Great case history, Marie!  I have had a number a babies like this, and they
do "outgrow" the arching and fussing, but you are right, many moms never
make it that long.  I too have had best success just lying these kids on the
bed and having mom drop her nipple into the baby's mouth, with min.
handling/stimulus.  Another helpful Modality is chiropractic/craniosacral
for baby, if the parents are open to it...........Martha Johnson RN, IBCLC
(Eugene, OR)

> ----------
> From:         Marie Davis, Rn, Clc[SMTP:[log in to unmask]]
> Sent:         Wednesday, October 14, 1998 7:58 PM
> Subject:      Surprizing outcome
>
> This was one of the most difficult cases I have worked with in a long
> time.
> After the problems I've had with unsupportive staff and last week I had a
> big
> scare with suspected new problems in my leg (which BTW is OK after all),
> this
> one was the highlight of my year!  I have her permission to post her case.
> She asked only that I protect her identity, so I will call her Anna.  At 7
> days of age, she came to me because her baby had never latched on since
> birth.
> Anna is a 31 year old first time mom with fertility problems, this will
> most
> likely be her only biological child. Anna had to be delivered by C-section
> 8
> weeks early because of high blood pressure and HELLP Syndrome. Baby girl,
> Carla was  4 and 1/2 pounds. She was discharged from the Special Care
> Nursery
> at 5 days of age, bottle feeding.
> In every way Carla was a healthy premature newborn who just refused to
> nurse.
> Normal  suckling assessment, good wave motion, cupping, normal palate
> shape
> except that the rooting reflex was dulled.
> I was unable to latch her on for more than a few seconds without baby
> becoming
> visibly upset.
>  By this time mom had very little milk,  she was pumping 10 to 15 cc every
> 2
> hours, with a small ev**f*o pump. At our first visit the goal was to bring
> her
> supply up, decrease mom's stress level about the lack of latch on and to
> try
> again in 2 days. She started Fenugreek and a hospital grade double
> electric
> pump.
> I saw her twice a week for the next few weeks. She was very hyper tonic.
> She
> arched, pushed the breast away with her fists and screamed after only a
> few
> minutes of trying, didn't cuddle, turned her whole body away from mom when
> held. Her back was arched constantly only her head and bottom touched
> mom's
> arm or on the exam table. If laid down she would immediately flip to the
> right
> side and hold herself in a tight fetal position, fists clenched so tight
> they
> turned blue.   I was beginning to have concerns that the baby was
> autistic,
> had a brain injury or CP.  She was also extremely difficult to bottle
> feed,
> taking nearly an hour to finish a feeding of 45 to 60 cc .
> Anna confessed that she often worried that Carla hated her.  I assured mom
> that Carla's behavior was not directed at her, but most likely the result
> of
> an immature nervous system and all we could do is wait and see. A referral
> was
> sent to the PT/OT department to assist with the muscle tone.  I told Anna
> not
> to worry, pump and keep trying to encourage Carla to latch on, but not to
> push.
> I also warned her that Carla might never latch on but I would be there for
> help and support for whatever she wanted to do.  Anna told me she had 12
> weeks
> of maternity leave and she would continue to pump her milk for at least
> that
> long.  Still, each time she came for an appointment I was surprised to see
> her. Most of the moms I've met with this type of problem give up within a
> week
> or two.
> Anna was doing lots of skin to skin, co- bathing, sleeping with Carla and
> attempting latch on if Carla showed any interest. Saturday morning, the
> day
> she turned 6 weeks old, Carla began rooting toward the breast, so mom
> leaned
> over and viola Carla latched on and nursed for over an hour! She's been
> nursing like a champ ever since.  Her muscle tone is still hyper tonic.
> Mom
> lays her on a pillow and leans her breast over for latch on and touches
> her as
> little as possible while she nurses.
> Mom thanked me profusely but I had to tell I didn't do anything. And I
> really
> didn't--Carla got too distressed too quickly every time we tried to latch
> her
> on. I never  stress baby or mom because I firmly believe it is counter
> productive for both of them.  I quickly back off at first sign that it is
> too
> much for the baby to handle. Anna DID IT ALL by herself, every two hours
> around the clock for the past 6 weeks; pumping and bottle feeding an
> obviously
> unhappy baby. She learned how to best comfort Carla on her own. Babies
> like
> her are often very hard to fall in love with (I know I had one myself).
> The
> way she stroked and cared for that baby was wonderful to see. I was
> constantly
> amazed by how well she was handling the situation.
> Once again a courageous mom has taught me a great deal.  I am now
> convinced
> that in this case and cases like this, that the key is a calm mother, who
> does
> not FORCE her baby to take the breast. I see a lot of moms who are
> pushing a
> baby to the breast despite baby's objections. Some have come into the
> office
> and reported that they were trying to latch the baby on for hours at a
> time.
> As if you can make them breastfeed by sheer will alone. Anna took my
> advice
> literally--try: but never push, watch the baby's signals. And it worked.
>
> Marie Davis, RN, IBCLC
>