Saw a baby yesterday.  7 weeks old.  Called because baby was "biting."
History as related by mother.  Infant born by Cesarean after failed
induction.  Mom asked to nurse baby immediately after birth but told
sugar was low and baby needed bottle.  Second feeding, mom consented to
bottle because she was too groggy (epidural only worked on one side so
she had general anesthesia for C-section) and afraid she couldn't safely
care for baby.  No more bottles in hospital.

Mom allowed baby in nursery first night but after that insisted on
keeping baby with her.  She says two hospital LCs told her baby was
well-latched, though neither watched her latch the baby, only saw baby
nursing.  Before discharge she told doctor two recent feedings had been
one and two hours long.  Doctor told mom to limit feeds to 15 minutes
and not feed baby more often than every two hours; baby would get all
she needed in 15 minutes--she was only pacifying at the breast.  Mom
tried to stick to this, but often fed baby after an hour and a half
because baby was crying so much.  Mom didn't want baby to become nipple
confused, so argued with family members who wanted her to bottle feed
the baby.   Baby had no more than one bottle a day despite incessant
crying.

Baby weighed just over 6 pounds at birth, lost a few ounces in the
hospital and regained birth weight by 2 weeks of age.  At 6 week
check-up baby weighed 8 lb.  Mom stated her nipples were sore, and baby
never seemed satisfied.  Doctor told her baby was fine, but she (mom)
wasn't so she should see a lactation consultant.  Mother was also
surprised that pediatrician told her, just make sure baby gets 18-22 oz.
of milk a day, either breast milk or formula--said peds didn't seem to
think it mattered which.

I urged mom to see a lactation consultant as soon as possible.
Meantime, I encouraged her to feed the baby on cue and discussed
positioning.

Later in the day mom called to request a consult.  When I arrived, I
immediately noted baby was thin though not dehydrated.  She cried most
of the 2 1/2 hours I was in the home, except for when she was at the
breast.  When put to breast, I noted a shallow latch.  Even with
corrected latch, sucking was almost entirely "non-nutritive" (fast
sucks, mostly without any noticeable movement of the muscle in front of
the ear).  After some time, I began noting occasional swallows--after
eleven sucks, the one time I counted.  I discussed need for
supplementation, and mom decided on a supplementer, with some
reservations because she was sensitive to tape.  Baby's sucking pattern
immediately changed with milk flow and baby relaxed.

I taught mom to hand express.  In about 5 minutes, she expressed enough
to cover less than half a 2-cup liquid measuring pitcher.  She then
decided to rent a hospital grade electric pump.  She obtained very
little milk in 5 minutes, then we put baby back to breast because she
was crying again.  By the time I left, mom could assemble and apply the
supplementer and put the baby to breast with a little help from dad,
achieving good latch.

Mom called me today.  Pumped once this morning.  Started one other time,
but baby started crying, so she held baby.  Used supplementer once, but
it is too much for her to manage by herself, and dad was at work during
day.  Says the tape is starting to bother her, too. She is bottle
feeding baby more.  (I had stressed Rule # 1--feed the baby.)

Has anyone tried another method of securing supplementers?  I did
suggest dad might try to put it in side of mouth after latch when he is
home.  This doesn't work for me, so I have serious doubts about this
working.  Suggested she might try different kind of tape.  Covering the
supplementer with a shield has no pluses in this situation in my
thinking.

Meantime, I told her to bottle feed an ounce or more at the beginning of
each feeding, then put baby to breast, emphasizing again importance of
good latch), then finish supplement after breastfeeding.  Told mom to
pump a minimum of 6 times a day.  There is a helper in home, so
suggested mom have her bottle feed while mom pumps.  (Having helper
assist with breastfeeds apparently is not an option.)

This baby willingly sucks on the breast, even when poorly latched and
obtaining very little milk, so I think she will continue breastfeeding.
My main goal is to increase mom's supply.  She seems highly motivated to
breastfeed, but overwhelmed.

Another question?  Can poor latch alone (with a baby who is held a lot
and breastfed frequently) explain the very low supply?

I haven't discussed galactagogues.  Guess I could discuss that with her
tomorrow.

--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
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