Thankyou for replies on and off list. 

What has occured to me is how vastly we all practice! Both during the birth and lactation management wise. 

For homebirth midwives, a 6 hour phsyiological 3rd stage, while longer than ususal is not atypical. It is usually over within a hours of birth.  I have heard of 12 hour 3rd stages also. Usually in mothers who know they are having their last baby and don't want to emotionally let go of the placenta. So long as there is no bleeding, it doesn't matter how long it takes, the woman will start contracting again when her body is ready and birth the placenta in her own time. There are ways to naturally help this process, blowing on a bottle, coughing, vomiting etc etc.... The only posibble hazard is that this potentially could effect lactogensiss 2 by delaying it somewhat, but this certainly isn't a universal rule and seems to be a natural variation amongst women. Isn't nature grand!?!?!

This woman lives 2.5 hours away from me, I stayed 3 nights after the birth, then left late day 3. I was mildly concerned that the baby had lost over the 10% but didn't worry overly because babes who have physiological 3rd stage (as compared to active management of oxytocic, early cord clamping) have the advantage of having the full blood supply from the placenta that they were suppose to. As opposed to babes who have been subjected to active management of third stage and start life hypovolumic. On day 3 she felt like her milk was coming in, so I didn't worry thinking baby would quickly gain again. 

When we noted the drop on day 5 (not weighed on day 4), I thought it was time to quickly boost this mums supply,with the 90 minutes feeding routine instigated. There were keytones noted in the nappies also. Although getting 6 disposibles a day with poos. Absolute over kill by weighing nappies, but since I was back home, it gave me a good idea of how wet they actually were and what the output really was. When being so far away, I needed to have some idea of what exactly was happening so to make a action plan. I think I have scared this mum, but a weightloss still on day 5 isn't good either. However, we have worked out that the scales go in 10 unit increments, not 1's, so perhaps the weight loss could be considered negligiable. Though again, not being just there to physically examine the babe that particular day, was not something I take light heartedly and let go and end up with a babe in hospital unnecessarily. 

However on visit yesterday, day 6 mum was naturally very tired, and babe was cranky (had previously been happy). her breasts felt lower in supply than they had previously, though I suggested that is a good thing because they less full they are, the more they make. Which was our desired effect. Babe seemed to attach well, could be heard swallowing, though not gulping as you would expect if the milk was fully in. Babe certainly was hungry alot...not satisfied after feeds although taking each side for approx 15-20 minutes. 

I managed to get some donar breastmilk from a trusted and known source, and recommended that be given. Though at this stage mum is still reluctant. I am concerned that with such a weight loss that babe will quickly go down hill if mum's milk takes longer to get in and is using much of her energy feeding, but not really getting enough to gain weight. She is definately getting enough to maitain hydration, but not gain weight. 

When I left, we come to the arrangement if there was any keytones in the nappies or baby seemed to becoming dyhyrated in any way to give the donor EBM. She is also expressing after each feed, at least in the daylight hours. I did do a test weigh yesterday twice and first time there was a increase in weight by (from memory) 100g. Second time only 20 grams...that was after both sides. Babe was still very fussy and wanting more, and she had fed 15-20 minutes. She is feeding up to 4 breasts each time. The babe certainly hadn't lost anymore weight though, so perhaps starting to level out?? I hope so!

This mum does have very asymetrical breasts, but not with insufficient glandular tissue. One is quite large, the other medium sized. She is vegetarian, though cannot fault her diet in anyway, they are very diligent. No retained placenta (complete, with membranes, fundus F&C minimal blood loss). her HB is fine and also taking spatone (iron supplement). She has nothing else that I can think of why her supply would be low? or slow comming in. Babe doesn't have tongue tie or anything that should impede this either. 

At this stage I just hope the extra expressing helps it to comes in quickly so we can start seeing some weight gain in this bub. 

Sorry, I have rambled quite a bit. I hope it all makes sense, I got home very late last night and am a bit tired! Thankyou again for the replies on and off the list. I have to trust mum knows her body/baby best and be guided by her at this stage. 
____________________________________________________________________________________________________________________
GentleBirth Pregnancy and Birth Education
Rachael Austin RN, EM, IPN, Adv. CBE
Student M&CHN
Trainee ABA counselor 
Midwife in Private Practice
Ph: (07) 49 931 213
Fax: (07) 49 931 341
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Email: [log in to unmask] 
www.gentlebirth.com.au 

2008 - The Year of Homebirth Awareness.
Help support and value women. Protect their babies.
Tell everyone you know that homebirth exists as a VALID birthing choice!

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