Tag Archives: Infants

Lactation Derailment Can Begin in the Hospital: 10 Tips for Avoiding a Trainwreck

29 May

I must preface this blog by explaining that

fourteen years ago I became a mother/baby nurse, and ten years ago I became the resident childbirth educator and “breastfeeding counselor” on staff at a local hospital.  We did not have an IBCLC on staff, so I was IT until we hired another educator.  My training as a nurse, some time as a member of La Leche League and my own personal breastfeeding experience was all I had in my arsenal.  Though I wasn’t “official,”  I worked the position of a lactation consultant.  And it wasn’t easy…so many moms…so little time…so many interventions.  That being said, please read the following with the understanding that I have been “on the other side,” doing my best as a nurse to help fresh babies latch…bending over beds as an educator positioning babies and sandwiching breasts for moms who were too sleepy on pain medication post-cesarean to do it themselves.

A week ago, I had the privilege of visiting a new family in the hospital to provide assistance with breastfeeding.  She has given me permission to share my observations.

When I arrived, I had dad undress baby down to diaper and in skin to skin with mom.  The baby was only 36 hours old and very sleepy after a long labor and difficult delivery.  Mom, Dad and I chatted for a moment then got to the business of latch.  The baby would not wake up.

A nurse came in to give mom pain medication.

Though I was not surprised at the baby’s behavior, he appeared jaundiced, and I knew it was important to get colostrum into him.  So, we proceeded to hand express and collect colostrum to spoon/syringe feed him.

Then the baby photographer came in to show the picture previews.

Mom asked her to come back later.  (Reminder:  Mom is sitting in hospital bed with her breasts exposed.) We continued hand expression and then fed the colostrum back to the baby.  He began to exhibit some hunger cues, so we put him back to the breast.

The OB came in to check on mom.

Once again, latch attempt without success.  More hand expression.

Knock, knock? Have you had a chance to look at your pictures? Baby photographer again. (Are you kidding me?)

More teaching, more skin to skin….fed baby more colostrum.

A different nurse came to check on mom.

Another latch attempt…

The first nurse came back to tell mom the baby’s procedure had been delayed.

We wrapped up latch attempts (and the baby) as we knew the nursery nurse would be coming to get the baby soon.  He was happily sleeping in Grandma’s arms as we discussed a care plan.

Persistent photographer, back again, insisting on showing the pictures.

I wrote out mom’s care plan.

Nursery nurse came to retrieve baby.

I ensured mom had my number for questions, planned to follow up with a home visit, and I made my exit.  Did you count the number of interruptions?  How long do you think I was there?

Eight interruptions in one hour and fifteen minutes. 

I left there concerned about derailment and feared I would encounter a trainwreck at her home visit.  Fortunately, when I arrived, breastfeeding was going well and she needed very little assistance from me at the follow up.

Now, I realize everyone that came in just saw me as a visitor.  They weren’t aware of who I was or why I was there.  However, my presence aside, feeding her newborn was mom’s priority, but what was the priority for the people that kept interrupting?  Definitely not feeding a 36 hour old, sleepy newborn who appeared jaundiced.

How can a mom even think about getting breastfeeding established when she is being bombarded by staff from all sides?  It’s sensory overload.  As a private practice lactation consultant, I see the outcome of this all the time….the trainwrecks…the result of the cascade of interventions.

What steps can you take to avoid the trainwreck?

  1. Take a prenatal breastfeeding class so that you know what’s normal for the early days of breastfeeding.
  2. Hire a Doula to minimize birth interventions which can lead to troubles breastfeeding.
  3. Find a breastfeeding friendly pediatrician who will support your breastfeeding goals.
  4. Research local resources for breastfeeding help that are available to you once you get home such as La Leche League or private practice lactation consultant that is an IBCLC (International Board Certified Lactation Consultant).
  5. Prepare your partner to be the gatekeeper after delivery to minimize interruptions in your breastfeeding. You may also want your partner to accompany your newborn to the nursery to keep watch and ensure your feeding preference is respected.
  6. Hand express your colostrum and feed back to the baby. Doing this up to 6 times a day can increase and speed copious milk production.
  7. Reinforce your desire to breastfeed without any supplementation to every nurse that you have contact with.
  8. Room-in with you baby to keep your baby close and to learn his hunger cues.
  9. Better yet, keep your baby “on” you to facilitate skin to skin contact which has been shown to stabilize temperature,
    heart rate and oxygenation. You are your baby’s best habitat!
  10. Ask to see the lactation consultant…and keep asking….getting help early is so important!

A BABE Mom’s Story: 6 Tips For 6 Months

14 May

  Three weeks into her breastfeeding journey

we had the privilege of meeting this sweet momma and her precious little boy.  Our first contact was November 15, 2011.  She was our fifth client but our first real challenging case.  Over the phone, she described that she was having some pain and nipple damage with latch and decided it was time to get help as she suspected what she was experiencing was not normal.  This was her third baby to breastfeed yet the first time to experience this situation.

Baby was ready to eat soon after we arrived, so we had her proceed with breastfeeding in her normal fashion.  As she readied herself and the baby for latch, she was relaxed and calm.  We then got our first look and could hardly believe what we saw.  To date, we have yet to encounter nipple damage as severe as hers!  There were actual craters in the center of each nipple.  Leah and I could not believe she had made it this far.

Our assessment revealed that the baby had

a very shallow latch.  His mouth would stay open no longer than a millisecond to achieve latch, and once he did latch, his lips stayed pursed on the breast.  Our impression was that his jaw and mouth were hypertonic (increased muscle tone).  At rest, he kept his lips tight, and we could not even properly assess for tongue-tie (which we suspected right away because of the nature of mom’s damage) because his mouth was so tight!

Over the course of the next five or six weeks

we worked with Linda in person, via email and over the phone to assist her in getting to a comfortable and enjoyable place with breastfeeding.  Using a combination of breast rest, APNO, pumping, finger feeding, bottle feeding, chiropractic, time, and a lot of patience and determination, we were thrilled to hear from her late December that healing was complete and breastfeeding was finally pain-free!

Sweet, little Sam is now six months old.  He never had one drop of formula…how did she do it?  Keep reading for his mom’s advice:

1.  Let it go:  I had a hard time accepting that my house wasn’t always tidy, the laundry and dishes piled up, and gathering my hair into a ponytail was as close to “styling” as I could manage.  It took me a while to figure out that it is OK to not be able to accomplish everything I could pre-baby.  None of those tasks are as important as being able to meet the basic needs of my family and myself.

2.  Don’t be afraid to ask for help:  Asking for help doesn’t come easy for me but I learned to not be shy about telling others what needed to be done.  My husband was great at taking over the jobs he could do while I concentrated on my needs and the needs of the baby – but I needed to be sure to ask!  Something as simple as asking someone to look after the baby (and my 2yo and 4yo!) so I could take a shower or just have a few minutes to myself to eat a big bowl of ice cream in peace made all the difference in my outlook on life.

3.  Trust your instincts:  I think everyone who knew I just had a baby had an opinion on how I should be feeding the baby.  I had to believe in myself and my ability to know what will work for me versus what doesn’t feel right for my family.  My grandmother probably meant well when she told me that babies do just fine on evaporated milk, but after thanking her for her concern, I forgot she ever mentioned it.  I also had to trust my instincts enough to know that I needed outside help.  I figured that since this was my third, I should have known what to do on my own when he had problems – I didn’t.  My only regret was not getting outside help sooner.  I could have saved myself some addition pain.

4.  Find a cheerleader:  Having immediate family members and lactation consultants to tell me that I was doing a good job was priceless.  Affirmations are important – I needed to be reminded that I am strong and I could do it and that the sacrifices I was making were for the new little person I just brought into the world.

5. Set short term goals:  Even though it was baby number three for me, I was feeling overwhelmed about surviving the whole newborn period.  So I aimed to just make it through the week, the day, the next feeding session, or past whatever other hurdles were getting me down.  Once that was behind me, I would give myself a pat on the back, consider it an accomplishment and set a new goal.

6. Believe that does get easier:  It can be so hard to see past the present, but the first few weeks really are the most difficult.  I knew that if I could just make it past the hump, things would start to get better.  I had to cling to the knowledge that one day soon I would feel human again.  Six months down the road, I am grateful I stuck it out.

What most helped you get to where you are in your breastfeeding journey?

Does my baby have Oral Motor Hypotonia?

26 Nov

Oral-Motor Hypotonia and the Role of the Speech Pathologist

by Leah Jolly, BA, IBCLC, RLC 

I never thought a speech pathologist would be in my circle of breastfeeding support, but just a few days after the birth of my first son, we were referred to one. At our first appointment with the speech pathologist, Ellen Carlin, we discovered through thorough hands-on testing that our son had oral motor hypotonia, a condition of weakened muscles of the mouth. We were quite surprised when our second son was born a few years later and had the same latch difficulties, so we headed back to Ellen Carlin and received the same diagnosis. Both boys had weekly therapy with Ms. Carlin and a home therapy program we learned at our visits. When I tell other Leaders and breastfeeding professionals about our experiences with speech pathology and breastfeeding there is always a list of questions. The following questions and answers are from an interview with Ellen Carlin and will be helpful to others in understanding how speech pathologists play a role in breastfeeding help and support. Ellen Carlin is a speech pathologist practicing in The Woodlands, a suburb north of Houston. 

What training/background does a speech pathologist need to work with breastfeeding babies?

 A speech pathologist must have an interest in working with infants and obtaining additional trainings in oral motor function and intervention techniques. The speech pathologist should be a master’s level therapist, ASHA Certified and have a Certificate of Clinical Competency. Oral motor training is the key and the Beckman Techniques for evaluation and exercises, as well as Susan Evans Morris feeding training are very comprehensive trainings for oral motor evaluations of infants. Speech pathologists working with breastfeeding babies should have hands-on experience in these evaluation and therapy techniques. Additional training in sensory systems and head/neck and trunk support as well as knowledge of a variety of oral motor techniques and theories are also recommended.

What types of conditions do you most often diagnose and treat for breastfeeding babies? 

Most often babies are referred by doctors or lactation consultants when positioning attempts have been unsuccessful, the infant presents with an unsuccessful latch, for suck/swallow coordination issues, leaking of milk during feeding, and general feeding difficulties that are not responding to normal courses of treatment/support. Upon evaluation infants may be diagnosed with oral motor hypotonia, coordination disorders and/or feeding difficulties and mismanagement. 

What types of therapies/treatment are available with speech pathologists?

Treatment for infants who have been found to have feeding difficulties begins with a thorough hands-on evaluation. By testing range of motion and reflexes of the mouth, tongue, cheeks, palate and jaw, the speech pathologist can determine what exercises are needed to improve strength and range of motion for appropriate function of the muscles.  The parents are trained to use their infant’s individual exercise program and encouraged to use the exercises on a daily basis.

 In your practice, how does breastfeeding impact the outcome of oral motor conditions?

Once the infant is able to efficiently breastfeed, the oral exercise program may be weaned. Normal use and function of the oral muscles needed for breastfeeding, will keep the muscles toned in a typical developing infant. What I find in my practice is that once the infant’s oral motor strength improves and normal function is regained, feeding skills and speech/language skills will also develop normally. Keep in mind that children with other neurological difficulties may need additional support throughout development.

What is an oral motor evaluation?

The oral motor evaluation consists of two evaluation sessions. During the first session medical history is obtained and the mother discusses problems the baby is having. This is important because difficulties may not be occurring at every feeding and the mother can describe sensations or pain she is having during the feedings. A thorough history is taken to evaluate if birth traumas or other complications of pregnancy or birth may have contributed to the feeding difficulties. Next, the oral reflexes are evaluated to determine where muscle weaknesses exist and a feeding observation of the infant is obtained. The speech pathologist looks at the latch, jaw motions, tongue placement, lip seal, suck/swallow/breathe pattern and overall feeding behavior.

The reflexes are tested by stimulating different regions of the mouth with the finger while looking for tongue movement reflexes, suck reflexes, suck/swallow/breath patterns and jaw motion reflexes. This helps determine where weakness/dysfunction are occurring and which exercise will be helpful.  The areas of oral strength ranging between 79% and 0% are identified, and an exercise program is initiated. Parents are trained to use the exercises and are instructed to use the exercise program daily. The second evaluation session is scheduled following a week of exercise use. The infant’s oral strength is reassessed and parent information is collected regarding feeding progress to determine if additional exercises are needed. Typically the exercise program is a ten week program.

What “red flags’ would a Lactation Consultant or doctor be looking for when referring an infant to speech pathologist?

*Absence of a gag reflex – infants should have a strong gag reflex, which is protective in nature.

*Reflux diagnosed – may signal difficulty with suck/swallow/breath triad. (The infant is getting too much air in tummy during feedings.)

*Multiple apnea and /or bradycardia episodes

*Difficulty with grasping the nipple after 35 wks GA – they don’t have the strength to produce a good latch on.

*Length of time to feed (2 oz. in 20 min is too long)

*Absence of 1:1:1 ratio for suck/swallow/breath denotes disorganization of oral musculature.

*Infants with a poor lip-seal, leakage of milk around lips (bib soakers) or milk coming out of nose.

*Snack and snoozers – mom’s report that the infant is always eating because he can’t stay awake to finish a feeding. (Infant doesn’t have the muscle strength to finish a feeding then wakes up hungry – falls asleep- wakes up hungry….)

*Infants who are loud feeders – they display inconsistent tongue suction during feedings

*Infants who clamp down on the nipple causing nipple pain, trying to stop the milk flow due to difficulty managing it.

*Infants who refuse the breast and will only drink from a bottle-may start and stop crying at the breast.

*Infants that require maximum flow nipples or cross cut nipples

*Poor non-nutritive sucking patterns

*Infants for which positioning techniques do not help with feedings.

When to call a Lactation Consultant (IBCLC)

22 Nov

Breastfeeding should be an enjoyable experience for both mom and baby! Although breastfeeding is natural many factors play into the ease to which mom and baby learn and adapt to these new skills. Lactation Consultants are trained medical professionals who can evaluate the source of your breastfeeding challenges and offer ways to improve the outcome for both you and your baby.  Below is a list of common issues lactation consultants can assist with:

A mom who:

v Has Sore nipples

v Has Mastitis or plugged ducts

v Is Engorged

v Has flat or inverted nipples

v Is Ill or needs surgery

v Has a low milk supply

v Wishes to breastfeed an adopted baby

v Needs to take a medication while breastfeeding

v Plans to return to work

v Experiencing stress about breastfeeding

Or a baby who:

v Refuses to latch on

v Is jaundice

v Is not gaining weight well

v Is fussy at the breast or between feedings

v Is premature or is a late preterm

v Spits up frequently

v Has physical challenges that impair breastfeeding

Or anytime you feel breastfeeding is not going well!