These two cases might be interesting to some of you lactnuts out there. 1st case: We had a mom deliver at 34 weeks in the middle of what she thought was a 'summer cold.' Turns out she had pneumonia and developed adult RDS;, ended up in adult ICU, sedated, on a ventilator and Pavulon (which, for those of you who don't know, paralyzes the person temporarily so they don't fight the ventilator) Mom was completely paralyzed and only partially conscious. The baby, meanwhile, was in much the same condition in NICU, but minus the Pavulon. Both sick, sick, sick. Believe it or not, after the husband told the nurses in adult ICU that the mother had really wanted badly to breastfeed, they got a pump from CD at 1:00 in the morning, and pumped her breasts FOR HER every three hours all night long. ...... That has to be a first! They got grandma and dad to do it during the day. I didn't have to go down, tell them how or what to do, or anything. I heard about it much later. WOW! The only problem I had was that, because of the medications the mom was on, they dumped all the colostrum down the sink. After checking the safety of all the meds the mother was on, and telling them that it was okay, they said, "Well, we have an order to pump and dump anyway." NOOOOOO!!!! I finally convinced them not to throw it away, to send it right on up to NICU and we would use it for the baby. By today, the baby had yanked out her own endotracheal tube and gone to room air. This evening, mom is awake, off the sedation and Pavulon, doing her own pumping and looking forward to nursing her baby sometime in the next few days. Hopefully all will go well so that tomorrow, we can take the baby to adult ICU for snuggling and breastfeeding. 2nd case: The other case is a mom who called today with a fairly complex problem. She had premature (34 week) twins who are now 5 1/2 weeks old. I saw her in the hospital a number of times and we got the babies both nursing well, but because of low tone and fatigue, they were not able to totally breastfeed and still gain weight. So, we were gavaging three feeds a day to allow them to sleep through some feedings. Then somebody told her that she needed to get the babies on a bottle so we could get them home sooner, which she did, and now has two babies who have never ever gone back to breast with all kinds of coaxing methods suggested by a LLL leader. She is pumping and bottle feeding twins and is exhausted. To compound the problem, the mom had a lumpectomy 14 mos ago (one day before her wedding for heaven's sakes) and that breast is painfully and chronically engorged. No amount of warmth, massage, nipple stim, pumping, hand expression, oxytocin spray has helped at all. She simply cannot get milk out of that breast. Most of the time she gets 2 - 30 cc out , although about every three days, she says it is like the whole thing explodes and she can get six ounces out all at once. Then she feels pretty good for a couple of days until the pressure builds back up. (Would scar tissue or strictures explain this, or what? Anybody know?) I suggested wearing hard shells thinking the "leaking faucet" principle might reduce some of the tension within the breast. Looked it up in Riordan and Auerbach, checked with several other IBCLC's and didn't come up with anything really helpful. Mom may be able to completely allow that breast to involute and produce enough on one side to supply twins, but she is nervous about it. She is going to come in and we will help her get the babies back to breast, but I sure wish we had two of them functioning. Maybe the babies will have better luck than the pump. If anybody has any suggestions, I would love tohear them. Deanne, R.N. IBCLC *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html