In regards to tight jaws and mis-shapen nipples. Experience tells me that the
causes are multi-faceted and that to suggest "because all epidural babies don't
have this, epidural cannot be implicated" is faulty reasoning.

I have certainly seen my share of this among forcep and vacuum extraction
babies...and both of those procedures are more likely to occur in the medicated
mother.

Who do I refer to? Usually start with our OT dept. because, in order to get
treatment...there must first be a diagnosis. Make sure your OT knows about
infant suck. There was a recent article in Neonatal Network by an OT  and I
referenced it on Lactnet. If you want to win an OT over to your side on the
drippy nipple issue...just refer her to this.

I am very fortunate because my OT is also certified in CST, so she can actually
get paid for it. If yours isn't...ask her if she knows one that is.

With these kind of babies.....I like big, dripless nipples or, better yet,
finger feeds in order to suck train. Sometimes an SNS at breast can help a baby
relax there in the presence of a low supply.

Susan Keith-Hergert RN, MS, CPN, IBCLC
Mercy Health Partners
Cincinnati

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