Dear all:

I'd like to second Cathy's comment about calling on behalf of clients when
the situation looks serious.  I just saw a woman on Monday whose very
legitimate concerns were begin ignored by health care practitioners on a
number of fronts.  She had extreme edema and tingling in her feet and was
quite concerned.  When I sat there and listened on speaker phone to how
they responded to her phone call, or perhaps I should say didn't respond,
it was quite appalling.  Instead, I put her to bed, elevated her feet and
called myself on the "doctor" line.  That finally got them to pay attention
and call her back.  AND since it sounded like they weren't going to call
soon, I called up our local breastfeeding medicine specialist as well who
does house calls.  Fortunately, the edema started to resolve with the bed
rest, but this mother needed someone to take her seriously.

The obs office completely dismissed the concept that the edema play a role
in delaying lactogenesis.  She was on day 4, absolutely no changes in her
breasts which were completely flaccid, and was one of only 3 women from
which I could not express a drop of milk.  Last night she still could not
express a drop, but her breasts were feeling fuller after the edema started
to resolve. She had passed out for one of her four-hour glucose tolerance
tests which were otherwise within normal limits, had no history of
hypothyroidism, irregular period or fertility problems.  She was
overweight.  No breast surgery.  So we'll see what happens when she sees
the breastfeeding medicine specialist today.

As for the finger feeding, I do agree that it is helpful for stimulating
sleepy babies, but I also see some infants that cannot make a seal
sufficiently to create enough suction to finger feed.  This case was one of
those babies. He had lost 10%.  He could not drain milk from the syringe
with the tube on the breast, nor on the finger because he could not make a
seal on either.  By the time the pediatrician saw him the next day his suck
was completely different - which is also something I notice with babies
that lose a lot of weight.  Digital suck assessments just don't tell you
what they'll be like the next day.  I especially find oral tone to be
unreliable and dependent upon the baby's state.

Susan Burger, MHS, PhD, IBCLC

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