The cases of breast refusal I have had recently and how they were resolved
(or not)
1. Home visit - mom home post c/s, baby had breastfed well until the day
she called me (4 days pp) and was then refusing to breastfeed - over 8
hours had passed. Breasts were hard and swollen, but nipples well formed.
I tried to help with standard positions, also with football hold, cross
cradle.. NOTHING. Finally had mom go to bed, baby on top, skin to skin,
baby latched on his own. I teased mom that he was behaving like a 2 year
old... ME DO IT! She laughed, but after that found this was very much her
baby's way. She had to let him latch on, then he was fine. If she tried
to help or guide - no go. For almost 6 weeks, she could only breastfeed in
bed - with him finding his own way. Finally they developed a way of
breastfeeding that worked better (and was more compatible with her sitting
up...).
2. Baby pushed (per mom's description) onto the breast in the hospital.
During Home Visit, (2 days pp) my observation was a baby who was truly
stressed. We put her skin to skin, and I never touched her - mom held her
for a while, then when we observed her (baby was lying on mom's chest)
moving towards the nipple, I helped by making the nipple firm and more
easily grasped, and mom steered baby towards the breast by supporting her
through a thick quilt (baby really didn't feel Mom's hands on her back).
Baby latched on well, nursed for over 20 minutes, let go. I then tried to
see if mom could get baby on by herself - but this time, baby wouldn't
latch. As I was leaving, we used a nipple shield, and baby latched on
great - good milk transfer heard. It took this mom 3 weeks, but in the
end, baby exclusively breastfeeding without nipple shield. She never
needed to pump, milk supply increased well and baby gained well. Why did I
use the nipple shield? Mom's hands couldn't both support the baby and help
form the breast and nipple to achieve a good latch, and she had no one else
to help her once I left.
3. Mom told Public Health Nurse baby refused to breastfeed, even though mom
had wanted to in the hospital. I made a home visit with the nurse at 1
week. We tried everything, all positions, all ways, all methods I knew -
baby refused. She would scream until she lost her voice and breath every
time she was near the breast, or in a cradling position. Even to bottle
feed, which mom was doing by the time I met her, she had to be held away
from the body. I never did get this working (mom was not living in a
situation where she could try the bathtub rebirth - mom was homeless and
living in a motel, no tub, no help once we left, etc)... Wondered what
had happened to this baby that had caused such a negative reaction to the
breastfeeding position.
Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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