i have searched the archives, and read what i could find, but am hoping to
get input on the following situation:
baby is 5 weeks old, fairly easy, vaginal delivery, short time with
epidural, and morphine at 2 cm dilation, cord around neck, but no problems
after delivery; baby healthy.
baby had some initial trouble with latch in the first day or 2 and was
given a nipple shield by the post-partum nurse. baby latched happily with
the shield, and because of weight loss, was supplemented for the first two
weeks (1oz bm or formula every feeding, about 9-10 ounces in 24
hours). they began supplementation with finger feeder, but baby began
refusing shield, so mom was shown by hospital lc (not ibclc) how to thread
the tube into the shield.
at 2 week check, baby had gained well with supplement, and they stopped the
supplement. 2 weeks *lost* 5 ounces (different scale). so they started
supplementing again, and baby gained astronomically (approx. 11 ounces in
one week - different scale)
what i observed:
mom has small flattish nipples, with full, firm, but not engorged
breasts. it is really hard to form a latchable teat with her breast. baby
was latching only to the tip of the shield; mom had no idea that was not
correct. even with proper positioning, pillow height adjustment, etc, baby
would not open widely with shield, until we supplemented with the shield
and then baby relaxed after the first minute or so, and had a better
gape. baby has a smallish mouth, a slightly high palate, but decent
tongue range. sucked my finger well.
it takes a *lot* of effort to keep baby actively nursing at the breast,
though i hope with knowledge of a how to get a better latch with the
shield, the baby will be able to remain vigorous for longer periods and
with less supplement due to better milk transfer. mom is able to pump
(with a PIS) 1-2 ounces *after* nursing, so that either means she has a
good supply, or baby isn't transfering much of her milk - she's pumping it
all . . ?
i suggested a smaller shield (i'm pretty sure it was a regular, but she
didn't have the packaging, and i haven't seen enough shields to know
without a side by side comparison (can someone tell me hoe long each size
is, so we can figure out what she has? do they make a premie size or just
a small and regular?)
i suggested living with the shield (baby will *not* latch without it, and
gets hysterical) for a while while the latch and supplementation issues get
worked out, and the baby grows - she was fine with that. but lots of
questions about the best way to supplement, pump, etc., and her problems
are compounded by lots of stressors in her life, the least of which is an
impending cross-country move, in 4 weeks!
i would love input on how you handle these multiple factors: ungraspable
breasts, shield use, supplementation and weight loss, etc.
i really feel tincture of time would work wonders for this couplet, and i
just want to make sure she finds a way to give herself that time, while
gently encouraging her baby to nurse more effectively. i suggested all the
usual (co-bathing, slinging, rocking, skin to skin) and we discussed the
sns and lactaid, etc., but i would just love some input, or direction
toward protocols for handling multiple factor situations like this one.
mom has no health reasons to suspect a primary milk supply problem. she
never became engorged, though (full, yes). nipples and breasts are
comfortable.
Thanks for any guidance,
and if anyone on lactnet is practicing/providing support in minneapolis,
MN, and would like to be a resource for this mom when she moves, please let
me know!
Lyla
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