Hello Friends -
My client has given permission to post.
I am working with a mom of a 3.5 week old. 1st consult was at 3 days (LII), mom found latching unbearable, described as 10/10. Latch was very shallow, baby clamping, mom engorged, mastitis starting. Very large hard breasts. Oral exam showed mild PTT and labial frenulum. Baby not waking alot, and when awake frantic. I had the impression babe had not been at breast much due to pain and when there, not very effective. We tried laid-back positioning with baby prone and diagonal on mom, rolled towel under breasts, baby-led with minimal assistance from mom. Baby still barely opening and clamping once on. Still unbearable for mom. So we tried more upright, more assisted latching. Same results. Had mom begin regularly removing milk and feeding using alternative methods. They did not like the cup, so we settled on finger feeding with a tube. Encouraged mom to continue to try occasionally, suggested 2 options: 1. Frenectomies ASAP and continue to improve technique or 2. wait for frenectomy to see if things improved with technique alone and giving babe a chance to come off epidural. parents decided frenectomy right away.
A few days later, with softening breasts, mom was able to achieve a tolerable latch using an upright saddle hold. pain was 6/10 Both lingual and labial frenulums clipped at 2 weeks, stretching protocol followed. Mom reported immediate improvement, pain down to 1-2/10, baby now fed almost 100% at breast, with occasional finger feedings of EBM. Mom has an abundant supply and fast MER.
Follow up consult today, babe is now 3.5 weeks old, 100% fed at breast, with mom's pain level still 1-2/10. Babe is gaining quite well, lots of full diapers. Babe feeds every 3 hours, taking about an hour, on and off, then is satisfied for another 3 hours or so. The biggest problem is that mom is feeding in a position that is exhaustive for her. Bolt upright, babe is in saddle hold on one side, cross-cradle on the other. Mom is lifting her large heavy breasts way up high, holding them there throughout the feed. Again today, I tried laid-back positioning for her, but babe only got onto the nipple, not opening wide. Breasts at this point are very large, pedulous, and VERY soft (like big fluffy pillows). It is as though babe just sinks into them, getting burried, rather than being stimulated to open. It is almost as though when the chin connects with the breast, it is so soft it does not signal babe to open. Is this possible? Today, the best I could do for her is to tuck pillows in after she latched her babe on, to support some of the weight, while she is using this really awkward upright positioning that honestly is painful just look at. What else can I do? What works well with very large, penulous, very soft breasts? I'm a bit stumped here and would appreciate some voices of experience!
Thanks!
Jennifer Welch, IBCLC (2010), LLLL (2006)
Montreal, QC Canada
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