From time to time we all see babies who suck their own tongues from the
start, and I assume they have discovered this in utero.  We had a very
pronounced case last week.  The first day we could barely visualize baby's
upper lip and when she sucked, you could actually feel crepitus in the
parietal suture.  Mother was feeling discouraged and at a loss.  Baby was
born spontaneously; mother did have an epidural from 7 cm to birth, which
was the very last hour of labor.  It was given because of mother's very
strong desire for this form of analgesia.

We made a plan, based on the two principles 'feed the baby' and 'protect the
milk supply'.  Baby was given expressed milk by syringe, then by cup as the
amount increased.  After hand expressing the first few feeds, mother was
pumping one breast at a time, her choice, as double pumping felt too bovine
for her taste and her milk supply was increasing quickly.  Meanwhile they
were 'assigned' to spend as much time as possible relaxing, skin to skin.
Baby started showing interest in the breast early on but it was not even
possible to do a suckling assessment with a finger because she flat out
refused to accept anything but her own tongue in her mouth.  She would
almost latch at the tip of the nipple but this was so painful for mother
that we didn't push it at all, in hopes that she would start opening up more
with time.

At about 50 hours of age she suddenly started opening her mouth and really
rooting during a cup feed.  We tried finger feeding immediately and it was a
great success for that feed.  Mother tried it but found it awkward.  Staff
helped with finger feeds that night and baby latched for a short time on
that shift.  Next day baby was showing much more interest and by 3 p.m.
mother had successfully latched baby unassisted.  She had already been
offered an extra day or two on the ward and had accepted.  Went home the
next day with a fully breastfed daughter.

What was unique in this case, for our unit, was that by making this plan on
the very first day, we avoided any sign of the aversion that usually
characterizes the course of breastfeeding in these babies.  We have tended
to be more and more forceful the longer it takes to get baby to take the
breast, despite the fact that it is always very stressful for mother, and
baby, and notoriously unsuccessful for getting baby to breastfeed well.
Forcefulness isn't easy on staff either, as it takes a lot of time and gives
unimpressive results.

I am well aware that in the US, the option of staying in hospital for 3
nights after a normal birth simply isn't there, and that is really a shame.
It would have been possible to send them home sooner if we could give them
daily, family-friendly follow up until baby was feeding smoothly, and
perhaps there are settings where this is an option.

If you have never had the chance to try this approach, I can almost
guarantee you will be pleasantly surprised at how well it works for the
reluctant starters, and their mothers.  Skin to skin means they
automatically get the rest they both need too.

cheers
Rachel Myr
Kristiansand, Norway

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