I have a mother baby newborn pair- mom really into breastfeeding- read a lot-
prenatal consult- latched well right after delivery and first day- second day
had circ- where they put pacifier and hearing test- maybe pacifier- and
bilirubin checks day 2, 3, 4 and 5- on day 2 mom was starting to have sore
nipples- I was out for medical reasons- covering doctor saw them- but
breastfeeding was not discouraged- bilis were climbing but peaked at 15 day 4
and 5- 6 stools on day 5 BUT mom is in extreme pain and wt is >10% down- did
have IV Fluid in labor- mom is watching closely for feeding cues and trying to
get good latch infant is feeding every 1-2 hours- seems that he may be sucking
on lower lip and curling up tongue- definite swallowing heard- mom is now
engorged- also had ampi due to GBS+  and nipples are cracked and bleeding- I
Rx'd nystatin and bactroban oint for her nipples and Tylenol #3 one Q4h PRN
pain- she's going to call breastfeeding warm line at Morristown- nipples are a
bit big, but infant mouth seems nl size -he was 8# at birth- no tongue tie or
other unusual anatomy- nipples looked nl size day 1 now may be swollen, but
when he latches I don't see any nipple- he seems to be covering a lot of the
areola- we discussed possible temporary use of nipple sheild- pumping and
giving milk by spoon (would a wide nipple bottle be helpful as training him to
open bigger? or introduce more nipple confusion) also recommended mom to get
shells to help with engorgement and keep bra off nipples- also for mom to pump
or express small amount prior to feed to soften up breasts and relieve
engorgement- mom was also doing some breastcompression to keep infant
interested and get more milk into him- he seems satisfied after a feeding- but
cries a few minutes later- mom is unable to talk b/c of the pain- I plan to
check wt again on Sunday (from Thurs night) b/c of good out put and alert
infant- I am not yet so concerned about the wt- although the numbers are not
good (10/24 BW 8-6, 10/25 7-12, 10/26 7-10, 10/28 7-7 different scale)- However
on day 2 his wt was 7-12 and he had 5-6 wet diapers- so he lost 10 oz the first
day- must have been mom's intrapartum IVF- if there's any thrush on Sun I may
consider giving him also nystatin- if wt not up- will have to pump and feed
Any more advice? we were trying to calm him last night prior to the feed- gently
pull the lower lip/ chin so that its not tucked under- I just can't believe that
human evolution would make breastfeeding painful so often- what gives? How
common could oroboobular disproportion be? Is it the antibiotics she got and
already thrush? Is it the few times of pacifier use?  Is it the epidural- so he
has discoordinated suck even though it looked great on day 1? is it the circ and
heel sticks?

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