Thank you Lisa, Pamela, Denise and Rachel for your comments. I did leave out
a lot of detail originally for the sake of avoiding a long post.
I will try to answer your questions.
Denise asks:
From your post I was a bit unsure of just how poor
> the mother's supply is. Was the 30ml given after each feed all EBM? Will
> the 60ml you suggested be all EBM? If so it sounds like the milk supply
is
> OK, or at least build-able, more a problem with the baby not transferring
> the milk during feeding.
to paint a clearer picture:
This baby was 4036g at birth, 450g below birth weight on day 13, 420g down
on day 14, today day 16 now 370g below. That's 50 g weight gain in 2 days
from Sat to today, which I would like to have more catch up on top of that,
but still better that no gain at all.
Yes all EBM, but only during the daytime feeds, not all feeds Mum felt baby
was sleeping well at night so didn't comp (arg!). She was giving 30mls
because that is all she could collect after 20 mins of hand expressing. She
would then put the baby to the breast again because the baby was still
hungry. She does not and has not given formula. I did say to her on Sat that
I was concerned that the baby's intake was not enough as the baby had not
had a bowel action in 12 days (since mec on Day 2) and was not back to
birth weight on Day 14, and would have to introduce formula if she could not
keep up with the comping EBM. I suggested the 60 mls as an estimated amount
after working out that this baby needed at least 80 ml every 3hrs, as I was
concerned that there was little milk transfer actually going on. Today she
showed me her feeding/diaper diary and has only been giving 40 mls approx
but at least its every feed.
Since commencing pumping with an electric pump 2 days ago she is managing to
express 40-50 mls now after 20 mins of pumping, this being after a
breastfeed every 3 hours. A movement in the right direction at least.Today I
expressed with the pump on one side while she BF on the other so I could get
some EBM for the supply line and got 50 mls in 10 mins. Getting better, I
thought.
As for the baby not transferring, I wondered about this too. I asked her on
Sat if she thought this baby's suck was different than her previous baby and
she said it was "weaker". This is why I got the baby to suck on my finger
because I wanted to feel how weak it was (not something I do routinely). I
didn't think it was too bad, and its jaw movements were ok on the breast,
just not swallowing much, which is why I concluded it was probably more a
supply issue. Today I asked her if there was any difference and she said it
was stronger now. I would think that this baby was tiring easily because of
the calorie deprivation. Once I got the supply line going today, there was a
lot more swallowing going on (of course) and more active sucking. I had the
Paed assess the baby to cover all angles and she felt there was a "slight
decrease in tone", so maybe there is more to the story....and we had our
first poo in 13 days yesterday!! ( YEAH!)
As I said too this lady has large nipples ( I am talking as big as a ten
cent piece, the face of the nipple that is) so there may be a degree of
'oroboobular' disproportion too.
Mum not too keen on the supply line, took some coercing from her husband and
myself to just try it, once we got it going she relaxed a bit and took it
home so I hope she continues with it. I am concerned that the feeds are
taking too long with BF, expressing and cupping/spooning and she need to
rest. So looking for ways to maximize intake in less time. Has a toddler
too. Chinese lady so has baby with her all the time, lots of close contact,
co-sleeping etc.
> Not sure how you can lactoengineer breastmilk unless you have an
> oversupply. If you don't have enough I'd be giving every single ml of it,
> low fat or not.
Yes Denise I was just brainstorming here LOL I realise we have to get her
supply up well before that!
Lisa Pamela and Rachel asked re Hb:
9.1 on Day 1. Is taking 1 Fe tab a day. Don't know ferritin levels. Did a fu
ll blood examination today. results not in before i left. I am not working
tomorrow so will find out results Wed. Did TFT's, didn't do prolactin as
unsure if I should have or not. Spoke to another LC and decided between
ourselves that it would be so variable according to time of day, time
between feeds etc and we have no experience at interpreting the result so we
just left it for now. (and still don't know the answers)
As far as galactagogues go.....she refused. Wants to wait and see how
pumping goes, so I will support her there.
Is being seen by another midwife ( hand picked by me ;-) ) tomorrow at home
then I will catch up on Wed. Have rebooked her for BFC (breast feeding
centre) Monday.
I do not normally work in the BFC, just picking up extra shifts, so I will
not be there. So was a pure fluke that I was doing 'hospital in the
home'/domiciliary on Sat and BFC Monday to follow the story through.
Warning rant to follow ;-)
What disappoints me ( I am being polite) is that this baby was, rightly,
identified the previous week as being a poor gainer by domicilliary staff.
Had already had 2 visits to Breast feeding centre on Wed *and* Friday
(different staff). On the Wed she was admitted to HITH, from the BFC, for a
close watch.
However from the Wed to the Sat she had daily visits from 'Hospital in the
Home' and prior to me coming in on Sat, there was no change in plan/increase
in intensity of plan, despite things not improving as well as they should
have and still and NO bowel actions! No apparent identification of red flags
like PPH, poor audible milk transfer, lethargy etc.
I really feel we need to educate staff to identify these at risk dyads
*early* , and that early intervention is better than late! Get in there,
identify and act on what you see, get her pumping *effectively/efficiently*,
and get that food in to that baby!
End of rant!
Will keep you posted
Karen Clements
IBCLC Melb Aust
(who had to laugh to myself when I saw my spell check had changed google to
goggle...........can you see me sitting here with goggles on, searching the
internet!! Sorry my warped...and tired... sense of humour LOL)
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
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
|
