Barbara,

I liked your post on the baby with torticollis and iatrogenic downregulation
of lactogenesis.  I have had the same experience and have the same perception
that women have different levels of sensitivity to interruption of the normal
sequence of events.  Some women can have everything go wrong, in some cases
not even intend to breastfeed, and have copious supplies.  For others, it
seems that anything not quite perfect can make it difficult to ever build up
a milk supply.

One thing that I encounter working with moms and babies in the first few days
is the phenomenon of the baby who has no reserves, who gets hungry before the
mother's milk increases.  Some start as early as day one!  It is very
frustrating and difficult to decide what to do.  It is not always possible to
express enough colostrum to satisfy the baby.  Some babies actually get
dehydrated in as little as 24 hours.  These are often situations where there
has been a difficult labor, maybe fetal distress, maybe a C-section after a
long labor, etc.  Mom is exhausted, overwhelmed, baby is bouncing off the
walls, maybe all the relatives are increasing her anxiety about the baby.
Sometimes in these situations even someone like me who knows all the
negatives of formula ends up helping the mom to supplement in a way she can
tolerate and, hopefully is not too damaging to the breastfeeding.  In the
past week and a half, I have done two home visits where I have helped the
parents to do some judicious supplementation - one at 3 days - mom had had a
large blood loss, lactogenesis II was delayed, baby and mom were frantic -
and one at 5 days, history of fetal distress, milk just coming in, baby OK
but frantic.  In the first case, only 24 hours of supplementation was needed,
everyone calmed down and mom is totally BF.  In the second, things are
improving and I'll see them again today.   Sometimes it's what the baby
needs, sometimes it can be what the mom needs to keep going.

At my hospital, we do minimal supplementation.  We have a 90% breastfeeding
initiation rate.  So all in all we use very little formula.  But these things
do come up.  Have you noticed how one gets several of the same situation in a
row?

I always enjoy your posts.  Miriam Levitt RN, IBCLC, Berkeley, CA

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