed (as opposed to pumping and bottling, which she is also motivated
to do if necessary).  Someone told her (MIL I think) to only let him feed at
the breast, if he was hungry enough he'd eat.  Mom and I think this is a
little harsh for a one week old.

I'm thinking aversion due to the invasive proceedures, but he'll take the
bottle.  Is he totally nipple confused?  He won't get anywhere near a nipple
shield.  Suggestions?  Comments?

Thanking you all humbly and in advance,
Dawn Martin
Austin, TX

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