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Thread: Baby won't latch, mom is engored

  1. #1
    Join Date
    Sep 2014
    Location
    Canada
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    3

    Exclamation Baby won't latch, mom is engored

    (This isn't a question for myself; my two kids are 9 and 7 and both fully weaned.)

    My sister in law just had her first baby on Sept 21, and despite my brother helping and supporting her as much as possible (he was going online to find videos about latching on youtube until the hospital's wifi randomly cut off, and he's feeling pretty stuck without that resource), they have yet to get the baby to latch properly. They've been using a hospital grade pump and supplementing with formula at the doctor's recommendation due to jaundice (though the baby is no longer jaundiced now).

    My SIL suffered a sort of palsy with stroke-like symptoms (apparently related to the birth?), and now that her mature milk is coming it, she's far more engorged on the side affected by the palsy. The breast is so swollen the skin is shiny, and the engorgement is all the way into her armpit as well. (But there are no visible injuries/cracks to the nipple.) They're trying massage, warm wet cloths, and warms showers in addition to pumping, but so far nothing seems to be working.

    My brother called me this evening (they live in another province) asking for advice. It sounded like a plugged duct to me, and I told him what I could from my own experiences and what I was able to find on kellymom, but if anyone has any suggestions of what might help (both with the urgent engorgement issue and with the baby refusing to latch), I would be very grateful!

    They've been managing to get some milk out of that breast by pumping, but it's much less on that side than they're getting out of the other. (The engorgement is new as of today.)

    They spent the whole day trying to get the baby to latch (they've been doing lots of skin to skin), but all she wants to do is sleep. My SIL is feeling pretty emotional about the whole situation (understandably). She's also reporting that she feels like she's freezing, which sounds to me like a sign of mastitis.

    I am frustrated that the hospital won't provide them with an SNS, since I was given one by a public health nurse (this was 9 years ago when I had my first), and it worked great to get my baby back to the breast. The hospital is having them give emb/formula with a bottle instead. (It's a pretty rural hospital, and my brother says it's grossly understaffed.)

    I just feel mostly helpless stuck out here where I can't do anything, you know? I wish I could just walk into the hospital and help them face to face.

  2. #2
    Join Date
    May 2006
    Posts
    24,794

    Default Re: Baby won't latch, mom is engored

    Wow, what a rough situation!

    This is a good link on reverse pressure softening: http://kellymom.com/bf/concerns/moth...oft_cotterman/

    This seems like a long shot, but... I wonder if the palsy on the engorged side could be to blame. If the palsy means that nerve signals from that breast aren't coming through the way they should, maybe that would explain why that breast isn't able to let down the milk. If that's the case, I can think of 2 things to try. First, they could try pumping both breasts at the same time. That way the oxytocin from the "good" side will stimulate the engorged side to let down, as well. Second, they could try an oxytocin nasal spray when trying to pump the engorged side.

  3. #3
    Join Date
    Jun 2009
    Posts
    10,754

    Default Re: Baby won't latch, mom is engored

    Hi. This not only sounds like a difficult situation, it sounds like a bit of an emergency. Severe engorgement like this requires all the focus imo. If baby cannot latch, an SNS is not going to help. My suggestion would be to make sure baby is being fed in as breastfeeding supportive way as possible, perhaps cup, or spoon or syringe, and work on the engorgement. This does not mean do not try to get baby to nurse! Of course if baby can and will nurse that will help the situation in many ways. But just now, the priority is SIL's health.

    They're trying massage, warm wet cloths, and warms showers in addition to pumping, but so far nothing seems to be working.
    Sounds like they are trying nothing but heat! Any medical professional MUST be aware that Heat and direct massage tend to exacerbate inflammation and consequently are NOT always the best approach with severe engorgement! What about cold packs? Cabbage Leaves? If there is a plug, vibration? Milk extraction is VITAL as well. If the pump is not doing the job, perhaps a different pump, better fitting flanges, or hand expression? If mom is not able to hand express, it can be done for her. Your brother could also try gently extracting milk himself orally. I know that sounds like an odd idea, but IMO it cant hurt and it might help.

    Is there LLL where your SIL is hospitalized? Perhaps a local Leader could talk to your brother on the phone or print out more up to date information to bring to the hospital. If there is a bookstore around, he can call them and see if they have a copy of The Womanly Art of Breastfeeding.

    While I agree with mommal that this may be a letdown issue and may be related to the palsy, and I think her suggestions make a lot of sense, this situation can also can happen with no letdown issues. It happened to me with my last baby- she could latch, but I had incredibly severe engorgement in one breast, leading to a huge plug and mastitis.

    severe engorgement is self perpetuating. Engorgement is about much more than just milk stuck in the breast, it involves excess fluid in the breasts and inflammation that causes the milk to become stuck-it is a congestion of the breast. The milk is there but it cannot get out-this is why reducing the swelling with cold rather than heat may help. I imagine your SIL was or is on an IV as well? The resulting Edema is going to make this all more problematic. -but edema is a temporary situation that will resolve once she is off IVs for several days-

    But reassure your brother this is early days! Breastfeeding can almost certainly be rescued! At this point most important- protect SIL health, protect her milk production, and feed baby in as breastfeeding supportive a way as possible- this means small amounts frequently, and probably avoiding bottles if possible. This will allow the optimal chances fort normal breastfeeding to resume.

    hand expression http://www.llli.org/docs/00000000000...expression.pdf
    feeding the non latching baby http://www.llli.org/docs/00000000000...ching_baby.pdf

    masitis http://www.llli.org/docs/00000000000...atcanyoudo.pdf
    plugs http://www.llli.org/docs/00000000000...plugsblebs.pdf
    engorgement http://www.llli.org/faq/engorgement.html
    Last edited by @llli*maddieb; September 25th, 2014 at 11:14 AM.

  4. #4
    Join Date
    Mar 2014
    Location
    Central FL
    Posts
    1,575

    Default Re: Baby won't latch, mom is engored

    yes first things first,
    Help mom recover from engorgement.
    And having dad suckle to help deal with a plug is not odd at all.

    Once that is taken care of, if baby will latch then you can make your own lactation aid
    http://www.nbci.ca/index.php?option=com_content&view=article&id=25:la ctation-aid&catid=5&Itemid=17
    Or it can be used for finger feeding.

    And this link might help find an IBCLC
    http://www.ilca.org/i4a/pages/index.cfm?pageid=3901

  5. #5
    Join Date
    Sep 2014
    Location
    Canada
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    3

    Default Re: Baby won't latch, mom is engored

    Quote Originally Posted by @llli*maddieb View Post
    Sounds like they are trying nothing but heat!
    ...
    Is there LLL where your SIL is hospitalized?
    I actually rcommended that they use cold compress and forgot to say that in my post.

    There is are two LLL leaders in their area, and I gave them the contact info today when I spoke to them again.

    Thank you all for your help! (I somehow managed to screw up logging in here yesterday, so that was frustrating.)

    Anyway, an update:
    SIL is doing well! The palsy-effected side is still slower than the other side, and my brother suspects this is in fact due to the palsy effecting the let down as suggested, but the swelling is almost completely gone now.
    SIL has been able to pump enough milk to keep up with baby's needs thus far!
    Baby is also now latching some of the time, but SIL reports that it hurts.
    I gave them the contact info for two two IBCLCs in their area as well, so hopefully that (and/or LLL) will be the answer now that they can contact face to face help.

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