Hi all,

I came across a baby who is really frustrating me as well as her  mother.
Mom gave permission for me to post.

Hx: Mom...37 year old prime, 3 hour prostaglandin induced labor,
intrathecal for last 30 min of labor, no vigorous suctioning of neonate at
birth.  Very sore nipples (read on to find out why!!)

Baby...Full term female, 6lbs 4 oz almost 24 hours old. is sleepy, but will
eventaully rouse to feed.  Will root and partially open mouth and accept
nipple and begin to suck.  The problem here is the partial opening.  If
baby opens wide enough for better latch, she gags with nipple placement and
readjusts the placement to her liking (near the front of the mouth).

Mom reports that "all the ultrasounds showed baby sucking on her fingers"
Why all the ultrasounds you ask???  Mom is an OB doc, so some were "done
for fun" but near the end of the pregnancy her MD felt baby was slowing
down in growth.

Could finger sucking in uetero cause a tight latch?  And why gag
reflex....same reason??

So far I have gone over with mom what a "good latch" is...on the rare
occasion that baby latches well mom was able to verbalize that it felt
good.  Also showed her how to work with baby to encourage wide open mouth
and took suggestion from a LLL book that discussed "walking the tounge"
down (I think that was the term)  Also at this point mom is unable to
tolerate the poor latch and so she pumps after trying to get baby to breast
with out sucess...I went over options with mom re feeding while she works
with baby to obtain better latch...she was most comfortable with using a
wide base nipple and trying to simulate the wide open mouth (mom was
relieved when she saw that baby also approached the bottle in the same
fashion....I think  she believed it was her causing the problem).  I also
dicsussed healing techniques for her already damaged nipples.

what else could I do here????



          Thanks       Lori Peters RN IBCLC