On Sun, 25 May 2003 13:45:00 EDT, Karen Kerkhoff Gromada, MSN, RN, IBCLC
<[log in to unmask]> wrote:

>In a message dated 5/24/03 11:34:31 PM Eastern Daylight Time,
>[log in to unmask] writes:
>
>> quote Changes were: nursing baby developed nipple confusion and mother
>> was convinced to change from a Lactina (with which she was getting an
>> adaquate supply) to a Classic. Within 3 days on Classic milk has dropped
>> from 3-4 oz per q2h pumping about .5 oz.
>
> (quote from Karen) If I'm reading correctly, this MOT is pumping 12x/24
hours and was getting a
>total daily volume of 36oz (1080ml) to 48oz (1440ml) with the Classic, but
is
>now getting a daily volume of 30oz (900ml) to 42oz (1260ml)? I'm with you
re:
>moving back to the Lactina if that is the only difference/only thing that
>changed in her routine. However, production seems WNL, so I'm wondering
why there
>would be a need for a galactogogue at this point. (I work with a lot of MOT
>and find most are not pumping as many times in 24 hours as they first
>indicate--just seems like it to them. I'd suggest looking very deeply into
basic pump
>management re: pump "recall" for number of actual pumping session in 24
hours
>and pump routine/use of equipment to assess actual milk removal
opportunities
>before moving to a galactogogue.)

She is overwelmed (lots of info to relate) she *reports* same interval
between pumpings but volume dropping from 3-4 oz to .5 oz. I feel strongly
she needs that Lactina back. (I wasn't the renting LC, though.) Her MS
seems to effect her memory, so she is almost complusive about writing
*everything* down. She showed me her records and her last pump results
yesterday AM and it was about 2 oz.(I am wondering if she may have been
reading the volufeed container incorrectly!) Not too bad. I think we will
reserve and wait about the galactx. Got baby B (the one who never nursed,
but is home) on with lots of encouragment, rewards with a dropper and a
Contact sheild after almost an hour of trying to wake the poor little guy
up. Nursed well for 10 min one side then about 5 on the other, w/ reg
swallowing, not bad for a 4.5 lb babe who never went to breast before. Mom
cried! I think with his nursing, and continued pumping, her supply will
increase. Baby A due to come home tomorrow.
>
>I'm with you about the possibility of maternal overhydration. The research
>evidence does not support X amount of fluid as associated with increased
>production. But you've shared that with her and you aren't responsible for
what she
>chooses to do. And from your post, it sounds as if this mother may indeed
pick
>and choose interventions for reasons that don't always make sense and she
does
>not appear to be the most reliable transmitter of second hand info, as per
>the cup-feeding info she said the hospital told her vs. your experience
with
>that hospital and its LCs. She also hints at being a "yeah, but" client.
C'mon--a
>woman buys a glucose monitor without medical rec, but then can't remember
the
>results? Sure...
>
>> ...One baby is home, one is still in NICU. (The baby in NICU was the one
>> who was nursing before bottles were introduced.) I asked about cup
feeding and
>> she said her
>> hospital "won't do it."
>
>I've moved away from believing in "nipple confusion," per se. I'm more a
>believer that a baby either can't suckle effectively yet re: CNS,
mechanistic or
>systemic reasons or the baby's been given the wrong teat--one that
reinforces
>neurobehavioral responses in the oral cavity that are contradictory to
>neurobehavioral responses needed for BF. I've had too many MOT transition
babies from
>bottles to breast or continue to alternate using a more BF-friendly teat.

Yep, they had him on one of those awful red "premie" nipples. Bleh. And
yes, she is a "yeah, but" client. I suggested an Avent Newborn if Bottle
feeding needs to be done.....she will make the choice, though.
>
>This MOT has a lot on her plate after a pregnancy and birth that typically
>are more complicated, plus the MS concern always hanging over her head.
Having
>one baby in NICU and the other in her care can be very stressful; mothers
who
>experience this often say they constantly felt they should be with the
other
>baby. She may have said the hospital doesn't cup feed because she elicited
a
>response from care providers there that "fit" with wanting to do what
often seems
>less stressful--bottle-feeding, which is more socially understood. It may
be
>that she doesn't want to/can't think about one more thing just now, or it
may
>be that she's a borderline personality.

That was one of my thoughts also. She also appeared depressed
(understandable.) Slow moving, almost inaudible voice, eye half open,
shakey, pale. Probably from combo of Vicodin, depression, exhuastion, MS,
worry and perhaps some BPD, too. She REALLY perked up after the baby
nursed. Almost a different woman! We also cupfed him, and she seemed to be
interested and paying attention. I also taught her some exercises for his
tongue, as he seems to have some bunching and oral aversion, probably from
the suctioning, and N/G tube. He needs to learn how to trough his tongue.
>
>I hope some of the above makes sense and does not come across as
>smart-alecky.

Not at all, I was thinking some of the same things.

> It isn't intended that way. This MOT has a lot on her plate but she's also
>sending you mixed signals about BF. We do our best but mom is always the
>"gatekeeper" when it comes to BF or expressing milk for her own infant(s)!
Good
>luck...
>
>Karen G

Thank you, Karen. It was an intense consult, but with good results, we may
have to do it all over again when Baby A comes home.

Mary
>
>
>             ***********************************************
>

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