Tricia

This certainly sounds like a difficult combination of 
circumstances.  Bubble palates can make latching especially difficult 
if the mother has short/flat nipples.   If there are still scanty 
quantities of colostrum then I'd continue hand-expressing (often!) 
and feeding by spoon/syringe while continuing calming techniques for 
the baby and further efforts at latching.  Specifically, if the 
areola remains stretchy, you could perhaps show the mother how to 
latch using the tea-cup technique, ie by "putting" the nipple right 
up into the bubble palate  where the infant can feel it and then 
letting go of the "handle" of areolar skin you've created when you 
feel the tug that tells you the baby has latched and drawn in the 
nipple/areolar tissue...  However,  if the mother's milk has started 
coming in in any quantity, then I'd consider using a nipple shield to 
assist latching and keep baby on the breast - perhaps using the 
pacifier to calm the baby while getting him into position, then 
whipping it out and substituting with the shield...  You can always 
plan to wean the baby off the shield when he's realized that 
starvation is not imminent, os obtaining nice large quantities of 
milk and has calmed down a bit - anywhere from a few hours to a few 
weeks, IME...

Good luck in this challenging situation and keep us posted!

Pamela Morrison IBCLC
Rustington, England
----------------------------------------
Date:    Sun, 16 Feb 2014 09:19:44 -0800
From:    Tricia Shamblin <[log in to unmask]>
Subject: help for mother with infant with bubble palate/fibrocystic 
breasts/flat nipples

Hello Lactnetters, I have a case that I'm really having trouble with 
and hoping you can help me. I have a mother who is having a great 
deal of difficulty with breastfeeding and wondering if anyone has any 
thoughts or suggestions. This is a very nice couple who had planned a 
homebirth with their first baby, but then decided to switch to a 
hospital birth due to mother's having thromocytopenia.... ...... I've 
only ever seen him get on for a minute, then lose suction and pull 
away distressed. Now he's very distressed and arches away whenever we 
bring him near the breast. I'm finding little info on high/bubble 
palates, and very few suggestions other than getting the breast 
deeply into the mouth. Any other suggestions would be welcome. 
Parents are very committed to breastfeeding. Getting the breast in 
deeply may be especially problematic because mother has small, 
fibrocystic breasts. So to recap: High bubble palate Fibrocystic 
breasts Rusty pipe syndrome Flat nipples Any thoughts or suggestions 
would be greatly appreciated. Thank you so much. Tricia Shamblin, Rn, IBCLC


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