I just made a home visit on an extraordinary mom - Her living situation is
horrid (NO visible food or even cooking appliances, I asked if she had
enough food, and she said yes, but we don't have a good enough relationship
yet, so the Public Health Nurse will be making "weight check" home visits to
try to establish rapport), she's VERY shy and quiet and only got help
because the Home Health Nurse who was unable to get baby to breastfeed and
sent the referral.  As domestic violence is rampant in our population, it's 
hard to tell if she was being guarded with her answers (very slow to reply,
hard to read her facial expressions) due to her undocumented status, fear of
the father's reactions to her opening up to us, postpartum stress and blues,
her normal pace and pattern, or that she's actually slow.

Mom has been using a Medela hand pump and supplying baby breast milk
exclusively, no one in hospital was able to get the baby to breastfeed.  I
found the baby with a "moderate" tongue tie and a VERY HIGH palate.  As
mom's breasts (now 8 days pp) are very pliable and flexible - the "silly
putty" type of tissue, I was able to get baby to take the breast deeply
enough that I observed good suck-swallow patterns on the right breast.
However, her left nipple is inverted (the "let's form a dimple when baby
latches on" kind).  I was able to get baby on only with a nipple shield, and left
mom with instructions to pump after every feeding.  WIC is arranging an
electric breast pump as I think she will need to maintain an "oversupply" in
order to have enough for baby to get it.

Question:
Have you ever been successful with babies with very high palates?  NONE of
the ones I've worked with have done well.  I've had great luck with babies
with moderate and even bad tongue tie if mom has this type of breast.  I'm
hoping that using the breast pump after feeds will be enough.  Any other
ideas?

(There is NO MD or dentist in the county who will clip, so I refer moms to
out-of-county people, but as my moms are low income, if MediCal won't cover
it, they can't afford it - and MediCal will not cover out of county
services.)

However, I don't think the problem here is the tongue as much as the high palate 
which will prevent good breast compressions...

Jeanette Panchula, BSW, RN, IBCLC

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