PS. Additionally, I would suggest finger feeding with a feeding tube, #5,
with mom or dad's biggest finger, pad UP, as a viable alternative to bf, for
a short period, if she cannot feed due to pain. Advil will help. Feeding
with an eyedropper with an antzy three year old is not going to work well,
and may drive the mom over the edge.  Even a paced bottle feeding of
expressed milk once would be better than the mom ending up not breastfeeding
at all due to pain or being overwhelmed.  I always tell my patients that the
chin must be brought INTO the breast, nose tipped back, and baby's body
close to mom's, turned right in, tummy to tummy.  Mother's do not do this
instinctively. They want the baby's nose tucked in and the baby's chin down
towards its chest, which does not facilitate a deep and proper assymetrical
latch.


Kathleen

Dianne, I would first explain skin to skin contact to the mom, and suggest
rallying the forces, and getting help for the 3 year old so that she can sta
out of the car and get into bed and take care of her baby and herself.

The cracks are due to poor positioning, and may get worse with ascending
staph A, etc, if not cared for.  Normal saline soaks are helpful, as is
gentle washing with soap and water. (not antibacterial soap). Proper
positioning with chin IN and nose tipped a bit back (off center latch, as
described by Newman at www.drjacknewman.com) in the videos there is key. Use
of APNO ointment is also key to avoid worsening infection.  Fixing the latch
is FIRST, and cue feeding is also key....as scheduling a baby who is not
gaining is pointless and even detrimental.  I am sure this is not
everything, but it's a start.


Kathleen Bruce RN IBCLC
Independent consultant:
Lactation Resources of Vermont, Medela, Inc. Listowner Lactnet listserv
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Kathleen

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