Hello Brandy,
From what I know, anticipation of fear by the mother entails some
stress, or some kind of bad mood, or "unconfortable feeling" which can
be "received" by the babies so they won't be prone to go back to breast;
this anticipation also entails physical movements by the mom herself,
she may try to protect herself, all by reflex (she may be totally
unaware of it) with a movement of her arms/shoulders/back, so closing
her thorax. Thus closing the thorax is an (unaware) reflex of
protection, that goes against a feed at breast (geographically, and
emotionnally).
There was a good presentation at gold15 by Dr Virginia Thorley "Latch
problems arising from mothers' fear response to anticipated pain" but we
could find some elements that address your case;
This is not evidence-based, juste "from my clinical cases based":
Even if I will correct the "false and problematical position/latch"
because the mom may +/- wish to return to that kind of position:
I always propose a position that is totally different from the one that
the mom has used until the consultation; particularly I guide them
toward a back-reclined position (nurture breastfeeding).
Totally different: so the conditions are totally different for the mom
and the child(s). the mom is installed differently and shows breasts
(form, volume) and nipple (pointing) differently. Also the point of view
of the child is different; its acting may be different; and simply:
being in a different position may not entail the same anticipation fear
compared with being installed as usual.
Back reclining helps the mom to have more physical and muscular
relaxation. it also helps opening the thorax, so even if the mom started
to show a closing movement of arms/shoulders, it stil would be more open
that when sitting upright.
still from my clinical cases:
when there is a strike (singleton, or multiples), I seek for the reason;
mostly there is anger or reproach, maybe fear -it can happen after a
"bad high reaction" of the mom after a bad high bite for example; I have
seen strikes as the mom was proposing the breast and rewrapped her
breast because it was ringing at the door and it was the postman and a
package was expected that day....
And from my clinical cases I finally took it for granted that whenever
there is a strike, breast should not be shown to the child, when he/she
is aware, alert... because: as the breast/ breastfeed became, one day, a
source of anger/ reproach/ fear (and so on), seeing the breast become a
source of re-acting with anger/ reproach/fear and so on; the child show
angerness, for example, cries, shouts, refuses the breast of course and
sometimes, only the arms of the dad will calm it;
when striking, my first-line approach will then be: free breasts under
the clothes (if volume/weight allows it) but no breast on view (buttoned
shirt for example) ; watch out for the baby to become drowsy (at the
opposite: starting to wake up) - say spy on the child if you want; and
when the moment seems good (baby not alert, not vigilant, the cortex is
sleeping....), keep gently the child up and move slowly the baby to the
breast;
In parallel, I try to determine wich cause entailed the strike; and my
parallel approach is to pick up the child in a moment he/she is awake,
alert, but not hungry/angry, have an eye-to-eye contact, and have a
short talk explaining what happened, the sorry the mom is to have
cried/shouted/rewrapped her breast, the hope she has that all resumes as
before.
strikes with multiples can have other etiologies, dedicated to the
multiplicity, it seems it is all biting here; also biting can be
reloaded by the fact they are twins; one will find more strikes by
multiples in general; and weanings, it seems;
I am quite sure you have tried all this but maybe there is one of the
upper elements that could entail an idea?
Maybe a massage of the mom (back/shoulders) before trying a breastfeed
would help too so the mom feels she is taken in charge, the massage
itself will relax her, and diminish her rate of anticipation of fear ;
and if still available, the massage continues during the attempts;
music - relaxation music, or soft music, or music that she likes -maybe
avoiding hard rock anyway even if she likes that- and as a global help,
maybe her physician could prescribe acupuncture or Bach Flower Remedies
(soft things).
And helping her dealing with futur potential bites, maybe you have
explained ways to limit the risk that children bite, to my mind it is
really needed that she knows how to recognize when the children are at
risk to bite and act - without pinching their nose and discuss with the
children: biting nipples is bad;
Hope it helps anyway,
Breast regards,
Françoise Coudray, IBCLC
Le 15/06/2015 05:53, Brandy Hansen a écrit :
> Need some advice for a mom with striking twins, w/PTP per client.
>
> I'm sparing some details to keep it shorter, so here's the summary:
>
> Mom contacted me initially when Twin B was striking at 9mo of age. We
> worked through that strike, and then she contacted me roughly a month later
> when Twin A started a striking after a bloodied nipple biting episode in
> the middle of the night. After three weeks, baby will not take expressed
> milk from a sippy or regular cup, but will take it from a bottle with no
> problem. Encouraging her back to the breast has been unsuccessful so far
> via various methods. Because even gentle attempts to offer the breast
> seemed to cause baby more stress, mom elected to take a break from and
> exclusively pump, hopefully helping her to forget her trigger and 'reset'.
> Mom would continue to nurse Baby B. However, over the weekend, Baby B
> started biting again with each feeding, and her decision was to pump during
> the day for him as well, and continue nursing him at night. Now he has
> completely started refusing the breast.
>
> Mom is not happy about the situation, as she hates pumping and would like
> to make it to her year mark at the breast (coming up very soon). After
> talking it out, I don't think it's so much about the twins forgetting the
> trauma as her--she was bloodied with biting a few times and is, herself,
> traumatized and frustrated by all of this. I told her I would ask
> colleagues for suggestions to help HER relax, since she agrees that her
> tension and apprehension is probably the bigger problem here. She wants to
> know how she 'should' react if nipped, what she can do to ease her own
> stress, etc.
>
> I've had personal experience with this, and really stressed prevention and
> patience, but I don't have any evidence-based advice on what to do with a
> mom whose anxiety is probably the root problem. Anyone have good tips to
> help this mom unwind and/or guide her through the double strike?
>
> -Brandy, IBCLC
> The Mobile LC
> [log in to unmask]
> https://www.facebook.com/mobilelactation
>
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