Ok - here's a new one for me, so I thought I'd share it - everyone else may already know this., so I'm opening myself up for charges or being incompetent...but what the heck...

In the last 2 months I (as a La Leche League Leader, as I work as a Lactation Consultant for the County and the state) have had two very frustrating situations.  Both mothers desperately wanted to breastfeed, had "tried the usual things" with their first baby (seen IBCLCs, taken galactogogues, pumping, SNS, etc.) and came to our group prenatally for support.  They then called me a few weeks after delivery  because both their babies had lost a dangerous amount of weight, so I asked them to come by my house.  

Of course I assessed moms and babies, moms breasts (in both cases) had easily expressed milk but did not transferred enough milk to their babies during the observed feeding despite assistance with positioning, breast compressions and hand expression.  

What was different for me, is that usually I then give suggestions, they go home, try them and with most moms, baby is fine - with other situations, moms decide "this is too much, I'm going to supplement my baby with a bottle" or "I quit, I'm giving formula"...  So I never see the NEXT step - bottle feeding the baby.

BUT with these two moms, the situation was too serious and they had brought bottles (one with mom's milk, the other with formula, as she had not been able to pump much), as they had already started supplementing.  Observing the baby bottle feed was an eye opener for me!  The lips for BOTH these babies did not form a seal around the bottle nipple - and milk kept leaking out.  

Now mind you, I HAD (after observing that little milk was being transferred at the breast) done a finger suck check, and not found a serious problem - tongues extended, babies sucked my finger in and "popped" when I removed it, so a seal had been formed - with my FINGER - but obviously the LIPS were not sealing around the bottle nipple.  

I did recommend that both moms have their babies checked with speech therapists...but this still has not happen (shades of insurance!).  I've provided them information from Catherine Watson-Genna's book, (Supporting Sucking Skills) and tried to get them to see IBCLCs in the area...

Now the question I have - could the lack of lip sealing - even if the suction occurred deeper in the mouth - have caused this low milk transfer, by the 2- 3 weeks?  How else could this have been assessed sooner?  Do you observe babies at the bottle if breastfeeding is not going well?  When?  

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome