A friend of a friend (both Certified Professional Midwives) called me about an Amish client of hers this week. Rather, the husband initially called me from the neighbor's barn.
 
Regardless, there is such bad nipple trauma that the nipple does appear to be about to fall off. (via cell phone pic from the CPM today). The base of the nipple appears 75% detatched at the areola, as though it is all about to slough. I plan on going to see them tomorrow. Please share any thoughts you might have.
 
The baby was severely tounge-tied, per the CPM. The FOB clipped it himself (at 1 day of life), rather than pay the $250 it would have cost them to go to a ped. The baby is now 4 weeks old, and gaining weight, but the mother has these severly traumatized nipples. The CPM feels that the baby is latching appropriately, but admits that she and her fellow CPM rarely deal with nursing issues. The mother has been trying a shield (which is making me nervous-because it is a brand I have never heard of, and none of these people are well versed in sheilds) which apparently the baby doesn't like. The mother has been applying milk to the nipple and allowing it to air dry, and she states that this does help it stay together. BUT that when the baby starts to nurse it pulls it back apart and causes excruciating pain. 
 
There are a number of issues here, including that this family may or may not want to use medications and the lack of electricity and refridgeration. I understand that the barn has electricity and that renting a pump to pump while the nipples heal may not be out of the question. 
 
From what I have seen in pictures and heard on the phone, I feel that it is likely that there is a continued tounge tie and/or an improper latch of some kind. 
 
Anyone have anything furthur to add? This family lives far out in the country, and expenses are a big concern, and travel a barrier as well. 




      

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