Greetings,
I could use some insight into a recent client, with whom i have a follow-up
visit this week.
2nd Baby, nursing problems the first time (pain and mastitis) that
persisted for 9 weeks, but mom went on to nurse first baby for nearly 3
years. This baby (now 3 weeks old) is gaining great, mom has abundant
supply (transfers 60 cc in less than 10 minutes on one breast, and another
60 on the other, with no problem) and can eject across the room with hand
expression.
Mom experienced pain right away with this baby, which was ameliorated by
latch adjustments using rebecca glover's "follow me mum" technique, which
mom and baby both took to beautifully. Pain improved for 24-48 hours, and
then returned, although now mom described a "chewing" feeling, rather than
the toe-curling latch-on pain she had experienced in the beginning.
I returned for a follow up visit, and we refined the latch a bit. mom felt
the chewing happened with let-down, and we agreed that it might be a
defensive reaction to OALD/oversupply. The new plan was to manage flow
with a variety of standard techniques, focus on getting a great latch, and
see how things go.
Again things improved for 24 hours and then got much worse. She called me
saying the chewing had spread to "all the time" and the baby also wanted to
nurse all the time all of a sudden, and often, wouldn't even be latched on
with any suction, but just sitting there nibbling (and would slide down to
a shallow position if latched deeply to begin with.)
I did check lingual frenulum, which appears normal, as did digital suck,
but i have yet to check superior labial frenulum (where mom is now
reporting the chewing sensation.) I mentioned that I would check at our
next visit, and she immediately confirmed that it was "very attached."
So, I am going tomorrow, and wondering:
I reviewed the posts in the archives regarding labial frenulums (frenuli?)
and the common denominator does appear to be a "chewing" sensation. What I
cannot find a great deal of info on is the procedure to clip it. Is it as
straightforward as a lingual frenotomy? Will most ENTs who clip lingual
frenulum be willing and able to clip a labial frenulum? i do have brian
palmer's presentation on my laptop to show her, but there is only one slide
of a labial frenulum in it. I have evelyn jain's video, but have not
viewed it in a while and i don't think there is a labial frenotomy in
it. Any peer reviewed articles to share with this family and possibly
their HCP regarding this issue, if we do decide that is the problem.
other suggestions welcome as well!
Thanks!
Lyla Wolfenstein, B.S., IBCLC, RLC
[log in to unmask]
www.beyondbirthservices.com and www.earlyattachments.com
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
