I have been no mail for a long time so will re-introduce myself. I am a
Certified Nurse Midwife in a fullscope rural practice on the coast of
Washington.

In April, a client of mine gave birth to a baby girl, 9lbs. 8 oz. The
birth was unmedicated. There were no apparent signs of fetal distress, but
baby came out rather floppy (mom pushed 2-1/2 hours) and needed some
resusitation then was fine.

Despite skin to skin contact and no separation other than the time spent
in the first few minutes to resusitate the infant off the mom's belly when
it was obvious that she needed help, the baby exhibited no interest in
breastfeeding until about 18 hours post birth.  The baby would clinch her
jaw when mom offered the breast and also sucked her lip (she was born with
a blister on her lower lip!). I taught the parents some techniques of
stroking the baby's lip and encouraging her to open her mouth and also got
her to suck on their fingers and then the baby went successfully to breast
and has been gaining well.

The problem  is that at about four weeks of age, the baby started
occasionally clamping down hard on the mom's breast with her jaws when
feeding. This was obviously painful. The mom complains in the past few
weeks that it feels like the baby "does something wierd" with her tongue
sometimes with breastfeeding and that sometimes the tip of her nipple is
blanched when she takes the baby off. Her left nipple is more affected
than the right.

When the discomfort started, my partner was able to see the mom and work
with her (I was in the middle of cholecystitis and having to arrange
gallbladder surgery).  My partner did correct some minor positioning
problems that she picked up and the situation improved a little. However
when I saw the mother recently for her six week checkup, her nipples were
still tender and pink on the tips.  Positioning looked wonderful. There
are no anatomic abnormalities that I have picked up. The baby is gaining
well.  When I checked the suck, the baby does seem to bunch her tongue up
at the back of her mouth from time to time.  There are no signs of thrush.

I would like to be able to help this mom and baby more effectively.  I am
not quite sure where to go next though with them.  The mother gives no
bottles or pacifiers, never has, and is very concientious about trying any
suggestion.

If anyone has ideas, please share.  I would appreciate it if you could
email me privately, even if you respond to the list as I get overwhelmed
fast by the volume of mail and tend to scan my messages by topic.

Thanks.

Ione Sims, CNM, ARNP, MSN
Community Nurse Midwife