Permission from mom to post her story in hopes someone will have answers:
30yo G3P2 Mom: 
"The only possible trauma I can think of is that Caroline was OP, and it took a heck of a long time to push her out.  My labor was average length -- 16 hours if you count the regular contractions I had the night before, but only about 7 hours if you count from the time I woke up and started feeling the really intense ones.  It was all back labor, and the pushing lasted over 2 hours and completely sucked.  But other than that, nothing unusual.  Oh, and the labor was natural, so there were no drugs to make her groggy, etc.  DH says he doesn't think they suctioned her mouth at all.  
Caroline was 8 lb. 14 oz. at birth and lost down to 7 lb. 8 oz. by the time she was about a week and a half old.  I tried to nurse her immediately after birth, before she was even cleaned up, but she wasn't very interested.  She did latch on and nurse a few minutes later -- maybe 15-30 minutes after she was born.  She seemed to be nursing well and passed lots of meconium the first couple of days.  The second night in the hospital was a nonstop nursing session, and I eventually broke down out of exhaustion and gave her a pacifier, which was supposed to be one of those "okay for breastfeeding" ones, but we later figured out it probably gave her nipple confusion.  I'll get to that in a minute.
 She was born on Friday afternoon, and my milk came in Sunday night after we got home from the hospital, causing Incredible Hulk boobs -- you know, the ones that bust out of clothing, popping buttons across the room, etc!  I was using warm compresses to try to soften my breasts before feeding because they had gotten so big and hard and scary and because I already knew that Caroline's latch was shallower than it should be, and the nipple flattening from the engorgement wasn't going to help that.  I was also having some problems with her not wanting to latch.  She would just root and thrash and fuss and throw her head from side to side never latch on, which I guess was nipple confusion from the pacifier.  I eventually got her latched on, but once I finally got her to take the nipple, I was reluctant to take her off, so I probably let her get away with some bad latches just because I was so thankful that she had finally latched on at all.
I noticed a dramatic decrease in dirty diapers the day after we got home (Monday), and by the time we took her to the doctor on Tuesday to get her checked out by her regular pediatrician, she hadn't had a dirty diaper in over 24 hours.  I saw a LC on Thursday, and that's when we discovered that she wasn't getting much of anything from me.  After nursing for over an hour while doing compressions + pumping the other breast & feeding what we got with a syringe, she had gotten less than 1/2 oz (we also tried a nipple shield at that appointment, but it didn't seem to make a difference).  By that point, my supply had decreased quite a bit, so I started doing the herbs and stuff to try to get it back up.  I also started taking the Metformin I had left over from before I got pregnant, but I ran out of that the other day and need to get my endo to Rx a refill.  In the meantime, we've been supplementing -- first with breastmilk and/or formula in a syringe or starter SNS, and now with strictly breastmilk (mine if I can pump it, but if not, I use donated milk) in the Lact-Aid.
The main issues, as far as we can tell, are a shallow latch and a weak suck.  The latch has improved somewhat, but it's still pretty inconsistent.  If I can get her to open up, she'll latch pretty well, but if I don't hold her head perfectly steady during the entire feed, she'll slip down so that she's only taking the very tip of the nipple.  Ouch.  Her suck does seem to be a bit stronger, as well, but her suck pattern is still "choppy" according to the LC I saw the other day.  Basically, she goes sucksucksucksucksucksucksuck...swallow (sometimes sucking 2-3 times, and sometimes 5-10 or more times before swallowing) and never falls into the longer suuuuuuuuuck...swallow...suuuuuuuck...swallow pattern.  She also still falls asleep at the breast quite a bit, and she'll often latch on and fall asleep almost instantly.  Other times, it takes several minutes.  If I catch her at a really alert time, I notice a big difference in the amount of swallowing I hear while she nurses (I've even heard a few big gulps!), but I only catch those really wide-eyed alert times once or twice a day.
I've definitely seen some improvement over the last few days, so I'm hoping we're really on the upswing.  She usually gets enough from me in the mornings now that I don't have to supplement until the 3rd or so feeding of the day.  Afternoons and evenings are still hard, though, because she just doesn't seem to suck well enough to pull the milk out.  She's also been having green poops, which makes me think she's getting a lot of foremilk, but I don't know how to fix that in a baby who is not nursing effectively.   I still have to switch Caroline several times per feeding just to keep her awake and sucking, so I'm not sure what the answer is there.
 
Ann Henninger IBCLC, RN 

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