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