Phyllis
there are many choices here, but the main thing I am picking up here is that
HER MILK SUPPLY MUST BE PRETTY LOW. sorry to put in bold letters but this is
the important part, in my opinion. "Baby would not latch for more than 5-10
seconds on the left side without having a
fit; ...We used a BP, to be sure mother is producing milk from left breast
with only a few drops obtained."

There seems to have been some bf mismanagement going on during the 2nd
hospitalization (possbly the first?), so that any supply she might have had
in early days was compromised (was she expressing REGULARLY during that week
long bf ban?), but the question is WHY was the baby "readmitted to hospital
when 4 days old with jaundice and recieved phototherapy for nearly one week
(in-hospital)." You need to get to the bottom of this. Possibly this mom has
a primary lactation failure situation - did she go thru some real breast
fullness in the early days? what is her history as far as breast changes,
endocrine, breast surgery etc.? Even is she had normal breast development,
normal breast fullness, milk surge in early days, it seems there was an
early milk transfer problem and mom lost her supply.

She should continue to SUPPLEMENT the baby with post feed ebm, donor milk,
or formula using whatever alternate feeding she is comfortable with and baby
can effectively obtain the milk he needs. If the SNS is no longer preferred,
she could bottle feed or cup feed. DO NOT BACK AWAY THE SNS if the SNS is
going to be the alternate feeding method, UNTIL SHE HAS ADEQUATE SUPPLY. "I
suggested retracting the tubing slightly with each feed until hopefully it
is not used at all."

Agree with this: "I also set mom up with an Elite BP to boost stimulation
and milk production and use EBM for feeding." You could discuss herbal
and/or prescription galactagogues. You have your work cut out for you! Let
us know how it progresses.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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