Sometimes we only hear the hospital frustration stories (sometimes we only
HAVE the hospital frustration stories!) so I thought I'd share some good
news. I have mom's permisison to post!
Very late last Sunday night (almost midnight) we had a difficult delivery of
a 9 lb 9 oz big boy. Mom had a postpartum hemorrhage (PPH) with a hematoma
besides. The estimated blood loss (EBL) between the two was >1700 cc - and
EBL is notioriously underestimated.
The gals on nights called me just before they left (about 0715) to tell me
to get me thinking cap on. Thank God, we don't get these very often, we are
very aware of the challenges of getting in those milk supplies, and they
wanted me to think up a plan that would make sure mom continued to
breastfeed even if the expected happened (milk in late and baby looking
ravenous).
You know, I couldn't think of anything we could do beyond the expected --
give her really good help, get baby to breast as often as possible, and make
sure the latch was great.
1.The nurses had already made sure he nursed before they took mom to the OR
the night before. (By the way - our latest number was 94% of babies to
breast within the first hour! Wahoo!)
2. The baby had gone to breast once during the night. The next morning he
was "on" (with nursing help) in a modified side-lying position. Mom was
quite woozy but happy to be nursing. After this feed we noticed her nipples
were torn up on the end. The baby's tongue had a very thick and wide
insertion - I'd say the posterior HALF of the tongue was the insertion, all
the way across, plus a little tie for good luck anterior to that. He did
have a big mouth, and was able to trough. Tongue up on roof of mouth of
course! He went to breast about 8 times in the first 24 hours, not all good
feeds, and mom's nipples getting worse.
3. By 36 hours mom was significantly sore and baby was starting to grouse.
He was stooling and voiding but was into that "I want steak and potatoes"
routine that you see with these big guys. A nurse had done a little formula
supplementation with a tube feeder at the breast (5 cc or so). They had
already given some expressed colostrum by spoon but she hadn't been able to
express much. We continued this plan of care.... Mom had received 2 units of
packed RBCs for low H& H (hematocrit and hemoglobin). Hydrogel dressing
given as lanolin not sufficient for the now very-abraded nipples. (Still
working on "perfect" latch but achieved transiently only.)
4. Mom's breasts were warm and heavy at 48 hours! I think this is the first
thing that amazed me. We reliably see "milk in" on primips as well as
multips, like clockwork, 48 hours after that placenta falls out. And after
all that anecdotal knowledge I had about when milk comes in! (I go back to
the juice jar days too - usually cranberry juice jars around here.)
Nonetheless, baby's weight was down 9.8%. We try for not more than 7%. So I
think he weighed about 8-10.
5. By 84 hours -- mom was using a nipple shield, was a bit engorged, and the
chart said baby weighed 9-2. Baby was clearly reveling in the milk supply,
nipples felt do-able, and nobody believed the weight. We weighed him again
before discharge and he weighed -- 9 lb -4-1/2 oz!!

Kudos to all our motivated nurses....who do it all, from antepartum testing
to labor to postpartum. And we had a wonderful  article and picture in the
Gauzette (our hospital newsletter) for IBCLC Day. I'm really proud of us!

Dawn Kersula in southern Vermont
recovering from a great performance of Gilbert & Sullivan's Ruddigore last
nigth - I'm a Professional Bridesmaid!

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