-----Original Message-----
From: Barbara Wilson-Clay <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Thursday, June 03, 1999 7:01 PM
Subject: complicated case
>I want to briefly share the details of the presenting problems of a consult
>I did today:
>
>Mother is a 40 yr old primip with a hx of fertility problms which required
>progesterone therapy to maintain the preg.
>She did not exper. any breast changes during the preg.
>She had a breast reduction in 1991, and has reduced nipple sensation. Is
>pumping with hospt. grade pump about 6 x per 24 hrs and gets max. 2 oz
total
>each pumping.
>She had gestational diabetes.
>Baby was induced at 37 weeks.
>Delivery was unusually rapid and resulted in baby having broken clavicle.
>Baby was aggressively suctioned after the birth, which was repeated on 2
>additional occasions in the nursery.
>Baby is under birth weight at 14 days, very sleepy, and has had episodes of
>nasal regurgitation, prolonged crying spells, and aversive feeding behavior
>when bottle fed. Mother offers her at least 18 oz per 24 hrs by bottle,
but
>baby often falls asleep bottle feeding and won't take all the milk she is
>offered. She falls asleep at breast after 2-3 sucks.
>
>I have a plan to manage this case, but I thought it would be fun to throw
>out the situation for discussion and brain storming.
>
>
>Barbara Wilson-Clay, BSEd, IBCLC
>Austin Lactation Associates, Austin, Texas
>http://www.jump.net/~bwc/lactnews.html
>Where are all the responses to your request? I'll brave the waters here.
It occurs to me that at just 2 weeks postpartum and pumping only 6 times per
day with little or no baby stim at breast, we still don't know what these
breasts are capable of doing. Also, this baby is for all intents and
purposes behaving like a premature. I am assuming that her clavicle is not
causing her unusual distress at this point.
In an ideal world, I'd begin by putting them to bed for the weekend. A good
supporter would be essential. She/he would keep the room clean and sweet
smelling and prepare for mother the comfort foods of her youth, and kindly
reroute all phone calls and guests. Mother and baby would rest in almost
constant skin to skin contact with baby placed at breast at every cue. When
attached to the breast no one would jiggle baby or otherwise disturb her
with talking, noise or bright light. Nor would baby be removed from breast
if she were asleep but otherwise well attached. Additionally, mother would
pump 8 to 10 times per day during this "Babymoon" . If baby wakes up and
begins to nurse well, mother or her supporter may pump the opposite breast
during nursings, instead. Any pumped milk would be offered to baby by cup
or bottle, as mother and baby prefer, whenever baby was able. Hindmilk
could be spooned off the top of EBM to give baby some extra energy, also.
Voids would be charted.
On Monday,(or at the beginning, if a weekend together could not be arranged)
baby would be placed in Kangaroo Care to "live" most of the time, and
mother would follow as much of the above as she could manage on her own
until all nursing problems are resolved. A daily weight check with rented
digital scales would help mother determine if/when a formula supplement is
needed, or if further decline was noted, when to contact the pediatrician
for further assistance.
I certainly hope others will stick their necks out with mine. It's scarey
out here!
Anne Grider, IBCLC, Private Practice, Marietta, Georgia
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