I would love some input on this situation. On Tuesday, a mom called me b/c
her baby was refusing the breast. She had nursed her other baby for a year,
so felt confident about bf'ing. She had flat nipples, but her first baby had
no problem at all. His birth weight was 8lb10oz and he was at 7lb10oz at day
4 (12%!). She began to pump and has an excellent supply. She was feeding him
with an eye dropper as was suggested by an LLLL, so his weight was at 7lb10
1/2oz on Tuesday. The baby was induced (b/c he was "almost a week" overdue)
and then she had an epidural and after 2 hours of pushing, the baby was
subjected to a vacuum extraction. The hospital-based LC had seen her nursing
and told her that the baby was doing "ok". She told me that she had been
concerned that his latch was wrong in the hospital, but was assured it was
"ok". I saw her on Wednesday morning. The baby was quite sleepy (mom said he
had been sleepy all along), but we were able to rouse him. He is quite mellow
and doesn't get easily agitated. The baby roots, licks, etc and then opens
and grabs the nipple. He then "sucks" away as if he is "kissing" the nipple.
Mom was very comfortable with the football hold and her positioning was very
good. When baby started to appear hungry and fussy, I showed her how to
finger feed him vs dropper feeding. He quickly drew my finger in and sucked
down the milk, his tongue was down and cupped well and he has a sustained
suck. But, if my finger were a nipple, he would have done damage, as he
clamps down very hard while sucking. When I tried to massage the tm joint, he
was somewhat uncomfortable with it, but what was more odd was that one side
was higher than the other. When he cried, his mouth did not open wide, but
almost seemed to be caught short, like being stopped by a rubber band. We
never could get him to latch deeply or even open wide enough to do so. She
said this was exactly what he had done in the hospital. Mom's milk flows very
freely and her supply is great, so the baby gets immediate reward. I also
recommended lots of skin-to-skin, regressive therapy (co-bathing) and mimicry.
I told her that I do not recommend a nipple shield as I felt it might
reinforce the clamping and that it would not solve the underlying problem,
which I suspected was due to the birth trauma. Besides, it isn't going to
make him open wide. I referred her to a chiropractor, but as she was very
uncomfortable with this, I also gave her the names of a massage therapist and
a PT who does integrated manual therapy. Instead, she called her ped, who
thought my referral was crazy and inappropriate. Then she called the
hospital-based LC for her opinion (as well as another LC in private practice,
who also refers to chiro's). Anyway, the hospital-based LC told her that a
chiro "probably wouldn't hurt" and that she had been to a workshop about it
once, but to come in and she would help her. I called this LC (w/ mother's
knowledge) and explained what I observed and why I made the suggestions that
I did. I told her that I felt that the baby would probably nurse w/ a nipple
shield and why I did not use it.
I spoke with this LC later in the day and she told me that the baby had
"nursed beautifully with a nipple shield". She told me this was a short-term
solution and she had spoken with the ped. I asked what her long-term solution
was and she said "I will be following up w/ her". I have spoken to the mom
who says she has used the shield twice more today and feels that this is
progress. I have known this LC for quite some time and can make some good
guesses as to why she did what she did. What I am wondering is how others
would handle this. Would you have used the shield? Would you have used the
shield if you felt knowledgeable enough to believe that the baby was injured
from the birth? Would you have done something else I didn't think of? How, if
at all, would you follow up with the ped and LC? With the mother?
Jennifer Tow, IBCLC, CT, USA
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