Dear Wise Ones,

I realize that everyone is probably having fun at ILCA but I need some input on a couple I am trying to help. I have mom's permission to post.

31 year old G3P2A1 del. SVD on 6/27/05  9# 4 oz. girl. Mom had lots of pain on latching infant (nursing staff labeled her drama queen). No one able to help her correct latch. D/c'd at 30 hours. Mom called hospital lactation center (pump rental station) with c/o sore nipples and pain with latch a few days after d/c. They convinced her to rent pump. She called me (7/4) when infant was 1 week old. Mom stated that infant falling asleep at breast, taking a long time to feed and waking up within an hour rooting. Mom concerned that she does not have enough milk. Mom had similar problem with first child and ended up formula feeding because LC told her she didn't have "mature milk". Mom stated that she just started pumping and was only getting 1 oz. from each breast. I tried to reassure mom and made appt. to meet with her next day. 

Mom has average size breasts with well-everted nipples. There is evidence of previous trauma but it is healing. Mom is on Synthroid.

(7/5) Mom had kept very detailed log of feedings but it turned out infant was only eating 7 - 9 times per 24 hours. I instructed mom that that wasn't enough. Mom did not keep log of output, however, but Dad reported that he thought he had changed a wet and dirty diaper before each feed (stool yellow seedy). 

Infant slightly jaundiced. Had wet diaper (Clear yellow urine, well saturated) before I weighed her. Weight 8# 9 oz.  Assisted mom with asymmetrical latch. Mom reported no pain. Weighed infant after each breast and total intake was 31g. Time of feeding was 25 minutes total but it took nearly the entire consult time (1 hr 45 min.) to get the baby to eat that much. Supplemented baby with formula since mom did not bring any EBM with her. Infant had a yellow seedy stool after feeding.

Plan was to keep feeding time within 1 hour so mom could get some rest. Feed infant for 30 minutes, waking and switching breasts, supplmenting baby with EBM or formula after, and mom pump for 15 minutes at a time during the day. I also suggested mom take fenugreek and blessed thistle. Mom unable to swallow pills so I suggested liquid/tincture. Infant had follow up appt. with Ped already scheduled for next day (7/6).

F/u phone call with mom (7/8). Mom reports Ped concerned with weight loss also. Agreed with my plan except for the herbs. Arranged f/u appt for weight check (7/11). Mom states that feeds are not getting better and she does not think the pumping is helping her supply. She is not taking herbs. She states that she has been having her liver function followed since before this pregnancy and during and is cautious about taking meds. She also reports that infant is sputtering and choking during feed. Told mom I would look into whether these particular herbs would be harmful to her liver and call her again.

F/u phone call (7/9). Reassured mom that these herbs should not be harmful. Mom reports that the pumping and all was going well but she has decided to just pump and feed EBM to infant.  I encourage mom to stick with it, try the herbs and wait to see how f/u weight check turns out. Mom is discouraged. 

So with the report now of the infant choking during feeds slong with falling asleep and rooting with in an hour I'm wondering several things: Instead of low supply perhaps it is -Overactive letdown causing infant to fall asleep and not get enough milk?.  Mom needs to have thyroid rechecked? Retained placental fragments (didn't ask mom about bleeding)? What am I missing?

Any help would be greatly appreciated.

Mary Tunstall RN, BSN, IBCLC, RLC

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