Erica Had No Pain For The First Month.
Chloe was born fairly easily. Her labor was not overly long, difficult or painful. And she nursed soon after birth. She was a natural breastfeeder and other than the few hours of pain, while her milk was coming in, her mom, Erica, was surprised by the ease of breastfeeding. None of her research and none of friends had prepared her for this! They had sore nipples, mastitis, babies who wouldn't breastfeed, low milk supply -- really, just every problem under the sun!
Erica had lots of milk and Chloe gained lots of weight. It didn't hurt. In fact, it felt wonderful and natural. Erica and Chloe nursed and dozed, each day blending into the next. Brad, the dad, scrambled up eggs, filled water bottles, and ordered in meals, diapers and supplies. The first two weeks were one very long, dreamy day.
A Tongue, A Buccal And Two Lip Ties
During the two-week check up, their pediatrician checked Chloe and found that she had tethering under both lips, under her tongue and between her top gum and cheeks. Erica checked her own mouth and found that she also had buccal ties on her top gums. Brad, had them too, and they laughed that Chloe was clearly theirs! The ties hadn't caused them any problems that they knew of--it was one of those things that they hadn't ever given much thought.
Their Pediatrician recommends they call me
As I watched Chloe nurse, I highlighted that she wasn't moving her tongue and jaw as easily as most babies. I helped Erica adjust their nursing position so that Chloe would be in the best position for optimal nursing. I taught them tongue exercises to do with Chloe and recommended that they have her evaluated by an ENT or Pediatric dentist for an exam and possible revision of the tethers.
Wait and See
Because breastfeeding was going well, Erica and Brad decided to "wait and see" about the ties. They felt conflicted about the procedure. It didn't seem right to cause Chloe unnecessary pain when everything was going well. Erica did not have the cracked and bleeding nipples she had heard about from her friends. Chloe was chunking up, and while gassy, as long as they made sure to burp her, she was generally happy.
Erica's Milk Shoots Across The Room.
At three weeks, Erica tried pumping so Brad could give Chloe a bottle. She was pleasantly surprised again with the ease of pumping! She easily filled the little bottles. As she moved the pump flange to a get a more comfortable fit, milk sprayed everywhere! She was a goddess with milk pouring out of her!
She put the two bottles in the fridge and each time she opened the door, she smiled! Pumping became her new hobby. Each day, she would sit down, pump, fill 2 bottles, and pour them into bags. She neatly labelled them and stacked them in the freezer. In a week, she had a dozen flat packages of liquid gold in her freezer.
Brad takes the night shift
Brad fed Chloe at 11 pm while Erica slept through. He happily took some of the burden off Erica. He snuggled Chloe, watching her watch him while she suckled the warm milk. He was content in a way he hadn't imagined possible. He felt happy and proud watching over his wife and his daughter in their home.
That Week Something Went Wrong.
Breastfeeding Chloe became challenging. Chloe began squirming each time they nursed, stretching the nipple, arching back, pulling off and crying. She would shake her head, find the nipple, start to nurse again, only to arch back and cry. This went on, over and over. She would feed from a bottle just fine.
She was very gassy and cried in pain until she farted or pooped. Her poop had turned into a slimy, spinach-colored mess.
Alarmed, Erica Researches Online
She found a lot of mothers who recommended cutting out cow's milk and this had solved their baby's problems. So she did this. Then she stopped eating eggs and soy. Chloe's poop returned to yellow but suddenly, Erica was only able to pump about 4 oz instead of 8.
She concludes "I've Lost My Milk!"
Erica called me and we set up an appointment for another lactation consultation. It was early in the day when we met. Chloe reproduced all the squirmy, nipple-stretching behavior Brad and Erica had described. But Erica clearly had not lost her milk and soaked through several burp cloths as Chloe repeatedly came off her breast. Erica was also very full and had several painful and lumpy areas in her breasts.
(She Hadn't Lost Her Milk)
While observing and talking, it looked like Chloe was not able to handle the amount of milk that Erica was releasing. Her jaw movement seemed restricted. She became visibly distressed as soon as Erica had a let-down. She began arching back, pulling on the nipple. I explained this was her way of controlling the flow. At a certain point, she paused, took a breath and milk filled her mouth. She started gagging, coughing and sputtering. Then she cried in anger. She was hungry and couldn't eat because there was too much milk all at once for her to comfortably handle.
Pumping had bumped up Erica's supply and now Chloe was overwhelmed.
Because Chloe was upset while feeding, she was not emptying Erica's breasts completely. Clogged ducts were forming, resulting in lumpy areas which blocked her milk from flowing freely. In a few days, Erica would most likely start to experience pain and possibly develop mastitis.
Considering How To Resolve The Situation
A simple strategy for the fast letdown would be for Erica to unlatch Chloe and catch the first milk in a towel. When the milk slowed, Chloe would continue breastfeeding. This could be done any time when it happened.
More is needed to bring her supply more in line with Chloe's current needs.
One plan of action would reduce or stop pumping and massage out the plugged ducts. We also needed to find a way for Chloe to transfer milk more efficiently. Erica currently had good milk production, but chances were, if Chloe did not improve her suckling, she wouldn't be able to suckle well enough to continue breastfeeding exclusively.
Erica's milk production would be shifting from "continuous production" to "on-demand production" in the next few months. Chloe was relying on the extra milk that mothers make in the early months that ensure babies have enough time to learn how to breastfeed well. Because of her restrictions in her mouth, Chloe might not be able to transfer enough milk as this shift happened.
I repeated my earlier recommendation of having a Pediatric Dentist evaluate the lip, tongue and buccal ties and possibly revise them. Life would be hard for a few days but most likely, they would see Chloe's breastfeeding improve after the procedure.
Are the Milk & Eggs really a 'Red Herring'?
I asked how Erica felt about her restricted diet. She said it was "OK for now. If it helped Chloe, then it was worth it." She said she would continue for another week. In a week, I recommended that she try eating eggs and see if Chloe reacted negatively. If she did, then she would know to not eat eggs for a few more months. In two weeks, try eating soy and see what happened. Finally, in three weeks, re-introduce cow's milk and see if Chloe had a reaction. If she did, then she would know it was beneficial to not eat dairy until Chloe was a little older.
Erica reported back that she was able to eat all the foods she had eliminated except cow's milk. They had Chloe's ties revised and after a week of erratic nursing, Chloe had improved greatly. Things were going well and she felt confident they would continue going well.