Okay--
I have my first case-history to ask about on LACTNET...
I have been trying to "unofficially" (because my malpractice isn't in effect
until
Feb 1) help out a mom from my church [along with her "bf friendly"
pediatrician who has only been weighing him once a week:( ] for the past 6
1/2 weeks. She has given permission for my post.
Mom's first baby (42 y/o)--baby was 37 weeks, and mom was induced for his
presumed large size. (Turned out to be 8-15.) She had truly inverted
nipples (Left>right)--looked great until baby tried to latch--then
disappeared. Failed the pinch test. A colleague saw them in the hospital,
and called me to warn me they were having trouble getting him latched--he
never did get onto the left side before discharge at 48 hours. She also had
the impression that he would "clamp down" in an effort to keep the nipple
from pulling out of his mouth. They were sent home with a hand pump to help
"draw out" the nipple.
I was contacted at 4 days--still never latched to left, and poor latch on
right--very shallow--poor supply--no bms--mom's nipples very sore. Rested
nipples, started pumping and finger-feeding. Used inverted syringe to pull
nipples out for each feeding--could get him to latch deeply more and more
often over the next several days...but then he would "slip" down on nipple
later in the feeding. We tried an SNS, but mom didn't like it. Had a pp
doula go over several times over the next 3 weeks (for 4 hours at a time) and
worked with mom on insisting he have a good latch. (Mom has a high pain
tolerence, tends to "settle" for a shallow latch) One of those days we tried
a "rebirthing", or at least my understanding of it. Mom and baby in tub,
lounged around, and latched when baby interested. He did well on Left in
there(his "bad" side at the time) because mom is left-handed, and we couldn't
get her as comfortable holding him on right. That was the turning point.
SInce THEN, he prefers the LEFT! (Or else mom does,subconciously?? Not
sure.)
SO- he took 5 weeks to regain his bwt. (He initially lost 15%) He gained and
lost in a see-saw fashion as we increased and decreased his supplementation.
He is now 6 weeks-3 days and is 9-10. I saw them last week and was
discouraged to find that his little jaw is clamped tighter than ever...it
seems it has gradually gotten worse; we cannot seem to persuade him to open
wide to latch anymore. Now that we finally have a digital scale at our new
center, I had her bring him in for a pre/post weight on Friday after mom had
been pumping more frequently ( getting 2 1/2 oz at a time) for several days,
but he only got 26ml from both breasts in 40 minutes of vigorous sucking,
with mouth not appearing to be open wide enough. (And I could see that he
was only swallowing with let-downs) Mom says she is "a little" sore, and no
damage is visible.
It seems to me that he has gotten really good at finger-feeding, and likes to
have his mouth open about that much, so is not transferring milk effectively.
We have tried:
more cobathing, "open wide" said by mother with positive verbal
reinforcement, placing finger farther back in his mouth for finger-feedings,
and fenugreek. Friday I was running out of ideas, but can't help thinking
that the finger-feeding is no longer a "good thing" for this particular
guy--so had them start using a Haberman, demonstrating how far they need to
get his mouth over the "big" part. It took some doing, but we got his gums
just over the thick portion. I have asked them to continue to try and place
it gradually farther back into his mouth, and vary the flow to simulate a
breastfeed.
My only other thought as I watched/felt this "tight" little guy would be CST,
but I don't know how to find a "reputable" therapist in our city...and he
wasn't "tight" from birth...it seems he initially "learned to" clamp down to
try and keep the nipples in his mouth...or maybe he STILL feels he needs to
do that--it's really hard to say just what her nipples do once he latches.
They don't appear to retract with pinching anymore.
Okay, wise ones...any thoughts? (Sorry so long)
Kathy Leeper, MD, IBCLC
Medical Director
MilkWorks
A non-profit Corporation providing breastfeeding education, consultation and
support in Lincoln, NE...opening Feb 1st!!
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
