In her answer to Ann, Lara wrote:
< If they are very large/limp with lots of skin and
fat, and she is emptying frequently now, they might not ever get that
"bursting out of her skin" feeling.>
My first thoughts were a lot like Lara's. Ann, these are all questions that
come to my mind:
Is it possible that she was at least somewhat engorged at about day 3-7 or
so, but that especially in view of now getting out 2 ounces q. 3 h (which
sounds excellent for day ll) she was expecting to continue to feel "full"
all the time?
Or perhaps she is one of those lucky ones who did not have IV"s and didn't
have the excess edema superimposed on the normal engorgement, and so has not
experienced the type of swelling you are used to seeing in most other
mothers who have had IV's and excess pitocin??
Even with a large amount of fatty tissue, which itself would not feel solid,
if her breasts are pendulous, I think it is quite possible that she may have
longer ducts, and is therefore capable of storing more milk without feeling
cram full than a mother who does not have pendulous breasts.
<much fussing at breast and poor latch>
Have you yourself done a suck check on the baby to try to see whether his
tongue is coming out beyond the lower gum, whether he is curling his tongue
around the examining finger as he should, or whether he is humping the
middle of the tongue (as we hope he is not??) Maybe some of Cathy
Watson-Genna's assessment hints on the various forms of subtle tongue tie,
or the training tricks she describes( in the archives) might be helpful.
Also, I have seen dads be very aggressive in fingerfeeding, and I have seen
many adults let the baby take the lead in bottle feeding, so that the baby
then learns to expect a fairly fast, constant flow, and gets very frustrated
when he doesn't get the same instant gratification at the breast, especially
if the mom is not leaking and/or letting down almost immediately.
I always question parents about the speed with which the baby takes
alternate feedings, for I have found that adults often take rapid sucking
and swallowing as a sign of how "efficient" and/or hungry the baby must be,
whereas I tell them it is a sign that the adult should take charge of the
flow rate and insert a breathing break every 10 swallows or so, #1 so the
baby doesn't get a choking sensation that causes him to swallow rapidly to
try to breathe, and #2 so he gets used to waiting patiently during
pauses, since the breast typically has some slow transfer periods in between
the "rush" of MER's.
Or would it be possible to teach the mom to trigger MER by fingertip
expression (or RPS) several minutes in advance of offering the breast so
that the flow is right there and ready to give the baby some more immediate
gratification from the breast?
Or alternatively, could the baby be fussing because of an overactive MER
coming at him like gangbusters?
If you have already considered the above things, please forgive my
questioning if you did, since you didn't specifically state some of the
things I asked about in reaching the conclusion that the latch is a poor
one.
I hope some of this helps.
Jean
**********
K. Jean Cotterman RNC IBCLC
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