I could use some input from some of you who have dealt with inelastic
breasts. The baby in question is now 11 days old, and I just saw her for
the third time today. She was born at 37 weeks, though the mother feels
that she might gestationally have been 36 wks (based on earlier
ultrasound discrepancies) at 5#13, dropped to 5#6 within the first 3
days, then back up to 5#14 now. Non-medicated birth, mother an athlete
in excellent condition. Mother came to me at day 4 because baby
had never latched on, and she was reluctantly forced to start ABM. Mom
was also very engorged at first visit, and so that was our first
priority.

In digital suck assessment I noted that the baby had difficulty
maintaining tongue contact with the finger; she had those exaggerated jaw
movements, more like a bottle suck, along with this loss of contact and
resultant loss of suction. Couldn't get her to do anything the first
visit, so I started the baby on fingerfeeds with modified Dancer support
on the soft sublingual tissue. Three days later she still had some
problem with this, but I was able to get her on breast after about an
hour's work (and I mean work!). Most of the time she hits the breast,
takes two tentative sucks, then quits. The nipple falls right out of her
mouth when you pull her back, so I know that she isn't drawing in the
breast. The one feed we had started roughly, and it took a lot to
convince her to suck; she ate lightly on and off, but did go for about 10
minutes. Mom was unable to duplicate our success from then to today (4
days), and we were not able to duplicate it in the office today, either.

As engorgement is no longer an issue, I am seeing how very firm (almost
fibrocystic, though she hasn't been diagnosed) and inelastic her upright
breasts are. Her nipples are just short of flat, and I am virtually
unable to manually elongate areola/nipple when I grasp to test elasticity.
Baby now roots willingly and attempts to latch on several times with a
nice, wide mouth, but after two half-hearted sucks she quits; nipple
comes out easily after that, despite the fact that the previous tongue
contact loss has almost disappeared.

I should also add that mom has a wonderful milk supply, is pumping twice
what her baby needs right now, and with one or two little expressions on
the areola, she readily drips and leaks milk, including right into the
waiting baby's mouth. Mikayla will actually swallow this "collected" milk
sitting there but not try to suckle!

I am weighing the relative factors of small, early baby and inelastic
breasts. I tried using a syringe at breast, but by the time the baby
latched on and took two sucks, she was off before I could slip it in, or
was disturbed by my slipping it in. Next time I will probably try an SNS,
but I am uncertain as to whether this will enable baby to nurse.

Any thoughts or ideas? Baby has learned to suck the milk preferentially
from the syringe during finger feeding, which is harder to do with
syringes than SNS's; I want to get her training in good habits soon!
I'd appreciate any input,

TIA,
Lisa

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Lisa A. Marasco, IBCLC                                /  [log in to unmask]
International Board Certified Lactation Consultant    /  [log in to unmask]

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