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From:
Lyla Wolfenstein <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 16 May 2008 12:37:52 -0700
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greetings, i seem to be challenged with the complex pain cases lately.  here is our latest:

now 2 month old baby, saw us when baby was very new, and has seen us 3-4 times since.  at first, baby VERY "tight"  in the gums - born by c-section, full tongue mobility, no posterior or submucousal tongue tie, normal palate.  mom came for pain - no damage, but significant compression after unlatching.  i was able to help mom get pain level 0, but there was still some compression, and mom wasn't able to duplicate painfree latch at home.  when she came back in, i was unable to get it lower than a 4.  after many weeks of struggling, 3 cst visits (significant release from the CST, but chiro says now nothing more to do, but says still "tight" in one side of hte neck and to rub it and help stretch it..) and finally, a week resting the nipples and pumping and bottle feeding (using appropriate bottle technique and nipple), she was pain free after the week of healing (derm had prescribed cortizone and she's been using APNO too) - she restarted nursing and it was pain free for the first few feedings *during* feeding - but significant compression and burning after.  

mom came in today, having just been resting the nipples again for a few days, and pumping - we latched the baby on - *perfect assymetric latch* - wide angle at junction of lips, chin buried in breast, nose tilted slightly away, nipple tipped up toward nose (and aligned with nose before latch) - perfect.  pretty comfortable nursing too - BUT tremendous compression along the horizontal plane (striped the same way as the lips were angled.)  she was confident that if she nursed like that a few times, the nursing would be painful soon, based on experience.  nipples look pink-ish and inflamed, but there are really no yeast/vasospasm symptoms, other than the pain - and given the tremendous compression it seems like looking for zebras when the horse is right there.... inlike my client with NO compression but significant pain.

we tried a shield - and baby latched initially - sort of - baby really wouldn't open wide for the shield and didn't seem to like the feel in the mouth, and seemed frustrated with the flow rate with the shield on.  the smaller shield worked a little better, actually than the large one, but baby still had a "clampy" latch and came on and off and then refused to nurse really with it there.  bare breast immediately comforted baby, and baby nursed well again (but compressed nipple).  milk transfer is excellent - no sign of OALD - tranferred 42 cc on the first breast in about 5 minutes or so, baby managed flow well, etc.  

so my primary questions are:

 - why would a baby do so poorly with a shield?  mom found it much more comfortable, and as much as i don't like using shields for pain, we all thought this might b e a good temporary solution...
 - would a different CST practitioner by possibly able to go "further" with the "release" and get things more comfortable?
 - would a different body work modality work better for such a baby - a textbook latch but something *invisible* going on in baby's mouth after latching (sucking on my finger didn't bring out any glaring challenges...but who could do a more involved suck assessment....?
 - what about an SLP?  i have a call into one - are there specific treatments/assessments i should ask about to assess her skill with breastfeeding issues?
 - any other ideas for suck training, tongue training or what else could be causing this compression?  baby led latch yielded no better result, and mom is NOT touching baby's head or making any of the common mistakes.  

thanks!

Lyla
 


Lyla Wolfenstein, B.S., IBCLC, RLC
Owner, Lactation Consultant, Parent Educator

  

Zenana Spa & Wellness Center, LLC and  Beyond Birth Lactation Services
503.238.mama (6262) or 504.232.baby (2229)
mobile  503.754.2718  fax 503.473-8047 
email [log in to unmask] 
web www.BeyondBirthServices.com and www.Zenana-Spa.com

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