Hi All,



I am working with a mom who just had her first baby - I have permission to
post.



Baby born 12-15-08 by emergency c-section.  32 hours of labor 4 hours of
pushing and then they discovered baby's head was off to the side and sunny
side up.  She had a 7 hr walking epidural.  Baby was 41 wks gest.  BW 8'8",
discharge wt 7'14" on 12-22-08.  Baby was admitted into NICU at 12 hrs of
age due to retractions.  He was there for observation for 36 hours.  Dr said
there was possible trauma due to over-suctioning of nose of from
labor/pushing.  Baby's sinuses were very swollen.



Mom was exhausted and doped up on pain meds when someone brought her a pump
- and did NOT show her how to use it.  Baby was fed 2 ounces every 3 hours
while mom was trying to recover.  (yes - 2 ounces - this is documented)
When baby was brought back to mom finally, the nurses tried to help by
giving baby only 10-15 mls per feed in an effort to 'shrink the baby's
tummy'.  An LC came to see her and immediately slapped a nipple shield on
mom WITHOUT allowing baby to attempt to nurse first.  Mom does NOT know why
(neither do I - her breasts are perfect - well almost - I'm getting to
that).   Then said LC taught <exhausted and on-pain-meds> mom suck training
- why?  I don't know and neither does mom.  She was given handouts with no
explanation of what they were or were for.



OK - now:  Milk comes in around day 4 - breasts get full and hard.  Within
24 hours breasts are no longer hard.baby nursing with shield and getting
fussy.  Mom tries to get baby off shield per 'tips' from LC she saw in hosp
but baby is thoroughly confused and refuses.



On 12-26 baby was only at 7'15" (11 days old).  Mom was told to make sure
baby gets hind milk so was allowing baby to nurse for 60 minutes per
breast.Saw Dr on 12-26 who told her to BF 20 minutes each side then
supplement with 2 ounces of ABM each feeding.



On 12-29 she saw a different Dr who weighed baby in at 8'7" and told her to
get baby off all ABM by 1-2-09.  Then mom called me.



Mom had been pumping sporadically but was only getting 10-22mls per side
when she had had 3 hours in between feeds.  (she was taking breaks to simply
feed the baby and get some rest)  I told mom to pump and feed the baby -
let's get the supply up since it was so low and I suspected it could be
because of mismanagement in hosp as well as possible suck issue with baby.
Pumping was hurting so recommended she get larger flanges.



I saw mom today (1-7-09).  She has been taking More Milk Plus - no results.
She pumps 8-10 times in 24 hours - she gets ONLY 10-22 mls per side.  I did
a visual exam - there is at least 5 inches between her breasts - but
otherwise they look perfectly normal - perky and rounded, quite beautiful
actually - she has the perfect breasts for BF (which is why I don't
understand why she was handed a nipple shield.).  Her mother was unable to
produce enough milk for either of her 2 children (but was able to produce a
bit more with baby #2) so there seems to be a possible family history here.
I did a suck eval on the baby - he has some issues - very disorganized,
chompy, tongue all over the place and some real suck/swallow/breathe issues.
I taught mom very carefully paced feeding technique as baby was inducing
apnea by forgetting to breathe.  His body is curved and out of alignment and
I have referred them to my Practioner for further evaluation.  I suspect his
issues are the result of birth trauma and should be fixable with treatment.



But what of Mom and her milk supply?  She was unable to get a prolactin
level test until day 18 - but her level was very high - 161.  Her thyroid
was also in good shape.  So what is the deal here?  What am I missing or am
I?  Why would she have great prolactin levels and breasts that look perfect
(aside from the wide spacing) and have very little milk?  Am I looking at
hypoplasia?  There is no history of any other hormonal issues for her.  She
had minimal breast changes during pregnancy.  This is a really frustrating
thing for me to admit - but I am NOT a hands on type of LC and so don't
really know how to palpate the breast to feel for glandular tissue.  I
rarely have the need to feel something going on in a moms breast and when I
do it is very obvious (like a plugged duct or abscess both of which I have
found easily).



I suspect that she has hypoplasia and that the supply was compromised to at
least some degree - but it is that high prolactin level that has me stymied.
I thought about retained placenta but then the prolactin wouldn't be that
high.  Thoughts?



Thank you!

Jaye



Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net <http://www.breastfeedingnetwork.net/>






















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