Rachel

You relate a very difficult postpartum course for a mother pumping 
for 2.5 months for multiples in the NICU.  It actually sounds as if 
the amount of pain she has experienced while pumping is so over the 
top that I'd be wondering whether she was suffering from postpartum 
depression. I recently heard Alison Stuebe speak in Spain and she 
described research she's involved in looking at pain in relation to a 
mother's emotional state.  Even without medicalizing this mother's 
distress, having multiples in the NICU for this length of time must 
be incredibly hard and exhausting.   Would it be an idea for her to 
ask her own physician about the adviseability of a 
breastfeeding-compatible anti-depressant?  This might not only enable 
her to cope a little better but may also act as something of a 
galactogogue, a frequently experienced side effect?

You say that she has "chosen" to wean, presumably due to the hassles 
and the pain associated with pumping for this length of time  .... 
but has she any conception of how important her milk is to her 
fragile babies?  There would seem to be a clear conflict of interest 
in this situation between the needs of the mother and the needs of 
the babies.  But truly, the mother is all grown up and the babies are 
at risk of infections/NEC etc now, and lifelong disadavantages if she 
puts them on formula now. I don't know if you have any 
handouts/literature to help mothers make these decisions and bolster 
their resolve - but she deserves to know the truth???

Just my 0.2ml.

Pamela Morrison IBCLC
Rustington, England.
-----------------------------------------
Date:    Wed, 18 Mar 2015 14:38:01 +0000
From:    "Cruz, Rachel (NICU)" <[log in to unmask]>
Subject: lecithin dosage

Hello All,

Permission to post: I have a patient  who has had multiple bouts of 
plugged ducts, mastitis and damaged nipples in pumping for the last 
2.5 months in the NICU for her multiples. She has used a Medela 
Symphony pump and felt too much pain. She currently uses a Spectra 
pump and feels that the pulsatile action of the pump is the most 
tolerable. I have been a NICU LC for 6 years and I've never had a 
patient with this much pain. We have tried all the usual-adjustment 
of flange size on many occasions (uses a 27-30mm flange) as well as 
use of Lanolin cream with pumping (not anymore), hydrogel pads, APNO 
cream after all pumping sessions and a course of 7 days PO 
antibiotics which is now finishing today. She uses heat before 
pumping and deep massage during all pumping sessions as well. (She 
watched the Morton videos)

She has pumped for 10 weeks and is now choosing to wean. She has been 
taking lecithin 4800mg daily which helped at first but is now only 
helping minimally. (This was started when plugged ducts initially 
began several weeks ago). I cannot find information if a higher dose 
of lecithin is safe. Please advise wise ones! Also, any other advise 
on the above mentioned scenario would be appreciated.

Rachel Cruz, RNC-NIC, IBCLC


  


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