Hello wise ones.  We've come across a difficult case and was hopeful extra 
eyes on it could help with some ideas.  I have permission to post as it is 
my baby ; )

Some history:

-mom "menopausal" pre-pregnancy as per OB specialist, 3cm fibroid present in 
uterus
-9th pregnancy, 5th live born child (all pregnancy losses in 1st trimester). 
2 c-sections, 2 vbacs
-mom 40 at time of baby's birth
-non-complicated pregnancy
-baby at 38 weeks gestation was found to be slightly transverse (head closer 
to mom's lower right hip) but ob's confident that head would move down with 
contractions
-labor began at 40 weeks with steady contractions (every 5 min).  no 
cervical change noted (2cm, 70% ).  returned to hosp in 48 hours with cntrx 
every 2-3 min.  no cervical change.  labored for another 12 hours in hosp. 
with cntrx every 2-3 min.  ultrasound done, baby still in transverse 
position.
External version done.  Baby moved, water broken and labor progressed.  1 
1/2 hours later, cntrx changed and mom unable to continue(felt like 
something was wrong).  cervix was checked, 3cm dilated but baby in brow 
presentation.  OB recommends c-section.  cntrx stopped with tributaline. 
c-section performed.  Healthy 9#2oz. baby born, skin to skin done in OR. 
Breastfeeding in recovery room within 30 minutes.

-baby very spitty/gaggy after all feeds from birth
-latch always tight (and continues to be at 10 weeks old), unable to adjust 
or she would just stop sucking
-frequent nurser from birth (every 30 minutes)

-baby at 1 week old had a craniosacral treatment w great success, spitting 
up decreased for about 1 week.
-no bottles or pacifiers attempted until 3 weeks, greeted w gagging and 
spitting up large amounts (thought was a pacifier could help reduce 
spitting).
-baby's weight gain fine for first 6 weeks (1 oz per day)
-mom removed dairy, wheat and soy from diet as baby was very fussy and 
projectile spitting out mouth and nose after all feeds.  Spitting has 
decreased and is no longer projectile.  spitting occurs about 5 times per 
day.
-at 8 week check-up baby dropped from 90% to 75%, weight gain now at 4oz per 
week.
-lactation consult revealed baby took about 40 ml. Fenugreek was started (3 
caps 3 x/day) and pumping 3 times per day after feeds.
-4 days later, weight gain was 6/10 of an ounce.  baby took 110 ml at this 
feed (feeds usually last about 1 hour w lots of switch nursing).
-baby now nurses often but nutritive sucking is not observed often.  she 
does short little sucks and when milk lets down she will either cry, move 
her mouth so it pours out the corner.  suck to swallow ratio is about 3-4:1. 
spitting up still but not as frequent. baby is still quite fussy especially 
from 2-8pm.  she sleeps at night anywhere from 3-5 hours and nurses better 
than she does during the day.  if baby is sleepy she will nurse better.
-this baby is also quite sensitive...will jump at noise (like someone 
talking, sniffing nose, etc.)
-baby has had copious wet cloth diapers and many yellow seedy bowel 
movements per day until 2 days ago and has only had 2 bowel movements in 
that time (both yellow)
-a referral to early intervention has been made to investigate possible suck 
or sensory issues and an appointment has been made for another craniosacral 
treatment.

I and my IBCLC colleague are at a loss here...not sure what is going on and 
why this baby isn't gaining weight more, fussiness, etc.

Any words of wisdom would be appreciated.

Colette L. Baran
IBCLC, LCCE, CD(CBI), CHBE
Berkshire Nursing Families (413)743-5338
NARH & WIC
(413)652-3433 

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