Hi, all wise ones,
I have this mom's permission to post her case for your insights. This case is the most aversive baby to the breast I have ever seen. It is a case involving both infant and maternal issues--mother presenting with low milk supply and baby deeply suctioned at birth and handled roughly in the hospital (i.e., forced onto the breast). Mom reported infant’s screaming and arching behavior began w/n first day pp.
Mom rep no breast growth during pregnancy and no sensation of milk coming in. Hx of menstrual irregularities, infertility and 1 miscarriage. Baby conceived w/Clomid; vag del. Baby bf in hospital, but began to cry and arch w/n 2nd day of life. After baby lost wt, mom began supplementing & bottle feeding. Mom has symmetrical, round brsts with 1.5 in spacing. Little veining noted. Mom protected her lactation by pumping w/SMB. She began using fenugreek about 3 weeks pp and increased pumped amt from 10 ml 2nd week to 25-30 ml 4th week pp.
Mother has done the most stellar job of increasing her supply of any IMS mom I've worked with--taken More Milk Plus and goat's rue and pumped every 2 to 3 hours. She increased her output up to 2.5 to 3 oz. About 2 weeks ago, she d/c herbs and recently reduced her pumping to 3x a day. She can still pump 2.5 to 3 oz. Maintaining 3x day is do-able for her.
Baby's oral structure wnl. At first visit, baby had difficulty organizing sucking. Broke seal and lost latch several times during digital suck exam. Very intermittent suck. When put to breast while hungry, baby quickly became frantic and upset. Noted spillage from sides of mouth with bottle feeding. Use of paced feeding and 45◦ posture seemed to increase calmness and reduce spillage.
Mom had prolactin, TSH and estrogen screen done at 2 weeks pp. Prolactin level of 181 wnl for lactation (70-220 ng/ml = nl lactating range). Rec Mom have progesterone and testosterone screen done as well, but mom chose not to do this because insurance would not cover it (OB insisted it was not medically necessary).
Tried everything I know to get this baby to breast including SNS, nipple shield, nursing upright in sling, nursing when sleepy, side-lying, lots of STS and remedial co-bathing. Baby would accept SNS with gloved finger, but not with mom's bare finger. Wouldn't stay on the nipple shield at all.
Baby had 3 CST appts--one at about 6 weeks and the other 2 at 3 mos. 2nd CST observed baby had a lot of compression and little movement of vomer, hyperactive gag reflex. After 3rd appt, CST felt baby did not need to be seen again--had 80% 'openness'. Baby still will not bf. Mom feels it may be from baby subconsciously remembering bf for 4 days and not getting anything.
Baby is beautiful, interactive, smiling and cooing. She is 3 months and 11 days old now. She is well bonded to mother, who is very patient, intuitive and sensitive to baby's state. When put to breast, baby will only lick or suck a minute or two at most and then start to fuss. CST did not help baby transition to breast. Baby does not use pacifier nor comfort suck. She only started sucking on hands a few weeks ago.
Any ideas or suggestions? Mom has made peace w/baby not bf. Baby now takes 4-6 oz bottle every 3 to 4 hrs and is now able to maintain sucking unless she is tired, when mom reverts to pacing. My hope is that when baby starts solids, perhaps mom could transition to sippy cup and see if baby will bf once she is no longer sucking on a bottle.
Many thanks,
Anna Swisher, MBA, IBCLC
Abundant Blessings
Austin, TX
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