Dear Lactnet Friends:
I love this clear and strong care plan that reminds and teaches all at once!
Bravo, Lisa!
warmly,
Nikki Lee
Date: Sat, 1 Sep 2012 12:27:06 -0400
From: Lisa W <[log in to unmask]>
Subject: misleading pees and poos
I have a great doc here in Vegas that work very closely with especially on
infant's that are not gaining well or FTTs in the deep dark whole.. MDs
like everything to be quantitative and factual so deal in facts not
feelings and you will develop a great relationship with the MD and they
will respect you and your knowledge.
Here is what I do:
You want to deal in facts so with a consultation you want do a pre/post
feed weight. You need to know how much baby is taking in with compressions
(Dr. Newman videos rock!) and with encouragement/stimulation of baby
midfeed.
Look in your Counseling the Nursing Mother book.. in the back is a chart
for ounces required per weight. Or you can take the weight in lbs and
ounces and multiply by 2.5 or you can use any tool on the internet. For a
baby >5 days of age if you want to deal in cc/kg the baby should be getting
150-180 cc/kg. So take a 3kg baby on breastmilk. If baby takes in 75cc per
feed 8 times a day for 24 hours you get= 75*8= 600 then 600/3kg=200 cc/kg
so this baby would be exceeding the need.
Then take what the baby took in during your consultation and see how this
relates to the ounce requirement. If it is dead on or over the ounce
requirement then suspect something is up metabolically, physiologically, or
milk wise (very very rare and usually shows on a newborn screening test).
If it is less then you know baby is not getting enough. So say you have a
baby who requires 32ounces every 24 hours, thats 4 ounces every 3 hours = 8
feeds in 24 hours. If your baby transferred only 2 ounces then each feed or
8 feeds in 24 hours will require a 2 ounce supplementation. How you
supplement is up to mom...depends on her situation, patience, and what her
desires are.
With this supplementation I also advise on a weight check every 3-4 days at
the peds office to monitor things. That baby needs to gain (prior to 6
months) 5-8 ounces a week. Usually when you see the supply kick up you can
catch it here as you see the weight gain jump to 10-12 ounces a week.
The mom/baby will need a pre/post feed weight check with you once a week
for about 2-6 weeks depending on how depleted the supply is and how
responsive her hormones are.
I also have mom pump with a hospital grade pump. At least 4 times in 24
hours, max 6. With 2 of those pumps being done in the night (one during
baby's 4-5 hour sleep right before mom goes to bed, after a shower, and
when she isn't feeding baby for 20 minutes). The other 3-5 are post feed
for 10 minutes. When you see that pump after the shower before going to
bed double in ounces then you are ready to decrease supplementation, but
you have to confirm with a pre/post feed transfer weight. I tell moms they
have to meet and then exceed baby's need in order for me to decrease the
supplementation significantly.
I also suggest anything with oatmeal or brewers yeast.. like lactation
cookies.. check drmommas lactation cookies online.
I also suggest ending the birth control if mom is already on it as this
seems to help kick the hormonal cascade back into gear and increase the
milk supply.
Hope this helps. Vegas is a tough crowd so the more I deal in facts and
numbers the easier my conversations are with the docs here and the more
respect I and lactation gains in the community. So far this protocol is
working for my moms and it can take anywhere between 2-6 weeks depending on
the mom's compliance, the baby, and the hormonal cascade in the mom.
Hope this helps.
Lisa Weinshenker, RN, IBCLC
Las Vegas, NV
--
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com
https://www.facebook.com/nikkileehealth
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