I am a birth and postpartum doula but a recent client's situation has me
stumped.
G1P1 woman gave birth to a boy, 7# even, at 40wks exactly, vaginal, no
complications, epidural @ complete dilation, pushed for 1.5 hours, only had
2 bags of IV fluids, did have 5 hours of Pit after SROM w/ no ctx. I helped
with baby's first contact at breast - made hunger cues at about 45 minutes
old - lip smacking, tongue thrusting, etc. Baby very alert for the
following hour. Mother has very large areolas (7-8cm), tiny nipple that
everts only slightly - somewhat large breasts. Brings baby to breast and he
opens very wide to latch, but won't suck. Tried several different positions
albeit with 'helpful' nurse looming over our shoulder wondering if he'd
latched 'yet!' Hand expressed drops of colostrum onto nipple and he eagerly
licked off but would not latch and suck. The colostrum is plentiful and
very easily expressed - totalled about 15-20 drops between both breasts in
about 30 minutes. He looked rather satisfied afterward too. The nurse was
baffled at how to chart 'licked 15-20 drops of colostrum off breast...'
In the following days, he still hasn't latched on well, but weight loss has
been minimal. At home on Day 3, breasts are VERY full, palpate milk in
both, but nipple is now flattened out and baby just won't latch, despite
help with positioning. Helpful neighbor brought client a pump and SNS which
has worked for now. I have strongly suggested she consult with an LC, but
she feels she can just pump and use SNS (with EBM) at breast until his mouth
grows :(. He gets very frustrated with trying to latch on and trying
different positions and holds of the breast to help him grasp as much of the
areola as possible. As mom says, "he just knows it's not going to fit and
he's trying to tell us."
When we did hand expression (both immediately pp and just this afternoon) I
noticed the most milk squirts out when we're pretty far back on the areola.
This baby's mouth is so tiny, I can't see him getting enough breast in his
mouth to compress the milk sinuses. I just know a more experienced person
(an IBCLC) could figure out a solution to this issue of mom's large areola
and baby's tiny mouth. Any ideas? I tried searching LactNet already but
"small mouth" and "baby won't suck" didn't yield any results.
TIA!
Lanell
_______________________________________
Lanell Coultas - CD (DONA)
DONA State Representative - TEXAS
Birth & Postpartum Doula Care
(512) 459-3088 * Austin, TX
http://www.lanellcoultas.com
_______________________________________
"Ask the woman; she will tell you everything you need to know."
-Ina May Gaskin
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