Ann affirms my previously posted comment that:  "I still see way too many
moms
who experience "failure" who have essentially been failed by the health care
system, which still is not up to speed on good bfg management ".  I had such
an illustration of this just this morning.

A first-time mom phoned with a basic concern about tender (not cracked
nipples).  While I try to stay off the phone because these free, "just one
quick question" calls eat up my time, I am way too used to the fact that too
many mothers and babies fall between the cracks.  This call wound up taking
about 25 min. once I elicited the info that the baby in question weighs 5
lbs and had been sent home with instructions on managing lactation that are
more suitable for the robust term infant.  The baby is 13 days old and
growing increasingly sleepy. Stooling is scant.  Due to mom's initial
engorgement, the baby (who had dropped to 4lb6oz at discharge) was back up
to 5lbs when seen a few days after delivery.  How much money do you want to
bet that in the week and a half since then, mom's milk has down regulated
and baby is not gaining any more now that she isn't "coasting" on the extra
milk of the engorgement phase?  At least baby is sched. to see pedi
tomorrow, and mom was receptive to my suggestions to initiate post feed
pumping to make sure the supply is adequately calibrated.  I told her that
if the baby is gaining well, she doesn't need to see me, but I bet I get a
call from her tomorrow.  These situations are so preventable with just the
littlest bit of anticipatory guidance.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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