Hi Rachael
How thorough you are! I agree that you're right to be keeping a
close eye on what's happening with this mother and baby. The weights
you've given are especially helpful to illustrate what might have
been happening. The baby reached her lowest weight on Day 5, with a
loss of almost 13% which showed somewhat delayed
lactogenesis. However, it really does look as if the milk _has_
started to increase since that time. To look at the weights since
Day 5, you can see gains as follows:
Day 6: 60g
Day 7: 20g
Day 8: 40g
Day 9: 20g
Day 10: 30g
So this shows a total gain of 170g in the last 5 days, or an average
daily gain of 34g/day. This is fine! While I would usually like a
baby to have regained her birthweight by Day 10, and this baby is
still 8% under that weight now, it looks like it's because she lost
so much weight by Day 5. Since Day 5 she has clearly had sufficient
intake. I'd be cheering the mother on for now, while being privately
cautiously optimistic for a little longer until you see how this pans
out. Looks to me as if the milk _has_ come in - just without the
over-fullness/engorgement we expect to see for a day or two - and
maybe because the baby is drinking the milk mom is making.
How about if you were to ask the mother to keep on nursing exactly as
she is, drop the supplements of donor milk (30 ml is really neither
here nor there), continue to keep a daily record of urine/stool
output, and as long as this is within normal range, move the weight
checks to every other day, planning to move them quickly to weekly if
the baby still gains 30g/day or more on exclusive breastfeeding?
Many don't agree with obsessing about weights, but I think you were
right to be very careful with this baby. A 14% weight loss is
definitely cause for concern and better a stressed mother than a
dehydrated baby. But in view of what's happened in the last 5 days,
you could afford to give mom a vote of confidence by not checking for
48 hours :-)
Hope this makes sense!
Pamela Morrison IBCLC
Rustington, England
At 22:21 05/05/2008, you wrote:
>Date: Tue, 6 May 2008 07:21:18 +1000
>From: Rachael Austin <[log in to unmask]>
>Subject: Should I be concerned?
>
>This is the woman I posted about the other day. Beautiful home =
>waterbirth. Long 3rd stage of 6 hours. Grossly asymetrical breasts (one =
>very large, one medium sized). She has feeding frequently 1-3 hourly =
>with the longer stretches overnight and expressing after each feed =
>sometimes getting a bit out often not. So it would seem babe is mostly =
>emptying the breast. She is also taking nursing teas, blessed thistle, =
>stout to help her supply. The biggest concern to me is that she is Day =
>11 today and her milk still hasn't come in. There is no chance of =
>retained placenta, illness etc. Nothing that I can put my finger on =
>specifically, except for the asymetrical breasts. She is vegetarian, but =
>has a great diet, and I cannot fault it in anyway. The baby is =
>otherwise healthy, no tongue ties etc. Any suggestions as to why would =
>her milk be taking so long to come in?
>
>The baby's weights have been:
>
>Birth 3550g
>Day 3: 3100
>Day5: 3090g
>Day 6: 3150g
>Day 7: 3170g
>Day 8: 3210g
>Day 9: 3230g
>Day 10: 3260g
>
>Should I be concerned about this? Because frankly I am, mainly because =
>her milk still hasn't come in and she is working so hard to have babe =
>put on this minimum weight gain already. At this point babe is weeing (6 =
>nappies) and poos, is altert and happy (as per the woman's description). =
>These are great signs, but to me the proof is in the pudding where we =
>have a slow weight gaining babe with a mother who is still feeding =
>colstrum on day 11. I have recommended that she see the GP today and =
>ask for domperidone to try and help her milk come in.=20
>
>I feel she is blaming me now for stressing her out and therfore her milk =
>hasn't come in. What do others think, should I be worried or not? =
>Overnight she herself felt the babe was still hungry and gave the donar =
>EBM I got her the other day, babe drank 30mls via syringe. She is =
>exclusively breastfeeding, no dummies etc. She is also cosleeping.=20
>
>Any advice would be appreciated. I have never seen such a delay in =
>lactogenesis 2, in a woman who hasn't had a traumatic birth experience.
>
>Blessings,
>Rachaelxx=20
>_________________________________________________________________________=
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