Hi, all

I just came from a most frustrating consult. I got a call earlier today from
one of the doctors here that I have been trying to get to begin referring to
me. He had a mom in his office who was having problems getting the baby
latched on, had plenty of milk, and the health dept had just given her ABM.
He was appalled that they would give her ABM when she desperately wants to
nurse and had so much milk. He said the baby looked good and was obviously
getting enough to eat.

I went to see the mom this afternoon. This is her first baby, delivered by
C-section after 9 hours of intense labor. Mom had an epidural and Stadol,
which according to her "threw her for a loop." She was out for 4 hours
before being awake enough to see her son. In the meantime he was deep
suctioned because of breathing difficulties at birth.

She nursed a few times before her mature milk came in. The nurses would take
the baby to the nursery for baths and occasionally to let mom get some
sleep. Baby would come back from the nursery and spit up clear fluid--mom
said she was pretty sure it was water, meaning the nurses had given him
bottles of sugar water while in the nursery.

When her milk came in her nipples all but disappeared. The hospital has no
breast pump. The nurses were no help and basically told her they didn't know
what to suggest. Someone from the health dept came and tried to help but
couldn't do anything either.

So baby is 8 days old, and getting most milk from a bottle. Mom has been
using a small electric pump that takes an hour and she gets 6 ounces which
baby downs in one feeding. She leaks and has a strong letdown that
frustrates the baby.

I watched them try to nurse, and also tried finger feeding baby to calm him
to the point of going to the breast without pitching a fit. Baby has a
slightly recessed chin, and a relatively high palate, and while I finger fed
him he would move his tongue back inside his mouth and clamp down on my
finger more or less rhythmically.

We tried football holds, cradle, cross cradle, prone postions and couldn't
seem to find one that would compensate for the recessed chin and relatively
flat nipples. She tried one of the inverted syringes to draw her nipples
out, which worked but only for short periods.

She had been given nipple shields by somebody. They were useless (something
other than the clear Medela variety. She was using a NUK nipple on the
bottle and discovered that she could use that on her nipples as a shield and
it would work some. She had also been given an SNS but I couldn't see the
point in adding that to what she was doing since he wouldn't latch on to
begin with and her milk supply is fine--too good, if anything.

Tomorrow I will bring her a Medela Classic pump to at least make pumping
more bearable. But beyond that, I don't know what to do with this mom. I am
not a miracle worker and it frustrates me no end the kind of "help" she got
from the hospital. (I've been trying for a year now to convince the hospital
that they need to hire me part time to work with the moms IN the hospital,
rather than waiting until things are so messed up. )

Monday I plan to go in and talk with the doctor who referred her since he
seems pretty receptive. I'm not sure how far to push things with him, though.

Any words of wisdom out there? What kind of position might be best for this
mom? I suggested the rebirthing in the bath bit, but she isn't allowed to
take a bath yet because of the surgistrips (sp?) used on her C-section cut.

GGGGrrrrrr. This is SO frustrating. So few women here want to breastfeed and
it is so aggrevating that one who wants it so badly has been treated the way
she has--and has an unfortunate combination of anatomical features. The
nipple/palate/chin probably would have been possible to nurse in spite of,
but that plus all the other stuff is making this a very tough case.

Thanks in advance!

Melissa Vickers, IBCLC
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