Hi All,

 

I had 3 babies who were t-t this week.  Wow.  One I need to vent with – Baby
could NOT BF with this T-T at all.  Absolutely NO milk transfer at breast
and had issues with bottle.  This frenulum was not only attached to the
tongue all the ay to the tip but also to the lower gum ridge – when baby’s
tongue was lifted up (when he slept he put the tip of his tongue on the
upper gum ridge) it looked like a full web, straight line on the edge
connected to lower gum ridge up to the tip of the tongue.  We tried to get
pics, but gramma’s camera wasn’t very good – darn it!  Lots of support under
chin helped him maintain suction on the bottle so he could feed better.  I
recommended a very good ENT here – so parents went to Ped for a referral.
Baby’s ped blew the parents off about clipping it and when they insisted for
a referral she got irritated and clipped it herself saying they just don’t
do this very often.  She did NOT swaddle baby – had dad force baby’s chin
down – baby is screaming and flailing – mom in tears – dad panicked – Ped
lifted baby’s tongue with her fingers, used a REGULAR pair of surgical
scissors – lots of bleeding – baby traumatized – parents traumatized.  I
come in the next day – parents showed me the scissors (the Ped left them on
the table – dad took them – I couldn’t hide my shock when I saw them – I was
floored!) - baby is STILL t-tied because the web on the floor of the mouth
had not been released.  He can breastfeed now, but still hurts mom – does OK
with a nipple shield.  I told parents honestly that I agreed with their
feelings of absolutely not having this ped re-clip, please get him in to the
ENT I rec.  This same ped is supposed to do the circ…parents backed out of
that and are looking for another Ped…

 

Baby number 3 I saw yesterday – TT was clipped, again by (different than
above) Ped – didn’t do it all the way, I think she was being conservative
(no complaints here from me).  At least this time it was done right with
correct tools.  Mom however has very little milk – gets a total of ½ ounce –
she is on day 9 today.  (baby born 5-9)  She saw the LC at the hosp (nice
gal but very young and very new) who gave her a nipple shield and no real
care plan other than feed the baby and lets get you some domperidone.  No
testing for hormones (prolactin, thyroid, etc).  I hate it when others just
throw meds at the mom without finding out why there is little milk.  I
talked to the RN at mom’s OB who told me that since I wasn’t an RN, IBCLC, I
didn’t know what I was talking about and she’d been an RN for 25 yrs and
never ran a prolactin level because as we all know when a mom delivers a
baby her prolactin levels go up.  You’d have been proud – I professionally
informed her that all I have studied for 12.5 yrs is lactation and that
there are circumstances where prolactin doesn’t rise – and can we please get
an ultrasound to rule out retained placenta and get blood work to check her
prolactin and thyroid?   I was then told that there would be all sorts of
signs by now if placenta was still in there (I don’t buy it – I’ve seen moms
at 3 wks out with no signs but it was still there).  Also questioned about
what I would do if her prolactin levels were low (then interrupted
repeatedly while I was trying to tell her).  She then wanted to throw Reglan
at the mom and got very firm about NOT doing that, again told I didn’t know
what I was talking about (her 25 yrs as RN…blah, blah), then I told her that
new research stated that Reglan had nasty side effects and as a good IBCLC I
would NOT recommend Reglan to a mom already suffering emotionally – and all
the reasons we here at LN know about.  I suggested Domperidone – she blew me
off – I reminded her that the LC at the hospital had suggested it – she put
me on hold – came back 5 minutes (I counted) later and quietly asked what
tests I wanted and how much domperidone to prescribe if we needed it.
UGH!!!  GGRRRRR!!!!!  Meanwhile mom is listening to all this – me trying to
maintain a clam professional manner – mom is crying, saying she can’t handle
the stress, why isn’t the nurse just doing what obviously needs to be done…I
spent almost 4 hours with her trying to just keep her calm and give her some
sense of hope.  We’ll get prolactin levels in a day or so – anyone know any
reasons why a mom without any history of hormonal issues, breasts that look
perfect, no infertility 34 yrs old, pregnant on first try, would have no
milk?  Milk has never come in – breasts got larger during pregnancy, and a
little bit after delivery – but that is it.  Yes baby was nursing, mom was
pumping (all within normal needs) – she has done everything right – but gets
½ oz at best.  Is currently on fenugreek…thoughts?  And can someone please
explain to me the retained placenta and what a mom would be experiencing if
there was one?  What is the range of normal?

 

Last mom – baby is now 5 wks.  I didn’t get in to this picture until
Wednesday (5-16).   TT clipped week 2.  Baby is nursing well but hurts mom
like crazy.   Did a suck eval – this baby is unbelievably orally aversive
and has a gag reflex that would blow your mind.  Even just the tip of my
finger in her mouth (which she did open for) caused her to gag and use her
tongue to push my finger out.  Never did get a good suck evaluation – I am
not into forcing babies…  The only thing she will allow in her mouth is
mom’s breast.  She didn’t really like the shield but would tolerate it –
barely.  She refuses bottles, refuses to suck on fingers (including her
own)– mom and dad report that after week 2 she flat out refused to allow
anything in her mouth.  They couldn’t pin down any particular incident –
both were so sleep deprived (baby is high needs) they could barely remember
the clipping – which they said when OK – they didn’t like the Dr tho…said he
wasn’t nice to them at all – but can’t remember what happened with baby.   I
believe that babies gag reflex and oral issues are keeping moms nipple too
shallow and that is what is causing mom pain.  She also has a high palate.
When mom does manage to get her on deep – baby will shake her head and
readjust…

 

So – what else can we do to help this baby settle down and lose that oral
aversion?  CST?  Any oral desensitization therapies??  I am looking for any
and all ideas on this one.  

 

What a week.  My kids, partner and I are going to 6 Flags today for a field
trip – out of town, go play – RELAX!

 

Thanks for all input and ideas…

 

Warmly,

Jaye

 

 

 

 

 

 

 

 


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