In a message dated 6.26.04 3:54:01 PM, [log in to unmask] writes:
Jeannette writes;
> Just as breasts are asymmetrical (as are eyes, ears, etc.), why not the
> internal organs and ducts?
>
> We need to be aware of these differences and variation and be skilled in
> recognizing what works and what doesn't. (Perhaps a pump flange will need to
> be designed that changes in size? Why not? Pumps now offer a large
> variation in cycling and suction!)
>
> I found this post fascinating and wondered if you could help with a Mom that
I'm currently working with; baby was full term, is about 2 weeks old, I first
saw him at about 5-6 days of age-referral from pedi d/t excessive wt. loss,
jaundice.
Mom claims normal breast changes during pregnancy, milk in around 3 days. At
tov I found baby sluggish at breast, w/o stool x 48 hrs, jaundiced and after
trying for an extended period to increase fdng effectiveness at breast , I gave
baby formula via bottle (no pump other than Isis (no success) at home), he
hadn't been offered any suppmt for 2 days as mom was feeling confident once milk
came in. On exam breasts were moderately full (not as full as I would have
expected this close to peak volumes and a poorly feding baby), sucking was weak
w/o letdown noted, particularly notable were Moms nipples-although not
exceedingly so, they are on the longer side. I left Mom with a plan to see pedi later
that day (wt down 3 more oz and bili up to 18.)-pedi than gave plan to
suppmt. Parents obtained (expensive!) new medela PIS (symphony model) but pumped
volumes have cont'd low despite pumping after every feed (1oz/DAY-she is fuller
than this) although baby has cont'd to nurse q fd. I saw them again 2 days ago,
effectiveness at breast has improved somewhat, suppmts are down (awaiting
next wt check) but still no letdown noted. Could this be related to the length of
her nipples? I know BWC and others have posted on nipple length in the past
but I'm wondering about this more minor variation-what do you think? I have
given Mom info on fenugreek and domperidone (!) and talked with her about
oxytocin nasal spray but am unsure of which path to take....
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts
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