Hi all, I am looking for help with a current, difficult clinical case. I
will try to make this brief; Mom and baby are currently 4 wks. post repeat
C/S. This is Mom's third baby in 3 yrs, I consulted with her for her first 2
as well, with problems r/t sl. inverted nipples (ie. center of nipple
dimples in but there is graspable nipple tissue) , the first baby had slight
probs with latch but resolved quickly, 2nd latched fine, both had issues with
wt. gain which required constant monitoring and supplements over time. THIS
baby will not latch, hasn't latched since delivery, mom has been cup feeding
per my instruction since 1 wk. of age, interestingly has plenty of pumped
milk. I was called to see this baby at 1 wk of age by the visiting nurse d/t
1lb. wt loss, 6oz since d/c on day 5. Mom had been given a nipple shield in
the hospital by the LC. As I noted on my visit the same day, the baby wasn't
sucking hard enough on the nipple to latch thus wasn't sucking hard enough on
the shield to allow milk transfer of any consequential amt. Needless to say,
we abandoned the shield but despite my efforts over long periods and mom's we
have not been able to facilitate a latch, she will suck if the nipple is
placed far enough back in her mouth with help there to prevent retraction but
not sustained enough to "hold it" in place. She and Mom have become very
adept at using the cup; total pumping/feeding time 45mins! Because I was
somewhat worried about the lack of sucking and because I ran out of ideas. I
helped Mom to arrange a "wet nursing" type session with another nursing mom ,
a few days ago, with the hope that we could latch the baby to the "donor"
Mom's breast and quickly transfer to her Mom. The baby latched pretty quickly
to the donor but didn't to her Mom, despite repeated attempts. Her mom was
disappointed but felt encouraged that she could "do it", she too had been
concerned about the lack of nutritive sucking. Mom decided to give it another
week of trying. The baby has gained well on cup fds. is probably around 91/2-1
0lbs at this point.
Sorry about the length, tried to keep it as brief as possible. Any ideas
would be greatly appreciated!
Lynn Shea Rn, Bsn, Ibclc........from Franklin, Massachusetts, 25 miles SW
Boston
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