I have recently on my caseload a very unfortunate dyad:
Mom is 21 and gave birth to first baby about 4 weeks early. Babe had poor suck and was in NICU being gavaged for a week. Babe was never put to breast in hospital. She has gained, though not a lot, but is still very tiny. Mom was discharged home with _no transportation_ to her home town 20 miles away. She had been pumping in hospital but it took a little time to get her just a hand pump (I wasn't involved at that time). At that time she felt full, but does so no longer. Baby did not go home with mom but was apprehended from hospital by child welfare. The problem is the baby's father's history, though he is not currently in the same home as mom. Babe is in foster care about 40 miles from the mom. Mom has supervised access for 2 hours, 3 times a week. She is overwhelmed, but really wants to maintain her milk supply and breastfeed. Already her supply is limited. Her primary nurse has encouraged her to pump, pump, pump.
I saw Mom and babe together yesterday. Baby has typical bottle suck. Mom has soft, pliable nipples that baby doesn't register as a nipple. Mom has prompt letdown, in very small quantities -- 1.5 ounces pumped in two days. After much effort baby latched though not well and was willing to suck for a short time. A little ice was helpful in making the nipples more graspable.
So far, I've asked her to pump at least 12 times a day (at least until supply increases), and her physician has agreed to prescribe domperidone as a trial. On my next visit, tomorrow, I'll be reinforcing the pumping and domperidone to get milk supply up again. At the moment it seems more important to work on supply rather than on getting babe to breast when that can only happen a total of 3 times a week.
Any thoughts?
Judith Hayman
Judith A. Hayman, RN, BSc, BScN, IBCLC
Public Health Nurse, Lactation Consultant
Haldimand-Norfolk Health Unit
***********************************************
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
|
