I had a similar case recently. There were several interesting aspects to the
situation--baby was also 37 weeks (induction, cesarean), baby was 5 days when
we met. The mom's nipples were truly the longest I have ever seen, although
not the largest in diameter, still pretty large. The mom had severe edema. The
baby had a tongue-tie, but the ped told her it was normal. Fortunately, in
speaking with her own mother, mom discoverred that she was weaned due to
tongue-tie and was willing to get a second opinion. Frenulum was clipped. Mom also took
the baby for CST, as baby could not extend without obvious discomfort. Just
like the baby you describe, this baby was very agressive at getting to breast,
but could not get her mouth wide enough to get around the nipple, and also
slurped on. Mom bottle-fed and finger-fed for about 10 days, while using
domperidone and pumping (took about 6 weeks for a full supply) and umlimately had to
treat thrush as well.
Some interesting points:the chiropractor found that the baby was literally
dislocating her jaw in an attempt to latch-on, the mother's nipples were
significantly smaller in size after a few weeks (edema, I'm thinking) and use of the
bottle very carefully after the clipping helped the baby learn to open wide
w/o the trauma of latch (given the circumstances, a nipple shield would have
fared no better, if we could have even found a comfortable one).
At 3 mos, this baby weighs about 15lbs (was under 7lb at birth!!!), is
exclusively bf and mom is very happy--quite an amazing woman, IMO. My suggestion,
besides all that you are doing, is CST. Babies who have to compensate very
often benefit immensely.
Jennifer Tow, IBCLC, CT, USA
Jen wrote:
Moms supply was almost non-existent"The most notable thing, though, was that
mom's nipples are very large in
diameter, at least quarter size. Baby was at the breast when I came in the
exam room, and when he came off the breast the nipple was flattened, and
even larger in diameter appearing. It looked like baby had obtained a deep,
enough latch based on how much breast came out of his mouth when he opened
his mouth. Remarkably, though, there was no obvious nipple damage other
than mild redness on both sides. Baby opens wide to latch on, but his
little mouth is small enough that the nipple doesn't clear the opening, even
when he's wide open. (Does that make sense?) As a result, baby tends to
slurp up the nipple until he obtains a deeper latch. Mom about levitates
off the chair during this process, but is comfortable once he's settled on.
Although his weight was a little worrisome, he is not even slightly
jaundiced, is very vigorous, and with his current output I'm guessing he's
going to start gaining. (Will of course weigh him again, soon.) I went
ahead and clipped the frenulum although I wasn't sure it was causing a
problem. Baby then latched at breast again readily for me, but again just
can't open wide enough to get around these nipples in one fell swoop. WE
tried again in football hold, and had a little better result as mom could
see the breast and his mouth better, but still it was hard to avoid scraping
the nipple along his gums as he latched on. The baby is very agressive at
latching on. I'm guessing a less aggressive baby would not be able to latch
at all. "
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