Hello Lactnetters,
Case: Advanced maternal age G3 P3, older sibs in their teens. Mom had
ended up giving ABM at 3 months and 3-4 weeks respectively. Her delivery
was par for the course here, epidural but no other interventions. Good
post partum course. Inf latched well per mom and was nursing at least Q3H
during hospital stay. I received a call from the pedi at 5d visit
requesting SNS (BW was 8#1oz, d/c wt at 1 d 7#13 - day 5 7#2.7oz all
exclusively bf) they purchased an SNS mom deferred consult at this time (is
a NICU nurse). Next day, after supplimenting weight was 7#7.6oz. One week
later mom called for consult inf had increased to 8# 1.8oz BF first for 30+
min both br then supp due to hunger signs 6-8 oz daily. At consult the
next day mom was well rested, non-smoker, no medications other than
prenatal vits. Good interaction with baby, inf was quiet and alert ac wt
was 8lb2.6oz pc after 45 min feeding using both br transferred <1oz still
showed strong hunger signs. Mom supplimented. During feeding inf had good
latch, mom with bilateral let down, milk easily hand expressed - good latch
mom handled inf well, open pause suckling suck to swallow only 3/4:1 most
of feeding in my estimation. Mom did not appear tense or excessively
anxious - had pretty much accepted matter of factly the apparent
insufficiency. She wanted to know how to increase. Plan was more freq
feedings (was demand feeding roughly Q3), wear the baby, fenugreek/mother's
milk tea, for 48 hrs pump for 10 min after feed for stim. and ad lib
suppliment to meet inf need. Mom still had sns but had switched to A----
btls. Thyroid studies done during preg were WNL, had exp. only mild
engorgement, no hx of surgeries, nl br development, 1st trimester br
changes noted. Both of mom's sisters had similar experiences with
breastfeeding with early suppliment. We discussed having prolactin levels
drawn and thyroid studies redone, possible retained placental frag (though
the history with 2 other kiddos made me doubt this possibility) and mom was
to talk to the nurse midwife she used and get back with me if they decided
to do the level. She called back 4 days later reported no appreciable
change in supply very little to no residual milk with post feed pumpings
but inf still showing hunger signs after bf. Had had prolactin level drawn
(unstimulated 89) no thyroid done at this time. Had added Reglan but had
used this with last bf experiences without increase in milk so she wasn't
optomistic. At this point was willing to give another week to her
efforts. Yesterday, my partner saw this mom and test wt indicated again
about 1oz did have 1/2:1 auck/swallow for initial burst of suckling <3-5
min. Mom has had a stimulated prolacting level and the thyroid studies done
and is waiting on results.
Whew -- ? What next? Mom has indicated that she has followed the plan. We
had suggested seeing an IBCLC for a second opinion and mom deferred. Any
suggestions? Her family is very supportive as is her HCP, mom has surpassed
her 1 week self limit to try, so she does appear motivated to affect
change. Your input is appreciated.
Hopeful,
Kathy Amell LVN
IBCLC hopeful
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