greetings, i hope some of you have seen this situation before nad can shed
some light:
Mom is a Primip, graduating this month from Naturapathic college, to give
you her orientation.
baby DOB 5/2/03, home birth, at 42 weeks gestation - 7#3oz. Normal vaginal
delivery, albeit with 2.5 hours of pushing. No head molding or hematoma,
no visable birth injury. Mom has been suffering from *severely*
traumatized nipples since day 2-3. Baby gained fine from birth to 1 week
(lowest weight was 6#10 oz on day 2, 1 week weight was 6#15 oz). First
seen by my colleague on 5/16, at 2 weeks of age, when baby weighed6#14oz
(no weight gain in the past week).
Mom began pumping and feeding ebm plus 4-5 oz per day of donor ebm) via sns
with nipple shield and occasional finger feeds. Baby transferred from SNS
well, but essentially takes all his milk via sns - no transfer is happening
from the breast. At this point mom is providing all the milk the baby
needs by pumping, so milk supply is not the issue. Milk is readily
available to fingertip expression.
Baby's frenulum was clipped 1mm on 5/23, and a couple mm more on 5/30, with
no obvious improvement in milk transfer or pain, but mom was using nipple
shield and SNS by then so pain is difficult to assess. Baby has had 3
cranial sacral treatments which mom felt didn't do much (and she was
dissapointed because she is a believer in CST, and has personally
successful experiences with it).
Mom has been plagued by plugged ducts, mastitis, and a "tugging" sensation
deep in the breast, all of which she has treated with a variety of herbal
remedies. The pain is not consistant (any longer) with yeast, and has
vastly improved by using nipple shield and sns.
I saw baby today (6/16). The main problem remains a milk transfer at
breast of ZERO (or nearly 0). Baby's superior labial frenulum *appears*
tight to me, but I am not sure what the assessment criteria for that would
be. All efforts to get a wide latch with flanged lips were
unsuccessful. The baby *pretends* to breastfeed very well, and even
pretends to latch well, with an open mouth and an assymetric approach to
the breast, but transfer is zero, sucking is inconsistant, and nipple is
often wedge-shaped upon removal from baby's mouth, and a bit
traumatized. Baby did not transfer any milk with nipple shield in place
either.
Digital oral exam revealed a somewhat high, but normal palate, and a
somewhat irregular suck/tongue placement, until finger feeding tube in
place and then suck was perfect. Gum line assymetry was apparent to both
me and the mother, which i have observed to exist in tandem with
cranial/sacral or chiropractic issues that impede on bf.
My recommendations:
- Consult with ND re: clipping the superior labial frenulum
- Consult with pediatric chiropractor/CST re: treatment (she saw a
different practicioner, and i have observed different modes of treatment
working well for different babies).
- Use "follow me mum" latch technique or "nipple sandwhich" technique and
try different positions.
- Try rescue remedy and/or pumping first to elicit let-down before latching.
- Continue to supplement with SNS or improvised SNS, at breast, using
nipple shield for comfort when necessary.
My questions for you all:
- Have you seen tight superior labial frenulums impede milk transfer this
severely? what about inferior labial frenulum?
- Does clipping for the labial frenulum work the same way as with lingual?
-brian palmer's presentation on tongue tie says clipping is usually ~ 1
cm. is 3-4 mm not enough, even if the translucent portion is clipped all
the way bacK? baby's tongue does come to lips, but appears flattish/kind
of square-tipped, rather than pointy or long. Is there such a thing as a
short tongue without a frenulum restricting it? or are the frenulums red
herrings and there is really something else going on here?
- Why is this baby transferring zero milk at breast, even though the milk
is readily available to the pump and fingertips - I would think at least
*some* would dribble in, even with an inneffective suck! could the baby be
compressing the ducts with the gumline and impeding milk flow? and if so,
would the milk still flow through the SNS?
- What other conditions could be causing this completely inneffective milk
transfer? and besides chiropractic, any suggestions for assessment and
treatment modalities that might help?
thanks in advance for any wisdom or experience you all can provide!
Lyla Wolfenstein, B.S., IBCLC, RLC
Early Attachments - Breastfeeding Preparation and Support Services
email: [log in to unmask]
web: http://home.attbi.com/~earlyattachments
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