Hello all,
I have permission to post by a mother I have been working with, and I would welcome your suggestions. Her baby was born October 12th at 39 weeks. She was induced after her water broke. Reports hard labor but otherwise baby was said to be healthy. No additional interventions at birth. She is currently pumping and feeding only her ebm by bottle because breastfeeding has been painful since birth. A nipple shield was introduced on the baby's second day of life, but mother reports pain even with the shield. I saw her on DOL 5 but was unable to help her to resolve the nipple pain with latch (encouraging wide gape, trying laid back/biological nurturing, ridging breast). Nipples were cracked and painful so mother decided to take a break from direct breastfeeding and pump for a day to allow time for nipples to heal. When she resumed breastfeeding latch was still painful. She was able to achieve a comfortable latch only once at home, however she reports the baby couldn't keep milk in her mouth and milk went everywhere. She continued to focus on offering only the breast, and reports baby was fussy, seemed unsatisfied and wanted to nurse constantly. In addition she developed a plugged duct and mild fever. As a result she went back to just pumping and feeding and reports fussiness stopped and baby was eating and sleeping regularly. I was only able to examine the baby's mounth and tongue briefly, and I suspected she could have a short frenulum. The pediatrician (who is supportive of breastfeeding and will assess and clip frenulums if needed) said the tongue looked fine. I spoke to her on the phone recently and she states she tried again to only breastfeed, baby again was fussy constantly, latch uncomfortable, and breasts became engorged. 
Baby obviously has trouble latching and transferring milk on her own. Mother's milk supply is adequate and baby's intake is appropriate, and ouput and weight gain is normal. Mother is very frustrated, really wanted to and was looking forward to breastfeeding, but when we last spoke said she was just going to pump and feed. I am suspicious of the milk spilling out with the comfortable latch, and the engorged breasts and fussy baby when trying to only breastfeed, but am at a loss for what else to recommend she do/try. Any suggestions to help improve this relationship would be greatly appreciated.
Thank you,

Samantha Slaughter, IBCLC
Yolo County WIC Program
Northern California

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