Hello everyone,
I have seen a mom at my clinic, and she is my first to be with an SNS. I need some support and help, please!
This is the case (with momīs permission):
Mom is 25 years old, this is her first child. Went into labor at 36 weeks and her baby girl was born with 2,600 kg. She was discharged from the
hospital three days later, baby weighed 2,300 kg. She was exclusively breastfeeding. No one did an assesment of the breastfeeding.
Mom got in touch with me when baby was ten days old. She was upset because baby was latched on all day long, hardly slept, and cried when
away from the breast. At the pediīs the baby had weighed 2,350 and of course pedi had insisted on formula. Mom refused.
When I saw mom and baby it was day 11.She weighed 2,350 on my scale. Baby was irritable when not on breast. Her latch was a bit shallow
and we corrected that. Positioning was ok and she was feeding on demand, which was almost every hour and for long periods of time. She had
no signs of dehydration. Her poops where scarce (small amount 2-3 times a day) and green. Some wet diapers but difficult for mom to tell
because they are very absorbent. She looked positively HUNGRY to me. Her suck was vigorous and coordinated, her tongue normal. Test weighs
before and after a feed at my consult showed an intake of 10 ml - after a feed of about 30 minutes.
I explored momīs breasts: no sign of nipple damage. Breasts are VERY small although their shape is normal, not tubular. Mom tells me they
have not grown in size during pregnancy. She feels no let-down during the feeds.
I suspected on this first visit that there might be two problems: the babyīs inmaturity - although the suck assesment and her work at the breast
seemed ok - and hypoplastic breasts. I spoke to the mom about both possibilities and she was very upset that her breasts might be the problem.
She acceded to try stimulation with the pump but was wary when I suggested SNS. At that point I did not suggest domperidone as I thought it
might overwhelm her.
So she left with a corrected, deep latch and instructions for pump use (manual Avent ISIS as there was no way to get an electrical one in her
small town). She was to supplement the baby with her expressed milk in a syringe. Maybe I should have suggested hand expression?
Anyway, I called her up two days later and she told me she was hardly getting 5-8 ml with the pump and that baby seemed to still be hungry.I
asked her to come in again and she did, on day 15.
On day 15, baby weighed 2,500 kg (had not regained birth weight, which had been 2,600). I had to fight with mom s refusal to feed the baby
artificial milk but I explained that it was paramount that baby got more food into her. Mom accepted using an SNS. We used it together for the
first time and baby downed 30ml of formula in five minutes. Tests weight revealed an intake of 40 ml, so it was 30 of formula and 10 from mom s
breast. Mom was VERY HAPPY, specially after baby fell asleep blissfully on the stroller.
So I sent her home with SNS, pump stimulating 2-3 times a day (she could not handle more).
A week later baby weighed at the pedi s office 2,850 kg and was not irritable but calm and slept well between feeds. Mom is happy. She is
putting baby on the breast without SNS whenever she demands to be fed and 3 hours have not gone by since last SNS feed. SHe is pumping
twicw a day (after feeds) and getting 1-3 ml.
A week after this (baby is now a month old), mom calls to tell me she feels she is running out of milk. Baby does not want to be at her breast
without the SNS (from which she is drinking from 60 to 80 ml every three hours). I suggest skin to skin, breastfeeding in the bath, breastfeeding
when baby is almost asleep... and I encourage her to pump more often. I also start her on domperidone.
This was a week ago. I am a bit at a loss about what to do. Those of you who have experience with supplementers, what do you do when you get
to this point? Have I been doing things wrong for mom to be loosing her milk? What can I tell her to expect from now on?
Thanks for your help,
Kika Baeza
Family doc in Spain
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
