I came across a condition in a mom this week that I am not familiar with. I
searched the archives but didn't find the answer to my question. This mom
was a c-section for a big baby...big baby! I helped mom the day after c/s.
Baby was still under 24 hrs. He was sleepy but latched ok, though didn't
suck much. Just fell asleep. The 'usual'. I didn't see them again until
4th day (2 days later) but the nurse said they were doing ok. When I saw
them a.m. of 4th day, baby's dex was 29. It was at this time that I found
out that mom had chronic adrenal hyperplasia. This was mentioned as an oh,
BTW, by staff.
Mom had blisters at tips of both nipples (we worked on latch then, of
course) and showed no signs of lactogenesis and I didn't observe any
swallows. Just short chewing type sucks. Parents reported that baby had
nursed the day before for 45 min at a time, then would cry for 2 hrs (why
didn't staff call me?) , so they all thought he was feeding ok! Obviously,
he wasn't latched or sucking appropriately, but was this cause or effect?
Was he not sucking right, thus no milk, or was he 'chewing' because he was
frustrated that there was not much milk? Mom reports changes in her
breasts during pregnancy but we only saw a small drop of milk when we tried
to express and then only after a minute or two of trying. She also had
flaccid-looking breasts (not much glandular tissue palpated) on 4th day,
We supplemented baby at breast and boy, did he guzzle! Parents stated they
had not observed this kind of swallowing the day before.
They ended up deciding, before the day was through, to just bottle feed
(they told me they had given it much thought before making the decision)
partly because they were scared that they had thought they were doing things
right and it turns out things weren't going right. I know it really shook
their confidence. We talked about options if they changed their minds and
that they could still try bfding when (or if!) milk came in So, my question
is: does anyone know about this condition, chronic adrenal hyperplasia? The
info I found told what to expect in a baby with it, but not much on mother.
The info says as long as they take meds to replace what adrenals make, they
can live normal lives. But, I couldn't find info in ref books or online
about if this could affect milk supply. My sense, just from my observation,
is that it could. Today is the 5th day and still no fullness. Does anyone
know? Could her supply just be slower coming in? No depo given, BTW.
TIA! :-)
Warmly,
Marsha, in Indiana, where I'm so glad it's Friday!
Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
John S. C. Abbot
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