From the mother I have permission to ask for your input.  She phoned me
today for advice, had read something I had written in the BF newsletter, I
think.  She doesn't live close enough to me for me to see her.  She says she
has a good relationship with her public health nurse at the health center
but that the nurse has no more suggestions for her.  She is hoping to get
her baby to take the breast better.  The info here is from her account to
me.  I was at work when she phoned and couldn't ask all the questions as
systematically as I would like as you will see from the info below.

Baby was born at term, vacuum extraction (slow progress), birthweight 4.2 kg
(9 lb 4 oz).  Mother says baby was not suctioned at birth.  I didn't get
info about labor medications.  From the first feed baby 'resisted' coming to
the breast.  Would feed finally when exhausted after up to 3 hours of
crying/screaming.  Sometimes spits up (mother said 'vomits') large amounts
after a feed.  According to mother they spend 'lots' of time skin-to-skin
and have always done so.  This pattern of screaming resistance has continued
for the 6 months that have passed since his birth.  Has fed without the
screaming fits when sleepy, but in the last couple of weeks has started
getting upset at all feeds.  Mother takes the initiative for all feeds,
otherwise 'he doesn't eat'.  When I asked how long he would wait, she said
12 hours.  I don't know if this happened once and put the fear of starvation
into her, or if she has tried to let him cue for a feed on other occasions
and he consistently declines to ask for 12 hours.

Because the screaming and crying take so long, she only manages to get in 4
feeds/24 hours, one of which is at night.  Baby weighs now (at 6 months) 8.5
kg (18 lb 12 oz) or about twice birthweight.  PHN considers growth adequate
but nothing to shout hurrah for.  Baby was admitted to peds ward some time
back to rule out medical causes for his behavior and after they eliminated
any organic cause (and I don't know what they looked for, or how)  mother
was told it was 'colic' which she does not believe it was or is.  She says
no one found anything wrong with her technique or positioning; there are no
IBCLCs where she lives and I don't know how BF savvy the hospital staff were
at her hospital.  She has been in touch with the BF mothers' organization
but I don't know if it was only by phone.

Mother says they have tried 'everything' though I don't think CST has been
tried.  Also don't know whether they ever tried co-bathing or alternative
modes of administration of the milk.  Before I suggest this I wonder if it
has any value so long after the fact.  Also I don't have a clue where she
would find a practitioner where she lives so don't know if it is realistic
to discuss.  She pumped for a while but got too tired from pumping so
doesn't do it anymore.  She wants the baby to take the breast, and she wants
the battles to stop.  She notes supply is dwindling, as expected with such
infrequent feeds.

What baffles me most is how she has managed to survive for 6 months of
deadlock around every feed, and how the baby has managed to double his
birthweight.  I didn't ask whether she has been feeding him any supplements
to or substitutes for her own milk.

I've been trying to think what SuperIBCLC would do here.  (See the dyad,
most likely, but that isn't in my choice field.)  Speech therapist?
Chiropractor?  Suggestions?

I'm going to call her back in about 12 hours and it would be so nice if I
had something to tell her that could either help us figure out what is going
on, or a suggestion for something to try that she maybe hasn't heard of yet.

cheers
Rachel in Norway

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