----- Original Message -----
From: Kathleen Bruce <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, February 22, 2000 7:08 AM
Subject: difficult situation
> Dear Louanne,
>
> Some comments on your situation:
>
> >Mother gave birth to second child at 38-39 weeks. Had severe pain when
> feeding her now 3 year old. Pumped for awhile but gave up after a few
weeks.
> Is having severe nipple pain with now 5 week old. She tried nursing at
the
> hospital but the pain was terrible. The LC followed up and did latch pain
> free once or twice but mom has not been able do this. The baby was given
> formula because of weight loss but that same night was in the hospital
> because he stopped breathing..
>
> KB: He stopped breathing? What is this about?
>
> > Mom is now pumping and bottle feeding 24 or
> so ounces a day. She tries latching twice a day and feels he gets some
milk
> but can't stand the pain. One LC weighed the baby after an hour of
painful
> feeding and said he only took 6/10 oz.
>
> KB: I think that it is not advisble to let a mother breastfeed while in
pain
> for 60 minutes. What is the point of doing so?
>
> The pediatrician was convinced there
> was something wrong with the mother's breast so referred her to a ob/gyn.
> Mom was fine. Ped wants baby on bm only because of the breathing
problmens
> but will not give insurance referral for baby suck assessment (there is a
> local provider that does these).
>
> KB: Well, the mother can pay for help out of pocket. Many times this is
what
> is needed...and people will *easily* pay a lot more for dog obedience
> classes than they will for professional breastfeeding assistance, at leat
in
> my area.
>
> >>. He feels that pumping and bottle feeding is
> fine. Mom could pay for assessment herself with no insurance help. Ped
> thinks baby has some sort of reflux. He's not sure. Baby is gaining now,
> about 3 lbs. since lowest weight.(baby is now 8 lbs or so). Baby is using
> the avent nipple for new born. The nipple shield did not work. Several
> nurses and the LC's seem to think it is a suck problem not a mom problem.
No
> one has suggested Yeast because pain seems to be only nipple area. The
> baby's suck turns mom's nipple white. Mother is large breasted but she
has
> been told her nipples and areola seem normal.
>
> KB: Several things you say here indicate possible problems. First, I see a
> situation where there are too many "cooks" in the kitchen. Lack of
> continuity seems to be a real issue for some clients. Yeast, or fungal
> infection, can start on the nipple only. If one reads Kay Hoover's work,
or
> Lisa Amir, you will see that fungal infections can begin as an itchy
> soreness, and can progress, but sometimes it doesn't. There can be
> exquisite pain on an otherwise physically unremarkable nipple. Can occur
on
> one side both. So, to rule this out is not correct. I think that in this
> case, Dr. Newman's all purpose cream could be suggested to the
> physician...as it covers fungus and staph A and the cortisone calms down
> inflammation. We have seen it work well in the practice I work in.
>
> >I have not personally seen this woman. I told her to get a second
medical
> opion in hopes of getting a suck assessment paid for.
>
> KB: I think that sometimes, if a mother is reluctant to seek further help,
> the insurance question ( if there are funds avail.) is a hedge. People
who
> really want help get it...and if they don't, then they are working from a
> different belief system. Perhaps there is a history of abuse, or of other
> psycho-social issues surrounding breastfeeding.
>
> Also, to get in touch
> with the LC that got the baby latched pain free (this LC has a great
> reputation but I think the mom has seen so many people and gets told so
many
> things that she just didn't think of contacting the person again.)
>
> KB: LIke I said, many mothers would move heaven and earth to see the
> person with whom they had the most luck.
>
> The pain she has could also be related to Raynaud's of the nipple...if her
> nipple has white/pink or blue/pink/white color changes. Search for
Raynaud's
> in the archives for further info, or look in Auerbach and Riordan, or in
> Lawrence, or in Jack Newman's sore nipple computer info page. Does
pumping
> hurt? She has had a lot of different things...SNS, nipple shield, and
> nothing seems to work, ..is that right? I wonder if continuity in care
giver
> ( ONE person) with daily followup would help her?
>
> ANother question to ask is did she have a predisposition to fungal
infection
> before birth.? Did she have a recent course of antibiotics or a recent
> vaginal infection, or antibiotics during birth for Group B Strep? Does
she
> have Raynaud's in her hands? How is her latch?
>
> The basic intervention is to have someone who is very knowledgeable in
latch
> assess this and make corrections. It is basic, but it is amazing how this
> can be overlooked.
>
> Kathleen
>
> Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
> Williston, Vermont
> mailto:[log in to unmask]
> http://homepages.together.net/~kbruce/kbblact.html
> LACTNET Archives http://peach.ease.lsoft.com/archives/lactnet.html
>
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