Guest guest Posted August 28, 2003 Report Share Posted August 28, 2003 At 08:55 PM 8/27/2003 -0700, you wrote: After trying various positions, nipple sandwich, assymetrical latch (which only made mom's nipple pain worse) and finally a shield that she'd come home from the hospital with, the baby did latch and I did observe a good 15 minutes of suck, swallow, breath (coordinated). wendy - it sounds like you were really thorough, and my input is inno way intended to say you did *anything* wrong - just an alternative approach, and wondering how you think it would have panned out with this approach: i probably would have tried the sns at the breast before the shield. i find that many babies who won't latch without the tube, will latch and nurse well with it. they are seeking immediate flow and need that instant gratification (either because of bottle introduction, extreme hunger, or just low threshold for frustration - whatever). what was the milk transfer with the shield? did baby transfer well after the 15 minutes of nursing? did you do pre and post feed weights? i know it is cotnroversial,but i find them essential in most cases. also - i would have left *very* specific instructions for skin to skin contact/kangaroo type care. The baby was ready to nurse when I arrived. Since mom's engorgement had eased, I suggested that we try nipple rolling without pumping and then try to get the baby latched. He would have none of it! The second he felt her nipple in his mouth he arched his back and let out a lusty cry (which really sounded good to me, after the last time I'd seen him). i might have tried finger feeding a little, and then tried latching with the sns. i *do* use nipple shields, as a last ditch effort to keep/get baby at breast, but i would always try a lactation aid first. (obviously a clear, and very strong preference for a firm nipple) or a rapid flow? do you carry syringes and shields with you to consults? i find it really helpful to have a few of anything i might need, just in case. i don't think you failed at all. and this baby might have gone to breast without hte new shield or the syringe, a day or so later anyhow. the family will need help transitioning baby off the shield as well - and support around skin to skin, and tincture of time, etc. don't beat yourself up! Lyla Wolfenstein, B.S., IBCLC, RLC Early Attachments - Breastfeeding Preparation and Support Services email: IBCLC@... phone: web: http://www.earlyattachments.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2003 Report Share Posted August 28, 2003 At 08:55 PM 8/27/2003 -0700, you wrote: After trying various positions, nipple sandwich, assymetrical latch (which only made mom's nipple pain worse) and finally a shield that she'd come home from the hospital with, the baby did latch and I did observe a good 15 minutes of suck, swallow, breath (coordinated). wendy - it sounds like you were really thorough, and my input is inno way intended to say you did *anything* wrong - just an alternative approach, and wondering how you think it would have panned out with this approach: i probably would have tried the sns at the breast before the shield. i find that many babies who won't latch without the tube, will latch and nurse well with it. they are seeking immediate flow and need that instant gratification (either because of bottle introduction, extreme hunger, or just low threshold for frustration - whatever). what was the milk transfer with the shield? did baby transfer well after the 15 minutes of nursing? did you do pre and post feed weights? i know it is cotnroversial,but i find them essential in most cases. also - i would have left *very* specific instructions for skin to skin contact/kangaroo type care. The baby was ready to nurse when I arrived. Since mom's engorgement had eased, I suggested that we try nipple rolling without pumping and then try to get the baby latched. He would have none of it! The second he felt her nipple in his mouth he arched his back and let out a lusty cry (which really sounded good to me, after the last time I'd seen him). i might have tried finger feeding a little, and then tried latching with the sns. i *do* use nipple shields, as a last ditch effort to keep/get baby at breast, but i would always try a lactation aid first. (obviously a clear, and very strong preference for a firm nipple) or a rapid flow? do you carry syringes and shields with you to consults? i find it really helpful to have a few of anything i might need, just in case. i don't think you failed at all. and this baby might have gone to breast without hte new shield or the syringe, a day or so later anyhow. the family will need help transitioning baby off the shield as well - and support around skin to skin, and tincture of time, etc. don't beat yourself up! Lyla Wolfenstein, B.S., IBCLC, RLC Early Attachments - Breastfeeding Preparation and Support Services email: IBCLC@... phone: web: http://www.earlyattachments.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2003 Report Share Posted August 28, 2003 Hi Everyone, Thanks Lyla for the following. >>i probably would have tried the sns at the breast before the shield. i find that many babies who won't latch without the tube, will latch and nurse well with it. they are seeking immediate flow and need that instant gratification (either because of bottle introduction, extreme hunger, or just low threshold for frustration - whatever). Sorry - left that part out - yes we did try the SNS without the shield first. No go. Also, mom was so good about almost all the stuff we tried, but she really disliked the SNS, so I didn't push it. He'd latch for a second then pull away screaming. We also tried a dropper of milk - a drop here a drop there to keep him interested. That was on the day she was pretty engorged, though, so I think that was causing her nipple to be too flat for him to get a good latch - and that was after a pumping. So, I probably should have tried all these things again after the baby was rehydrated, yes? >>what was the milk transfer with the shield? did baby transfer well after the 15 minutes of nursing? did you do pre and post feed weights? i know it is cotnroversial,but i find them essential in most cases. These are truly excellent questions. No, that day I didn't do a pre weigh. I really wished I had - have the scale, had it right there in the room, but for some reason didn't do the pre-weigh (which made the post weigh virtually pointless). I assumed good transfer because of the suck-swallow-breath that I was hearing (finally), but looking back I probably won't assume that ever again. Thanks, Lyla. >>i might have tried finger feeding a little, and then tried latching with the sns. i *do* use nipple shields, as a last ditch effort to keep/get baby at breast, but i would always try a lactation aid first. Again, excellent feedback, Lyla. I probably should have had them try finger feeding him before the bottle. And I agree, that I will in the future use nipple shields when a case like this presents itself. This baby clearly would have benefitted from a good fitting one. Thanks Lyla. I appreciate the input very much. Warmly, McCoy, LLLL, IBCLC, RLC Best Beginnings Breastfeeding Support Svcs. Placerville, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2003 Report Share Posted August 28, 2003 Hi Everyone, Thanks Lyla for the following. >>i probably would have tried the sns at the breast before the shield. i find that many babies who won't latch without the tube, will latch and nurse well with it. they are seeking immediate flow and need that instant gratification (either because of bottle introduction, extreme hunger, or just low threshold for frustration - whatever). Sorry - left that part out - yes we did try the SNS without the shield first. No go. Also, mom was so good about almost all the stuff we tried, but she really disliked the SNS, so I didn't push it. He'd latch for a second then pull away screaming. We also tried a dropper of milk - a drop here a drop there to keep him interested. That was on the day she was pretty engorged, though, so I think that was causing her nipple to be too flat for him to get a good latch - and that was after a pumping. So, I probably should have tried all these things again after the baby was rehydrated, yes? >>what was the milk transfer with the shield? did baby transfer well after the 15 minutes of nursing? did you do pre and post feed weights? i know it is cotnroversial,but i find them essential in most cases. These are truly excellent questions. No, that day I didn't do a pre weigh. I really wished I had - have the scale, had it right there in the room, but for some reason didn't do the pre-weigh (which made the post weigh virtually pointless). I assumed good transfer because of the suck-swallow-breath that I was hearing (finally), but looking back I probably won't assume that ever again. Thanks, Lyla. >>i might have tried finger feeding a little, and then tried latching with the sns. i *do* use nipple shields, as a last ditch effort to keep/get baby at breast, but i would always try a lactation aid first. Again, excellent feedback, Lyla. I probably should have had them try finger feeding him before the bottle. And I agree, that I will in the future use nipple shields when a case like this presents itself. This baby clearly would have benefitted from a good fitting one. Thanks Lyla. I appreciate the input very much. Warmly, McCoy, LLLL, IBCLC, RLC Best Beginnings Breastfeeding Support Svcs. Placerville, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 Hi, , My thoughts... * Why did the asymmetrical latch make her feel worse? I'm wondering what is going on. Maybe a tongue movement/suck problem? Was she *really* latched as deeply as possible? * What kind of bottle nipple were they using? What flow rate? * According to the Wolf and Glass seminar I attended in the Spring, the first choice of nipple shield size to use is the newborn (smallest) size unless the mom's nipples are extraordinarily large. They felt it is more important to fit to the size of the baby's mouth than the mom's nipples. They are also concerned about creating a " super stimulus. " Since the seminar, I have been mostly using the smaller size, with very good success. * I don't see how using a syringe was better than using an SNS or fingerfeeding, but I haven't used syringes much in my practice. I am interested in learned when and why some of you use them over other feeding methods. * I agree that getting weights would have been useful, but you had a lot going on and it's hard to do it all when there is so much stress emanating from the parents. It really sounds to me as if you did a very competent consult. I'm betting a large part of the reason you felt like you had " failed " was the father's comments about when to give up. That kind of negativity could make an LC feel like she hadn't done enough to make them see the light at the end of the tunnel. But the reality is that some partners or grandparents will be that negative no matter what, even from the first *hint* of trouble. I try to politely validate their concerns, but then tune the negative person out and focus even more intently on the mom and baby, trying to compensate with my unflagging faith in their ability to make it work. You're doing great, ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 > and as for the presumed good milk transfer with suck swallow breath - i > will never again assume that, because in my one year (less) of practice, i > have already been fooled SO many times, in both directions - a baby who > doesn't look like they are doing anything transferring 2 ounces in 5 > minutes and many babies who appear to nurse well and transfer 6cc! i truly > don't understand how to do this without a scale! I like the pre/post weighs for this reason, too. The other thing I did this past week was to use a stethoscope to listen to the swallow. *Very* cool to listen to! I think this is talked about by Wolf & Glass, too. Wagner- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 > and as for the presumed good milk transfer with suck swallow breath - i > will never again assume that, because in my one year (less) of practice, i > have already been fooled SO many times, in both directions - a baby who > doesn't look like they are doing anything transferring 2 ounces in 5 > minutes and many babies who appear to nurse well and transfer 6cc! i truly > don't understand how to do this without a scale! I like the pre/post weighs for this reason, too. The other thing I did this past week was to use a stethoscope to listen to the swallow. *Very* cool to listen to! I think this is talked about by Wolf & Glass, too. Wagner- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Hi Everyone, wrote: * Why did the asymmetrical latch make her feel worse? I'm wondering what is going on. Maybe a tongue movement/suck problem? Was she *really* latched as deeply as possible? She did have a crack on the nipple that we were trying the asymmetrical latch with and no, at that point I don't think the baby was really latched deeply. The pain from the crack did ease though when we put the baby in a sidelying position and then got him latched well (for about 35 seconds). * What kind of bottle nipple were they using? What flow rate? They had an Avent silicone nipple - newborn. He had a decent strength suck, so we bottle fed in a neutral position so that there wasn't too much gravity pushing on the EBM in the bottle. That worked okay for him - but again I think he REALLY preferred that rate over mom by the time he was rehydrated. * According to the Wolf and Glass seminar I attended in the Spring, the first choice of nipple shield size to use is the newborn (smallest) size unless the mom's nipples are extraordinarily large. They felt it is more important to fit to the size of the baby's mouth than the mom's nipples. They are also concerned about creating a " super stimulus. " Since the seminar, I have been mostly using the smaller size, with very good success. You know, I've heard both sides. I observed a consult with a mom with average size nipples using the newborn shield and I've seen it work (thus supporting Wolf and Glass's preference) This was one of those cases where the nipple size was just way too big for that size shield. Baby just couldn't draw enough of her large nipple into the shield to bring a bolus of milk into his mouth. * I don't see how using a syringe was better than using an SNS or fingerfeeding, but I haven't used syringes much in my practice. I am interested in learned when and why some of you use them over other feeding methods. I don't either, - except maybe that the SNS tube is so floppy that it can be difficult for parents to coordinate it all when they're trying to use it behind a shield. I do know that the LCs that use them (and with whom I'll learn to use them) like them because they can help baby with just a little bit of milk or with more if the suck is weak. I'm betting a large part of the reason you felt like you had " failed " was the father's comments about when to give up. That kind of negativity could make an LC feel like she hadn't done enough to make them see the light at the end of the tunnel. I think you may be right. I'll keep that in mind next time and just press forward with my 'unflagging faith' too. Thanks very much, ! Warmly, McCoy, LLLL, IBCLC, RLC Best Beginnings Breastfeeding Support Svcs. Placerville, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Hi Everyone, wrote: * Why did the asymmetrical latch make her feel worse? I'm wondering what is going on. Maybe a tongue movement/suck problem? Was she *really* latched as deeply as possible? She did have a crack on the nipple that we were trying the asymmetrical latch with and no, at that point I don't think the baby was really latched deeply. The pain from the crack did ease though when we put the baby in a sidelying position and then got him latched well (for about 35 seconds). * What kind of bottle nipple were they using? What flow rate? They had an Avent silicone nipple - newborn. He had a decent strength suck, so we bottle fed in a neutral position so that there wasn't too much gravity pushing on the EBM in the bottle. That worked okay for him - but again I think he REALLY preferred that rate over mom by the time he was rehydrated. * According to the Wolf and Glass seminar I attended in the Spring, the first choice of nipple shield size to use is the newborn (smallest) size unless the mom's nipples are extraordinarily large. They felt it is more important to fit to the size of the baby's mouth than the mom's nipples. They are also concerned about creating a " super stimulus. " Since the seminar, I have been mostly using the smaller size, with very good success. You know, I've heard both sides. I observed a consult with a mom with average size nipples using the newborn shield and I've seen it work (thus supporting Wolf and Glass's preference) This was one of those cases where the nipple size was just way too big for that size shield. Baby just couldn't draw enough of her large nipple into the shield to bring a bolus of milk into his mouth. * I don't see how using a syringe was better than using an SNS or fingerfeeding, but I haven't used syringes much in my practice. I am interested in learned when and why some of you use them over other feeding methods. I don't either, - except maybe that the SNS tube is so floppy that it can be difficult for parents to coordinate it all when they're trying to use it behind a shield. I do know that the LCs that use them (and with whom I'll learn to use them) like them because they can help baby with just a little bit of milk or with more if the suck is weak. I'm betting a large part of the reason you felt like you had " failed " was the father's comments about when to give up. That kind of negativity could make an LC feel like she hadn't done enough to make them see the light at the end of the tunnel. I think you may be right. I'll keep that in mind next time and just press forward with my 'unflagging faith' too. Thanks very much, ! Warmly, McCoy, LLLL, IBCLC, RLC Best Beginnings Breastfeeding Support Svcs. Placerville, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 At 02:36 PM 8/29/2003 -0400, you wrote: I like the pre/post weighs for this reason, too. The other thing I did this past week was to use a stethoscope to listen to the swallow. *Very* cool to listen to! I think this is talked about by Wolf & Glass, too. i have seen thi s mentioned a few times and now i need to go out and get me a stethescope! ;-) how much do they cost? lyla Wagner- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 At 02:36 PM 8/29/2003 -0400, you wrote: I like the pre/post weighs for this reason, too. The other thing I did this past week was to use a stethoscope to listen to the swallow. *Very* cool to listen to! I think this is talked about by Wolf & Glass, too. i have seen thi s mentioned a few times and now i need to go out and get me a stethescope! ;-) how much do they cost? lyla Wagner- Quote Link to comment Share on other sites More sharing options...
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