Dear trusted and very smart peers...
I have looked in the archives, and not finding this specific situation, I
turn to you for information. Much has been said about blood in the
infant's stools, but this situation has me perplexed.
Mother has given permission to post. She is a G2P2L2 mom. Approximately
8 years ago, mom had breast augmentation to go from C cup to D cup
(infrasubmammary technique). She grew during first pregnancy from D cup
to E cup and stayed at E cup after weaning. During 2nd pregnancy, she grew
from E cup and is now F cup. There have never been transfer or production
issues with either baby. She feels her MER, but baby doesn't seem to be
overwhelmed with the MER during feeds. Other breast leaks but does not
spray during MER. Currently her nipples are intact and appear healthy,
and she states she experiences sensation as before the surgery. First
baby was term and born at a large teaching hospital. Within a few days of
her milk coming in with first baby, the baby began passing coffee ground
stools and would vomit bright red blood after some feedings. Alarmed
pediatricians ran extensive tests on this baby and found no ulcers or
other problems... suggested she stop breastfeeding. They tested milk and
found no evidence of blood in her milk. If mom pumped, she could not
visualize blood in the milk. But if she pumped and bottle-fed, the stools
and bright red emesis stopped. Mom was committed, and continued this
routine for 6 months.
Second baby is now 5 weeks old and weighs 9# 7 oz today, transfers 136 cc
with observed feeding. Mom reports this is a typical feeding. No signs of
overwhelming let down. Mother reports about every 3 or so hours she
responds to baby's feeding cues. Mom reports this baby is having same
symptoms as first baby. She is obviously reluctant to have testing done
since no problems were found with first baby and this baby has developed
normally. There is no visual blood after the feed, but mom did report
that when she puts her pump on "high" she has seen "strawberry colored"
milk. When she pumps and feeds baby EBM (fresh, not frozen) the stools
change to yellow and seedy and the bloody emesis and stooling stops.
From earlier posts on bloody stools, I understand that as long as the baby
gains, thrives, and is mostly tolerant of the blood in the milk, mom
should not worry. However she does not want to pump and bottle feed to
avoid the problem as she so desires to exclusively breastfeed. The
question I have is why the improvement of symptoms when feeding method is
changed but same breastmilk from same mom with nothing done to alter it?
This is probably very elementary for most of you, but based on my math,
this baby needs at least 25.2 ounces/day to gain (Counseling the Nursing
Mother, page 304). If he receives 4.5 ounces every 4 hours, then he is
eating what we would expect (27 oz). However, if he is eating 4.5 ounces
every 3 hours, then he is taking about 36 oz. Is this completely
incidental to the equation?
Any thoughts would be greatly appreciated.
My best regards,
Angie Sohler, RN, CLE, CLC
Beauty of Breastfeeding Calendar Editor
www.beautyofbreastfeeding.com
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