Hi all,

I was debating whether or not to post this, but the mom is concerned--not
about the breastfeeding problem,  but I'll relay the entire story.

I had a home visit with a mom of twin girls born at 36 weeks both weighing 4
lbs. 10 1/2 oz. at birth.  One was born vaginally the other by C-Section.
 Both babies left the hospital nursing well.  After the mother's engorgement
past, the vaginally born twin had problems latching on to the softer breast.
 I saw these babies at one week.  The one having the problems had not nursed
well in about 18 hours at this point and had three wet diapers since midnight
(I saw them in early afternoon). Mom had given about 2 bottles of EBM by the
time I saw the baby.  The baby having difficulty, initially latched on well
and nursed well.  Then appeared to have weak suck and be a lazy nurser and
sleepy.  Mother has tried everything to keep baby awake.  My suggestions for
nursing baby included cool compresses, different positions, skin to skin
contact in order to keep baby awake.  I showed mom the dancer hold to help
keep baby on.  Suggested super switch nursing also.  Baby became frustrated
and needed to eat.  Mom used manual pump and expressed 2 oz. faster than I
've ever seen.  Put teat on and fed baby.  Baby took bottle readily.
 Finished 2 oz.  My initial concern was making sure baby gets milk.  Both
babies are being nursed about every three hours.  I suggested every two
hours, and if the one twin would not nurse, give EBM.  I suggested
alternative feeding methods, but mom did not seem concern about possible
consequences---nipple confusion, weak suck continuing.  Baby was not
dehydrated.  I cautioned mom about this as it was Sunday afternoon, and she
would not be seeing LC until Monday or later.   I felt LC would be better
able to help.    This mom didn't mind expressing.  She had an abundant supply
and could supplement with EBM.  Since she had the other twin to nurse and
nursed a previous child, I felt that with the help of the LC she could get
baby back to breast and not go downhill to formula.

I talked to LC myself.  I explained situation and that I thought she needed
to see this family ASAP.  She said she would call mom and felt that baby
taking 2 oz. of EBM every 2 hours would be fine until she saw her.  (Mom
asked me how much to express per feeding.  I told her whatever the baby would
take and that she'd have to get that info. from the LC or her doctor as I was
not sure.  Isn't this done thru a calculation based on baby's weight?)

I called mom back to follow up.  Babies are now 2 1/2 weeks old and gaining
fine.  Still same scenario with the twin who was having difficulties.  LC
never contacted mom.  Mom said she tried a few times to get in touch with LC.
 I was upset.  I felt this mom would listen to the LC as far as alternative
feeding methods.  She did not seem to take in anything I said regarding
getting baby to breast.  Since I thought she'd be seeing LC, I did not push.

Mom's present concern:  She is very hungry.  There is not enough time in the
day to eat.  Also very tired.  She wants too start giving ABM, so she can get
some rest.  My suggestions:  let other people take care of house, etc.  Nurse
babies, then let family care for them while she rests.  Went thru the risks
of ABM in regards to her milk supply going down.  We discussed calorie intake
and eating to satisfy hunger, which she says she cannot do.  I suggested she
see her doctor.  Bringing us to the final concern.  Mom has burning in her
back during nursing for up to 1/2 hour after nursing.  Went to doctor who ran
test for urinary tract infection.  Doctor never called with results, so mom
is assuming no infection.

Although mom does not seem to want anymore breastfeeding help, I would like
to know what others would do in this situation to help this mom and baby.
What have I missed?  I did not pursue getting baby back to breast with this
mom as I felt LC would be better, and maybe I was missing something.  Mom
doesn't mind using bottle and is confident of her abundant milk supply and
does not see any risks using ABM. Mom would like info. about being so hungry
and burning in her back.  I told mom that in my experience---after birth, I
eat like a horse and gain 10 to 12 lbs.  I know my body needs this as I tend
to lose all my pregnancy weight with the birth of each child.

I would appreciate any suggestions to any of these concerns.

Aloha,
Gloria Thai  LLLLeader Hawai'i