Dear Friends:
   I have posted twice about the mother with constant bright red bleeding, even today on day 14 postpartum. I have told you how her MD isn't concerned, although this mother has never had any signs of lactogenesis II and her baby is still not back to birth weight.
  The mother bought herself a home pregnancy test, which she said was negative. I thought that was a clever way to find out what is going on. The mother has also contacted another physician ( a family friend) who wasn't concerned about the bleeding either. A midwife friend said that the bleeding was probably because this mother had been doing to much. I pointed out that she has been bleeding non-stop since the birth, and that no one has connected the dots between the bleeding and the lack of milk.
  I have made two home visits with this mother. I gave her a copy of the letter I sent to her doctor.(That I sent certified mail, just to underscore the importance of the communication, and also to cover my butt, which I am sorry to say but seemed to be the right thing for this particular situation.)
  On Saturday, we weighed the baby, who had not gained any weight in 24 hours, and was 7 pounds, 12.7 ounces (only a gain of 1.7 ounces from the week before). Birth weight was 8 pounds 4 ounces.
  This mother felt that her milk volume had increased and had given the baby only 1 bottle of formula since my first visit, on Friday. After seeing that the baby had not gained any weight, I stressed the need to feed the baby and said she should supplement with formula at every feed. She liked the SNS, because the baby goes to breast very well, although baby does tend to go for the tube if the mother isn't attentive to the latch. Smart baby.
    After my visit on Saturday, I called her doctor. The doctor plans an ultrasound today (Monday). I told the MD that the baby had not gained any weight and she agreed with me that the baby had to be supplemented.
    I have been encouraging of the mother all along, praising her efforts. The baby latches fabulously, the mother is dedicated. She is breastfeeding, although not the way she planned (with the SNS) but the baby is feeding at breast. She is disappointed at the way things are going and I encouraged her to see the SNS as a temporary measure, to meet her goal.
   This morning, I called her. She said that she wanted to terminate our relationship. She didn't like my "aggressiveness" by calling her MD. (She did sign the consent form and I told her that I would be communicating with her MD during our first visit.) She said that she had different expectations of our relationship, and that she wanted someone more positive and affirming. She felt that she was doing better until I came along.
   She is still bleeding.
   I am stunned.
   warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE

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