Hi, Terri. Are the mom's breasts sort of flat or are they somewhat pendulous? Any surgeries at all, including biopsies? Augmentation? Accidents where seat belt bruised the breasts? Does the doctor that ruled out tongue-tie know about the deeper posterior ties? Is mom's milk supply staying with her or dwindling? Does pumping hurt? Does the baby have low muscle tone? How about labial frenula, are they tight or short? Does the tongue extend past the gum line? Is the end of the tongue indented, flat or pointy? When baby comes off the breast is the nipple white? Is there a stripe? Are there blisters? Could she have milk blebs (any small white spots on the nipples)? Are the nipples pink and shiny? Is she making a "breast sandwich" that matches the baby's mouth? Is she continuing to compress the "sandwich" while the baby nurses? Do the baby's cheeks dimple while s/he nurses? Did you check the suck with a finger assessment? (I don't do that often, but recently I
 was with a mom who was very uncomfortable even tho the latch "looked good". Finger assessment showed strong suck, coordinated movements, and tongue not extending past the gum line, chomping on my finger and mom's nipple.) Still fishing for clues....
Rowena Tucker IBCLC
Texas, USA

You wrote:
Date:    Thu, 10 Sep 2009 17:03:32 -0400
From:    Terri Klein <[log in to unmask]>
Subject: painful latch

Dear Lactnetters,
Need help with a mom. Baby is now one month of age. Mom continues to
have pain during feeding. Worse at latch but some discomfort throughout
feeding. Mom has inverted nipple on right side and flat on bottom of
nipple with raised at top of left side. Shaped somewhat like a pacifier.
This is the shape of the nipple prior to even nursing. Areola is very
firm. I suspect some adhesions and that it is painful when baby latches
because she latches well and nipple is everted at end of feeding on
right side and more round on left. Did not have good luck with nipple
shield. I felt the baby had a much better latch without. Tough to get a
decent seal.
First baby she pumped for 10 months because that baby would never
latch. 
Mom has tried pumping first then latch but remains painful. Ruled out
tongue tie. Pediatrician evaluated at birth and again today. Doesn't
seem to have a short tongue. Have given mom some suck training exercises
to see if she is holding tongue back. Couldn't see her today just over
the phone today. 
Any further ideas that I can suggest to this mom?
Warm regards,
Theresa Klein RN, IBCLC, RLC


      

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