Dear Friends:
      I was very excited yesterday about the opportunity to use what I had
learned in the Wolf and Glass workshop. I got a little carried away. While W &
 G have certainly given us a huge framework to work in, there is more to
breastfeeding than one element, as this case illustrates.
     With yesterday's case, (baby with suspected reflux) there was a lot
going on:
     1) The mother had had a horrendous experience with oversupply and
recurrent mastitis for 6 months with her first baby. She didn't see a LC
until she was at the end of her rope at the end of that 6 months. Every
single time she saw this new baby, #2, do anything that reminded her of
oversupply, she did things to reduce her supply. She started this right away
after the second birth (spontaneous labor, epidural, no pitocin). Baby #2
gained at the appropriate weight of between 1/2 ounce and 1 ounce (15
grams-30 grams) a day for the first two weeks.
     Her first baby had gained 2 pounds. This baby has gained only 2 pounds
over discharge weight in 2 months. Mom was successful in preventing
oversupply; too successful. Now she has undersupply.
     2) Her first baby, a 2 year old toddler boy was driving her nuts with
constant demands for attention. She found it easy to stick a pacifier in baby
#2's mouth and tend to her toddler.
     3) Baby #2 was happier in many ways with the pacifier; feeding made baby
#2 so uncomfortable that she started sleeping longer and longer intervals:
going for 8 hours at night, and several 4 hour stretches during the day. A
"good" baby...content to starve. Sometimes the breast wouldn't comfort this
baby, although the pacifier always would. Baby is not a vigorous cue-giver.
This is another factor in mom's undersupply.
     4) Mother taking care of 2 babies pretty much alone. Helpful husband at
night, although he works 2 jobs so mother can stay home with babies.
     5) Baby wanting to go to breast but never satisfied. Mother very unhappy
because baby is not happy.
     We have to look for all the factors that lead into the case in our
office. Expecially in a case such as this, where baby is 2 months old, there
is never just one neat tidy answer.
     Fortunately, this mom is dedicated. She wants what is best for her
babies. Her babies are lucky to have her as their mother.
     Warmly,
Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI, CCE, craniosacral therapy
Adjunct faculty, Union Institute and University, Maternal and Child Health:
Lactation Consulting
Supporting the WHO Code and the Mother Friendly Childbirth Initiative

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