Jennifer writes:  "What I am wondering is how others
would handle this. Would you have used the shield? Would you have used the
shield if you felt knowledgeable enough to believe that the baby was injured
from the birth? Would you have done something else I didn't think of? How,
if
at all, would you follow up with the ped and LC? With the mother?"

This Mom was not able to accept your suggestions for a chiropractor or
massage therapist.  She chose to seek other opinions - from her Ped and the
other LC.  Although you probably had the situation nailed as birth trauma,
and the chiropractor would have been the "cure", this mom was not willing to
go that route.  The other LC might have chosen to use the nipple shield as a
"last resort" - shield or lose the BF due to nipple trauma and inadequate
intake.  This was an intervention the mom was willing to try.  Hopefully,
with time and patience, and feeding with the shield, the baby will begin to
heal, the amount of breast milk taken in will increase, he will begin to
open wider, and he will BF more effectively.

Your suggestions were great, the mom just couldn't do it that way.  This was
her choice.

In an effort to maintain your connections with the community (not to defend
your suggestions), you could send a brief report/letter to the Ped outlining
your observations, assessments, plan of care, and expected outcomes - just
the facts.  You could call the LC to check the progress of this BF couplet -
as a way of sharing techniques and learning from each other.  You could call
the mother to support her decision-making, check on the progress of the BF,
and offer to help with future BF concerns.

You win some, you lose some.  The trick is to not take it personally.  Go
and do something nice for yourself - lounge in a bubble bath, go out to
dinner, buy yourself some flowers, whatever will lift your spirits....
Tomorow will be another day, with another mom and baby who will need you.

Barb Berges BS, RN, IBCLC
Rochester, New York

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