I made a followup call to a client from our hosp, whom I myself did not see
in hosp or on followup outpatient consultation. Can't remember how old baby
is but is probably about 2 weeks old, great weight gain, currently on
expressed ebm feeds (no formula) and direct bf only 1x per day. Mom has good
supply. Mom not sure if wants to pursue direct bf, but may continue
expressing and bottle feeding only.
History: Notes indicate baby was bf well in hospital (24 hrs). Mom developed
very sore, scabbed, "yucky" (her description) nipples first few days at home
which is when I called to check on her (day 3 or 4). I counseled her on
phone (advised her to come in) and she treated with saline and antibiotic
ointment, and of course re-teach positioning and latch (over the phone!).
Also she had to express and feed some feeds due to high level of pain. Mom
developed lumps, fever, apparently mastitis and was successfully treated
with oral antibiotics and general mastitis relief measures. She came in to
see another LC who evaluated that everything was fine with latch etc,
nipples well healing, mastitis resolved. Today mom tells me she pumps out
and baby takes about 3 - 3.5 ounces per feed in bottle, but when she bf mom
feels baby gets only 1 or 2 ounces. She has to pump the rest to feel
"drained." She feels that the baby is "biting her" into the feeding. This
still points to me that the baby is not effectively latched or in some way
not milking the breast. Maybe baby needs craniosacral or chiropractic
therapy (I discussed this with mom), altho mom reports birth was easy,
albeit very fast, and no obvious birth trauma noted. I offered another
consult (with me!) but not sure I will find anything else, mom not sure if
will take advantage of consult. I advised breast compression when swallows
slow, and "switch" nursing ala Dr. Jack to maximize milk intake at breast.
What do you guys think???? BWC, I hope you will respond. Thanks.
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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