She has a right to her feelings -- this has been a long road. Sometimes
it helps a little feel that she's on some common ground -- *everybody*
in the early weeks of breastfeeding is figuring out how they "fit"
together -- mothers are built a lot of different ways, and babies have a
lot of variation in their oral anatomy. And some combinations of mother
and baby can add up to a trickier.fit to work out.
Even with the tongue-tie clipped, the baby may still have a high palate
or a less mobile tongue, and thus need to draw in a big mouthful of
breast tissue. Yet the longer-than-average nipple and the baby's
sensitive gag may make that difficult right now. Babies get bigger
every day, and the lower jaw grows forward a lot across the early
months. So maybe you can talk with her about some ways to buy this baby
some time. One approach might be really focusing on the pumping for
milk removal, and continuing to offer the breast as "dessert" and for
comfort between feeds -- to keep the baby enjoying the breast and to
keep experimenting with the latch, perhaps a exaggerated assymetrical
approach. It's good that she's listening for the swallowing.
The largest nipple shield certainly seem worth experimenting with, since
it would give a clear oral signal for the baby to organize around, and
would go far enough to trigger the suck, but no further.
I'm assuming she's experimented with larger flanges, or the Pumpin' Pals
shape?. Maybe the baby is having difficulty milking the breast because
the "sweet spot" is further back away from the nipple, so maybe the
larger flanges would be more productive.
If someone is trying to fit a lot of pumping into an already-full day,
and the milk is going to be used within the day, sometimes the mother
will not take the pump apart each time -- just take the pumps off the
tubes, put them in a baggie in the fridge, so it's easy to just grab
them and wedge in a pumping session whenever. Every 6 hours or so, every
2-3 pumps, the kit is disassembled and washed and left to dry, before
being reassembled for the next stint.. Maybe sterilize once a day.
The exact timing of the pumps is less important than the number of milk
removals. Acknowledge that it's tempting to wait longer between pumps
because more milk will have accumulated. And yes, maybe one longer
stretch of rest at night will make it possible for her to stay in this
game long enough for it to unfold. But (warning: extended metaphor
ahead) if we're trying to get the factory to pick up production, we
can't have inventory sitting on the shelves. We have to get across the
idea that "the product is selling" -- even if it wasn't a huge shipment
out of the warehouse, the production manager only sees that the shelves
are empty.
A hands-free rig, purchased or home-made, also helps make the pumping
more manageable, since she can multitask it onto holding the baby or
eating her lunch. I've known mothers who were so exhausted that they
put the flanges on hands-free and lean forward into some pillows piled
on a desk to get some rest.
She's now got the baby gaining well, and it sounds like the baby is
happy enough to take the breast. This hand-out can sometimes be good
for morale, since some of these stories are babies who are not even
willing to latch:
http://www.normalfed.com/Help/babyget.html
Yes the baby is having difficulty transferring milk (and may need to
grow into the job), but her efforts to build supply, such as trying the
domperidone, will make the baby's job easier. So maybe that could be
the current focus.
Margaret Wills, IBCLC, Maryland
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