Any Ideas would be appreciated to aid the latch of a 7 week old girl,
full term, 9lbs.,11oz, precipitous delivery after long pushing stage in
birthing certer, no epidural, transient tachypnea at 24 hours, transported to
NICU and given oxygen thru nasal cannula and suctioned (lightly?), no
intubation, kept 36 hours then sent home weighing 9 lbs., 1 oz. At that
point, baby refused to feed so mother pumped and fed pumped milk to baby with
syringe for 24 hours. Then baby began to show signs of wanting to nurse but
it was impossible to get baby to open wide for latch and baby insisted on
curling bottom lip in.  No frenulum problems and palate normal. Mother tried
everyting I suggested to get baby to latch better. Extremely sore nipples.
Suck training ala Chele Marmet techniques did not help.  Mother persisted
despite soreness and lack of stools.  Plenty of wet diapers.  Extremely
supportive ped said baby was healthy and well hydrated and to continue
nursing despite weight dropping to 8 lbs.1 oz at its lowest (on my digital
scale).  At 16 days and no stool since meconium ped suggested 4 oz ABM in
bottle once a day.  Mother used feeding device with 1 oz at 4 feeds instead.
Quickly went to 26 oz of ABM, mostly in lactation device with occasional
bottle and weight began to rise.  Mother spent time talking with Jimmie Avery
about lactation device about what to expect.  Baby began to feed constantly
and fall asleep at the breast shortly after latch (still shallow and with lip
curled in) and whenever mother attempted to detach baby would act hungry and
frantic.  This would go on for most of day. Now getting about 20 oz of ABM
via lactation device, about 7 times a day and occasional bottle. (Mother
always pumped when a bottle was given.) This is down from a high of 28 oz. so
I interpret that to mean baby is getting more breast milk.  Some good days,
many days bad. Baby can now open wide for latch but frequently won't unless
crying, weighs 10 lbs 15 oz, and mother fears she can't keep this up. Wonders
what it is doing to her relationship with baby to constantly put her on and
then take her off to try to get a better latch. Often mother puts up with
less than ideal latch rather than frustrate baby. I'm so impressed with this
mother's determination. Saw speech therapist Ann Toolajian last week and it
came out that mother has TMJ which Ann thinks baby has. (Plan to put question
about TMJ on my history form!) Did some cranio-sacral work and have joint
apt. with Ann and John Chappel, PT but not until next week.
        First child, now 2, born after long labor with epidural, and vacuum
extration had horrible suck problem and mother pumped for several months so
baby (boy) only got pumped breast milk despite many trips to LC. Mother
atended LLL all through pregnancy and is really dedicated to getting
breastfeeding to work.
        Mother, this week, developed a cystocele and is supposed to be doing
bladder retraining involving urinating every hour for a week, then every hour
and a half for the next week and then every 2 hours for the duration to avoid
infection.  Seems to be controversy between docs over whether kegels will
help.  Mother already feels there is no time in her day for her 2 year old
and newborn (who is nursing constantly) and now she has this added dilema.
        Any suggestions to improve the latch that I haven't thought of?
        TIA for your collective wisdom.
Gerri, IBCLC in central NJ

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