Dear All

I have been working these past five weeks with a mom and baby where we just don't seem to be getting to the resolution of the problem and I wondered if the shared wisdom of this forum would be able to help as I am feeling as desperate as the mother at this point. In the 16 years since I became an IBCLC, it has been rare for problems with lactation not to be resolved, but with this case, I do not seem to be able to help breastfeeding become the joy that it should be.

This mom attended my antenatal class and her planned home, water birth ended up being a Caesarian due to failure to progress. She was bitterly disappointed with her birth outcomes and says that she will feel even worse if she gives up on breastfeeding.

I went to see her on day 5 because she was having difficulty with latching the baby. Her nipples were raw and bleeding and she was in a great deal of discomfort. The baby had a tongue-tie, but we were able to get the baby latched and he was able to breastfeed without causing any pain. She was using Lansinoh after feeds. She has large pendulous breasts.

Day 7, repeat visit as she was still having difficulty with latching although her nipples were healing and there was no further damage. The baby latched and fed well on the Right breast although the Left breast was more difficult. The baby was having 3 - 4 yellow / curdy stools per 24 hours and there was a wet nappy (diaper) at every feed.

Day 9, repeat visit because she was extremely distressed and still having pain with latching. Now comfortable latch on the Left breast and the Right was the more difficult one. There was a red line running upwards from the Left nipple and she was recommended to see her doctor for a course of antibiotics and to start using Dr Jack Newman's APNO. (The red line resolved within two - three days).

During this time, when unable to latch, the mother expressed and bottle fed EBM to the baby (she chose not to cup feed). On the odd occasion, she used formula because no EBM was available but the total number of bottles given were very few. She gave the baby a dummy (pacifier) only when desperate.

Day 10 - 14, very little improvement with latching and night time feeds the most painful. The damage to her nipples, although much improved, was still evident.

Day 15, after a very stressful night, I suggested that they visit one of the local doctors to explore having the tongue-tie snipped. Which was done.

Day 16, repeat visit including a baby weigh. The frenotomy had not caused too much change in the painful latching but for the first time we could see the baby's tongue cupping the nipple while attached.  The baby weighed 3.96 kg (Birth Weight 3.92 kg, Lowest weight 3.54 kg on day 4) 

Day 17, repeat visit because things were still not going well with the latching. We went back to the very basics of attachment and latching and re-explored different positioning at length

Day 21, severely engorged Right breast which resolved with usual treatment

Day 23, Baby weigh 4.14 kg (180g gain in 7 days). Nipple trauma still evident. Latching still painful towards end of feeds

Day 29, Baby weigh 4.20 kg (60g gain in 7 days - although poopy / wet diaper adjusted weight of 60g could be added to that). Baby continuing to stool 3 - 4 X day, wet diapers at every feed

We are now on Day 33 and this mother is at the end of her endurance (as is her husband). This baby will latch on each breast and drink greedily without pause for a sustained 3 - 4 minutes without causing pain but then delatches / adjusts and the pain returns. Feeds can last an hour or more with repeated re-latching and the baby falling asleep, only to wake and need to return to the breast, which then causes pain. I am also wondering whar we are going to do if there is not a significant weight gain at the next weigh on day 36. 

I aplogize for the length of this post and I would be most grateful for any help. I am no-mail at present and would welcome input direct to me at [log in to unmask] as well as to the list.

Thank you

Rose Gauld


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