I am presently working with a mother who has extremely small breasts, and whose baby is having
difficulty in latching on. I would appreciate any suggestions!
This mum gave birth to her son, a firstborn, 10 days ago. She was eager to nurse, and
attempted to do so on the delivery table. Unfortunately, just as the baby was nuzzling away, a
nurse snatched him up to give him a bath. When the mother complained, she was told that human
babies don't know how to nurse when they are first born, and she would get him back again later.
She was then given a sedative which made her sleep for over three hours.
The baby was brought to her when she awoke, but by then he was fast asleep and impossible
to awake. He was brought to her regularly, but she could not get him to latch on, and she was
taught to finger feed using a syringe, a tube, and ABM. She was told that she had inverted nipples
and encouraged to pump. She was released 48 hours after the birth, never having nursed.
Soon after she got home, she started to pump about every two hours, using a M----a L-----a.
On the third day pp, she became very engorged, to the extent that she could not lift her arms. She
called a local LLL Leader, who called me. By the time we got back to this mum, she had gone to the
hospital ER, and we were not able to speak to her until the following day. She said that the ER
people did not seem to know what to do (why didn't they call the LC on staff?) and they had
eventually called a doctor who (without seeing her) diagnosed mastitis, prescribed tylenol with
codeine (T3), and sent her home. They told her that the engorgement had been caused by her pumping,
so she did not pump that night.
She said that the first dose of the T3 had left her dizzy, and so she did not repeat it,
but took straight tylenol instead. I suggested that she resume pumping, and use both hot compresses
and cabbage to help reduce the swelling, as well as rest and drink a lot. The baby was still not
latching on.
I finally saw her the next day. Her breasts were very hard. The right one had a flattish
nipple, and the left an inverted one. Her breasts were tiny - the size and shape of a well-muscled
male's pectorals, and even on the right side, the nipple was so flat that there was nothing for a
baby to grasp. I helped her to soften her breasts with hot compresses, and showed her how to hand
express. This was the first time she had ever see her milk, since all previous attempts at pumping
had yielded no milk at all. Her milk was buttercup yellow in colour. She then used the electric
pump. and was able to get about half an ounce from the right side, and a few drops from the left. I
encouraged her to keep pumping, finger feeding her milk plus ABM as necessary, showed her how to
use her finger to do suck training, and her mother how to give her a backrub to encourage let-down.
I also urged her to allow the baby unrestricted access to her breasts, especially at night.
Now for my questions...
What more can I do to help the baby latch on? I am considering re-birthing, and using a
silicone nipple shield, although I truthfully do not know if there will be enough soft tissue for
the nipple shield to hold onto.
My other concern is about the codeine. The other day, I was talking about this case to a
friend who happens to be a pediatrician in New Zealand, and is very knowledgable and supportive of
breastfeeding. When I mentioned the codeine, she became very upset. It seems that in New Zealand,
codeine has been shown to be contra-indicated for use in pp women, because it encourages
hemorrhaging. My friend was just leaving for a week long trip, and couldn't put her hands on the
studies right then, so I did some research on my own. I have looked in the archives, in Hale, and
in the USPDI, but I cannot come up with anything. It has been suggested that these studies simply
have not yet made their way to the USA. Are there any New Zealanders out there in lactnetland who
are aware of this research?
Thank you all in advance!
Norma Ritter IBCLC
<[log in to unmask]>
"If not now, when? If not us, who?" R. Hillel
|
