Does anyone have input on this situation? I have a client who is currently on
Reglan. He baby was 37+ weeks and experienced a very difficult birth. The
baby did not stimulate her mother's breasts well enough to establish a good
supply within the first 5 days. She was *extremely* sleepy when I first made
a home-visit and was exhibiting signs of impending dehydration. She latched
only on the nipple and her suckle was extremely shallow. The mother began
pumping immediately and was able to nourish the baby sufficiently, such that
she began to have normal bowel movements (frequency and consistency) within a
short time. I taught her to finger feed. The baby's suckle was of good
strength, but a little erratic--something I was familiar with at her
gestational age. She had a very difficult time opening her mouth wide enough
for a proper latch, which seemed to me to be birth related. We tried a
supplementer at the breast and the baby did very well with it--efficient
suckling, but the parents would not continue to use it, finding it to be
awkward. They preferred to finger feed. Initially we tried only the pump to
increase milk supply but soon moved to Reglan. Mom took 30 mg per day for 2
weeks, has been taking 20 for the past week and is supposed to cut down to 10
tomorrow. She is able to pump enough milk for her baby, but her breasts have
never really been full, she never leaks or feels MER (while not everyone
does, it is info). Mom has been taking the baby to an excellent Network
Chiro, which has given the baby proper jaw motility and woken her up
dramatically. However, I watched her nurse today (mom has been working
diligently on bf), and it is clear to me that there is still not enough milk
supply. Mom has also been taking fenugreek and is at 6 capsules per day (I
cannot remember right now the exact amount). I am concerned that now that the
baby is finally opening wide enough and latching correctly, the Reglan is
being reduced. Mom is willing to continue to use it, but I am wondering about
dosage and length of time. She still pumps 6-7X per day (skips the pump on
the occasional good feeding). Mom is also using alternate massage. One more
thing--her baby appears to have a dairy sensitivity and mom has not yet fully
eliminated dairy--I am hopeful she has done so as of today, as her baby is so
gassy, it is difficult to tell how much this is affecting feeding and
stooling. So, my big question---would it be beneficial to continue the Reglan
at the original dosage, a different dosage or in combination with something
else (oxytocin spray?). I think this baby would do well if mom's milk supply
came up. I would appreciate any help asap as she is extremely frustrated. TIA.
Jennifer Tow, IBCLC, CT, USA
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