Thought you'd be interested in an unusual case. Mom is a 40 yr old primip
who had a complicated delivery with long pushing stage and eventual foceps
delivery. Baby girl born close to term with two of the largest
cephlahematomas I've ever seen on the back of her head, and foceps bruises
on the TMJ. Her tongue was partially paralyzed, and there was a droop to
half her face when I first saw her about 2 weeks after the birth. Baby was
bottle feeding pumped milk when I saw her. Mom had damaged bladder and was
in a lot of pain and extrememly depressed.
The plan I set in motion was to protect the milk supply and keep baby on
exclusive human milk feeds. Baby was to be fed using an avent bottle teat
to help her tone her lips and to help her tongue groove. A gel filled
Playtex pacifier was used to provide NNS exercise for her mouth and to keep
her using her facial muscles. I showed mom how to use a newborn small size
nipple shield to coax baby to breast, and even tho baby was only able to
manage a few weak sucks, she did do that much. Mom was thrilled, and agreed
to put baby to breast a few times a day to keep her oriented to the breast.
Mom has required a lot of emotional support and I went back by to do some
Holistic touch therapy on her as a relaxation aid. (I don't charge for
that).
It has been a roller coaster ride. Baby has gained beautifully, the bruises
are fading, hematomas resolving with no calcifications, and neurologist
feels uncertain if he's still seeing any droop. The tongue is working --
lateralization to both sides, central groove visable around bottle and
pacifier, and for the past week there have been a few good sessions at
breast with baby sucking for a few min. I went by yest. to visit and take
some pictures, and suggested we do a nursing attempt. Using the bottle at
breast to calm baby, we got her in the position, and she latched, sucked
rhythmically for 20 min. and took in (by test weight) 48 ml directly from
the first breast. She needed to be coaxed on to the 2nd breast, but took it
and fell asleep nursing. A call later in the day confirmed that she'd
continued to feed effectively the rest of the afternoon and evening.
So again, tell mothers that no matter what, just keep working with whatever
skills the baby has. Remind the mother that sucking is physical therapy for
the oral structures. If baby is too weak to nurse, start on other tools
which encourage sucking. As babies recover, they can go to breast providing
there is available milk, and providing some contact with the breast has been
maintained even if it is just token nursing. If you quit too soon, you miss
the miracle.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
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