I had a GB patient a few years ago so I searched the archives and anything
else I could find at the time to help the mom.  Evidently B12 and zinc can
be big deficiencies in these moms and subsequently in the babies, leading to
possible FTT if not closely monitored.  Another post suggested that you
remind the mom that every morsel she puts into her mouth has to have a big
nutritional punch, because these moms have to take in three times the
qantity of a nutrient in order to absorb what we normally absorb.  Hopefully
she was in close contact with a nutritionist during her pregnancy and will
continue to do so.

The typical prenatal vitamin tablet will probably not be digested in such a
quick trip down the pipe, so a liquid vitamin might be a better bet; same
with those herbs she is taking (tincture might be a better choice than
capsules or tablets).

Also keep in mind that the reason the mom needed GP in the first place might
have been because of PCOS.  Given that she also just had twins suggests that
she might have had some fertility treatments as well, so obviously she has
some challenges ahead of her.  Remind her that her milk is medicine to these
babies, as is obvious with the poor babe who has already experienced NEC.

Best wishes to your client,

Debbie Gillespie, LLLL, IBCLC
Sunny Tempe, AZ

On Dec 18, 2007 6:41 PM, Jaye Simpson, IBCLC <[log in to unmask]>
wrote:

> Hi All,
>
>
>
> I am working with a mom who just delivered twins at 36 wks 3 days.  Mom
> had
> Gastric by pass surgery (not sure when - she will be getting me that info
> soon).
>
>
>
> Babies were delivered 12/3/07 by c-sec.  On 12/09/07 she was admitted to
> the
> hospital for an upper GI bleed that required 4 units of blood plus 1 unit
> of
> plasma.  Mom is getting only 10-15 cc total with pumping q2-3 hours.  With
> discussion it turns out her flanges are too small and she is on a pump I
> don't particularly care for so she is switching out to a Classic and 30mm
> shields ASAP.  She is taking Fenugreek and Blessed Thistle (brand Soloray)
> 3
> caps 3 times per day.
>
>
>
> She is also taking a medication called Pantoprazole (which is fine with
> BF)
> for acid issues.  Dr's put her on 10mg 3/day of Reglan to help with milk
> supply.  In researching the archives I found that that is NOT recommended
> for women who have had gastric bypass and neither is domperidone.  I
> recommended she get off the Reglan for the other side effects and she was
> perfectly happy to do so - she was concerned about taking 2 drugs that
> works
> with the gastric system.
>
>
>
> Baby B (boy) had a run in with NEC due to being fed ABM - he was off all
> feeds for a week.  He was started on feeds again today - mom had barely
> enough EBM for him for today only.  I have strongly encouraged donor milk
> from the HMBANA milk bank here in our area.  Mom is all for it - the neo's
> may have to be convinced.  The hosp they are at is not known for its use
> of
> donor milk - at least not to my knowledge.  Baby A is home but has 4 times
> the amount of platelets she is supposed to have and no one seems to know
> why
> or what to do about it other than wait and see.  Mom is very concerned.
>
>
>
> Any input at all on these issues will be greatly appreciated.  We need
> help
> from an excellent Neo (Nancy are you available??) as well as any updated
> information about the gastric bypass issues.  In searching the archives I
> found stuff up to 2005.that was it.  I may just be tired and didn't put in
> the right request, but I could have sworn we have discussed this more
> recently than 2005.
>
>
>
> Thank you very much!
>
>
>
> Warmly,
>
> Jaye
>
>
>
>
>
>
>
> One baby had a run in with NEC due to being fed ABM
>
>
>
> Jaye Simpson, IBCLC, CIIM
>
> Breastfeeding Network
>
> Sacramento, CA
>
> www.breastfeedingnetwork.net
>
>
>
>
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