Just wanted to share an update on my 3 difficult cases taking a huge amount my mind space for a long time now.

Case 1: Posterior Tongue Tie with labiel tie - 4 frenectomies (done in installments since doc was new to doing the procedure) and later baby developed a palatal Torus : Homeopathy worked so well Torus almost disappearing for baby. Nursing getting more comfortable now for mother now after 6 months of ordeal. Mother is eternally happy to be able to nurse her baby painfree. This motherbaby dyad have had a profound affect on me as a person and as an LC. I am glad a journey of 6 months continues in gratitude and joy of nursing motherhood.

Case 2: Premature baby with Posterior Tongue Tie with labial tie at age 3 months (corrected age term)- post fenectomy which was not a pleasant experience for mother and baby, they nursed for 30 days painfree but excruciating pain returned for mom who also had a accidental fall at home and was bed bound due to deep stash in her arm and fracture in her leg. Appeared as if PTT reattached despite careful after care. Post sessions over weeks of bodywork 'Rekie' and loads of skin to skin sessions mother calls me to say, "Baby's nursing beautifully with absolutely no pain at all, thank you for being there." and this at age 4 months (corrected age 1 month). 

Case 3: Reported episodes of thrush earlier, turned out to be thick Maxiallary labial tie and severe nipple trauma for mother at age 4 months (travelled long distance) - Post frenectomy for labial tie, nipple distortion disappeared and deep lacerations at the base of the nipple healed. Soreness remains up until now. Mother has large nipples causing friction at the base with a high palate baby. Mother today said, pain while nursing has come down consistently since frenectomy to 4 on a scale of 1-10. As baby grows this seems to be getting better by the day. Baby age now 5 months.

I was to have a peaceful sleep tonight but for a new case 4 which has left me baffled at the poor breastfeeding management at the hospital. Mom cames in for consult today (travelled long distance). I was shocked to see the baby's state - looked scary to me. (I must admit this has been my scariest so far) baby born 4.5 weeks ago at full term 3.1 kg and today's weight gain check shows 3.2 kgs at 4.5 weeks. Baby had a worried anxious look with eyes wide open looking FTT. Bbay has deep arched palate, little fat pads, submucosal tongue tie and a labial lip tie and diminished rooting and sucking reflex. Mother has been shuttling between two doctors. One attempting to tell mother during more than 2 visits since mom was worried about baby asked mother to "enjoy motherhood and continue to breastfeed. Baby is doing fine" with a baby with a average just 3 diapers a day!! the other doc suggests to buy breast pump to express and 'Calma' bottle (very expensive for
 Indian mothers) just 3 days ago with no breastfeeding management before during several visits to the hospital. and also prescribed formula for baby when mother is able to express 120 ml of milk at one pumping session! Recently Medela business development LC had visited the Hospital for promotion of their products. This motherbaby needs skilled breastfeeding help asap not breastfeeding 'gyan' from a breastfeeding advocate who refuses to see the gravity of the situation nor a push from the other for formula and 'Calma' !! I am deeply disturbed and needed to share with my community (LACNET) out here who have not only provided me the skills I have today (although limited) but also the courage to anticipate to see hundreds of more such motherbaby dyads in the hope of a better tomorrow. 

Thank you for listening.

Yasmin
MA, HDSE, CLEC, LLLL, IBCLC
www.nourishandnurture.in
Mumbai, India         


----- Forwarded Message -----
From: Yasmeen Effath <[log in to unmask]>
To: laurie wheeler <[log in to unmask]>; Lactation Information and Discussion <[log in to unmask]> 
Sent: Wednesday, 18 April 2012, 9:51
Subject: Re: 3 difficult cases
 

Dear Laurie,

Thank you for your time in providing your insights. Find my comments inline below:

Case 3 (possible repeat thrush) - Try "laid back" positions if baby is willing, have mom make sure she is supporting baby and breast
throughout feed, treat for bacterial infection and take probiotics.

Laid back position has been tried for several days with no improvement. She is on probiotics as well. I have not yet suggested her antibiotics for bacterial infection. Find pictures of the moms breast in the link below (If posting a link to pictures violates any rules of lactnet do send me a gentle reminder please). Its pinkish but not flaky. her breast did respond to thrush treatment first time but not the second time. the white flakes like what you see in the picture is actually yogurt used for soreness which helps a bit. 

https://picasaweb.google.com/116981295021286182011/ClinicalLactationPictures?authuser=0&authkey=Gv1sRgCIXlyKnj4qPumAE&feat=directlink

Case 2 (premie now on bottle) try nipple shield and breast compression, notice if baby has airway symptoms or difficulty pacing feeds, experiment with positions where baby's airway is in best position (extension) and/or mom's breast not obstructing in any way.

Baby wont accept nipple shield at all. Does not like prone position. Does better on supine position and does not appreciate baby body turned to side as in normal tummy to tummy hold. Baby did have stridor which disappeared after lip tie release. Feeding stress visibly reduced after lip tie release. Baby now on bodywork called Reiki. 

Case 1 ( palatal torus) Perhaps return for more bodywork for baby and mom, both have been through quite alot. Assess/increase mom's supply
make sure it is adequate. Try laid back positions where baby is prone on mom. 


How do I assess milk supply. She refuses to pump or hand express and has a slow let down. This baby also does not like prone very much she likes to be on her right side turned towards mom not even the left. Will ask mom for more bodywork. Sadly she dint have a good experience with her first CST session. We have only one CST practioner in the city. Will have to suggest some other form of bodywork. Does Chiropractic help? What about Reiki.

Thank you so much for your time.


Yasmin
MA,HDSE,CLEC,LLLL,IBCLC
www.nourishandnurture.in
Mumbai


________________________________
 From: laurie wheeler <[log in to unmask]>
To: [log in to unmask] 
Cc: LACTNET <[log in to unmask]> 
Sent: Tuesday, 17 April 2012, 22:43
Subject: 3 difficult cases
 
Case 3 (possible repeat
 thrush) - Try "laid back" positions if baby is
willing, have mom make sure she is supporting baby and breast
throughout feed, treat for bacterial infection and take probiotics.

Case 2 (premie now on bottle) try nipple shield and breast
compression, notice if baby has airway symptoms or difficulty pacing
feeds, experiment with positions where baby's airway is in best
position (extension) and/or mom's breast not obstructing in any way.

Case 1 ( palatal torus) Perhaps return for more bodywork for baby and
mom, both have been through quite alot. Assess/increase mom's supply
make sure it is adequate. Try laid back positions where baby is prone
on mom.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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