Just thought I would describe a situation that I assisted with last week. I
think it shows that there can be some changes, even if they come slowly. Mom
delivered at 34 weeks, although baby seemed older, and tested older. Mom was
in my prenatal breastfeeding class. Baby latched in delivery room and
subsequently on postpartum.
On day of life 1 became very sleepy with very brief attempts at latch. The
nurses contacted me to work with her, but started her pumping before I got
there. They encouraged the mom to put baby to breast striving to get him
there at least every 2 hours, sooner if the baby seemed hungry. Bilirubin was
elevated, baby left in mom's room with wallaby for phototherapy. We continued
putting baby to breast then had mom pump as the baby really was not doing
anything at the breast. Mom's choice was to give the milk by bottle, but the
nurses discussed with her all of the options, fingerfeeding, cup, and spoon.
Bili was further elevated, warmer and bili lights rolled into mom's room.
Formula supplementation was discussed, but the pedi felt mom was producing
plenty and that we could just use that for supplementation, about
25cc/pumping. Baby became more awake, better at breast, we still had mom pump
to encourage supply and gave some by bottle as baby was not stooling. By day
3 milk was in, baby started stooling, bili dropped, and baby at breast. Baby
went home day 4 (mom C/S), on the breast. Baby then readmitted for increased
bili two days later. I was afraid that I would hear that breastfeeding was
not going well. Lo and behold baby was gaining like gang busters, but had ABO
incompatibility. Back under the lights, mom in room with baby. Mom told me
that breastfeeding was a breeze at this time, compared to the first few days.
She felt wonderful and very in control of the feeding of her baby. Every
staff person did a great job in supporting this mom and baby.
I just wanted to show that there are some good things happening out there. We
are a Boston teaching hospital and it doesn't always go right, but we are
working on it.
Lisa Enger RN BSN IBCLC
Boston, MA
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