I am a LC in private practice and would appreciate some advice on a recent
client. Saw mother in home for first time at 9 days postpartum. Primip
delivered at 42 weeks vacuum delivery with epidural( 3 and 1/2 hour second
stage).Male over 10 lbs with fractured clavicle. Apgars were fine. Mother
said that baby never latched on to breast at all in hospital. At 2 days
postpartum baby was very hypoglycemic and started on formula by bottle. Mom
did start double pumping at that time and baby continued to be fed formula
and EBM by bottle for remainder of hospital stay. Mother was gestational
diabetic and has cystic fibrosis. At home visit mother is still pumping but
using single pump and only twice in 24 hrs. Gets about 16 oz in 24
hours.Oral assessment revealed tight frenulum. Attempted latching during my
visit using football hold . Mom has very large breasts with broad nipples.
Baby would not open mouth wide. Latched on just beyond nipple and slipped
off. Started to fight breast and fuss so did not continue. Mother says baby
always fights at breast and in hospital lots of vigorous trying to get baby
latched. Mother fed baby small amount of EBM and then we tried in lying down
position. Better mouth position but soon fussed so I backed off. There are a
number of issues here. First I feel baby needs frenotomy(I'll have to work
to find ped to believe it is necessary). We've talked alot about nipple
confusion lately on Lactnet and this is another major problem. I would love
the assistance of those wonderfully skilled people who believe there is no
such thing as nipple confusion. Have encouraged mother to get double pumping
going and to increase frequency. Also gave suggestions for gently getting
baby to back to breast.
I am hoping we'll sort out the baby's tongue in the next day or so. Probably
related to difficulty latching in hospital. What about approach with
supplementation method? This mother's energy reserves are low due to cystic
fibrosis. Don't think she would cope with cup or finger feeding. Have
suggested using wide bulb  rubber nipple. What about nipple shield? I have
not had alot of experience but may be useful in getting baby to take breast.
Supply is not what it could be due to inadequate stimulation so will need
supplement until increases. I would appreciate feedback ASAP. Also any info
on cystic fibrosis and breastfeeding. TIA Janet Murphy Goodridge RN, MN, IBCLC
St. John's Newfoundland.