With permission to share her case, here are the details:

G1P1, non-eventful vaginal delivery of full-term 7 lb 14 oz baby girl on 3-30-01 (6 days ago)  Some suctioning at birth, some meconium staining.  Baby did not latch in delivery room -- and not at any time during hospital stay.   Discharged at 7 lb. 4 oz. 

 

Baby acts, for all the world, like a "nipple confused" baby -- yet she's never had a pacifier or a bottle.  She purses her lips and pushes Mom's nipple out of her mouth.  Mom positions baby well, and forms breast well.  Mom attended pre-natal BF classes; is calm and well-motivated; was double-pumping and cup feeding by the time of discharge. 

 

My digital exam indicatd a nicely arched upper palate, a tongue extending nicely over the gum line, a lovely "tongue wave" motion toward the back of the mouth, and a baby who was perfectly and happily content sucking on a finger.  Baby doesn't appear to be "sucking her tongue."  Baby is alert during "feeds."

 

Relevant?  Baby was fitted for a "hip harness" on Day 5; does not appear at all uncomfortable in it according to Mom.  Mom has been able to comfortably position baby to "breastfeed" in the cradle and football positions -- but baby, of course, isn't nursing.

 

Mom had been offering breast first at each feed; trying to latch until she or baby got frustrated, then offering cup-feeding of expressed breastmilk.  I suggested feeding a bit first (1/2-1 ounce), then offer breast.  With this technique, baby was much more willing to "hang-out" at the breast ... mouthing nipple, perhaps latching briefly with no suckling.  But Mom had to return to cup to give baby enough.

 

At the hospital, she had tried a nipple shield.  If anything, Baby fought latch more.  Mom's nipples stand out with areolar compression, and her breasts are not engorged. 

 

Other suggestions I gave her: 

* Lots of skin-to-skin contact.

* Try bathing with the baby in a warm tub (she didn't get around to this before the harness was put on -- I do not know yet if the baby can be immersed).

* To get the 2.4 ounces of breastmilk baby needs (assuming 8 feeds/24 hours), try finger/syringe feeding.  (Mom reports that feeds do go a bit quicker -- and more is taken in -- using this technique.  Baby had been getting about 1.5-2 ounces per feed .... just not enough according to my handy-dandy Kitty Frantz pocket charts).

* Climb into bed with baby at every opportunity.

* Remember the goals:  (1)  feed the baby [being done], (2) protect mom's milk supply [being done], and (3) stay sane [she seems to be scoring here, too].

 

So, what else -- if anything - can I suggest?

 

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA