These are real clients from the past 20 years whose privacy is protected through name change and/or a blending of details. The case studies have no names, photos or identification of any kind because our clients value their privacy. Nonetheless, when you read the case studies, you will see that they used to be in a similar situation as you might be, and you can learn how they overcame their issue.
Right after she was born, Olivia was placed on her mom's stomach. Slowly and surely, she made her way up to Tricia's breast. She kicked her legs and bobbed her head. She lifted up, sweeping her head from side to side. She paused and sucked on her fist and then bobbled back and forth, finding the nipple. In the delivery room, and to everyone's amazement, she found the nipple, and in one lunge, attached and began suckling intently. She continued nursing for nearly an hour. Someone joked that they'd never seen a baby born with a milk mustache!
Before Olivia was born, Tricia studied up on breastfeeding. She wanted to breastfeed and also to pump so her husband could feed the baby with a bottle. She and Chad met with me for a prenatal lactation consultation where I gave them breastfeeding education and a system to help them figure out when to ask for help if they had a breastfeeding challenge.
We practiced positioning learning how to support a tiny, floppy newborn while leaning comfortably back in bed. At home, they continued by watching nursing videos on Global Health Media and YouTube.
Tricia had sore, cracked nipples on the second day. She tried to be more conscious of Olivia's positioning. The nurse taught her to hand-express her milk and rub it into her cracked nipples. The healing properties of her breast milk helped a lot and by the next day, her nipples were completely better.
Tricia practiced the leaning back position pulling Olivia in closely so that her cheeks, nose and chin had good contact with her breast. Chad would tuck a pillow under Tricia's arm so she could relax even more and check that Olivia was well-supported and in alignment.
On the third day, Tricia was still a little tender but the pain had resolved. She and Olivia were over their first speed bump and happily breastfeeding together.
The night before her six-week checkup, Tricia was getting out of the shower and noticed a red streak on her breast. She texted me and I suggested using a warm compress and massaging her nipple below the red area to help move milk past the clogged duct. And to definitely show her doctor at the postpartum visit. Her doctor diagnosed mastitis and prescribed antibiotics. She kept massaging and never developed typical flu-like symptoms. The day after she took antibiotics, it cleared up.
Tricia started pumping a little bit every day so that Olivia's Dad could feed her. However, Olivia refused to take a bottle. At first they thought it was the type of bottle, so they tried a few others, but she refused every single one. Tricia posted in our Café Mama forum and got a number of other ideas to try. Several people also shared that their baby had also refused to drink from bottles.
Chad tried. Olivia's Grandma tried. Tricia left the house. She left a tee-shirt she had slept in so that Olivia smelled her. They tried but Olivia refused to drink from a bottle. Tricia left for a longer stretch and Olivia got cranky but she still refused to take comfort from a bottle of Tricia's milk.
Tricia called to see if she had overlooked anything, "It's a good thing I don't have to go back to work! Olivia would starve herself."
I assured her that Olivia would never do that! If Tricia was gone all day, every day, Olivia would adapt and eventually find a way to eat."
It was difficult for Tricia to go out because she had to plan around her feedings.
Around 6 months, Tricia and Chad left Olivia with her Gramma and went on their first date since her birth. They had a great dinner and then walked through the town. It felt good to have fun together. They reminisced about the good times they before they were parents and celebrated how they much closer they had become through all the challenges and frustrations of new parenting.
They ended up in the park, sitting on a bench. Chad held her hands, knelt and asked Tricia to marry him. He said that he had never known such a deep love was possible, as he felt when he watched Tricia with their baby.
Tricia started crying as she said yes. Her mascara was running and she wiped it with her thumb, giggling about the streaks. Chad told her she was never more beautiful than that moment.
They kissed and hurried home because they had a hungry baby to feed.
"Breastfeeding is so amazing. We've never had to buy formula. Tricia lost all her baby weight right away with the breastfeeding. I get so choked up when I see the two of them. It just looks so natural and she and Olivia are really bonded, which I think is due to nursing."
Olivia weaned because Tricia became pregnant. Tricia didn't want to tandem nurse and she didn't want to wait until the baby arrived to stop breastfeeding. She didn't want Olivia to blame the new baby for weaning and honestly, she wanted her body back.
It took them about three weeks. It wasn't easy but Tricia's nipples had become very sore from the pregnancy hormones and that made it easier. First, they cut comfort feeding and added snacks and drinks. The nursing before naps was next and bed time was the last. They switched to rocking her to sleep and Olivia learned to go to sleep without nursing.
Tricia said that she would give this advice to other new moms. "Accept whatever way your breastfeeding goes. Sometimes it doesn't work at all. I was lucky and it did, but I thought I'd be able to pump and give a bottle until Olivia refused everything we tried. And now that the new baby is here, its a different story. He takes a bottle with no problem!"
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.