On Apr 30, 2006, at 9:46 AM, laurie wheeler wrote:

> The data don't totally make sense to me because of the early  
> weights. The wt loss was 7% and the wt gain was 10 oz in 3 days!  
> Was there any jaundice in the first week?

They don't totally add up for me either, but I have seen a 2 oz gain  
from evening to morning so it doesn't seem impossible that a baby  
could gain 3+ oz a day three days in a row...also I have seen many  
babies gain a pound to pound in half in a weeks time immediately  
after onset, which is over a three ounce gain every day so I can't  
completely discount that the baby did gain well in the early  
days...the mother does report that she had feelings of fullness that  
coincide with this time...feelings- and a look of fullness that her  
husband noticed- that have now dissipated
>
> I would suspect insufficient glandular tissue and that the weights  
> were inaccurate, particularly the 10 oz gain. I bet the baby was  
> not nude and not sure what type of scale was used. (I have seen  
> babies with high wt loss turn around and gain 4-5 oz overnight once  
> supplementation has begun. But I cannot imagine such a large gain  
> if the mother's milk did not really "come in.")

The baby was nude for the birth and day 3 weight check which was done  
with sling type scale and then the day 6 weight was done with a  
digital scale baby dressed and in a diaper...I did my weight check  
the same way as the day 6 check in an attempt to compare apples to  
apples and measured a 4 oz loss over 12 days...
>
> If something is different about the night nursings, perhaps the  
> latch is different at night using another position? This could be  
> investigated as well.

I was thinking just higher prolactin levels at night accounted for  
the difference at night but it couldn't hurt for her to use whatever  
positions she uses at night in the day also....
>
> I would recommend a hospital grade pump instead of a working mom's  
> pump, perhaps a different supplementer device like Lact-Aid or a  
> simple feeding tube threaded through a bottle nipple, herbal and/or  
> prescription galactagogues. Of course, close f/u for baby and mom.

I had a Symphony ready for her but I didn't push her to take it  
because my gut instinct is that milk transfer is not the  
problem...and I probably won't have her continue to pump beyond today  
(unless she sees an improvement in milk volume by tonight) until she  
gets checked for a retained placenta(thanks Kathy!)  and has her  
thyroid and prolactin levels checked...

This might seem out there but is it possible that she had a temporary  
drop in placental hormones and lactogenesis II but a retained  
placental fragment became re-annealed and now is suppressing her milk  
production?
>
> I am not well-versed in vegan diets but it seems mother grew the  
> baby quite well in pregnancy. But a dietician or nutritionist could  
> help mother assess her diet if needed.

I agree...I'm thinking perhaps the only reason vegetarians and vegans  
are over-represented in my client population with what look like  
primary insufficiency problems is that vegetarians and vegans are  
more committed to breastfeeding than the general population and thus  
are more likely to seek me out....
Thanks for your help Laurie.
Warmly,
Jen O'Quinn IBCLC
>
> Laurie Wheeler, IBCLC, MN, RN
> Mississippi, s.e. USA
>
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