Dear Mary,
You have one other option - stop seeing her- You have given her lots of help
and options , she is an adult. She needs to own the breastfeeding, not you.
I sense you are caught up in her anxiety and she is not compliant.
Good luck with your private practice -
Karen Querna, RN, BSN, IBCLC
Spokane, WA

>
> Date:    Mon, 15 Dec 2003 09:10:40 -0500
> From:    Mary Jozwiak IBCLC <[log in to unmask]>
> Subject: Almost out of options, sheild AND SNS together?
>
> I have permission from the mother to post.
>
> Long story. Saw baby at 3 weeks, mom says "not enough milk." Observed
baby,
> found moderately tight frenulum. Mother VERY distracted by 2 yr old. Kept
> getting up, to tend to her (she was *fine*) during breastfeeding baby.Baby
> poppin off every time. Baby latched "OK" Mom had slightly delayed MER, but
> baby gained 3.5 oz (Medela elect scale) in about a 20 min, both side
> nursing, using the first breast twice. Mom was using about 6 oz ABM sup a
> day at this point. I showed her Compression, better latch, leaving the
baby
> on until several MERs occured, and tongue exercizes. Gave referal to MD I
> use who frequently performs frenotomies, told mother it was essensial he
> evaluated. Left her with a pump, instructed to pump every 2-3 hours, after
> each nursing. Showed cup feeding for sups, left instructions for reducing
> sups as milk catches up. (Baby does NOT like the ABM!) Baby had gained 10
> oz a week since lowest discharge weight. Told mom I had to weigh him in
3-5
> days.
>
> One week later. Mom didn't call or set up weighing appt. I couldn't reach
> her. Was temp living in family member's home while home was being painted.
> Asked if she had seen MD for tongue. Nope. Asked if pumping. "It's hard,
> someone will hear me." (?)Claims pumping "about 4 times a day" In the
> *bathroom* at her brother's home! Asked if using tongue exercises to help
> stretch. Nope. Toddler makes it "too hard." Baby now up to about 10 oz ABM
> a day. Told her I NEEDED to weigh baby. Told her she NEEDED to see MD.
>
> Send report to MD. Mom said it was "too far" to come to me for weighing.
> (It really is moms' responsibility to come to me for a weight check. I
> don't charge for them. I thought a follow up consult would be useless
until
> MD was seen.) Told her we would recommence after MD visit, but I really
> needed to weigh this baby. Tole me she would have MD weigh. Two days
later,
> She finally Saw MD, he said "It isn't bad enough to snip."
> (ARGHGHGHGHGGHGH!) MD did not weigh baby, although I really stressed that
> she should ask him to. She "forgot."
>
> Mom is not keeping adequate records, says she "thinks" baby is having 5-6
> wet and one big poop a day, (he's 5 weeks now) says pumping 4-5 times a
> day, 20 min, getting only 1 oz. Refused to try galatagouges. Tried to
> schedule an other consult. Said she would "Try" to pump more and "wait." I
> said, "Don't 'try' DO it!" Asked her to please come in for weigh. She
> didn't.(Again the fact that she has a 2 year old is used to excuse lack of
> compliance.)
>
> Yesterday, called in a near panic. Yet not much has changed. Still not
> pumping enough.  Thinks she is "losing my milk." "baby is needing more
> formula." Yet still using the *same amount* of ABM he was over a week ago.
> When I pointed out that *I* was keeping records, and that she is using the
> same amount of ABM as a week ago, she said "Oh." Expalained a baby at her
> baby's weight is taking about 30 oz a milk a day, if 10 oz of ABM, SHE is
> still providing 20 oz or more. Stressed importance of record keeping. Made
> appointment (finally!) for today.
>
> She is going to need a supplementer. I can't count on her to pump. BUT she
> is STILL nursing. (Amazing!) This is the only ray of light in this
> situation, the fact that this baby LOVES to nurse. She will *not* tolerate
> and other referal to an other ENT or ped dentist for this tongue. The
> tongue IS working, yet he could be doing a bit better. I also feel he
might
> get a better latch (mom says he tries to nippple feed, I stressed she
> needed to take him off and relatch when he does this.)with a sheild, but
> with her lack of record keeping and precarious supply, I am not really
> comfortable with shield alone. I KNOW she would use the sheild! But may
not
> pump to continue supply. I won't know the story thus far until I see him
> nurse and finally weigh him this afternoon.
>
> My  hairbrained scheme. Try a shield to see if he latches more deeply.
> THEN, Thread an SNS tube THROUGH the hole in the sheild and have her use
it
> (this contraption) at ever OTHER feeding, and then really stress she HAS
to
> pump after she does this. Do every other feeding on the bare breast.
>
> This would give him a deeper latch, AND sup him at the same time,
> eliminating her bottle usage. I feel with his tongue,and her slow to start
> MER he is going to become more dependent on the bottle and ABM if
something
> more drastic isn't done.
>
> I will watch a feeding and then introduce this thing (Sheild/SNS) I made
> this morning. (At about 5:00 AM, because I couldn't sleep thinking about
> it.)
>
> I HATE to gadgetize this baby, but he *does* need the supp, at least for
> the time being, and a deeper latch will only benefit both of them. (Mom
has
> told me "how much faster" the bottle feedings go....) But mom does NOT
want
> to quit.
>
> Input please. I am only doing this, as this mother cannot be counted on to
> keep adequate records, seems to panic easily (and then give more ABM) and
> seems to have a hard time with compliance. I think she may actually USE
> this device, the baby will get more milk, a better latch, and she will be
> more stimulated. Her problems with compliance may actually work in their
> favor, as she probably won't want to be bothered using this thing at EVERY
> feeding, which would be perfect!
>
> Why do I feel I have to justify this plan of attack?
>
> Input please, Wise Ones.
>
> Mary Jozwiak IBCLC, RLC, LLLL, AAPL
> Private Practice
>
>

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