anne,
i helped a first time (teen) mom in the del. room yesterday. her baby
seemed nipple confused! she would do as you describe, <<infant gapes
widely, latches on, comes off, shakes his/her head back and forth as if
searching for the nipple, latches well again, soon comes off, and
repeats this over and over>> except this baby didn't gape real wide.
After several attempts, she did latch and nurse well. the mother
de-latched her to cover up to let grandpa visit (against my gentle
advice to let the baby finish, I covered the mom), but thankfully did go
back on to the breast a good long time. The baby even left a little
bruise after a couple minutes first fdg. I don't know the answer,
however I use the "desert island" scenario, i.e. what would we do if we
were on a desert(ed) - not to be confused with desserted i.e. chocolate
- island: we have to feed thisbaby who won't latch and we have no
bottles nor abm. what do we do? we express milk frequently, feed to baby
dripped in or with finger, kang care, and keep trying; tincture of time
usually works if no other unnecessary interventions interfere and mom is
able to express reasonable amts colostrum. I would try this 24-48 hrs
with cont. bedding in if I had my druthers, but alas hosp routines, etc
most always intervene. After 24 to 48 hrs, I would bring out alternate
fdg if baby no closer to latching or even nipple shield if breast/nipple
anatomy seem they would benefit.
Now, I want to add, that in del. room with first bf, I like to let the
baby do the natural thing and I don't want to interfere much, except for
proper positoning. So if baby is not opening as wide as I think maybe he
should, I usually just let it go. What would you wise ones do? Perhaps
the little bruise could have been prevented. I don't like the even
gentle pressure on the chin at these early times (if ever - this has
been discussed). And yes, the mom had an epidural, gest. diabletes
mangaged with diet, no other pertinent hx I am aware of.
Comments? I never stop learning from all of you.

Laurie Wheeler, RN, MN, IBCLC
Hosp LC
Louisiana Breastfeeding MediaWatch Campaign
Violet Louisiana, USA
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