Today I received a call from a teary, weary mom.  10 day old baby
who's gaining/growing and doing well.   I was able to head over to her
house right away.  Her nipples are badly damaged.  One of them
severely damaged and infected.  She also has mastitis and started abx
for it on Friday night.

We had some time to talk while baby was in gramma's arms sleeping.
During a very very thorough hx I asked if anyone had checked to see if
the baby  was 'tongue tied' or had a 'short frenulum'.    She said
that yes, 'just yesterday' the pediatrician told her that the baby had
an 'exceedingly' short lingual frenulum and that it would likely
interfere with language development and would likely require surgical
intervention at some point.

She then went on to rave about baby's weight gain and comment to mom
that breastfeeding was going well.  Mom clarified that no, it was
really going poorly and that she, while very commited was concerned
she would have to stop b/c her nipples were so damaged.  The ped
didn't make the link between the nipples and the tt.   Oh well, she's
my ped too and she loves learning about breastfeeding so I know she'll
be on board.

The mom and the dad were at first concerned when I mentioned the
tt/breastfeeding relationship, but eventually relieved to know that
for this there really is a pretty easy fix.   I'm suprised the tt was
missed.....she had a lot of great early lactation support both in the
hospital and after returning home.

Anyway, my point/question:  In this case, we did go with a nipple
sheild.   Mom's left nipples is incredibly badly damaged. there is a
crescent shape 3 mm wide crevasse that circles underneath and aroun
mom's nipple from 2 oclock to 10 oclock,  it's deep as well.  She's
been feeding on it until 24h ago, then she borrowed a pump, quit
feeding on that side.  Her other side was badly damaged as well but
not to the same extent.

I went with a nipple shield for basically two reasons:
1)this baby was going to get a bottle *or* a nipple shield at that
feeding.  Mom was done.  Traumatized, exhausted and sick.  She
initially refused to put the baby to breast and I knew that b/c of
baby's tt, a better latch would still leave mom in significant pain.

2)mom has a great supply and there was still a good chance that even
with the sheild for 1-2 days, baby could still get a good feed at the
breast and mom could feed without pain and not have to pump.

So we did it and it worked.  Baby had a great feed (b/c of mom's
abundant supply), mom is very good with her, was very persistent but
patient about getting baby's mouth open.  It worked well.  All
involved (mom, grandma, dad) know that the nipple shield is not a good
solution nor a permanent one.

it gives her the opportunity to feed her baby at her breast when she
otherwise wouldn't be....which keeps her from having to 1)pump then 2)
still feed her baby in addition to pumping.  we talked about nipple
confusion and that it can happen with a bottle or a nipple shield and
talked about the fact that getting her back to feeding 'normally' at
the breast might be easy breezy or might be a bit of a process but
that either way it was doable.

In place is a very proactive wound healing protocol....so hopefully by
the time baby's frenulum is clipped on monday, mom's nipples will be
healed.

let me just clarify that in general, I'm not a big fan of nipple
shields.  I tend only to use one when the alternative will be not
feeding at the breast, from a bottle.  If it's the 'only' option to
keep baby at the breast successfully and keeps mom from having to
pump, then there it is.   For me that's a rare thing.  Really I've
only used it a handful of times - three times that I can think of in
10 years of breastfeeding help (about 1 mom every 1-2 weeks).

They'll also be doing CST asap.

Please feel free to comment;)

katherine

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