>Colleagues: Suggestions sought for this difficult situation. I am seeing
>a 11 week old baby who is an inefficient nurser. Birth history was
>normal. but baby didn't latch well, mother had sore nipples early on.
>Mother told baby's mouth too small for her nipples. Baby weighed 6#3,
>6#9 @ two weeks. Mother told to begin supplements because he cried so
>much. Weight gain continued to be okay, yet increasing supplements give
>till baby was getting 20+ ounces. Mother continued to breastfeed, but
>baby falls asleep at the breast. By 2 months, milk supply pretty low.
>Mother sought help of hospital LC who recommended a good pump and SNS.
>Mother didn't like the feeding device, but uses pump. I was called to
>see baby at 9 weeks. Mother's nipples were raw, position very poor, so
>we worked on that. Baby nurses a little better, but doesn't really drain
>the breast well. Mother able to drop the amount of formula significantly
>(12 oz), and can and collect 10oz/day in addition to breastfeeding. Her
>goals are: total breastfeeding, or provide enough breastmilk to
>eleiminate formula. Baby had severe diahhrea when she tried fenugreek to
>increase milk volume. She pumps frequently, feeds. Her best feedings are
>at night after she and baby have slept for 4-5 hours and there is a
>bigger volume of milk. Husband starting to get tired of all this. Baby's
>behavior is the key, as I see it. He doesn't "work at the breast" to
>drain it or he doesn't "get it" , that he can get milk at the breast if
>he keeps going. Have suggested compressing while nursing, different
>positions, switch nursing, marathon in the bed, power position on the
>floor. Am open to any and all suggestions, paricularly, how to teach the
>baby that the food comes from the breast. Thanks for your help
Your mom has a twin sister here. I saw them at 6 weeks when baby was
still at birthweight. Mom's nipples were badly eroded at the tips,
tho she didn't complain. This was her 3rd child; first two nursed
to around a year uneventfully, over a decade earlier. We worked on
position, but the baby continued to need her position monitored -
making sure lips were flanged, making sure baby didn't slide back onto
nipple, making sure chin didn't tuck.
She started using a Munchkin wide-based teat, and monitored baby's
position on that as well, so that a wide mouth and deeply placed teat
were reinforced both with bottle and with breast. Her supply
increased with pumping. She'd been pumping a couple times a day with
little result; 5-6 times a day provided enough milk to phase out
formula over a couple weeks. Mom also used breast compressions. One
nipple was a very long time healing. Antibiotic cream helped, but
the slow healing makes me think this baby was still sucking funny.
Mom had to hold her breast throughout each feed, or it would slip from
the baby's mouth. Breast compressions clearly helped, tho I think the
mom generally forgot to do it.
Pre/post weight gains were
.3 and .6 oz (left and right breasts) at 6 weeks,
.3 and .3 at 7 weeks
.4 and .4 at 8 weeks
1.3 and 1 at 10 weeks, but over a 2 hour period
.8 and 1.4 at 4 months, within a half hour
Most of what I did was just provide a cheering section. Resolution
was slow, and even now, at 5 months, the mom has to support her breast
on the left side. But the baby is now just about able to maintain the
supply on her own, though she's a more restless, fits and starts
nurser than most. Mom still pumps in the morning for an evening
bottle - she says for "convenience", but I suspect that little bit of
pumped milk may still be important. She's been on target in every
other way that we know of. Anyway, it's had a happy ending, mom is
thrilled, and they came to my last Walking Wounded to be a cheering
section for others.
Diane Wiessinger, MS, IBCLC, LLLL Ithaca, NY
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