Kathy wrote: "... Infant had nursed in recovery and one other time. Mother
stated he
appeared to do well, but she hurt badly. Her nipples did look very abraised
on both ends and her right areola had a diagonal bruise at the 10:00
position...reported the pain to be a level of 9 on a scale of 0-10. ...the
infant would suck on my finger with a feeling of "clamping down" at
times..."
It sounds like tongue-tie to me. Check for the infant's ability to extend
his tongue and maintain it there throughout the feeding. Look for
heart-shaped tongue when crying; short, or close-to-tip sublingual frenulum;
inability of tongue to cup nipple and extend over bottom gum-line.
I had a mom/baby pair like this at the hospital. A first-time mom, who had
a c/s delivery was complaining of very tender nipples within 24 hours of
birth. I helped with latch, and the baby was able to get on the breast and
suck with swallowing, however, the nipple was abraded afterwards. We talked
about latch techniques and tender nipple
care. Later that day, a nurse gave her a nipple shield when she complained
about the painful breastfeedings.
When I saw her the next day, her nipples were very raw. She had been giving
the baby bottles of formula, and had only breastfed a total of 5 or 6 times
since birth. When we attempted latch with the nipple shield, she started
bleeding, with bright red blood running down her breast. When we attempted
to pump the other side, it too started bleeding from a crack. That is when
I noticed the baby's tongue tie - frenulum to the tip, unable to sustain
tongue over bottom gum line. Previously, a digital suck assessment revealed
good sucking technique and an extended tongue. But, apparently he could not
maintain it throughout the feeding.
We rested her nipples for 24 hours, no BF and no pumping, and had her use
PureLan. I called the baby's doctor to report my findings. The MD is a
nursing mother of 3, so I hoped she would be helpful. She immediately
called the ENT practice she refers to, and asked them to stop in and see the
baby while they were rounding in the hospital the next day.
We continued to rest the mom's nipples another 24 hours. Since she was not
yet showing signs of engorgement I thought we could attempt to get her
healed another day before we started pumping. She was feeding the baby
bottles of formula. The ENT doctor came in that evening and clipped the
frenulum!!! I wasn't there when he came in. I was overjoyed when I found
out the next morning.
I took the baby out to breastfeed that next morning. She was understandably
reluctant, but the baby latched on beautifully, suckled with swallowing, for
about 15 minutes on each breast! Mom was smiling and her nipples looked
healthy after feeding! Because she was still quite tender, and has a low
pain tolerance, she chose to BF with the shield at the next feeding. I
showed her how to use the nipple shield correctly and discussed how we would
eventually stop using it.
Barb Berges BS, RN, IBCLC
Rochester, New York
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