Got a call from a mom two days ago. here's the hx.
At birth, baby latched and nursed well. 7#2 at birth, 6#14 at discharge (48
h). at 4 wk check, baby had gained 1#2. baby fussy in afternoon, increasing
in intensity toward evening - mom's convinced it's because she doesn'thave
enough milk. feeding 'on cue' about every 2 hours.
mom asks LC for advice. wants to start giving baby a bottle in the pm. one
bottle. given the okay, lc says that one bottle a day won't cause problems
since baby is nursing well at breast. after the one bottle, baby is happy as
a clam, no longer fussy (this is all per mom). LC also says that perhaps
baby's not getting enough hindmilk (hence the hunger - no other signs of
fm/hm issues though) and says to nurse 2 or 3 feedings on one breast before
switching to other breast. mom tries this but baby protests....at 2nd and
3rd feeding.....when mom offers other breast, baby is fine.
mom truly does feel that she has supply issues though.....I'm not convinced.
Anyhoo, mom is hosptalized at 8 wks after a fall - serious back injury -
baby on abm from bottle...mom pumping and dumping.
mom comes home from hospital, baby won't nurse (shocking) during the
day...will however, nurse during the night. while baby had previously been
co-sleeping, dad moved baby to own room in crib while mom was hospitalized.
from 8 wks till present (12 wks) mom has been pumping, feeding ebm/abm
mixed, and going to baby's room to nurse baby 2x per night.
mom's getting less and less with pumping (hosp grade double) - has tried
fenugreek, Reglan etc. At this point, doesn't "feel that relactation is
possible".....no one has mentioned helping her get the baby back on the
breast - until I mentioned it, she didn't think it could happen. Heck, baby
*is* nursing at the breast a couple times per day (night), doesn't take a
pacifier, nurses occasionally for comfort, but refuses breast for bottles
when wanting "to really eat".
She's heard of domperidone and asked her doc about it, but doc says that "we
use Reglan' instead. Reglan didn't help. I'm thinking that supply won't
increase unless she actually gets baby on again.
We've been talking about how babies would nurse in an evolutionary
environment, and how that frequency affects supply....the composition of
human milk, nighttime prolactin, benefits of nighttime nursing wrt supply etc
This mom is *fascinated* by this and is willing and eager to try. Only
issue is getting baby back on breast and supply back up. Didn't get much
help from the hosp LC's who are *really* busy at this major hospital.
Please help me outline a clear plan of action for her......my positions tend
to be very extreme so I need some balance...I'd probably recommend tossing
the bottles in the trash, cup feeding the supplements, getting baby to breast
as often as possible (trying esp when baby is sleepy), recommending totally
different positions (nursing in a sling while moving sometimes seems
helpful)...
thoughts, opinions, info greatly appreciated. Mom is frustrated with pumping
- "takes too much time away from A----" She tried SNS, but baby still
wouldn't stay on. How should this baby be fed in the interim? where does
domperidone fit in?
Hopefully, the simplest plan possible - mom is ready to chuck the pump and
other technology as she's finding it very time consuming and baby is
screaming whenever mom is doing anything besides holding her...
looking forward to hearing from you,
katherine in atl
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