Subject: | |
From: | |
Reply To: | |
Date: | Mon, 31 Oct 2005 11:55:52 -0500 |
Content-Type: | text/plain |
Parts/Attachments: |
|
|
Hello all.
I have persmission from the mother to post this. I have a coworker who I
visited in the hospital 24 hours after delivery who had a history of low
milk supply and continuous need for an SNS throughout the 2 years she
brestfed her older child. I observed a latch and infant was sleepy and
would not stay latched. We had her pumping after each feeding anyway for
reassurance. Her breasts were "empty sacks of skin and little tissue". That
is the only way I can describe them. I had an LC from the hospital assist
with her and did not tell her a thing about my observations. She told the
mother that she was concerned about the lack of changes in her breasts but
that we just needed to continue with the frequent feedings and pumpings and
wait and see. I told the mother that this was correct. I saw her on day 4
and she was engorged (Yeah) but not able to pump much out after feedings
and not getting relief after feedings. I assisted with the feeding and
pumping and instructed breast compression which helped greatly. Infant was
jaundiced and on a bili blanket. Her stools were dark brown. Mother was
applying hot compresses and I told her to change it to cold compress
between feedings which she refused to do since she felt it would decrease
her supply. (I brought muliple handouts and referred to web sites etc.) The
engorgement did eventually resolve. Infant had elevated bili levels-(bili
lights started at 18)- for 2.5 weeks and remained under a bili blanket for
that long. I encouraged supplementing after feedings with pumped breast
milk by SNS or syringe etc during this time but mother stated that infant
was full and would spit any supplements she would give. MD ordered
supplements of 1 oz of formula after feedings at day 7 but mother was
giving 5-10cc after some feedings and stated that infant wasn't tolerating
the supplements. I talked with the MD and had this changed to EBM but
mother continued to givn only 5-10cc and stated that infant spit if she
tried to give her more. The stools remained brown( not green or black) for
2 weeks. (I worked in a NICU previously and I've seen lots of stools of
hyperbili kids and this did not look like that kind of stool but maybe it
was.) The baby gained about 1/2 oz a day starting at day 6. She was up to
birth weight at 2.5 weeks. Mother stopped pumping on a regular basis
(hospital grade pump) after the bili lights were discontinued but she will
occasionally pump when she needs to prepare for an MD visit etc where she
needs a bottle just in case. When I have observed feedings I don't hear
much swallowing if any at all. The latch is good now though I had to
correct this on a regular basis because she would let the infant nurse on
the tip of the nipple because she was afraid to relatch her. (Afraid that
she wouldn't relatch but fall back asleep.) The baby continues to gain and
is now gaining 4-5oz per week which is WNL. Mother came to work with the
baby this week and baby is now 7 weeks old. She was fussy upon arrival and
nursed the entire 4 hours that they were there-or at least was at the
breast the entire time. If mother tired to unlatch her she cried until she
was relatched. This has really been the way it's always
been.
Now to my questions. Should I be concerned? Baby is gaining wnl. What
about the brown stools for the first 2 weeks? I was concerned but watched
the weight first before saying anything and just told her to let me know
when the stools changed to yellow. Now she has a stool every 7 days. I
really wanted a big supply in the begining due to her history but in
working with mother she was really not open to the extra pumping etc and I
respected her wishes after giving her my rationale for everything. Am I
overly concerned where there is no concern? Thanks,
Lisa Bell RN, BSN, IBCLC
Public Health Nurse
***********************************************
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(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
|
|