My client's baby is 4 weeks old--and it has been a lonnnnnng 4 weeks. Mom
never had breast fullness (though her breasts are well developed), baby
didn't suckle well at first, began sucling better but would have times when
he couldn't settle enough to latch, mom had trouble with let down.
Baby has never had a good stooling pattern. He had a few yellows in the
beginning but has had green, brown (abm), pasty, watery since. But since
the second week, he will not stool on his own. I just don't like the looks
of his stool most of the time.
Mom has been supplementing with abm since 11 days. The most he has taken
in a 24 hour period is 9 ounces--usually 7-8. He has plenty of very wet
diapers (urine clear)--and the surprising part--he is gaining well. He
gained 6 ounces from week 2 to week 3. And 9 ounces from week 3 to week 4.
Mom is doing better with pumping and increasing her milk supply since I
recommended supplementing. Her let-down is very erratic, and she said that
she feels so more relaxed knowing that his survival doesn't depend on her
making enough milk. There is so much emotional stuff going on here.
But, in light of the current discussion on how and when milk is produced,
I am wondering about her feeding pattern. Baby takes 2 hours to feed--at
breast first until he seems to not be getting enough, then the supplemental
tube with abm, then finishing with just breastmilk. After this feeding
time, he is happy and/or sleeping for 2 1/2 to 3 hours, and a couple of
times 4 hours.
He has exhibited some sensitivity to the abm and she would like to get him
totally on her milk. Is the marathon nursing sessions thrwarting her goal?
Would he be better served by frequent short feeds? Yesterday she was
trying to limit the abm, after seeing that he gained 9 ounces in a week on
only about 8+ ounces of abm a day. He fed for 10 minutes and came off
himself, slept for an hour and fed for 15 minutes, came off, and was asleep
when I left. Did he read of Peter Hartman's research and is set out to show
that it is, in fact, correct? [Why does Peter keep proving wrong everything
that I have believed to be right, such as milk is not made during a feed?]
Am I right to be concerned about his stooling? How can he gain 9 ounces in
a week with little stooling? What about the colors--Where are those lovely
yellows? Is it too early to begin to get him off the supplement, even
though he has the weight gain? Is the supplement interfering with the
breastmilk supply, or is it giving him the energy to build it? Can he
afford to slow his weight gains to stimulate more milk?
I had another client who had to supplement for 3 months, at which time she
had enough milk for her little one to grow well on. I hadn't believed that
she would be able to build to that place when her supply was so low in the
first 2 weeks. So, I never say "never."
Pat Gima
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