had another client deliver yesterday. wonderful birth, 1 hour of epidural or less (better 
than I'd hoped after talking to mom prenatally). They told her the baby has ABO 
incompatibility and actually took her this afternoon and put her under lights (won't allow 
babies to stay under lights in room with mom) Later mom called to say baby was back 
with her because the scan had been incorrect and the serum was actually only 6! The 
nurse proceeded to tell her that she really should give the baby some ABM because it 
would get rid of the jaundice. Mom had been hand expressing colostrum to cup or syringe 
feed (dad went out and bought a medicine dropper) and had gotten about 1/2 tsp from 
the one side and the nurse told her THAT WASN'T ENOUGH TO SUSTAIN LIFE! Mom 
countered that the pediatrician said it was fine and the nurse said the baby wasn't feeding 
long enough (5-8 mins on a side...) and that she HAD to nurse for 10 minutes each side. 
Nurse also questioned the doctor's orders to not give formula in front of mom. I 
recommended that her husband page the pediatrician and let her know what the nurse 
was telling them. SHe said her husband would also be calling the director of women's 
services...

Mom has nipples the size of quarters, which is why she's doing some hand expression and 
feeding as baby has a small mouth and hasn't quite mastered the latch yet (but she's not 
even 24 hours old yet...) so are the nurses giving her a hard time because they see her 
trying so hard to get the baby to latch? are they judging her? Both of my children had 
ABO incombatibilities and were delivered at the same hospital and had the same 
pediatrician and not once did they tell me what they're telling her. It's so frustrating! The 
nurse also demanded to know where they got the syringe and told them it could only be 
used once because they had no way to sterilize it - ( so bring them some they can throw 
away!)

I told her just to keep in mind that it's her baby, not theirs... While I was visiting her this 
morning she asked the nurse about leaving tomorrow morning and was told she could 
leave but that the baby was required to stay 48 hours. 

she never got her first daughter to latch effectively and ended up exclusively pumping for 
5 months. She realizes now that she probably just gave up too early and was so 
consumed with knowing how much the baby was getting that she never was able to work 
on the latches out of frustration. The baby's mouth is small and it's difficult for her to 
grasp all of the nipple, let alone the areola. We talked about it taking time for her to get 
the hang of managing the nipple and that it would come - just not maybe today. She's 
very committed, as is her husband, to getting this baby to breastfeed and not giving up 
so early. They are very anti-bottle and pacifier. There's a note in the bassinet that she is 
to receive no formula, bottles or pacis... not that the nurses will listen if they get it in 
their mind to give a bottle. Mom is already concerned they may have done so as baby is 
now super sleepy after she was waking up well during the night and morning.

Nipples are already red and sore. I asked for some shells for her and they only carry the 
therashells? quite small. For nipple size comparison - she can't fit her nipple in the 
opening they come preset with (for eversion). There's a local medela retailer who carries 
the softshells so i'll be recommending those the next time i talk to her. 

any suggestions for large nipples? her breasts are in the d-cup range (from A cup!) but 
not overly full, more pendulous at this point. She has large areolas as well and was 
concerned about the lumpiness/ puffiness but they seem to just be the montgomery 
glands that are slightly enlarged. 

she's having the most success with the football hold right now. Baby is 7 lbs 6 oz - I think 
her chin is a little more than normally recessed, but it appears similar with how their first 
daughter looked... she is passing lots of meconium - a poopy diaper with almost every 
change. Mom is concerned she isn't peeing much - but is going to try leaving her in the 
fresh air and see if that prompts her to pee. 

i don't get much in the way of private clients usually but it has poured this week with 
challenges.

thanks so much for all the responses you've all given whenever I post - I learn so much 
from them!

anne

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