I had a pretty wild case in this department recently.  For those unfamiliar
with the US system, doctors who have finished school and are MDs or DOs in
their own right, will then do a supervised residency in their specialty.
There is a family practice resident clinic in my town, supervised by my
favorite doctor in the world, and they can often give same day service if
you are willing to see whichever resident might be available.  One of these
residents is closely connected with a former client of mine, and he is very
good about making referrals, if he happens to be the resident they see.
Which is how I met this recent client.

PTP.  Brutal birth with multiple cervical and vaginal tears and a broken
tailbone and 500-1000mL hemorrhage.  The resident making the referral saw
them mostly for mom's issues but saw that bf was a struggle and referred
her for "tweaking and support."  As I'm doing intake for the family, I
learn that one resident attended the birth, and they have seen two other
residents postpartum.  At least all three were supervised by the same doc.
Then when I made it really clear that baby needed CST/OMM in a very big
way, they were able to get an appt with a second supervisor who was
available that afternoon.  FIVE DOCTORS.  My solution was to send a copy of
my notes to the main supervisor, with a handwritten note naming all the
other docs involved, mentioning how great it is that they can all learn
from this experience.

And the baby?  Late preterm, 11% below her 6 lb-ish birth weight, screams
All. The. Time.  Mom is so sleep deprived that she can't track well, and
utterly fried from hearing all the crying.  The upside was that when she
wept that her baby was angry at her, I was able to immediately point out
that baby was clearly in pain, screaming pain, every time she opened wide.
Fabulous reflexes, could crawl to the breast and choose a side and plant
her chin, but hurt to open wide.  She even screamed when getting milk from
a wide syringe, whenever she tried to suck it in past the tip.

This kiddo was born with a nuchal fist, which is likely what hurt mom so
badly and what has her jaw so kinked up.  She is the first hypertonic baby
I've seen in person. She is a tiny peanut, and according to everything else
I've seen, she should be weak and sleepy.  Well, when I attempted to remove
my pinkie finger after a brief oral exam, her suck was so hard and her jaw
so tight that I picked up her head, shoulders, and torso right off the
bed!  Of course I immediately laid her right back down and used my other
hand to persuade her to let go.  Mom described her as "stiff," and she was
totally able to do the breast crawl with amazing vigor.

So they saw supervising physician #2 yesterday afternoon and I will be
curious to get an update.

Lynn Carter SFO LLLL IBCLC
Missouri USA

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