Dear Nataliya,
Merry Christmas.
As you have noticed, not every suggestion works for every mother/baby pair 
in this situation.  How sad that mother would think she was a bad mother. I 
suspect that you are correct- the problem probably stems from the baby's 
discomfort with the mother's forceful milk ejection.   Baby may have become 
frightened if she was not able to breathe and nurse at the same time.  Four 
months is a prime time for breast refusal from this cause. If mother has 
been struggling with the baby for long periods, the baby may be terrified. 
Baby may also have associated pain from pressure of her vaccination sites 
with breastfeeding.  At this time the baby may also be experiencing 
discomfort from teething. I would suggest that she stop offering the breast 
for at least 3 days.  In the meantime, express her milk and offer it in a 
bottle, with baby almost sitting up, so baby has better control of the flow. 
If baby refuses a bottle from mother, someone else may have to offer it. 
Then, when she decides to introduce the breast again, suggest that she first 
express her milk until the flow is coming gently, have a bottle of her milk 
next to her,  then offer the breast to the baby. I'd suggest that mother be 
leaning back in a chair and baby be leaning foreward over her breast, if 
possible - or that she get herself and baby into this position immediately 
after the latch-on. Keep this a happy, playful time.  If baby refuses, 
smile, talk sweetly, offer the bottle, then try again.  Encourage mother to 
never struggle with the baby. Keep all feeds happy, playful with lots of 
smiles, kisses, encouraging words to baby.  I find that if mother talks 
calmly and encouragingly it not only calms the baby but also calms mother. 
If no improvement is seen in a reasonable length of time, I'd encourage 
mother to either give her expressed milk by bottle or, if this too is a 
problem, to wean. As sad as that would be, sometimes preserving the 
relationship is more important. This is my personal opinion.  It sounds like 
this mother, in her frustration, has been putting a lot of pressure on you 
to find a quick solution for her problem, which may not be possible. Be 
gentle with yourself.

Best wishes to you and this mother,
Anne Grider, IBCLC, Marietta, Georgia, USA 

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