Wise ones, I need your help.  

 

I have a client whose baby spent the first 15 days in hospital being
monitored and tested for every thing possible.  I was not there as the
hospital was in a different city.  I first saw them on day 18 post partum.

 

Mom has very large, spreading breasts.  They are pendulous, of course, but I
also would describe them as FLAT.  I know that must sound odd seeing as how
we are talking about large breasts, but they truly do spread *out* as much
as they hang down.  As you suspect in this case, her nipples are flatish.
The do protrude about ¼ of a cm, but invert upon compression.  When it is
time for a breastfeed, I have observed mom just sitting there, not really
engaging in facilitating the latch, if you know what I mean.  Often she
would call her husband to come and get the baby on – he would then
manipulate her breast a little while taking baby’s head and ramming it on.
(Yes, this made me cringe!).  I have never seen this before – a mother
completely inactive when offering the breast.  

 

This mother really does not want to breastfeed.  We have discussed this in
the past (before the baby was born) and she admits that she is only doing it
because she is highly educated and she knows it is best for her baby.
Otherwise she would just bottle feed.

 

She is using a nipple shield.  She was given two different ones in hospital,
and obviously never taught how to apply it properly.  Her nipples measure
about 20 – 21 mm; the shield she was using most often measures 24 mm, and do
not fit snuggly.  After I measured her nipples and the shields, I suggested
she use the 21 mm shield and we did get a much better latch with that one.  

 

Baby appears to have some hypertonia – but I do not have a lot of experience
with this so I am not certain.  She has a recessed chin and her lips are
somewhat pursed (tight).  She does not respond consistently to oral
stimulation – she will take a gloved finger to suck, but the first time she
winces and grimaces (due to oral & physical trauma in hospital?), but when I
remove my finger and try again, she relaxes and takes it well.  She tends to
do the piston-like tongue motion that Cathy Watson Genna describes in her
book, instead of the normal tongue peristalsis…but again…this seems to be
improving each time I offer my finger.

 

Baby will latch on to the shield and get a good feed – mom produces lots of
milk at this stage – but she is not milking the breast.  She is also being
bottle fed 1 or 2x per day with expressed milk.  I have suggested dropping
the bottle but mom is very resistant.  Baby has no idea how to even latch
herself on to mother’s breast without a shield – she needs the hyper
stimulation of the long ‘nipple’ on the shield or on the bottle in order to
know what to do.

 

I have tried the typical ideas in this scenario, such as having mom pump
before offering the breast in order to relieve engorgement…trying to latch
her own using a breast sandwich…attempting the tea cup hold…and trying
positions geared toward a recessed chin.  I really believe that this baby
needs oral exercises and suck training, as well as CST or chiro.  I *have*
recommended these things and provided parents with instructions, but I do
not know if they are doing it.  If this was a mother who was committed no
matter what, I wouldn’t even bother posting here, and would just work on the
different issues over time…but…this mother has told me that she is ready to
quit.

 

So…any magic fairies that can pull one absolutely fabulous idea out of their
hat that will make an immediate difference?

 

Blessings.

 

Karyn-grace Clarke, IBCLC, LLLL

Gulf Islands, BC, Canada


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