Dear ones,
I have a mom with very large/long nipples who is producing adequate amounts
of milk (thanks to Domperidone & pumping), but whose baby (4th son) is not
transferring adequate amounts. I know it is related to positioning and
latch. This is the fourth baby she has had problems with....she is majorly
discouraged, as you can imagine.
Her nipples are (at rest) 2.5 cm & 3 cm long; about 1.5 cm in diameter. I
didn't measure them after a nursing, but I suspect they are each at least 1
to 1.5 cm longer. She has nice squishy breast tissue, but the nipples are
much smaller in diameter at the base, so punky loves to slide down there and
just hang out. He gets more if she does breast compression constantly, but
that gets a bit wearing after awhile as you can well imagine. He can handle
(comfortably) my finger in his mouth up to 3.5 cm, so I don't think the
length is as much of a problem as getting him to STAY on the areola instead
of resting comfortably on the nipple as though it were a long pacifer with a
small base.
She's pumping at least 5 times a day, getting approximately 2 ounces each
time, breastfeeding 8 to 10 times a day in addition. She's now supplementing
with an average of 11 ounces/day -- mostly EBM, but over the last 6 days gave
him a total of 12 ounces of formula as well. With all that, he's gained 5
ounces in the last 6 days, and at 3 1/2 weeks isn't up to birth weight yet
(if we can believe the birth weight which is suspect).
This has been the same problem with all 4 boys. I've worked with her with
all but the first. She ends up breastfeeding for at least a year with each
one, but the first 6 to 8 weeks are rounds of weight checks, pumping,
supplementing, and nursing. And she's tired. And has 3 other boys at home
this time.
Any suggestions to MAKE this adorable baby STAY where he is meant to be to
get the maximum amount of milk from the breast AT the breast? The most he
has taken at a visit here has been today with 36 ml from both breasts.
Merry Days to all of you,
Jan Barger, RN, MA, IBCLC, RLC
Wheaton, Illinois
www.lactationeducationconsultants.com
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